Sunday, February 07, 1999
Dr. Einhorn discussed problems associated with metabolic bone disease, including osteoporosis, osteomalacia, renal osteodystrophy and Paget's disease. Scott D. Boden, MD, the director of Emory Spine Center and associate professor of orthopaedic surgery, Emory University School of Medicine, Atlanta, spoke on managing osteoporosis patients, including different strategies for operative and non-operative treatment. Spine fracture are a common result of osteoporosis, Boden said. "In some cases, a patient's first presentation is because of a spine fracture," he said, adding that the occasion should be taken as an "opportunity to assess the patient's total condition because osteoporosis affects bones throughout the body."
Although it is rare that osteoporotic fractures need surgery, if those cases are not recognized early, loss of neurologic function and paralysis can result, Dr. Boden said. Furthermore, "surgery is extremely challenging because the bones are so weak and the reconstruction is difficult."
Joseph D. Zuckerman, MD, professor and chairman, NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, focused on developing multi-disciplinary programs for managing hip fractures that include psycho-social factors.
Francis J. Bonner, MD, a clinical professor of medicine, MCP Hahnemann University and chairman of physical medicine and rehabilitation, Graduate Hospital, Philadelphia, Pennsylvania, discussed rehabilitation and exercise programs. Bonner recommends Tai Chi exercise, particularly for older women. "It is not strenuous and it is something they enjoy," he said.
Early prevention is key to preventing osteoporosis. "If we could institute a public health program to eliminate fad dieting in young women and begin exercise programs early, we could eliminate one-half of osteoporotic fractures," Dr. Boden said.
Use of bone growth factors and gene therapy are opening up new preventive strategies, Dr. Boden said. "Because we can now measure bone density, it would be possible to determine hips at risk, and augment bone mass before it falls below proper levels. "That is an eleventh-hour strategy, however," Dr. Boden said, adding that, "The vast majority of treatment protocols focus on slowing the inevitable loss."
Another theoretical possibility would be to insert a gene that is periodically turned on and off to control bone formation, according to Dr. Boden.
Osteoporosis, like stroke, is a silent disease process, Dr. Bonner said. As blood pressure measurement determines stroke risk, bone density measurement determines osteoporosis risk. "It is important that the federal government and physicians recognize this and get measurements for those at most risk." High risk factors include low body weight, a history of previous fractures and smoking.
Medicare currently reimburses bone mass density testing for women over 65. Dr. Einhorn believes that managed care organizations also will have to reimburse patients under 65. "It would be difficult for managed care companies not to reimburse," Dr. Einhorn said. "It would be irresponsible of them, as well as a poor business strategy, not to reimburse."