Experts in the Penn Bone Center evaluate and treat patients with low bone mineral density who are at an increased risk of fractures. Our team includes specialists in orthopaedic surgery, otorhinolaryngology (ENT) head and neck surgery, endocrine surgery, radiology, genetics, physical therapy, pharmacy, dental medicine and pathology. They work together to treat bone disorders, including:

  • Low bone density (osteopenia, osteoporosis) and related low trauma fractures
  • Hyperparathyroidism
  • Hypoparathyroidism
  • Vitamin D related disorders like Osteomalacia
  • Paget's disease
  • Bone diseases associated with kidney disorders, transplant, cancers
  • Rare disorders such as hypophosphatasia, osteogenesis imperfecta, fibrodysplasia ossificans progressiva (FOP) in collaboration with Penn Genetics and the Center for FOP and related disorders
  • Bone disorders related to Female Athlete Triad
  • Bone disorders related to Turner Syndrome
  • Bone disorders related to Klinefelter’s Syndrome

Infusions and injections of drugs for osteoporosis are given by our skilled nurses at the infusion center. Arrangements are also made to assist patients with injections at home.

Bone Density Assessments

At Penn Medicine, we have the most advanced options, including dual-energy x-ray absorptiometry (DXA) scans and Trabecular bone score (TBS), to study and assess bone mineral density.

Dual-Energy X-Ray Absorptiometry (DXA)

During a DXA scan, two x-ray beams are aimed at bone and the level of x-ray absorbed into bone is measured.

DXAs are available at most of Penn Radiology sites, including PCAM, PMUC, PAH, Radnor, Valley Forge and Cherry Hill. These machines are routinely upgraded and quality assessments are done regularly per guidelines provided by the International Society of Clinical Densitometry.

Please note: Follow up scans need to be performed at the same location every time (even within the Penn system). It is not possible to quantitatively compare bone density between facilities without cross-calibration.

Trabecular Bone Score (TBS)

Trabecular bone score is a recently developed tool that helps determine the risk of bone fracture.

TBS is FDA approved and uses software added to routine DXA scans. Images of the lumbar spine are examined for bone microarchitecture and provide skeletal information that is not available in standard DXA measurements. TBS is offered at the Perelman Center for Advanced Medicine(PCAM), Penn Medicine University City (PMUC) and Pennsylvania Hospital (PAH).

According to ISCD guidelines:

  • A low TBS score is associated with vertebral, hip and major osteoporotic fracture risk in postmenopausal women, and hip and major osteoporotic fracture in men older than 50.
  • TBS can be used in association with FRAX, a diagnostic tool that evaluates the 10-year probability of bone fracture risk, and bone mineral density to adjust fracture probability in postmenopausal women and older men.
  • TBS is associated with major osteoporotic fracture risk in postmenopausal women with Type 2 diabetes.

Metabolic Bone Biopsy

Metabolic Bone biopsy is a diagnostic procedure that is used in complex cases in osteoporosis, fragility fractures and metabolic bone conditions, especially when the cause of the condition is unclear. Using a local or general anesthetic (depending on bore size) and a needle, a tiny amount of bone is removed from the iliac crest and then examined under a microscope.

By examining the shape or form of the bone tissue (histomorphometry), we can determine the bone turnover rate, as well as any qualitative defects in the bone cells. Bone biopsy can be used to learn more about the cause of poor bone quality and guide treatment.

This diagnostic procedure is available only at very specialized medical centers, such as Penn Medicine. It requires extensive clinical training and pathologists with expertise in interpreting bone specimens.

Role of a Pharmacist at the Bone Center

Pharmacists play a vital role in the management of osteoporosis and work as part of the Bone Center team to reduce the burden associated with the condition.

Our pharmacist works to ensure access and adherence to medication therapy is achievable and maintained. This includes navigating insurance and cost barriers, reviewing appropriate supplementation for calcium and vitamin D, assessing medication lists, optimizing therapy, and discussing the evidence for recommended medications after a physician visit.

Meet Christopher Hvisdas, PharmD, Lead Pharmacist for Penn Bone Center

Image of pharmacist Christopher HvisdasChris graduated from Jefferson College of Pharmacy and completed his post-graduate residency training at Thomas Jefferson University Hospital. He currently works as an Ambulatory Care Pharmacist for the Department of Pharmacy at the Penn Presbyterian Medical Center. He continues to serve as the clinical pharmacist in multiple areas, including endocrinology, pulmonology, and allergy/immunology.

In the Penn Bone Center, he works to assist, monitor, and counsel patients on osteoporosis medications. He is involved with multiple health system committees and as a national advisory group member in the American Society for Health System Pharmacy organization.

Role of Physical Therapy in Management of Osteopenia and Osteoporosis

Physical therapy and exercise can strengthen bones to prevent fractures and decrease fall risk. Physical therapists who work with the Penn Bone Center have specialized training and interest in treating patients with bone loss (osteopenia) and osteoporosis.

Physical therapists customize safe activity plans depending on a patient’s individual needs. The goal is to strengthen bone, promote balance and improve quality of life.

Two women doing physical therapyA physical therapist provides core strengthening exercises to our team. Physical therapists at Penn Therapy and Fitness develop individualized, safe exercise routines that help strengthen bone, improve balance and decrease risk for falls.

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