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Could an Ounce of Prevention Actually Cause Harm?

Mehta & Stanton
David Stanton, MD, DMD, and Samir Mehta, MD, principal investigators on Penn Medicine's Bisphosphonate Biomarkers Trial
We’ve all seen theTV commercials in which a fabulous Hollywood-mom actress talks to us about thedangers of weakening bones, and the small pills or chewable capsules we cantake to avoid common bone maladies as we get older. I admit, watching a modernday June Cleaver tell me about tiny chewable vanilla or strawberry delightsthat I can take with dinner to help ward off the dreaded osteoporosis and otherconditions is definitely appealing. Who doesn’t want a fruit flavored gem thatis also good for their bones? But for select individuals, these little tabletsmay actually be advancing the bone weakening process, encouraging certain orthopaedicand oral-maxillofacial bone injuries and disease. So the question then becomes,how do you know if taking these pills will help, or hurt?

Anew study being conducted by a unique team of researchers from the PerelmanSchool of Medicine at the University of Pennsylvania will attempt to identify geneticbiomarkers that may play a role in how individuals digest the drugs, known asbisphosphonates. These prescriptiondrugs are taken to help prevent bone loss by blocking the activity of cellsthat normally absorb bone. The most common examples are Boniva andFosamax. The ultimate goal of the study – being led by a rare collaborationbetween researchers from Orthopaedics and Oral-Maxillofacial Surgery – is toidentify which patients might be genetically predisposed to severe, negativeresponses associated with these drugs.

Among the many thousands of individuals who currently takethese medications, certain individuals experience unusual leg fractures,osteonecrosis of the jaw – a condition causing the jawbone to become exposed,which requires surgical treatment – or even esophageal cancer. The unfortunatetruth is that right now, doctors have no way of knowing which patients willhave these unexpected adverse affects.

Whilegenetic biomarkers have been used in cancer and cardiac treatment strategies,their use in Orthopaedic surgery has been limited as many of the conditionstreated in Orthopaedics are considered mechanical disease, like arthritis wherethe cartilage wears away.  The use of biomarkers may lead to a betterunderstanding of why certain patients develop diseases like arthritis and howthey can be helped earlier in life.

“Studies that aim to identify genetic biomarkers fororthopaedic and oral-maxillofacial conditions are rare, but we need to find away of determining who should be taking these drugs, and who will be at risk ofsecondary injury and disease,” said Samir Mehta, MD, chief of OrthopaedicTrauma and Fracture Service at Penn Medicine and principal investigator on thestudy. “Bisphosphonates have a proven track record of benefiting thousands ofpatients, so we’re not trying to discourage their use. In fact, we want to beable to prescribe them for patients who are experiencing bone loss, but we needto be able to do so with the confidence that we’re not causing further injury,or putting those patients at risk.”

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