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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 the TV commercials in which a fabulous Hollywood-mom actress talks to us about the dangers of weakening bones, and the small pills or chewable capsules we can take to avoid common bone maladies as we get older. I admit, watching a modern day June Cleaver tell me about tiny chewable vanilla or strawberry delights that I can take with dinner to help ward off the dreaded osteoporosis and other conditions is definitely appealing. Who doesn’t want a fruit flavored gem that is also good for their bones? But for select individuals, these little tablets may actually be advancing the bone weakening process, encouraging certain orthopaedic and oral-maxillofacial bone injuries and disease. So the question then becomes, how do you know if taking these pills will help, or hurt?

A new study being conducted by a unique team of researchers from the Perelman School of Medicine at the University of Pennsylvania will attempt to identify genetic biomarkers that may play a role in how individuals digest the drugs, known as bisphosphonates. These prescription drugs are taken to help prevent bone loss by blocking the activity of cells that normally absorb bone. The most common examples are Boniva and Fosamax. The ultimate goal of the study – being led by a rare collaboration between researchers from Orthopaedics and Oral-Maxillofacial Surgery – is to identify which patients might be genetically predisposed to severe, negative responses associated with these drugs.

Among the many thousands of individuals who currently take these 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 unfortunate truth is that right now, doctors have no way of knowing which patients will have these unexpected adverse affects.

While genetic biomarkers have been used in cancer and cardiac treatment strategies, their use in Orthopaedic surgery has been limited as many of the conditions treated in Orthopaedics are considered mechanical disease, like arthritis where the cartilage wears away.  The use of biomarkers may lead to a better understanding of why certain patients develop diseases like arthritis and how they can be helped earlier in life.

“Studies that aim to identify genetic biomarkers for orthopaedic and oral-maxillofacial conditions are rare, but we need to find a way of determining who should be taking these drugs, and who will be at risk of secondary injury and disease,” said Samir Mehta, MD, chief of Orthopaedic Trauma and Fracture Service at Penn Medicine and principal investigator on the study. “Bisphosphonates have a proven track record of benefiting thousands of patients, so we’re not trying to discourage their use. In fact, we want to be able to prescribe them for patients who are experiencing bone loss, but we need to 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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