“It's A Bargain” Thrift Shop - Orthopaedic Hospital

20
Most of the medicines that are available
now decrease the number of bone-absorbing
cells, thereby leading to an increase in bone
mass that persists for two or three years. Very
few agents actually stimulate the bone-forming
cells. Obviously, what you want to be able to
do is a yin and yang thing. You’d like to be able
to increase bone formation and decrease bone
absorption at the same time.
motion: How would you treat a middle-aged person
at risk of bone loss?
Dr. Adams: I would measure bone-mineral density
and check vitamin D and urine status. I’d
look for an overactive thyroid. I would check
parathyroid hormone levels to screen for a
common disease called primary hyperparathyroidism,
which is caused by overproduction of
parathyroid hormone, which in turn increases
osteoclastic bone absorption.
Then, I would check to make sure that steroid
production was normal. In a man, I’d measure
androgens — testosterone. In a woman,
I’d measure pituitary hormones that would tell
me whether her ovaries were making enough
estrogen or not.
Simply by analyzing these findings and
optimizing the therapy, I can make a person
very susceptible to the drugs that are available
now.
motion: An ounce of prevention is worth a pound
of cure, as Ben Franklin would say.
Dr. Adams: Yes. The lesson here is that most of
the diseases we deal with are pediatric diseases.
They actually are present starting in children.
If we could divert our attention to looking for
those diseases in children, we could certainly
save a lot of suffering. If we could prevent fractures,
it would make a big difference.
Consider Pope John XXIII. He died of a hip
fracture. When you’re bent over with fractures
of the spine, all your body weight is thrust
forward. He was walking up a set of stairs and
slipped. He hit his hip and cracked the bone.
He then caught pneumonia, developed a pulmonary
embolism and died.
The idea is to do something before people
research
get to that stage. We’re trying to put together a
team of scientists that can look at all aspects of
the disease and cull out an area that is likely to
be most successful for intervention and focus
our activities there.
motion: Apart from osteoporosis, what would be
another key project here?
Dr. Adams: Another example we’re working on
relates to inflammation caused by prostheses.
Suppose someone breaks a hip or has arthritis.
You have to repair the hip by putting in a prosthesis.
There’s a part that goes on the pelvis,
which is the socket, and then you have the ball,
which fits in the back and is part of the femur.
“The lesson here is that most of the diseases
we deal with are pediatric diseases. They
actually are present starting in children. If
we could divert our attention to looking for
those diseases in children, we could certainly
save a lot of suffering. If we could prevent
fractures, it would make a big difference.”
To put both of these things in, you have to use
materials that are not inflammatory.
Can you imagine if you put in something
that causes inflammation? It would compound
the problem because you’ve just redeveloped
arthritis at a very rapid rate.
So, if you have a foreign material sitting in
that joint, it elicits the body’s own immune cells
to get rid of that foreign material. That’s what
causes the destructive arthritis we see in people
who have had implants for a long time.
One major reason why implants turn out to
be inflammatory is because some of the plastics
— used either on the head of the femur or on
the socket, or both — actually shed particles.
These particles stimulate the immune response
as if they were bacteria or foreign invaders.
It’s a lot harder for a living cell to get rid of a
piece of plastic than bacteria, which it can actually
attack, degrade and kill. A piece of plastic
doesn’t go anyplace. It sits in there and continu-