Can a Drug Jumpstart the Bone-Healing Process?

< Apr. 15, 2009 > -- Preliminary results released yesterday by US researchers reported on a drug that boosts the body's production of stem cells which appears to "jump-start" the bone-healing process to a point that older adults' bones heal as fast as children's bones.

Researchers found that teriparatide (Forteo) increases the bone-healing process of fractures by changing the behavior and number of cartilage and bone stem cells.

"The decreased healing time is significant, especially when fractures are in hard-to-heal areas like the pelvis and the spine, where you can't easily immobilize the bone - and stop the pain," says Dr. Susan V. Bukata, medical director of the university's Center for Bone Health.

"Typically, a pelvic fracture will take months to heal, and people are in extreme pain for the first eight to 12 weeks," Dr. Bukata adds. "This time was more than cut in half. We saw complete pain relief, callus formation, and stability of the fracture in people who had fractures that up to that point had not healed."

Research Studies on the Indications for Teriparatide

In 2002, teriparatide was approved by the US Food and Drug Administration (FDA) as a form of treatment for osteoporosis.

At the University of Rochester Medical Center in New York, researchers gave teriparatide, or Forteo, to 145 patients who had unhealed bone fractures - half of them for six months or longer. Based on research findings, after eight to 12 weeks, 93 percent of them showed significant healing and pain control.

Based on research data, the US National Institutes of Health (NIH) has agreed to fund a clinical trial of teriparatide's use on fractures. This study will consist of men and post-menopausal women older than 50, who are diagnosed with low-energy pelvic fractures. 

Research subjects will be given either teriparatide or a placebo (inactive drug) and followed for 16 weeks to measure fracture healing, assess levels of pain, monitor microscopic bone growth, and functional testing of bone strength.

Based on study results, this drug could be extremely beneficial in the bone-healing process in older adults, because their broken bones heal slowly.

Fractures in Older Adults

"In many people, as they get older, their skeleton loses the ability to heal fractures and repair itself," says J. Edward Puzas, PhD, head of orthopedic bone research at the medical center and the lead investigator for the clinical trial. "With careful application of teriparatide, we believe we've found a way to turn back the clock on fracture healing through a simple, in-body stem cell therapy."

Nearly 60,000 Americans who suffer from a pelvic fracture each year are unable to use bracing and immobilization as forms of therapy.

"It takes three to four months for a typical pelvis fracture to heal," Dr. Bukata says. "But, during those three months, patients can be in excruciating pain, because there are no medical devices or other treatments that can provide relief to the patient."

"Imagine if we can give patients a way to cut the time of their pain and immobility in half?" Dr. Bukata adds. Increasing the bone-healing process for pelvic fractures could reduce the risk of death and medical costs.

Pelvic fractures carry the same risk of death as hip fractures. Nearly "one-quarter of all older women with pelvic fractures will die from complications," Dr. Bukata says. "And during that year of recovery, a patient typically puts a greater strain on our health-care system, not to mention their pain and suffering."

The Centers for Disease Control and Prevention (CDC) reported that 90 percent of hip fractures are seen in adults that are 65 years and older. This type of fracture is primarily caused by falls and can lead to serious health problems. A reduced quality of life and premature death can result from a hip fracture in older adults.

Always consult your physician for more information.

Fractures

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed. An open fracture - also called compound fracture - occurs when the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin. A closed fracture - also called simple fracture - occurs when the bone is broken, but the skin is intact.

Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body.

The following are the most common symptoms of a fracture. However, each individual may experience symptoms differently. Symptoms may include:

• pain and/or swelling in the injured area
• obvious deformity in the injured area
• difficulty using or moving the injured area in a normal manner
• warmth, bruising, or redness in the injured area

Always consult your physician for a diagnosis because symptoms of a broken bone may resemble other medical conditions or problems.

In addition to a complete medical history (including asking how the injury occurred) and physical examination, diagnostic procedures are used to diagnosis a fracture.

An x-ray is a diagnostic procedure which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.  A magnetic resonance imaging (MRI) is another procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

A computed tomography scan - also called a CT or CAT scan - is another diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Specific treatment for a fracture will be determined by your physician based on age, overall health, medical history, the extent of the condition, and tolerance to specific medications, procedures, or therapies. Expectations for the course of the condition and a patient's opinion or preference are also important regarding the type of treatment prescribed.

The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the fractured area.

An open fracture is considered an emergency. Seek immediate medical attention for this type of fracture. Treatment may include a splint/cast which immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use.  Medication is also used to control pain.

Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.

Surgery may be required to put certain types of broken bones back into place. Occasionally, internal fixation - metal rods or pins located inside the bone - or external fixation devices - metal rods or pins located outside of the body - are used to hold the bone fragments in place to allow alignment and healing.

Always consult your physician for more information.