Keeping you up to date on recent headlines in orthopedic healthcare:

New target in fight against osteoporosis, periodontitis identified by dental researchers . . . . Osteoporosis and periodontitis are common diseases whose sufferers must cope with weakness, injury and reduced function as they lose bone more quickly than it is formed. While the mechanism of bone destruction in these diseases is understood, scientists have had less information about how bone formation is impaired. Now, researchers at the UCLA School of Dentistry (Los Angeles), working with scientists at the University of Michigan (Ann Arbor) and the University of California, San Diego, have identified a potential new focus of treatments for osteoporosis, periodontitis and similar diseases. In a paper published May 17 in the online edition of the journal Nature Medicine, Cun-Yu Wang, who holds UCLA's No-Hee Park Endowed Chair in the dental school's division of oral biology and medicine, and colleagues suggest that inhibiting nuclear factor-kB (NF-kB), a master protein that controls genes associated with inflammation and immunity, can prevent disabling bone loss by maintaining bone formation. The findings could offer new hope to millions who struggle with osteoporosis and periodontitis each year. The NF-kB protein, a culprit in inflammatory and immune disorders, plays a major role in both osteoporosis and periodontitis, disrupting the healthy balance of bone destruction and formation. It is this balance that Wang and his fellow scientists seek to restore, and perhaps even improve upon, by finding new ways to promote net bone accumulation. "Most studies focus on the part that NF-kB plays in the regulation of osteoclasts – bone-resorbing cells. For the past five years, we looked closely at the effect of NF-kB on osteoblasts – bone-forming cells," said Wang, the study's principal investigator and a member of UCLA's Jonsson Comprehensive Cancer Center. "We knew that NF-kB promoted resorption. What we discovered in our in vitro and in vivo studies is that this protein also inhibits new bone formation, giving us a fuller picture of its role in inflammation and immune responses." As a next step, Wang and his research team are planning to test small molecules that inhibit the specific bone-resorption and bone-inhibition actions of NF-kB in osteoporosis and periodontitis.

Cerasorb M used successfully during acetabular cup replacement . . . curasan (Kleinostheim, Germany) presented its medical products for regenerative orthopedics (orthobiologics) under the umbrella brand Cerasorb at the trade show held in conjunction with the 57th annual congress of the Association of South-German Orthopaedic Surgeons in Baden-Baden. Interest was primarily focused on the bone substitute material Cerasorb M with its successful use in acetabular cup revisions being highlighted in one of the lectures: Dr. S. Berger, a member of the working group headed by Prof. C. H. Siebert at the Orthopaedic Clinic, Annastift (Hanover, Germany) reported about the positive experiences relating to the use of the bone substitute material for the filling of defects during hip endoprostheses replacement procedures. Orthopaedic surgeons achieved good bone consolidation with Cerasorb M in more than 30 patients between the ages of 60 and 90 years. "Because of the aging population, orthopaedic surgeons will be increasingly confronted with the problem of cup loosening in older patients", explained Dr. Wolf-Dietrich Hübner, Director of the Medical Division at curasan, before adding: "This will inevitably lead to an increase in the number of revision procedures required." Particularly in older women, bone stock instability frequently becomes apparent during operations. This has been the reason for the frequent use of bone cement to fill defects, which however makes further replacements very difficult. Many patients also do not have enough endogenous bone to fill large defects. This provided the impetus for Prof. C. H. Siebert and Dr. S. Berger to investigate the use of the Cerasorb M bone substitute and construction material for this issue. The orthopaedic surgeons used Cerasorb M in more than 30 operations – in 13 of these cases mixed with autogenous bone. The subsequent observation period was at least 2 years. In 27 cases, treatment results were satisfactory, even though four patients received replacement under septic conditions.

Hot flashes may prompt closer look at bone health . . . . A new study, published in the journal Menopause, found postmenopausal women with vasomotor symptoms-which include hot flashes and night sweats-had lower bone mineral density in the spine and hip. Researchers at UCLA, and colleagues analyzed data from more than two thousand women between the ages of forty-two to fifty-two who participated in the bone sub-study of the Study of Women's Health Across the Nation. The authors of the UCLA study also found premenopausal women and early perimenopausal women who had vasomotor symptoms were found to have lower femoral neck bone mineral density than those without vasomotor symptoms. According to bone expert, Warren Levy, PhD, although the extent of correlation varied depending on the stage of menopause and the frequency of vasomotor symptoms, the findings did support earlier studies by others that have suggested an association between low estradiol levels, vasomotor symptoms, and low bone density. "The concept of assessing bone health via the amount or intensity of hot flashes is interesting and may provide another method for screening for osteoporosis," suggests Levy, who is also CEO of Unigene Laboratories (Boonton, New Jersesy), a biopharmaceutical company focused on peptide-based nasally and orally delivered osteoporosis treatments. "However, the gold standard today is a bone scan which is widely available and inexpensive for most patients. The study does help raise awareness about the importance of being vigilant about bone loss during this part of one's life, and encourages regular bone scans, if possible, because even early perimenopausal women can experience significant bone loss."

"We hope that the new findings will encourage physicians and patients to also consider the various treatment options that are available without the use of estrogen-based products," says Levy, who believes that as life expectancy rates continue to rise, osteoporosis will have a greater impact on national health and quality of life.

Spotlight to be focused on osteoporosis research . . . McMaster University (Hamilton, Ontario) has teamed up with Eli Lilly Canada and the Canadian Institutes for Health Research (CIHR; Ottawa) to put a world-class researcher on the track of the silent thief. Osteoporosis, the debilitating disease of bone deterioration, has been called the "silent thief" as it occurs without symptoms. The university reported a $2 million endowed chair has been established to investigate the best strategy for osteoporosis care, particularly for fall and fracture prevention, and to train the next generation of physician scientists to look for a cure. Dr. Alexandra Papaioannou, a geriatrician and specialist in osteoporosis, has been named the inaugural holder of the endowed Eli Lilly Canada Chair in Osteoporosis. This position has been endowed by $1 million in research funds from Eli Lilly Canada along with matching funds from the Division of Rheumatology of the Department of Medicine, Michael G. DeGroote School of Medicine. At the same time, it was reported Papaioannou also holds a five-year career award, the CIHR/ Eli Lilly Canada Research Chair in Osteoporosis, Falls and Fracture Prevention sponsored by the CIHR/Canada's Research-Based Pharmaceutical Companies (Rx&D) research chair program. This position will enhance the work of the endowed chair. CIHR is the federal agency sponsoring peer-reviewed health research in Canada. Rx&D is the national association of Canada's research-based pharmaceutical companies. The CIHR/Rx&D career award is valued at $400,000 over five years. The cost of treating osteoporosis and osteoporosis-related fractures is estimated to be $1.9 billion each year in Canada alone, including long term, hospital and chronic care.

Source: McMaster University: Article URL:

– Compiled by Holland Johnson, MDD