Killing two birds with one stone…

Every so often a unique medicine comes along.  Denosumab is a drug that’s going to be used for both osteoporosis as well as rheumatoid arthritis.  Sort of like the old Doublemint gum commercial with the Doublement twins.  Double your fun.

It’s given by subcutaneous injection every six months so the dosing interval is attractive.  What the price tag attached to this invention is the big question.

This is an abstract that appeared in a recent journal…

Denosumab for joints and bones

Current Rheumatology Reports, 07/30/09

Lewiecki EM et al. – Denosumab suppresses bone turnover by inhibiting the action of RANKL on osteoclasts. [Editor’s note: osteoclasts are the cells that break down bone] Denosumab reduces bone turnover and increases bone mineral density in postmenopausal women with low bone mineral density, reduces fracture risk in women with postmenopausal osteoporosis, and inhibits structural damage in patients with rheumatoid arthritis when added to ongoing methotrexate treatment. It is generally well tolerated, with a good safety profile. Adverse and serious adverse events, including infections and malignancy, are similar in patients treated with denosumab or placebo.

When this drug will be approved by the FDA is still uncertain.

It’s been an eventful week.  Last Friday within a span of 5 minutes I got called about one of my sons who was in a serious auto accident and was being sent by ambulance to the emergency room and then another call from my sister who told me my dad had fallen and broken his hip.

Life is certainly quirky.

So anyway, this week I had a great interview with Dr. Rocky Tuan, the world’s foremost scientific expert on stem cell biology.  Dr. Tuan has headed up the Cartilage biology section at the National Institutes of Health since 2001 and is going to the University of Pittsburgh Medical Center to be chief of their new Regenerative Medicine section.

I also talked with Dr. Joseph Purita, an orthopedist who does alot of regenenerative stuff with PRP and stem cells in Florida.  Very nice man.  And we had a nice chat exchanging ideas.

Like any specialty in medicine there are those who are willing to share and eager to learn… and there are those who are bloodsuckers.  I prefer to avoid the latter.

The field of regenerative medicine for arthritis, tendinosis, etc. is exploding.  I just had a recent article published in the Journal of Musculoskeletal Medicine on stem cells and PRP.  Here’s the link

Stem cell technology for the treatment of osteoarthritis and related conditions is constantly evolving as we learn newer techniques.

This coming week I’ll be interviewing Don Margolis, a stem cell crusader.

Which brings me to my secret.  I’m working a a new project on stem cells and PRP.  I’ll be letting out little hints pretty soon.  Some great content.  So make sure you follow the blog.

P.S. My Achilles that I had PRP on is doing very well.  Have started light jogging and rope skipping.

It’s been a little more than 3 weeks since my tenotomy/PRP  procedure for my Achilles tendon.  I have to confess, it hurt alot for the first 2 weeks.  But this past week I’ve seen the light at the end of the tunnel.

I’ve done my eccentric stretching exercises religiously- the ones Dr. Mulvaney gave me.  (And believe me, I’m the world’s worst patient when it comes to following orders). And I have no pain and I no longer limp.  The lump that was really painful where my tendonitis and tear was located isn’t tender anymore.

I haven’t started to run yet but I can do the bike and the elliptical without pain.

Would I recommend this procedure to others?  Absolutely!  In fact, now that I have first hand experience with tenotomy and PRP, I am a real zealot.

I’ll go way out on a limb and say that this is the procedure of choice for people with chronic Achilles tendonitis with or without a partial tear.

Great news for us Baby Boomers.

Healthday (6/30 Preidt) reported a study from the University of Milan, published in the July issue of Radiology, showing that a minimally invasive procedure is helpful for patients with calcific tendonitis of the shoulder. 

What the researchers did was to randomize 287 patients with calcific tendonitis of the shoulder to one of two grouops.  One group underwent ultrasound guided needling of the tendon with “washing out” of the shoulder and the other control group had no treatment.

Followup of the patients showed that the treatment group had significantly less pain and more mobility at one month, three months, and one year.

[This study actually describes a not so new procedure.  The “new” part is the use of ultrasound guidance, which actually is “old news”.  And the ability to break up the calcific depositis and wash out the shoulder is something that’s been done by many practitioners for several years.  This study confirms through a controlled study what has been known for quite some time. 

What really is new is something I’ve written about before… and that is the use of tenotomy… poking holes in a diseased tendon under ultrasound guidance  and injecting platelet rich plasma to heal the tendon and make new stronger tendon tissue. This is particularly useful for people with chronic rotator cuff problems.

My feeling is that  any press regarding the use of ultrasound guidance is a good thing since it informs prospective patients that they should demand a technology that will help them recover faster. NW]

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