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Orthopedic Surgery and Trauma Service

Metabolic Bone Disease

Metabolic Bone Disease and Osteoporosis Service

The Metabolic Bone Disease and Osteoporosis Service at Weill Cornell Orthopedics treats diseases that leads to bone fragility.

Conditions we treat include:

• Osteoporosis
• Osteomalacia, a metabolic bone disease characterized by abnormal mineralization of bone
• Stress fractures
• Collagen, calcium, and vitamin defects
• Genetic diseases associated with fractures
• We also help patients who were over-treated with bisphosphonates and now have problems with their bones. Bisphosphonates are a type of drug commonly prescribed to treat osteoporosis.

Diagnosis

Diagnosis of these bone conditions may include a bone density scan, a safe, painless x-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at 20 to 25 years of age.

Our physicians may also order blood and urine tests to look for markers – levels of different enzymes, proteins, and other substances circulating in the body – that give information about your disease and the progress of your treatment. These markers can provide information about the rate of bone formation, bone resorption (loss of bone), and vitamin D levels, which are essential for the body’s absorption of calcium.

Additionally, our physicians may also perform genetic evaluations for patients suspected of having a genetic disease associated with fractures.

Treatment

Drug Treatments

There are many drugs treatments for osteoporosis. These include bisphosphonate drugs such as Fosamax, Actonel and the monthly drug Boniva. These drugs help slow down or stop bone loss.

Forteo (teriparatide)

Another treatment option is Forteo (teriparatide), an injectable synthetic version of parathyroid hormone, a naturally occurring hormone that helps regulate calcium. This treatment helps build new bone.

Minimally Invasive Micro-Surgery

There are also a number of treatments for fragility fractures. We perform many of these techniques percutaneously (through the skin) using minimally invasive micro-techniques. These include:

• Vertebroplasty, which involves injecting cement directly into fractured vertebral bodies. This has been shown to decrease pain, increase mobility and improve spine stability. Vertebroplasty has no effect on fracture reduction or deformity.
• Kyphoplasty, which involves using an inflatable bone tamp to inject bone void filler under low pressure into the involved vertebral body. The fracture may be reduced, and pain relief is rapid.
• Wedge correction (spine wave), in which a series of wafers is inserted into the spine to build a tower that lifts up bone and corrects fractures.
• Spinology, a method that involves using a bone transplant to correct a spine fracture.

Delayed Fracture Healing

For patients with delayed fracture healing, we offer treatment including percutaneous injections of concentrated marrow cells, along with demineralized bone matrix (a bone-graft substitute) or bone morphogenetic protein (which stimulates the body to make more bone cells), and systemic treatment with parathyroid PTH (1-34), which has been shown to increase bone density and prevent fractures in both postmenopausal women and patients on corticosteroids.

We also heal fractures using a person's own bone marrow that has been concentrated, along with demineralized bone.

Avascular Necrosis

We also offer a comprehensive program for treating avascular necrosis, the death of bone tissue due to a lack of blood supply. This can lead to tiny breaks in the bone and the bone's eventual collapse. Avascular necrosis most often affects the head of the thighbone (femur), but it may also affect other bones. Treatment includes:

• Core decompression, a procedure in which a surgeon percutaneously removes part of the inner layer of the bone.
• Injection of one's own harvested bone marrow stem cells, along with demineralized bone matrix.
• njection of parathyroid hormone – PTH (1-34) followed by bisphosphonates.

Research

At Weill Cornell Orthopedics, current areas of research include methods to image the structure of bones and the molecular activity taking place within them. These include Micro-CT scans, which allow physicians to examine tiny pieces of bone to analyze their structure and shape; Quantitative Histomorphometry, which allows physicians to see the cellular activity within bones; and F-TIR testing, a test that uses infrared rays to let physicians analyze the minerals and collagen within bones.

Our Physicians for Metabolic Bone Disease

• Joseph M. Lane, MD