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A medication that builds bone mass in patients with osteoporosis might actually help repair damaged joints and could be used to treat people suffering from arthritis, according to University of Rochester Medical Center researchers. The study authors hope their findings, published in Science Translational Medicine, will lead to clinical trials to test human parathyroid hormone in arthritis patients. Many older people suffer from arthritis, which is a painful joint condition. Treatment options have been very limited for some forms of the disease. Osteoarthritis is the most common form of the disease. It occurs when cartilage breaks down, so it can no longer cushion bones as they move against each other in joints like the knee, hips, or hands.
The body maintains cartilage with parathyroid hormone (PTH). A synthetic form is used to treat the bone disease osteoporosis. It's called teriparatide, sold under the brand name Forteo. Researchers at the University of Rochester thought this osteoporosis drug might help rebuilt cartilage in arthritis patients. To find out, Michael J. Zuscik and his colleagues used mice with injured knees, simulating arthritis. Some of the animals got the drug Forteo, while others did not.
"The treatment with Forteo induced the cartilage to become thicker by 32 or 35 percent relative to animals that were given a placebo treatment," Zuscik says. Currently, osteoarthritis patients use a variety of medicines to treat pain, but available drugs do nothing to reverse the actual damage that causes the pain. "In the context of human disease, this is what we would love to do. We would love to be able to take an arthritic patient, provide them with a therapy that actually makes their cartilage thicker, so they have longer lifetime use of their joint," Zuscik says.
The researcher says it wouldn't make the joint like new, but it would roll back the clock, so that the painfully arthritic knees of a 70-year-old might become more like the pretty-good knees of a 60-year-old. More research is needed to see if Forteo would be effective in humans, and safe. Osteoporosis patients get a warning of one possible risk. Studies of Forteo in rats have found the drug increases the risk of a rare bone cancer, osteoscarcoma. But studies of other animals, including primates, have not confirmed the rat finding. Still, to be on the safe side, Forteo is not prescribed for people with a history of cancer.
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Researchers have tested an implantable device that releases daily dosages of osteoporosis medicine. The device may one day be a cost-effective alternative to daily injections, and could help manage other diseases as well. Osteoporosis is a common condition of older people, especially women, in which bones become weak and brittle, and can break easily. There are medicines to treat osteoporosis. One kind, known as parathyroid hormone, requires daily injections for two years.
But having to give yourself a shot every day, plus the lack of tangible improvement in the patient's condition, results in what researchers call poor compliance. "And as a result, only 25 percent of the patients will go through the entire 24 months of treatment," says Robert Farra, president of MicroCHIPS, a medical device maker that developed the implantable drug delivery system.
It's only a few centimeters long, and includes up to 365 tiny compartments, each with a single dose of medicine. At the beginning of treatment, the device is inserted under the patient's skin. "For osteoporosis, the physician will program the device, and the device has the ability to release a dose at a given time, every single day. For other diseases, where the physician may want to alter the dosing schedule, they will have the ability to wirelessly reprogram that dosing schedule," Farra says.
The injectable form of the parathyroid hormone is a liquid that has to be refrigerated, but for the implantable device, the researchers developed a powered version that remains effective when sealed in its tiny compartment for as long as a year. The device itself can be implanted in a doctor's office with local anesthetic.
Farra and his colleagues say safety tests of a small, 20-dose prototype unit were successful, and they are now designing a 365-dose version. "We anticipate two years to complete the design, and then we may be required to do two additional trials, taking us out to a total of four years before the device is available on the commercial scale." The price of the device is speculative, but Farra says the cost should be similar to the current regimen of daily injections.
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Most alternative treatments have either not been scientifically tested or subjected to limited investigations, says Arthritis Research UK. Of 25 therapies, only a handful were judged to have enough medical evidence to support their use. These included acupuncture, massage, tai chi and yoga. Very little evidence was found in support of commonly-used therapies such as copper bracelets and magnetic therapy for arthritis, fibromyalgia or lower back pain. For their analysis the researchers searched for randomised controlled trials - comparing the given therapy with a placebo, usual care or another treatment - that had been written up in English and published before the end of May 2011.
For arthritis, they found 53 trials of 14 different therapies among nearly 6,000 patients. Only tai chi and acupuncture appeared to work. For fibromyalgia there were 50 trials of 17 different therapies in more than 3,000 patients. Acupuncture and massage came out top, closely followed by tai chi and relaxation therapy. For sore backs, yoga and acupuncture appeared the most effective, and there was some evidence to also support the use of osteopathy and relaxation therapy as well as the Alexander technique which focuses on posture and movement.
Lower back pain was the most investigated condition, with 75 trials of 14 different therapies across over 11,600 participants. According to the lead author of the report, Dr Gareth Jones from the University of Aberdeen, there is very little evidence for most complementary therapies. "There's either no evidence that they're effective or there's some evidence that they are not effective. "But there are some exceptions, like acupuncture and the whole body therapies like massage and tai chi, which do appear to work."
Waste of money?
