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Hello Again

Welcome to our April Newsletter. We have been quite busy since our last newsletter. First, our staff of doctors has grown again- we are proud to have Dr. Harris Gellman, M.D. as an orthopaedic hand specialist on staff. Dr. Gellman is now consulting on our patients with hand injuries on Tuesday afternoons in our Weston office. Second, we are in the process of redesigning and building our Weston office- we are now designing the office to have 10 treatment rooms(an upgrade from 6), a much larger waiting room area, an improved imaging area, and an improved front office area. We look forward to having better patient flow through our office with these upgrades and we thank any of our patient's in advance for their patience and understanding as we complete construction.


Our focus this month is on newer medications to help treat osteoporosis. Osteoporosis is not just "an old ladies' disease"- there are people who are leading sedentary lives, not eating well and not getting enough calcium in their diets who are suffering from bone mineral loss at an earlier age- even in the late 20's and early 30's.

A new osteoporosis drug called zoledronic acid, currently undergoing Phase III clinical trials, has been shown to increase bone mineral density in rates similar to those achieved with medications taken daily or weekly. This medication, if approved, is administered during a 30 minute IV infusion once per year. Dr. Stuart Silverman, a clinical professor of medicine at UCLA and an investigator in the clinical trials, states "Right now, osteoporosis is under-recognized, under-diagnosed, and undertreated."

Bones are NOT solid, fixed structures that we assume them to be. They actually exist in a dynamic state known as the remodeling cycle. This cycle has 2 parts:
Bone resorption(osteoclasis): Special cells known as osteoclasts dissolve bone by removing calcium and depositing it into the blood stream.
Bone formation(osteogenesis): Special cells known as osteoblasts create new bone by removing calcium and other minerals from the blood and depositing them in the cavities where bone is needed.

About 55% of people over age 50 have low bone mass, and 10 million Americans have osteoporosis, according to the National Osteoporosis Foundation. An even more astonishing fact is that more and more younger people, sometimes as early as the age of 25, are being diagnosed with this disease. Quite often, these patients discover the problem after suffering a sprain or other injury, have radiographs taken at a physician's office, and the physician may notice x ray evidence of loss of bone density.

An advantage of the zoledronic acid is that if a person suffers a fracture and osteoporosis is discovered, the fracture can be treated, and then the patient can receive the IV treatment and the risk of another fracture or reinjuring the fracture site is greatly reduced for another year. About 20 percent of patients with osteoporosis who suffer one fracture will have another fracure subsequently, so the benefit of this treatment is obvious.

An additional benefit of the IV medication is avoiding stomach upset. Zoledronic acid is in the class of powerful bone protectors called bisphosphonates. Bisphosphonates attach directly to the bone; they inhibit the ability of the osteoclasts to attach to bone. Henceforth, the bone cannot be dissolved by the osteoclasts. Oral forms of this medication include Fosamax and Actonel. Unfortunately, many patients feel that that oral forms are hard on the stomach.

Zoledronic acid is not a new drug. It has been used under the name of Zometa, to treat complications of cancer that has spread to bones.

If the medication proves successful, it will probably be used in conjunction with other osteoporosis treatments, such as the newly approved medication Forteo, which can help build new bone.


We at South Florida Institute of Sports Medicine have seen our younger patients presenting with osteoporosis. From a preventive standpoint, adequate calcium intake, a healthy diet which is low in fat and derives protein from vegetable sources rather than animal sources, refraining from smoking, alcohol, and caffeine, in addition to weight bearing exercise, can help greatly to reduce the risk of osteoporosis. For those of our patients who have osteoporosis and may need intervention, it appears that the future holds promise for once-a-year treatment.

Until you all hear from us again, Be Well
The doctors and staff of South Florida Institute of Sports Medicine.