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AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS

Reaping nature's own solutions to heal broken bones
San Francisco, CA - Over the past quarter of a century or so, the era of biotechnology has contributed many new drugs and medical therapies to improve the health and well being of humankind.  One of these new products, produced from a naturally occurring protein, is recombinant human bone morphogenetic protein (rhBMP), which was approved for use by the U.S. Food and Drug Administration (FDA) in 2001.  These proteins have been proven to induce bone formation and enhance fracture repair, and often can be used as an alternative for bone grafts in healing difficult to repair fractures.  Thomas Einhorn, MD, professor and chairman, Department of Orthopaedic Surgery, Boston University School of Medicine, described his promising research with two different BMPs at the American Academy for Orthopaedic Surgeons 71st Annual Meeting today. 

According to Einhorn, more than 6.2 million fractures are sustained by individuals in the United States each year.  While most of these fractures heal promptly, as many as 10 percent fail to heal.  Surgeons typically apply bone grafts to fractures when this happens, but sometimes bones still refuse to mend.   "In some patients, after you've done one bone graft, there is no more bone to find, and patients might have chronic non-unions," he explains.  "Now we have this protein we can use which will perform as well as a bone graft."

Einhorn says that BMPs are expressed naturally on various occasions throughout our lives.  They "turn on" for the first time before birth, when they play an important role in fetal development.  These proteins "turn on" again after birth, whenever we break a bone. 

He explains that when most of the tissues in the body are injured or cut, they will heal with a scar, which is a different tissue than was there before.   In contrast, if you break a bone, the bone will heal, and the healing tissue is identical to the bone that was there before. 

"What distinguishes a healing bone from a healing cut in your skin is that the skin heals by a repair process, whereas the bone heals by a regenerative process," he says.  "One of the molecular phenomena that distinguishes between the healing of the skin and the bone is bone morphogenetic protein."

Einhorn is excited that there is a protein available that can be used instead of a bone graft for patients who have non-unions of fractures and for those undergoing spinal fusions.  A bone graft requires that individuals have an incision made in the area of their pelvis and bone removed.  This sometimes causes significant post-operative pain and is sometimes even associated with complications such as nerve injury or difficulty walking.

"There have not been any studies to show that BMPs are better than a bone graft, only that they are as good as a bone graft," Einhorn says.  "But you could interpret that to say that if they are just as good as a bone graft, then they are actually better, because you can just take it off the shelf and you don't have to expose another operative site and lose more bone.   Further, you can reduce the blood loss by a unit of blood, reduce the risk of infection, reduce the risk of injury to nerves or blood vessels, and cut the operating time by 45 minutes.

"Using BMPs would eliminate the pain from the bone graft, too, and this is an important point to make," he adds, considering that more than 1.5 million bone grafts are performed each year in the United States.  Many patients who have undergone these operations have more pain long term at the site where the bone graft was taken, than at the site where the fracture healed itself because of the bone graft.  To reduce this suffering to any degree would be desirable.

This is still cutting edge research and only a small percentage of our country's 18,000 orthopaedic surgeons currently use BMPs.  The proteins are gaining in popularity, however, both here and around the world.  At last count, they had been approved for use in Australia and in 11 countries in Europe.

"Now many of our patients will be able to have their operations done successfully without having to have a bone taken from one part of their body and put in another place, so there is no longer a need to borrow from Peter to pay Paul," Einhorn says. 

"Now we can take Peter off the shelf."

An orthopaedic surgeon is a physician with extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

With 28,000 members, the American Academy of Orthopaedic Surgeons (www.aaos.org) or (www.orthoinfo.org) is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals, and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (www.usbjd.org ) the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research, and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's Annual Meeting is being held February 23-27, 2005, at the Washington Convention Center in Washington, DC.  The AAOS will celebrate its 75^th Anniversary at our 2008 Annual Meeting in San Francisco. Visit (www.aaos.org/75years) and be a part of our history!

For Immediate Release
03/10/2004