In The News: July 2019
FDA Approves New Osteoporosis Drug
The Food and Drug Administration (FDA) approved the drug romosozumab (Evenity®) for osteoporosis in April 2019. Evenity joins two other anabolic agents (teriparatide [Forteo®] and abaloparatide [Tymlos®]), which treat the bone-thinning disease osteoporosis by stimulating bone formation. Evenity has a new mechanism of action. In head-to-head studies, Evenity increased bone mass more than Forteo. The anabolics differ from other osteoporosis drugs, which work by preventing bone from breaking down. (Bone undergoes a natural cycle of breaking down and building back up.) In one of the studies that led to the approval of Evenity, the drug lowered the risk for a spine fracture by 73 percent compared with placebo after one year. Evenity is approved for postmenopausal women with osteoporosis who are at high risk for a bone fracture. Evenity is given as a monthly injection for 12 months by a healthcare provider in a doctor's office.
Weight Loss Before Joint Replacement Improves Outcomes
For people with severe osteoarthritis in the knees, joint replacement surgery can relieve pain and improve mobility. People who are morbidly obese (defined as body mass index of 40 or greater) are at greater risk for complications during and after surgery. Surgeons often recommend weight loss before surgery. A study presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons (March 2019) sought to determine how much weight loss was necessary to improve outcomes. The researchers reviewed medical records of 203 patients who were morbidly obese before undergoing total knee replacement surgery. Compared with those who lost less than 20 pounds, those who lost 20 pounds or more had a shorter length of stay in the hospital, and they were less likely to need post-surgical care in a rehabilitation facility.
How Long Does Symptom Relief from NSAIDs Last?
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®, Advil®), naproxen (Aleve®) or prescription-strength ones, are often used for osteoarthritis. They can both relieve pain and reduce inflammation. However, because of potential side effects and risks, doctors usually recommend taking them for only short periods of time. A study published in Arthritis Care & Research (March 2019) reviewed results from 72 studies of NSAIDs to determine the duration of effectiveness and amount of time before adverse effects occurred. Their results showed that moderate pain-relieving effects and improvements in function peaked at two weeks and lasted for up to 26 weeks. However, the magnitude of effect decreased over time. People taking NSAIDs were more likely to experience gastrointestinal problems, although mild, than those on a placebo (an inactive pill) as early as four weeks after starting an NSAID.
Timing of Steroid Shots Affects Infection Risk from Shoulder Surgery
Sometimes surgery is needed to repair a torn rotator cuff (the muscles and tendons that surround the shoulder joint). The rotator cuff can tear from a sudden injury, but more often a tear results from degeneration over time. Conservative treatment, which might include a corticosteroid injection, is usually the first step. Surgery is usually delayed for a period of time after a corticosteroid injection, due to concerns about infection. A study published in The Journal of Bone & Joint Surgery (April 2019) investigated this relationship. The study included data on over 60,000 people who had surgery to repair a rotator cuff, 12,000 of whom had a steroid injection before surgery. Those who received an injection within one month before surgery had a significantly higher rate of infection compared with those who had not had a steroid shot. There was no increased risk if surgery took place one month or more after the injection.