Crumbling infrastructure puts us at risk, especially if it’s our own internal, bony frame.
But patients dealing with thinning bone in hips and spine have a choice to make.
They can accept the inevitable slumping spine and eventual hip fracture with all its associated disability that is quite likely to occur, or roll the dice with complications from osteoporosis medications.
Dr. Khosla is one of the top osteoporosis experts in the world and a past president of the American Society for Bone and Mineral Research and he is the society's Louis V. Avioli lecturer this year at the groups annual conference.
Dr. Khosla has spent the last 28 years translating clinical need into discovery, and discovery into clinical therapy to meet the needs of patients experiencing bone loss. If there’s one thing he knows, it’s the progression of therapeutic options for osteoporosis patients.
Osteoporosis Treatment: Research Success, Patient Concern
“When I joined Mayo in 1988, I could offer calcium, vitamin D, estrogen, and that was pretty much it,” says Dr. Khosla.
But through collaboration and explorations of the fundamental nature of bone biology, Dr. Khosla has witnessed a blossoming of therapeutic options. From examining the spiral of spine and hip fractures leading to immobility, loss of independence, and premature death; came a host of options to turn off the cells that breakdown bone, slow bone loss and help prevent those first debilitating fractures.
Some patients and physicians, however, are concerned about these medications because of the relatively rare risks of jawbone deterioration, leg fracture, or abnormal heart rhythm. Just when the future of osteoporosis therapy seemed bright, uncertainty has led to under-utilization of these therapies.
“I’ve been pushing to address this head on,” says Dr. Khosla, “because it has the potential to completely undo all of the wonderful research and translation that’s been done in the field.”
[Read Dr. Khosla’s editorial, “Crisis in the Treatment of Osteoporosis” in the Journal of Bone and Mineral Research.]
Researcher and Physician: The Patient’s Best Resource
Although research duties take up much of Dr. Khosla’s time, he is a clinician and actively sees patients. This allows him to identify the unmet patient needs and push his research team, and the field of endocrinology, to find solutions. It also allows him to separate likely findings from unlikely ones published in his field.
“The cross talk between what I’m doing in my research versus what I do in my clinical activities is important,” says Dr. Khosla. “It both helps to guide the research in new directions but also shuts off directions that don’t make sense from my understanding of what’s happening in the clinic.”
It’s this ability to see both his patients’ concerns and the clarity of the research that has led Dr. Khosla to push for more research on the subset of patients who will develop complications from osteoporosis treatment.
“I think the field has to be more proactive,” says Dr. Khosla, “and listen to what patients are saying and directly address the concerns they have.”
New Therapies on the Horizon
Some areas of research Dr. Khosla is investigating include better monitoring or adaptation of current bone density imaging to pick up the earliest signs of complications. Pharmacogenomics approaches may also help identify patients who may be at risk for complications. New bone remodeling pathways and new therapeutics in the drug discovery pipeline may also offer options for patients dealing with bone loss.
So while alleviating concerns over treatment complications poses a huge challenge for physicians, Dr. Khosla has high hopes for the field and its ability to get the answers patients need.
“The osteoporosis field over the past 25 plus years is really a great example of how a better understanding of the fundamental biology can drive new therapeutics,” says Dr. Khosla, “and it continues today.”