“DMOAD’omania”-Can Certain Drugs delay the need for Knee Replacement?
Can you delay knee replacement with drugs? A paper out this last week in a British Journal states that a recent presentation at a scientific conference marks the first time a DMOAD (“Disease Modifying Osteoarthritis Drug”) has been identified. DMOADs are drugs that will reduce the structural worsening of common osteoarthritis, which for many patients amounts to a delay in the need for knee replacement. As with most firsts claimed in medical journals, you can almost assume that if the authors claim it’s a first, it’s likely not a first. The same holds true here. The drug that was claimed to be a first is Strontium Ranelate (Protelos), an osteoporosis drug that both stimulates new bone formation and reduces it’s break down. This British study also demonstrated that it slowed the progression of knee arthritis (measured as joint space narrowing) on x-rays. If you read this blog, this isn’t new. In fact another osteoporosis drug was just found to have a similar effect. That drug, known as Fortical, is a calcitonin nose spray found to reduce knee arthritis symptoms. Of these two drugs, only Fortical is approved for use in the U.S. So if you have to take a drug for osteoporosis and have knee arthritis, then you’re in luck. However, what if you don’t have osteoporosis? I would caution against taking a drug that may increase normal bone mass to help your knee arthritis. If you don’t have osteoporosis, are there other DMOADs? Yes. Again if you read this blog you know that both Glucosamine and Chondroitin actually have stronger research than just pain questionnaires and x-rays, they have been shown to either make cartilage look better on MRI and or reduce cartilage breakdown products. In addition, would you believe an uncommonly used antibiotic is also a DMOAD? Doxycycline will also reduce the progression of knee arthritis, but not the symptoms of knee arthritis. The problem here is that being on an antibiotic long-term can have significant side effects, not the least of which is killing off the important good bacteria in your gut. The upshot? Is Protelos a DMOAD first? Nope, not even close (I guess the drug company should fire that PR guy). However, there are a few trends here that are emerging. First, osteoporosis drugs seem to have a DMOAD effect, which makes sense since much of end stage knee arthritis involves the remodeling of bone and creation of bone spurs. So shoring up the bone in patients with weak bone by using drugs that also have a positive effect on cartilage turnover is likely a good thing (if you have osteoporosis). Second, many supplements also seem to have a DMOAD effect, yet lack Pharma’s PR machinery to let you know about it. So the moral of the story is never listen to a thinly disguised press release (I mean medical journal review article) that claims a medical first. Instead, read this blog!