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Metabolic Bone Disease Service
Adult Orthopaedics
1425

Metabolic Bone Disease Service

Overview

Chief:

Joseph M. Lane, MD

Visit the Service Page for the full faculty listing.

2021 Published Studies: 23

Members of the Metabolic Bone Disease Service support and partner with other services across the institution to improve patient outcomes by optimizing metabolic bone health for patients with metabolic bone disorders including osteoporosis, osteomalacia, rickets, hypophosphatemia, avascular necrosis and Paget’s disease. The service also has established working relationships with the Foot and Ankle, Adult Reconstruction and Joint Replacement, Orthopaedic Trauma and Spine orthopaedic services. Registries have been constructed to evaluate the most appropriate diagnostic and treatment strategies. The HSS Osteoporosis and Metabolic Bone Health Center cares for patients with these types of disorders and consists of physicians and nurse practitioners in the fields of orthopaedics, endocrinology, rheumatology and women’s health.

Recent Achievements

Our service has seen great success through our HSS @ NYP program with NewYork-Presbyterian, in which a fracture liaison nurse practitioner is embedded with the orthopaedic surgical team. We have seen a high rate of capture for patients presenting with fracture to receive a metabolic bone evaluation, with appropriate care prescribed thereafter, thus increasing positive surgical outcomes for those patients.

The Metabolic Bone Disease Service has also trained its first endocrine fellow, Katherine Noto Haseltine, MD. Dr. Haseltine won the 2021 Best Research Poster Award for her poster entitled “The Effect of Epidural Steroid Injections on Fracture Risk Among Medicare Patients.” Dr. Haseltine joined the faculty on the service after completing her fellowship.

Emily Stein, MD, is leading a study examining the consequences of epidural steroid injections on bone health in collaboration with Physiatry and Anesthesia/Pain Management. This work was recently highlighted as an oral presentation at the 2021 Annual Meeting of the American Society for Bone and Mineral Research.

Notable Publications

Effect of Abaloparatide vs Alendronate on Fracture Risk Reduction in Postmenopausal Women with Osteoporosis. Leder B, Mitlak B, Hu M-Y, Hattersley G and Bockman R. J Clin Endocrinol Metab. 2020 Mar 105(3): 938-943. PMID: 31674644

Clinical Characteristics and Fracture Patterns Among Postmenopausal Women with Isolated Osteoporosis at the Forearm. Chukir T, Haseltine K, Do H, McMahon DJ, Russell L, Stein EM. J Clin Densitom. 2021 Aug 13:S1094-6950(21)0069-X. PMID: 34511326

Rationale for Bone Health Optimization in Patients Undergoing Orthopaedic Surgery. Anderson PA, Dimar JR, Lane JM, Lehman RA Jr. Instr Course Lect. 2021;70:355-366. PMID: 33438921

Patients with Abnormal Microarchitecture have an Increased Risk of Early Complications after Spinal Fusion. Kim HJ, Dash A, Cunningham M, Schwab F, Dodwell J, Harrison J, Zaworski C, Krez A, Lafage V, Agarwal S, Carlson B, McMahon DJ, Stein EM. Bone. 2021 Feb; 143:115731. doi: 10.1016/j.bone.2020.115731. Epub 2020 Nov 4. PMID: 33157283

MRI-based Texture Analysis of Trabecular Bone for Opportunistic Screening of Skeletal Fragility. Zaworski C, Cheah J, Koff MF, Breighner R, Lin B, Harrison J, Donnelly E, Stein EM. J Clin Endocrinol Metab. 2021 Jul 13;106(8): 2233-2241. doi: 10.1210/cinem/dgab342. PMID: 33999148

Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis. Krez A, Lane J, Heilbronner A, Park-Min KH, Kaneko K, Pannellini T, Mintz D, Hansen D, McMahon DJ, Kirou KA, Roboz G, Desai, P, Bockman RS, Stein EM. Osteoporos Int. 2021 Oct; 32(10):2095-2103. doi: 10.1007/s00198-021-05947-x. Epub 2021 April 20. PMID: 33877383

Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Nieves JW, Cosman F, McMahon D, Redko M, Hentschel I, Bartolotta R, Loftus M, Kazam JJ, Rotman J, Lane J. Osteoporos Int. 2021 Aug 12. doi: 10.1007/s00198-021-06065-4. Epub ahead of print. PMID: 34383100

Osteoporosis, A Clinical Casebook. Chapter 9: Relative Energy Deficiency in Sports/Functional Hypothalamic Amenorrhea. Natalie Cusano. Springer 2021. The pathophysiology of pregnancy and bone health.

Looking Ahead

Several studies are underway evaluating bone anabolics. The first, called the FAST Healing Trial (Fusion with Anabolics after Spinal Surgery), is being conducted with co-investigators from endocrinology, orthopaedics, radiology and rheumatology. It looks to use anabolics to improve surgical outcomes in patients undergoing spine stabilization. The second is a multicenter trial supported by the National Institutes of Health, for which HSS is the coordinating center, seeking to accelerate pelvic fracture repair with an anabolic agent. The first paper from this NIH study showed in a small cohort that an anabolic agent could improve physical performance more than a placebo following a pelvic fracture (see Nieves et al, above).

Linda Russell, MD, is the co-primary investigator for an American College of Rheumatology guideline for the treatment of glucocorticoid osteoporosis, which is due to be published in 2022.

Drs. Stein and Alana Serota, MD, are currently looking at the effects of vitamin D and risk for COVID-19 in the HERO Study.

Future goals for the service include focused integration with the HSS Spine service, with the aim of having spine surgical patients evaluated by a metabolic bone nurse practitioner prior to surgery to optimize bone health.

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