A new Concept in the Treatment of Chronic Bone Diseases
Osteoarthritis (arthrosis) and osteoporosis, the most common chronic skeletal diseases, present one of the biggest public health problems of our civilization. Despite the fact that this has been repeatedly confirmed by numerous statistics, from the World Health Organization (WHO) to the data which indicates that complications of these diseases represent one of the largest financial burdens on the state economy.
Skeletal diseases were ignored for many years and treated as a consequence of natural aging. The therapy was only partial and symptomatic, there were no tendencies towards prevention – there was no significant interest when it comes to this area whatsoever.
Unfortunately, even today the situation has not changed much. During the late nineties and at the beginning of this century, there was a certain increase in attention towards the problem of osteoporosis. This was primarily driven by the introduction of drugs and interests of pharmaceutical companies. In recent years, we are once again witnessing a loss of public interest. As a result one can rarely hear or read something about osteoporosis. This is certainly a consequence of disappointment with the effects of medicines and comprehension of the fact that osteoporosis is much more complex problem than previously thought, thus the interest of the pharmaceutical industry is reduced. It is also a result of insufficient basic knowledge about the bones from the physicians and the population as a whole.
When it comes to osteoarthritis, nothing has really changed for years. The area is still dominated by a fatalistic approach. There is still an opinion that nothing can be done, because we cannot regenerate cartilage. The only thing we can do is use different methods of physical therapy to slightly and temporarily reduce the symptoms, and in severe cases, implementation of the prosthesis.
It’s amazing how these attitudes are deeply rooted primarily among physicians who find it difficult to accept the new methods and insights. It seems as if they do not want to admit that the current approach to chronic diseases is bad.
Is it true that we cannot do better in treating our patients who suffer from chronic bone and joint diseases?
How is it that the other areas of medicine recorded great progress, and when it comes to skeletal diseases we are still in square one?
There is no unified profession that deals with skeleton as a whole. We are divided among orthopedic surgeons, physiatrists, rheumatologists, endocrinologists, who deal with bones in their own “backyard” and forget that the skeleton is a single organ. It is not a collection of bones and joints, but an indivisible whole. It functions in such a way that changes in one part are transmitted to the entire skeleton.
We can take knee osteoarthritis as an example. Knee osteoarthritis is a knee disease, but it leads to significant disturbances of bio-mechanics. This causes overloading of other joints, thus resulting in osteoarthritis in these joints. Therefore, possible knee replacement cannot solve the problem as a whole, because the knee pain may be smaller after the surgery, but the pain in the hip or back will intensify.
Less known fact is that due to the disturbed bio-mechanical balance, which is a result of osteoarthritis, bone quality deteriorates and the risk of fractures increases. In such cases, because of the calcifications that follow osteoarthritis, often we will not find low mineral density on the bone densitometry and we will not recognize osteoporosis, although that is the case.
After all, it is well known that in almost 50% of minor trauma fractures, that are a sure sign of poor bone quality, osteoporosis, we have normal results of bone densitometry. This evidence suggests that something must change in the approach to chronic bone and joint diseases.
So, there is plenty of evidence which suggest that something must change in the approach to chronic bone and joint diseases. Fortunately, in recent years, driven by an increasing interest from industry and better funding for the project, there is a major breakthrough in understanding the biology of skeleton. Also there was a significant increase in the treatment options with the introduction of new drugs and technologies. Now it is up to clinicians and the whole society to take the new scientific knowledge and technological possibilities and apply them into clinical practice.
Why do we need a new concept of treatment and what is it based on?
Based on scientific studies and clinical experience, we can say the following:
- Skeleton is a single organ. It consists of a number of bones and joints and at least three types of tissues: bone, cartilage and muscle-binding.
- Skeleton is affected by many factors which can be divided into genetic, bio-mechanical and metabolic. Since the structure of the bone is constantly changing through a process of bone remodeling we can say that bone structure and its quality is the result of all of these factors.
- Function of the skeleton as a whole depends on the structure and quality of all of its parts. Therefore it is always necessary to implement integrated treatment for the skeleton as a whole.
- Diagnostic methods that are available cannot accurately determine the condition of the skeleton. Therefore, it is necessary to make an assessment of the condition using a combination of several methods in order to predict the risks and dynamics, thus prescribing the suitable treatment. This requires good knowledge about the biology of the skeleton and possibilities of the diagnostic and therapeutic methods. It is important to improve the education of physicians in this area since it is deficient.
- Since it is not possible for the same therapeutic agent or drug to act on all parts of the skeleton, it is necessary to implement a combination of several methods when conducting the treatment.
- Approach to the treatment of chronic bone and joint disease does not yield satisfactory results and does not accept any of the above facts. Therefore it is necessary to change the approach and introduce new concept in treating metabolic bone disorders.
What requirements must the new concept of treatment meet?
Take into consideration everything that has been confirmed so far through scientific studies and clinical experience.
Introduce the new methods and technologies which will respect individual differences of patients and thus act on improving the bio-mechanics, metabolic balance, mobility and initiate tissue regeneration processes, as much as possible.
What is the “BAR” method?
“BAR” stands for: B – biomechanics A – analgesia R – regeneration. This is a combination of methods that improve the “bio-mechanics” of our skeleton and provide regular bio-mechanical stimulus through the use of appropriate daily exercise (“Tae do”). Correction of bio-mechanical balance is achieved with Isokinetic dynamometry and digital podometry analyses.
MBST (therapeutic nuclear magnetic resonance) stimulates the regeneration of cartilage and formation of bones. In severe cases accompanied by severe pain, MBST is combined with other methods to speed up the effect, such as the latest generation of “B.cure Soft laser”, IneterX, acupuncture, analgesics and antirheumatic drugs, electro-therapy, magneto-therapy and if necessary surgical therapy