“In addition to osteoporotic fractures, compromised cancellous bone leads to a multitude of other orthopaedic problems, such as limiting the ability to secure implants to bone,” Dr. Bostrom said. “The need for revision total joint arthroplasty often is due to adverse effects of the implant on the surrounding cancellous bone. Although great advances have been made in improving the implants and fixation methods used in total joint arthroplasty, little attention has been paid to understanding or enhancing the cancellous bone tissue with which they interact.”


Published 7/1/2008
Kathleen Louden

Research aims to improve understanding of bone healing

OREF Career Development Award goes to Mathias Bostrom, MD

After fracture repair or total joint replacement, patients may be able to get back on their feet more quickly, thanks to research being conducted by Mathias P.G. Bostrom, MD, and funded in part by the Orthopaedic Research and Education Foundation (OREF).

The OREF Board of Trustees named Dr. Bostrom a 2008 recipient of its Career Development Award, which encourages a commitment to scientific research in orthopaedic surgery. A professor of orthopaedic surgery at Hospital for Special Surgery in New York City, Dr. Bostrom will receive an annual stipend of $75,000 for 3 years. He will use the award to further his studies of how to improve formation of cancellous bone—the spongy bone that becomes compromised with age and the site of most osteoporotic fractures.

Mathias P.G. Bostrom, MD

A new loading model
To address this scientific gap, Dr. Bostrom developed a new animal model of loading on cancellous bone. The model, which applies a compressive load to bone, simulates the benefits of weight-bearing exercise for increasing bone mass. He will study whether this loading will enhance in vivo cancellous bone formation after systemic administration of the anabolic agent parathyroid hormone (PTH). Intermittent administration of PTH is known to stimulate bone formation in patients with osteoporosis, especially in load-bearing sites, such as the vertebrae.

“We don’t know, however, if PTH builds new bone in the presence of mechanical loading,” Dr. Bostrom said. “I believe PTH and load-bearing work synergistically and will have a greater effect than either alone.”

From his preliminary studies, Dr. Bostrom said it is surprising how little load is needed for an improved bone response. In his current project, he will compare two different load magnitudes applied to the distal femur of the rabbit and then analyze changes in bone quality and quantity. Additionally, he will explore the cellular pathways involved in the anabolic response to mechanical load and PTH, to better understand the mechanisms of action. Results may affect future orthopaedic treatment, he said.

“If we find, for example, that using PTH and a loading protocol significantly enhance the amount of bone,” Dr. Bostrom said, “our approach to managing osteoporotic hip [fractures] may be radically different. Instead of doing surgery right away, it may mean we give the patient PTH or some other agent.”

About 1.5 million osteoporosis-related fractures occur each year in the United States, according to the National Institutes of Health. Fixation of these fractures remains problematic, with malunions occurring frequently.

“Dr. Bostrom’s research will advance our understanding of osteoporosis, fractures, and their treatment,” said Thomas A. Einhorn, MD, OREF’s vice chair, grants. He called Dr. Bostrom “a recognized thought leader in orthopaedic sciences.”

Support is key
The OREF Career Development Award, according to Dr. Bostrom, will speed his ability to answer important questions about the interaction of bone with its mechanical environment. “Ultimately, this knowledge should help us improve bone quality and thus improve the health, activity, and quality of life of our patients,” he said.

In addition to funding from OREF, Dr. Bostrom’s work has received financial support from the National Institutes of Health and Smith & Nephew.

Candidates for OREF’s Career Development Awards must have completed a residency in orthopaedic surgery and demonstrated a sustained interest in research and excellence in clinical training. Through Project Year 2008, OREF has funded nearly $88 million in independent, peer-reviewed research and educational projects that benefit all of orthopaedics. Awards are given based on scientific rigor, contribution to orthopaedic knowledge, and clinical relevance.

Kathleen Louden is a contributing writer for OREF and can be contacted at communications@oref.org

Apply for 2009 OREF funding
Applications due October 1, 2008

OREF welcomes applications for 2009 funding for qualified, clinically relevant orthopaedic research and education projects. All OREF grant and award recipients are selected through an independent, peer-review process modeled on that used by the National Institutes of Health. For 2009 funding, applications must be received by OREF no later than Oct. 1, 2008; recipients will be notified no later than Feb. 25, 2009.

OREF invites orthopaedic investigators and educators to apply for the following grants and awards:

  • OREF Research Grants
  • OREF Prospective Clinical Research Grants
  • OREF Career Development Awards
  • OREF Resident Clinician Scientist Training Grants
  • OREF Clinical Research Awards
  • OREF Educational Grants
  • JBJS Resident Journal Club Grants
  • Fred W. Hark, MD, and William A. Hark, MD, Lectureships
  • OREF State Orthopaedic Society Awards
  • NIAMS/OREF National Research Service Award Post-doctoral Fellowships in Epidemiology, Clinical Trials, and Outcomes Research in Orthopaedic Surgery

Applications for additional grants and awards may be invited later in the year. To obtain electronic application forms, register for updates on available grants and awards, and for additional information please visit www.oref.org/grants or www.oref.org/residentgrants