Washington University Physicians - Washington University School of Medicine in St. Louis
Physician Quick Search
By Name:
By Specialty:
Your Healthy Update

Like us on Facebook
Text Size: S M L
Search

Share

Focus on Roberto Civitelli, MD


Roberto Civitelli, MD is the Sydney M. and Stella Schoenberg Professor of Medicine. He is also a professor of orthopedic surgery and professor of cell biology and physiology. His specialty is bone and mineral health with a special interest in osteoporosis.

Dr. Civitelli sees patients at:

The Center for Advanced Medicine, 4921 Parkview Place, 5th floor, Suite C, St. Louis, MO 63110.

Barnes-Jewish West County Hospital, Medicine Multispecialty Center, Medical Building Two, 10 Barnes West Drive, Suite 200, Creve Coeur, MO 63141.

FOR AN APPOINTMENT, PLEASE CALL 314-454-7775

What happened in the course of schooling to influence you to choose your specialty?

That’s not a difficult question to answer because I’ve always been interested in this field of medicine – bone and mineral metabolism. I went to medical school at the University of Siena in Tuscany, Italy during the late 1970s. My first mentor was a young professor, Dr. Carlo Gennari, who was one of the few investigators interested in calcium balance and calcium losses in bone. At the time we didn’t have any of the diagnostic tools we have now for measuring bone density. My mentor was very convincing and supportive -- I became captivated by the specialty and never left it.
Dr. Civitelli with niece and nephew in the Painted Desert


What brought you to Washington University?

In the mid 1980s, there was a very strong group at Washington University interested in bone metabolism -- Louis Avioli, MD, was the division chief until he passed away in 1999. He was known all over the world as a pioneer and one of the founding fathers of the American Society of Bone and Mineral Research -- he became my main mentor.

I received a fellowship here and my plan was to stay two, maybe three years, learn how to be a bone biologist and go back to Siena to start a lab. Because of the ability of Avioli to motivate people and the support he gave, I decided to stay at Washington University. Of course, the environment here was growing in terms of the number of investigators, breadth of interest and depth of talent – it was a very inspirational experience.

What brought me here was the talent, focus on bone and mineral diseases, and charisma of a great leader.

Which aspect of your practice is most interesting?

It’s a concentrated area that includes osteoporosis, bone disorders and calcium disorders. What really interests me is the ability to look at a disease beyond clinical management. It’s fascinating because we are in a medical center where we can actually look at the whole spectrum from clinical presentations to basic physiology mechanisms, to cells and molecules. Our center is at the forefront of bone biology research, with a milieu of expert clinicians and creative investigators who, working together, constantly develop new ways of approaching problems – that’s really the most exciting aspect of my practice.

What is new in research?

When I started in 1980, estrogen was the only therapy available for preventing osteoporosis. The therapeutic armamentarium has grown dramatically since then. Most recently there was a new drug approved – an antibody against a molecule that was discovered less than 15 years ago as essential for making osteoclasts, the cells that break down the bone.

It’s interesting to see the whole process develop from scratch, from a basic discovery to a new pharmaceutical product. There are other drugs in the development pipeline that hopefully will allow us to not only stop bone break-down, but stimulate new bone growth – called bone anabolics.

Can you describe the new bone scan technology?

As far as diagnostics, we are still relying on what’s called the DEXA or dual energy X-ray absorptiometry – which is measuring the amount of bone mineral present in the lumbar spine and the proximal femur. That’s proven to be a very useful diagnostic test.

In the last few years however, we have become aware that perhaps just measuring the amount of material is not enough to determine bone strength. Other factors that come into play include how the materials are organized in the bone (microarchitecture), the shape of each bone section, and the rate at which cells are renewed when repairing micro-fractures. We know all these factors play a role, but we don’t yet have the means to assess them in a clinical usable way, so we still rely on DEXA.

The most promising new technology is micro magnetic resonance imaging (micro MRI). The technique can generate a three-dimensional picture of bone at a high resolution – almost like a virtual bone biopsy. To be a viable technique for a clinical setting, the MRI must be on a much smaller scale. The micro MRI is still under development, but this is a viable new direction for diagnostics.

What are the best ways for a woman to maintain her bone health?

Very simple advice really goes a long way. For example, even before menopause, vitamin D is essential for ensuring absorption of calcium through the intestine. Right now the recommendation is to target a daily intake of approximately 1200 to 1500 mg of calcium per day and at least 600 to 1000 units of vitamin D per day. Sometimes it’s hard to achieve that with diet alone.

The major sources of calcium and Vitamin D are dairy products, but this might not be an option for someone watching his or her cholesterol. This is a case when supplements are recommended.
Good lifestyle habits – no smoking, limited alcohol intake and weight-bearing exercises are extremely important. Aquatic exercises are not as effective because the buoyancy of the water lifts weight and the skeleton doesn’t sense as much force as with exercises that include walking, jogging, low-impact aerobics and elliptical machines.

We find vitamin D deficiency highly prevalent in many geographical areas, such as the Midwest, where people stay inside a long time and use sunscreens. That works for protecting skin from skin cancer, but consequently it also protects from UV light stimulation of vitamin D synthesis.
 
Unfortunately, avoiding vitamin D deficiency is not always sufficient to prevent bone loss. Inherited factors contribute greatly to bone structure. Typically, people with smaller body frames are more prone to having a lower bone mass just because of overall body size. Because their bone density has been below average their entire life, when they reach their sixties and seventies they find themselves below the acceptable threshold – even if they have done nothing wrong. Those are cases when pharmacologic options have an important role in preventing fractures.

Where in Italy are you from?

I’m from Siena, Italy. Some people know it because of a medieval style horse race, the Palio. It is a small town, no more than 60,000 people, but it has a very long history. It was one of the old city-states that grew out of the 12th century commerce and new banking systems in north-central Italy and was part of what became the cradle of the Renaissance. It’s a very nice place to live – slow-pace, safe, good wine, good oil, good food.

I still have an apartment back in Siena and I like to go back to visit family and colleagues.

Is there a particular award or achievement that is most gratifying?

In 1994, at age 40, I received the Fuller Albright Young Investigator Award by the American Society for Bone and Mineral Research. That award is one of the oldest given by the Society, and it’s the most important one because it acknowledges a young investigator.

Fuller Albright was recognized as the father of osteoporosis, this award acknowledges not only the research achievements, but also a commitment to this area. Receiving this award has been the most gratifying recognition I’ve received in my life.

What is the best advice you’ve ever received?

The most useful advice came from my mentor Louis Avioli. He would not be satisfied unless you performed at the best of your capacity. He made us to always think as leaders, never as followers.
It is subtle, but key advice. It sets the stage on how to approach both career and life.

If you weren’t a doctor, what would you like to be doing?

I would probably be either an engineer or an architect. I toyed with the idea of engineering when I was in high school -- before I decided to go into medicine and biology. After all, DNA is a wonderful mechanism, when you break it down. Construction really fascinates me, if I wasn’t a doctor, I would probably be designing machines or drawing technical designs for buildings.

Essentially, it’s the yearning for learning how things work.

See all Featured Physicians
Washington University Physicians are the medical staff of  Barnes-Jewish Hospital and Children's Hospital - St. Louis Employment   About Us   Top Stories   For Your Protection      Site Map
Copyright 2013 Washington University School of Medicine
Copyright 2013 Washington University School of Medicine