OSTEOPOROSIS

Osteoporosis is a disease in which bones grow more fragile and porous over time, making them more likely to break. Often known as the “silent disease,” osteoporosis is painless and many people don’t even know they have it until they suffer a broken bone after a minor injury, or begin to lose height. Sometimes the only symptom is a dull pain that is felt, in the hips, lower back, neck and wrists.

Generally, our bones reach a peak bone density at 25 to 30 years of age. Shortly afterward, we begin to lose bone density. Osteoporosis is diagnosed when a significant amount of density within our bones has been depleted.

Certain people are at higher risk of developing osteoporosis than others. Risk factors include: *

• Being female
• Family history of osteoporosis
• Thin or small frame
• Postmenopausal
• Vitamin and nutritional deficiencies
• Diet low in calcium
• Inactive lifestyle
• Caucasian or Asian ethnicity
• Certain medications like corticosteroids or anticonvulsants
• Low estrogen levels in women
• Low testosterone levels in men
• Excessive use of alcohol
• Cigarette smoking

* http://www.nof.org/osteoporosis/diseasefacts.htm – February, 2006

Testing for Osteoporosis

Treatment for osteoporosis involves preventing further bone weakening, building bone density, preventing bone fractures, and managing any pain you have. But first, you must be diagnosed. A simple, painless screening called a bone mineral density (BMD) test is used to

• Identify osteoporosis before a fracture occurs
• Predict your chances of fracturing in the future
• Determine your rate of bone loss
• Monitor the effects of any treatment

In a BMD test, you simply lie on a padded table beneath a scanning device. The technician uses a small amount of radiation, or sound waves, to collect information about your bone mass. The results are then compared to normal values. If you are identified as having signs of osteoporosis, certain treatments can help slow bone loss and reduce your risk of fracture. Identifying osteoporosis early is important. Plus, most private insurance carriers and Medicare now cover BMD testing for certain individuals. BMD testing is safe, painless, and noninvasive; it is recommended that all women over age 65 be tested.

Osteoporosis Treatment

Treatment for osteoporosis involves preventing further bone weakening, building bone density, preventing bone fractures, and managing the pain associated with the disease. It is recommended that people of all ages engage in regular weight-bearing exercises, such as walking, riding a stationary bike, or jogging. Supplementing your diet with 1,200 to 1,500 mg of calcium and 600 to 800 IU of vitamin D daily can also help to keep your bones strong. In some cases, your doctor may discuss estrogen replacement or other medications that strengthen the bones by increasing the density and preventing further bone loss.

If you suspect that you have signs or symptoms of osteoporosis or have risk factors for osteoporosis, please see your doctor for further evaluation and treatment.

Following the orthopaedic evaluation, the orthopaedic specialist will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:

Non Surgical Options

Diet & Exercise

• Average American is 20–40 lbs. overweight.
• Average person takes 5000–7000 steps/day.
• Reduces stress on weight-bearing joints (extra pressure on some joints may aggravate your arthritis).
• A balanced diet helps manage weight and stay healthy.

ROM Exercises

• Maintains normal joint movement.
• Increases flexibility.
• Relieves stiffness.

Strengthening Exercises

• Increasing muscle strength helps support and protect joints affected by arthritis.
• Exercise is an important part of arthritis treatment that is most effective when done properly and routinely.

Aerobic Exercise

• Improve cardiovascular fitness.
• Helps control weight.
• May help reduce inflammation in joints.

Rest & Joint Care

• Short-term bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem.
• Individual joint rest is most helpful when arthritis involves one or only a few joints.
• Heat Therapy (increases blood flow, tolerance for pain, flexibility).
• Cold Therapy — cold packs, ice massage, OTC sprays and ointments (reduces pain by numbing the nerves around the joint).

Nutritional Supplements

Glucosamine and Chondroitin

Your doctor has provided this information to answer some of the questions you may have about nutritional supplements that may be linked to improved joint health. The possible beneficial effects of glucosamine and chondroitin, two popular supplements for patients with joint pain, have been making news in recent years. This information is intended to help you better understand who might benefit from the supplements and why.

What are glucosamine and chondroitin?

Glucosamine and chondroitin are actually two different molecules found in healthy joint cartilage. The medical theory behind taking these supplements is that they would help the body repair cartilage that has been broken down by osteoarthritis (the most common “wear-and-tear” form of arthritis). Some popular glucosamine supplements are derived from shellfish; chondroitin supplements are often derived from shark or cattle. Both can also be made synthetically. The supplements are sold and packaged much in the same way vitamins are. Like vitamins, they are not subject to review or approval by the U.S. Food and Drug Administration.

Do glucosamine and chondroitin help reduce arthritis pain?

Although the U.S. Food and Drug Administration has tentatively concluded that no studies to date have linked glucosamine and chondroitin to a reduced risk of developing osteoarthritis1, a large study administered by the National Institutes of Health has shown that glucosamine and chondroitin, when taken together, significantly reduce pain in patients with moderate-to-severe osteoarthritis of the knee.2 In fact, the study showed that people taking the supplements experienced the same amount of pain relief as people who took non-steroidal anti-inflammatory medications (NSAIDs)3 – long the go-to medication for people with arthritis pain. What sounds even better, treatment with glucosamine and chondroitin supplements has not been associated with any side effects. NSAIDs, on the other hand, have been associated with gastrointestinal side effects, including bleeding.3

Make a Plan with Your Doctor

Don’t assume that your doctor will not take your interest in nutritional supplements seriously. Many doctors understand how some supplements can complement your current arthritis treatment plan.4 Your doctor can also help you determine if a particular supplement is right for you given your overall health. Your doctor can also help monitor the effectiveness of your supplement regimen.

A Word of Caution

Because vitamins and other nutritional supplements are not monitored by any federal agency to assure purity or dosage, you’ll want to do your homework before you purchase or consume anything. Look for a familiar, reputable brand name. If you have questions about the product, write to the manufacturer for more information. Ask your doctor about his or her experience with the supplement. And, most importantly, if you experience any adverse reactions, stop taking the supplement and call your doctor right away.

For more information on glucosamine and chondroitin, talk with your doctor or visit the National Institutes of Health website at www.nih.gov.

Joint Fluid Supplements

For patients whose joint pain does not improve with medication or physical therapy, “joint grease” injections may provide temporary relief. The joint is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased joint and joint replacement may be needed as the joint worsens with time.

Physical Therapy

Physical therapy can be helpful in the management of Osteoarthritis (OA) and Rheumatoid Arthritis (RA). For example, a physical therapist may recommend:

• Isometric (“pushing”) exercises to help build muscle strength without subjecting inflamed joints to excessive wear
• Isotonic (“pulling”) exercises to further increase muscle strength and help preserve function
• Daily walking, using a cane or other assistive device as needed