March 03, 2015
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Osteoporosis and Osteoarthritis
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Osteoporosis and Osteoarthritis

Ms. Colberg is an exercise physiologist and associate professor of exercise science at Old Dominion University in Norfolk, Virginia. A diabetes researcher with almost four decades of practical experience as a type 1 diabetic exerciser, she is a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association, and the author of three books on diabetes.

Editor's Note: Keeping bones healthy is important, but if you develop osteoporosis, you are going to want to do everything you can to build bone density back up. Exercise and diet are still crucial, but they are not likely to be enough on their own. Luckily, hormones and several new drugs can help.

The following is an excerpt from a new book by The Doctor's Senior Living specialist, gerontologist, Dr. John Morley: The Science of Staying Young, 10 Simple Steps to Feeling Younger than You Are in 6 Months or Less, written with Sheri R. Colberg, Ph.D. (McGraw-Hill, 2008). Used by permission.

Hormones and Bone Health
It is well established that estrogen is essential for the maintenance of normal bone minerals. Despite the recent controversy from the Women's Health Initiative, for reasons of bone health alone, women experiencing early menopause should consider taking supplemental estrogen at least until the age that most women go through it, about 52 years. In addition, women with low bone minerals and a normal menopausal age should take estrogen (and in some cases progesterone) for five years after menopause, but not after age 60. Appropriate estrogen dosing is discussed in Step 3.

As for testosterone, it appears that this androgenic hormone may stimulate bone formation, while estrogen only prevents its loss. Males with low testosterone levels may need to take this hormone to protect their bones, but it may also improve bone strength in women. A medication called Livial is a unique estrogen-progesterone-testosterone agent that may be particularly useful for some women to reduce hot flashes and improve bone mineral content. It is not available in the United States, but is currently sold in the rest of the world.

Treating Osteoporosis with Other Medications
In addition to making healthy dietary and other lifestyle changes to improve your bone health, you may also need to consider using prescribed medications that can enhance bone mineral content. Drugs for treating osteoporosis include bisphosphonates (Fosamax, Actonel, and Boniva), raloxifene (Evista), calcitonin , and parathyroid hormone analogs. The first two classes of drugs are taken by mouth. Calcitonin is a naturally-occurring hormone produced by your parathyroid gland, but a synthetic form is available as nasal spray. Similarly, an analog of parathyroid hormones given by injection can help stimulate your bones to get stronger. Some other new drugs are in the pipeline and include medications that may work as antibodies to your body's natural hormones that cause bone thinning.

At present, most women and men with thinning bones (or at high risk) should minimally take a bisphosphonate, along with supplemental calcium and vitamin D for at least five years. A controversy over whether taking bisphosphonates for longer may actually lead to the development of more brittle bones (the opposite of the desired effect) exists. If you have been taking them for longer than this time frame, you should discuss whether to continue their use with your doctor.

Maintain Optimal Joint Health
Arthritis is the painful inflammation of a joint or joints, and having to live with the daily pain it causes can make you feel a lot less youthful. The most common type is osteoarthritis caused by degeneration of bony joint surfaces, usually in the knees, hips, spine, hands and toes. Often described as "wear and tear" arthritis, it affects more than 15 million Americans and is more common in joints that have been previously injured, particularly traumatically (through contact sports injuries). In addition, lower extremity joints are more likely to become arthritic if you're overweight since carrying around more weight puts additional stress on cartilage in hip and knee joints.

What Causes Arthritis?
Arthritis can result from trauma or from repetitive use, although often no single cause is identifiable. Joints, formed by the juxtaposition of two or more bones with cartilage coats on their ends, normally function to provide flexibility, stability, support, and protection to the skeleton, allowing movement of limbs. In a healthy joint, this coating maintains the separation between bones, allowing joints to move smoothly and without pain. In the early stages of this type of arthritis, however, the cartilage's surface becomes swollen (inflamed), forming tiny crevasses that hinder movement. A loss of elasticity in the cartilage also makes it more vulnerable to further damage, and outgrowths known as bone spurs often begin to form around its edges. Other associated joint structures, such as the synovial fluid in the middle, tendons, and ligaments, can also become inflamed. In advanced cases, the cartilage cushion is completely lost, limiting joint mobility.

How Can You Tell If You Have Arthritis?
Arthritis is easily identifiable by the symptoms listed [below], although their degree varies widely among individuals. It can cause pain in the affected joint or joints after repeated use, especially later in the day, or you may experience swelling, pain, and stiffness after long periods of inactivity (e.g., after sleep or sitting long periods) that subsides with activity.

Symptoms of Arthritis
  • Pain, made worse by cool, damp weather
  • Crackling or popping in the affected joints (most commonly knees)
  • Enlarged, swollen joints, often tender when touched
  • Stiffness and restricted movement in affected joints
  • Unstable joints that move too far or in the wrong direction

Symptoms also vary with the affected joint. For instance, if you have knee arthritis, you may experience problems with that joint locking up, especially when stepping up or down. Hip problems usually make you limp, while affected finger joints often result in reduced strength and movement, making simple tasks such as buttoning clothes or opening jars difficult. An arthritic spine can cause neck and low back pain, along with weakness and numbness, particularly if you have developed bony spurs there. Affected finger joints can also result in hard, bony enlargements.
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Readers Comments
(2) Comments have been made

very useful information -- thanks
Posted Sun, Aug. 3, 2014 at 5:26 am EDT
barbara cleary
at the beginning you refer to SEE step 3, Hormone and bone health..where is step 3. i have taken livial for vaginal dryness for taking me off..i am now 79..but have serious osteoarthritis,temperol artritis, polymyalgia, had two hip and one knee replacement..bones are very bad been at age 79, is it a general world thing that one cannot be on livial?doubt if yo wil answer this.thanks.
Posted Fri, Feb. 7, 2014 at 8:17 pm EST

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