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.
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.
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.
- 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.
The pain that you feel doesn't come from the joint cartilage surfaces themselves as they contain no nerve endings, but rather from the irritated nerves in adjacent stretched or inflamed areas. You can also experience what is known as "referred pain," meaning that you feel it somewhere other than in the affected joint. For example, an arthritic spine can cause pain in your neck, arms, or legs. Pain is only continuous when almost all of the cartilage surfaces of joints have been eroded, at which point it is indicative of advanced arthritis.
To further protect arthritic joints, focus on strengthening surrounding muscles that will support and protect them. For instance, for your knees, work on strengthening both groups of muscles in your thigh that affect knee movement including your quadriceps in the front (knee extensors) and hamstrings in the back of your thigh (flexors). In addition, non-weight-bearing ones like stationary cycling, aquatic activities, and light to moderate resistance work that put lower amounts of stress on joints should result in less pain and fewer arthritis-related problems.
- Participate in regular, moderate aerobic exercise
- Perform strengthening and full range of motion exercises for painful joints
- Receive massage therapy on muscles surrounding affected joints
- Use heat and cold packs whenever pain is bothersome and after exercise
- Use special gadgets to open jars to reduce stress on finger joints
- Use athletic tape around an arthritic knee to support and stabilize it
- Wear wedged insoles in your shoes for hip or knee problems (or orthotics, particularly if you have one leg longer than the other)
- Lose weight (through exercise primarily) to alleviate lower extremity arthritis pain
- Use a cane or walking stick with painful hips or knees
For painkillers to work effectively, you must take them regularly, not just when you can no longer stand the pain. It's particularly important to take a dose before going to bed so that you don't wake up stiff and sore the next morning, particularly at the end of a day when you have been more active than usual.
In rare cases of extreme pain, you can ask your physician to prescribe stronger pain medications, but be aware that they can be addictive and must be used with caution. Moreover, at least one anti-inflammatory prescription pain medication (Vioxx) was recently taken off the market due to concerns that it minimally doubled the risk of heart attacks and stroke compared with older, non-prescription pain medications like Aleve. A mechanistically-similar drug, Celebrex, is still available by prescription, however.
Keep in mind that any medications you take to control your pain, even over-the-counter ones, have the potential to interact with drugs that you may be taking for other health problems. Always be certain to let your doctor know what medicines you're taking so that appropriate dosing and scheduling of all of your drugs can be coordinated.
The jury is still out on herbal remedies, such as supplementing with glucosamine sulfate and chondroitin, two natural treatments for arthritis, but the latest research doesn't look too promising. In addition, certain natural herbs and spices, such as ginger, holy basil, turmeric, green tea, rosemary, scutlellaria and huzhang, are thought to contain naturally occurring anti-inflammatory compounds known as COX-2 inhibitors (also found in prescription Celebrex and previously Vioxx). However, the benefit of any of these dietary supplements for arthritic pain has yet to be proven with scientific trials.
Technological advances in materials, operative procedures, product design and manufacturing processes have brought joint replacement surgeries into the new millennium with a flourish. Surgical techniques are becoming more successful every day due to new bone substitutes, specialized alloys, and innovative designs for replacement joints. In the near future, you may be able to look forward to minimally invasive joint replacement surgeries and more, so stay tuned.
Read more about the science of staying young, 10 Simple Steps to Feeling Younger than You Are in 6 Months or Less Copyright ©2008 by John E. Morley and Sheri R. Colberg. Reprinted by permission of the authors.