Physical Therapy, Nutrition, NSAIDs, Creams, Surgeries, Medical Devices Target Forms of Arthritis, Experts Say (3 of 3)

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American Academy of Orthopedic Surgeons, http://www.aaos.org

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Arthritis Foundation, http://www.arthritis.org

“Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts,” U.S. Department of Health and Human Services, Food and Drug Administration,
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Centers for Disease Control and Prevention’s National Center for Health Statistics, http://www.cdc.gov/nchs

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FDA, http://www.fda.gov

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Handout of Health, Recognizing the National Bone and Joint Decade: 2002 – 2011 – (Back Pain), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Publication No. 09-5282, July 2009

Handout of Health, Recognizing the National Bone and Joint Decade: 2002 – 2011 – (Osteoarthritis), National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Publication No. 06-4617, July 2002 Revised May 2006

MAKOplasty, MAKO Surgical Corp., http://www.makoplasty.com, http://makosurgical.com

MedlinePlus, http://www.medlineplus.gov

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http://www.nccam.nih.gov

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Physical Therapy, Nutrition, NSAIDs, Creams, Surgeries, Medical Devices Target Forms of Arthritis, Experts Say (2 of 3)

Diagnoses, Testing, Treatment of Arthritis

The diagnoses, testing and treatment of the different forms of arthritis vary. This includes degenerative joint disease, osteoarthritis, rheumatic arthritis, fibromyalgia, gout and back pain.

Degenerative Joint Disease, Arthritis in General

To diagnose degenerative joint disease and forms of arthritis in general, a rheumatologist or an orthopedist will examine a patient’s medical records, perform a physical exam and secure laboratory test results, X-rays and medical imaging.

The rheumatologist or orthopedist would see a patient more than once to complete an accurate diagnosis. For example, in the case of osteoarthritis, one test alone cannot fully diagnose this condition. The specialists would combine several methods to isolate the illness and rule out others.

To treat joint conditions or support joint health against degenerative disease and various forms of arthritis, pharmaceutical companies offer, as an alternative to drugs, such nutritional products or medical foods that use pure, concentrated ingredients in such items as green tea, dark chocolate, fruits and vegetables.

A medical food is regulated by the Food and Drug Administration (FDA) under the federal Orphan Drug Act that legally defines them as “a food which is formulated to be consumed or administered enterally (through digestion) under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”

Seen as a safer choice to drugs and supervised by primary care physicians and specialists, medical foods do not undergo premarket review or approval by the FDA and are required to be labeled for nutrient health claims under the Nutrition Labeling and Education Act of 1990.

In particular, Fast-Acting Joint Formula is a one-a-day set of compounds to provide joint relief and capacity in a matter of days rather than weeks or months.

The formula offers the patient, in one daily capsule dose, 300 mg of solubilized keratin, a form of keratin protein that provides cysteine and other high-sulfur elements need to build joint tissue.

Keratin helps to oversee pre-inflammatory elements such as prostaglandin E2 that are linked to joint deterioration while promoting antioxidants such as superoxide dismutase and gluthathion to keep joints from aging.

The formula can be used with other nutritional products such as ArthroMax with Theaflavins. ArthroMax, also known as ArthroMax Advanced with UC-Il and ApresFlex, is a form of undernatured chicken cartilage (UC-Il). This product helps protect the immune system as it pertains to remedying joint pain or stiffness or reduced capacity in senior patients.

ArthroMax contains “UC-II chicken cartilage, 40 mg of glucosamine sulfate 2KCI extracted, which contains corn; 1500 mg ApresFlex (Boswellia serrata) extract, and; 100 mg of boron or calcium fructoborate, known commercially as FruiteX OsteoBoron, which contains 1.5 mg of corn.”

ApresFlex is a product of Laila Nutraceuticals. FruiteX B and OsteoBoron are products of BDF FutureCeuticals, Inc.

As another means of addressing immune issues of the joints, ArthroMax is also accompanied by Black Tea Theaflavins without chicken cartilage. Namely, inflammatory chemical activity are supervised by a series of cytokines in the human body. Aging produces an unhealthy balance of cytokines that create promote inflammatory disease.

Research finds that compounds in black tea prevent the inflammatory activity of cytokines. These compounds are called theaflavins and supervise the activity of genes and cytokines connected to inflammatory disease.

ArthroMax with Theaflavins and ApresFlex formulas provide these compounds as well as methylsulfonylmethane, or MSM, which consist of sulfur elements key to maintaining joint function. These formulas also contain commercially known Fruite X B OsteoBoron, a form of boron much like those found in food that promotes healthy bones and joints.

ApresFlex contains boswellia, which assists with resolving inflammatory diseases by inhibiting the enzyme 5-lipoxygenase or 5-LOX. Activity of 5-LOX allows an inflammatory compound known as leukotriene B4 to negatively impact aging joints.

Excess activity of 5-LOX results in the accumulation of leukotriene B4, a pro- inflammatory compound that affects aging joints. Boswellia binds directly to the 5-LOX enzyme to keep it from producing leukotriene.

Another nutritional product, Decursinol-50, a fluid compound extracted from the the herb Korean Angelica, acts quickly to protect joint health through the central nervous system to block the activity of “nuclear factor-kappa B, a DNA transcription factor” linked to inflammatory diseases. Decursinol-50 is taken in 200 mg doses per day.

Hyal-Joint, a form of hyaluronic acid that boosts the thickness of the synovial fluid to protect joint cartilage, is taken in 40 mg doses daily. The product is meant to guard against wear and tear and rebuild joints with a supply of hyaluronic acid, collagen and other glycosaminoglycans.

Additionally, Krill Healthy Joint Formula uses deep-sea krill oil in Antarctica, combined with hyaluronic acid and astaxanthin. Krill oil contains fatty acids successful in promoting joint health by particularly targeting joint tissue.

Hyaluronic acid, which is present in the joints through cartilage and soft tissue, moistens and protects them against potentially harmful physical activity. The acid is a large molecule that is not readily digested in the human body. However, when blended with krill oil, it can be more widespread and, thus, more effective in the blood than by itself as a substance.

Krill oil contains the antioxidant carotenoid astaxanthin, which suppresses free radical activity and improves mitochondrial function, guarding joints against aging. The formula holds 353 mg of these substances and can be taken as a dosage of one softgel per day.

Typically, for degenerative joint disease of the hip, rheumatologists and other specialists use non-surgical treatment methods first. This includes nutritional products or medical foods, rest for the hip, low-to-moderate impact exercise such as swimming or over-the-counter (OTC) drugs to handle joint pain.

However, if nutritional products or medical foods, exercise or OTC medications cannot treat degenerative joint disease, senior patients may have to speak to their rheumatologists or orthopedists. These specialists may turn to medical devices.

For instance, MAKO Surgical Corporation provides MAKOplasty, a surgical procedure that uses robotic arm technology to instruct an orthopedic surgeon to conduct total hip replacement therapy for severe patient cases of degenerative joint disease.

This form of therapy is aimed at boosting movement and capacity in the hip and other impacted parts of the body to enable patients to carry out daily physical tasks.

Also known as total hip arthroplasty, this therapy involves surgery in which the arthritic hip joint is removed and, instead, prostheses or implants are installed. The implants contain “a metal cup with a plastic liner, which replaces the socket (acetabulum) in the pelvis, and a metal femoral stem and head.”

The robotic arm is meant to provide an orthopedic surgeon with guidance to prepare a socket for the pelvis of a patient and to put prostheses or implants in the correct sites in the body.

The accompanying technology is meant to provide real-time data and imagery to allow an orthopedist to clearly identify and manage implant placement, which can be hard to accomplish using traditional surgery without a robotic arm.

Such medical devices can make for greater accuracy in placing hip implants in the body, decrease the odds of hip misplacement, ensure consistent leg lengths, reduce the necessity of a shoe lift, minimize the risk of implants and bones rubbing together to create discomfort for the patient or to lessen the effectiveness of the overall technology.

Prolonging the life of prostheses or implants is important as well and some artificial joints can last 10 to 15 years long. Implants can achieve and must be preserved for a long life span, depending on the patient’s weight, level of physical activity, quality of bone tissue and adherence with a rheumatologist’s or a orthopedic surgeon’s orders.

The orthopedic surgeon must conduct an exam to determine if a senior patient is a fit for the MAKOplasty procedure using the robotic arm. If the patient qualifies, then the orthopedist makes a computed tomography (CT) scan of his or her hip one to two weeks before the date of surgery.

The CT scan creates a 3-D model of the patient’s hip pelvis and femur. The specialist uses software with data about the model and the patient’s anatomy.

The orthopedist must decide if the patient must make a hospital stay for total hip replacement and also if he or she must be referred to a massage therapist, a physical therapist, an occupational therapist, a physiatrist, also known as a rehabilitation specialist, a licensed acupuncture therapist or a chiropractic for rehabilitative therapy.

In turn, senior patients and their families are asked to approach their assigned rheumatologist and orthopedic surgeon if they have questions or concerns about total hip replacement or other procedures:

–What causes my hip pain?
–Will scaling back on physical activity, taking pain or prescription drugs, getting injections or adding physical therapy ease my pain?
–Would total hip replacement relieve me from hip pain?
–Am I a fit for total hip replacement?
–What are the benefits and risks of undergoing total hip replacement?
–How long is the recovery time from total hip replacement?
–What is the life span of the implants that may be implemented in total hip replacement?
–How does my age influence the correct procedure for my illness?

Patients are also asked to manage degenerative joint disease in the following ways:

–Maintain proper weight to decrease joint pain and swelling.
–Recognize physical restrictions and how to cut back on physical activity in time of pain.
–Follow doctors’ orders in taking medications and a proper diet as instructed by dietitians and nutritionists.
–Make use assistive devices such as walkers and canes to reduce pressure on the joints.
–Keep a good posture to, again, reduce pressure on the joints.
–Put on sensible footwear that can bear weight.
–Maintain a sunny disposition to manage stress and control treatment.
–Take initiative in managing disease and adhere to a sound lifestyle.

Osteoarthritis

To diagnose osteoarthritis, including that of the hip, knees, hands, fingers and thumbs, spine or lower back or higher back, a rheumatologist or an orthopedist will examine a patient’s medical record and symptoms. He or she will watch the movement of the knees, grade knee and ankle joint alignment and test reflexes, muscle strength, motion capacity and the stability of ligaments.

These specialists may have X-rays conducted to measure the amount of joint or bone damage done, the mass of cartilage lost and whether bone spurs exist. More imaging tests such as CT scans or magnetic resonance imaging (MRI) can be used to pinpoint the damage and its spread.

The rheumatologist or orthopedic surgeon can order more blood tests to ensure that there are no other causes of the symptoms observed or request a joint aspiration procedure to draw fluid from the joint through a needle and examine its contents under a microscope.

Osteoarthritis is treated based on its mildness or severity in a senior patient. In either case, a primary care physician, a family practice physician, an internal medicine physician, an osteopathic physician, a rheumatologist or an orthopedist will recommend changes in a patient’s style of life to alleviate pressure on his or her joints.

Chronic illness and pain management strategies could include physical exercise, weight loss, reduced pressure on joints, physical therapy, steroid injections, over-the-counter pain medicine such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain-relief creams, rubs or sprays.

Goals for treatment of osteoarthritis include controlling pain, improving joint capacity, maintaining a healthy weight and maintaining a sustainable lifestyle.

Otherwise, if none of these or other treatments aren’t effective, a physician or specialist may determine that surgery and possibly complementary and alternative therapies are needed to treat a patient’s incidence of osteoarthritis.

Exercise is used to treat senior patients for osteoarthritis because of its ability to improve mood, lessen physical pain, extend physical range of motion, strengthen hearts and blood circulation, control weight and boost physical activity.

The amount and type of exercise will rely on the strength and stability of a patient’s joints and whether joint replacement therapy has been conducted. Exercise regimens could include strengthening exercises, aerobic activity, walking, swimming and water aerobics, range-of-motion activities and agility motion.

Both medicinal and non-medicinal relief to treat the pain of osteoarthritis may include heat and cold therapy with warm towels, hot packs or a warm bath or shower; transcutaneous electrical nerve stimulation (TENS) to use an electronic device to send electric pulses to nerves under the skin of the area of pain; creams, rubs and sprays such as Zostrix, Icy Hot, Therapeutic Mineral Ice, Aspercreme and BenGay; painkillers such as Tramadol, codeine, hydrocodone, corticosteroids, and hyaluronic acid substitutes.

NSAIDs are used when acetaminophen ceases to work with the best examples being ibuprofen and naproxen. Oftentimes, opioids, a form of narcotic drugs, are prescribed as well.

Complementary and alternative therapies come into use when patients don’t receive pain relief from traditional medications and treatments for osteoarthritis. They include acupuncture, folk remedies and nutritional supplements. Sounder sleeping habits are also recommended.

Acupuncture, the practice of placing fine needles at particular points of the skin, is considered effective in treating osteoarthritis because of its ability to incite the release of painkilling chemicals from the nervous system.

Folk remedies for osteoarthritis include copper bracelets, herbal teas, mud baths and WD-40 on joints to “oil” them. However, no research demonstrates that they are able to treat this illness.

Nutritional supplements that are found to address the symptoms of senior patients with osteoarthritis include glucosamine and chondroitin and a prescription medical food known as Limbrel, which can be found at http://limbrel.com. More research is being conducted to study the validity of the claims of glucosamine and chondroitin.

Additionally, improving sleep can reduce pain and enable patients to handle the effects of osteoarthritis. Senior patients with sleep problems due to arthritic pain are asked to consult their primary care physicians or physical therapists about obtaining the right mattress, the most accommodating sleeping positions or the correct timing of medications to incur pain relief at night.

Patients are asked to improve their night’s rest by getting sufficient physical exercise during the daytime; steering clear of caffeine and alcohol at night; making sure the bedroom is “dark, quiet and cool”; and taking warm baths to relax and relieve aching muscles.

When medicinal and non-medicinal methods of treating ostearthritis don’t work, rheumatologists and orthopedic surgeons may turn to surgery such as MAKOplasty partial knee resurfacing.

Partial knee resurfacing is a form of knee replacement surgery that uses robotic arm technology to guide the orthopedist to use computer imagery and “intelligent” instruments to place a prosthesis or implant in the right spot of the knee.

The procedure can be conducted through a four-to-six incision over the knee with slits in both the femur or thighbone and the tibia or shin. Restoring healthy bone, tissue and ligaments with more precise implant placement leads to a more natural-feeling knee for the patient and wearer.

Rheumatic Arthritis

Primary care physicians, family practice physicians, internal medicine physicians, and osteopathic physicians find it hard to diagnose rheumatic diseases because of the overlap between their symptoms and signs and that of other illnesses. These doctors may examine a patient and refer him to a rheumatologist or orthopedic surgeon.

A doctor needs to conduct a thorough medical exam of a patient to make an accurate diagnosis, researchers say. He or she may pose the following questions to a patient:

–Is the pain in one or more joints?
–When does the pain occur?
–How long does the pain last?
–When did the patient first notice the pain?
–What was a patient doing when he or she noticed the pain?
–Does physical activity make the pain better or worse?
–Has the patient had any illnesses or accidents that may account for the pain?
–Is the patient experiencing any other symptoms aside from pain?
–Is there a family history of arthritis or other rheumatic disease?
–What drugs is the patient taking?
–Has the patient had any recent infections?

Sometimes, patients may be asked to maintain a daily journal that provides details of the pain. Primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists and orthopedists may encourage patients to write down how the affected joint appears, how it feels, how long the pain lasts and what they were doing when the pain began.

Doctors may examine a patient’s joints for redness, warmth, damage, range of motion and tenderness. Some forms of arthritis such as lupus, may target organs and, thus, a complete exam of the heart, lungs, abdomen, nervous system, eyes, ears, mouth and throat may be needed.

These physicians may also require some laboratory tests to support a diagnosis. Samples of blood, urine or synovial fluid in the joint may be necessary. Tests may include the following: antinuclear antibody, or ANA; CCP; C-reactive protein tests; complement; complete blood count; creatinine; erythrocyte sedimentation rate, or SED RATE or ESR; hemocrit (PCV or packed cell volume); rheumatoid factor; synovial fluid examination; urinalysis, and; X-rays, CT, MRI and arthrography.

Treatments for rheumatic disease include sleep, physical exercise, sound nutrition, pain relief, medical devices and instruction from physical therapists, occupational therapists, physiatrists, licensed acupuncture therapists and chiropractics about massage and alternative therapy.

Primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists and orthopedic surgeons plan treatment with the senior patient to enhance his or her lifestyle. The plans may blend different types of treatment and change, depending on the rheumatic illness and the patient.

Physical exercise for rheumatoid patients falls into three categories and the benefits feed into each other: range-of-motion exercises such as stretching or dance to move joints, boost flexibility and alleviate stiffness; strengthening exercises such as weight lifting, to support muscle strength, which translates into joint support and protection, and; aerobic or endurance exercises such as waking, bicycle riding and swimming, to promote heart fitness, control weight and effect overall health and well-being.

The most common medications to treat rheumatic diseases include oral analgesics or pain relievers taken by mouth; topical analgesics or pain-relieving creams, ointments and sprays; counterirritants; NSAIDs; DMARDs; biologic response modifiers; corticosteroids, and; hyaluronic acid substitutes.

Medical devices used to treat rheumatic diseases include TENS and a blood-filtering device titled the Prosorba Column to weed out dangerous antibodies for especially severely ill patients. Massage and alternative therapies include heat and cold therapies, hydrotherapy, mobilization therapy, relaxation therapy, splints and braces and assistive devices.

The categories of surgeries to treat rheumatic disease are anthroscopic surgery, needed to view the joint through a small scope inserted through a small slit over the joint; bone fusion used to remove joint surfaces from the ends of two bones; osteotomy, a procedure involving removing a section of bone to improve the positioning of a joint, and; arthroplasty or total joint replacement.

Fibromyalgia

NIAMS and NCCM research finds that fibromyalgia patients will visit with many specialists before they are provided with a diagnosis of the actual disease. This is because the attendant pain and fatigue, the key symptoms of fibromyalgia, overlap with other chronic illnesses.

As a result, doctors must isolate other causes of these symptoms before delivering a diagnosis. Additionally, there are no other diagnostic laboratory tests for the illness as lab tests do not show a physiological cause for pain.

Sometimes, because there is no official, standard test for fibromyalgia, a physician is forced to judge that a patient’s pain is not real or often inform the patient that he or she cannot help him or her.

The greatest approximation to a standard test are the nine paired tender points created by the American College of Rheumatology, or ACR, for fibromyalgia. As a result of this institutional and trade professional standardization, a physician is empowered to make a diagnosis based on the criteria by the ACR.

Criteria for a diagnosis may include a patient’s record of widespread pain spanning more than three months and other symptoms such as fatigue, being aroused from sleep and feeling unrefreshed and cognitive issues such as with memories or thoughts.

Under this standard, pain is defined as widespread if it influences all four quadrants of the body, meaning that the patient encounters it on the left and right sides of the human body and above and below the waist. ACR has set aside 18 sites in the human body for tender points.

Fibromyalgia is hard to treat. Not all physicians understand the disease and its treatment so patients must find a doctor who does and then a team of specialists must be formed to work with both.

Three drugs have been approved the FDA to treat fibromyalgia, duloxetine, which was once developed for and is used to treat depression; milnacipran, and; pregabalin, which is meant to treat neuropathic pain caused by damage to the nervous system. Other treatments for fibromyalgia include painkillers, NSAIDs, complementary and alternative therapies.

Still, overtime, with treatment, conditions for patients with fibromyalgia improve, researchers say. Fibromyalgia is not a progressive illness. It is not deadly and will not damage the joints, muscles or organs.

To improve their quality of life under fibromyalgia, patients are asked to get enough sleep, make changes at their place of work, practice sound nutritional habits and obtain physical exercise.

Gout

To diagnose gout, physicians would search for uric acid crystals or hyperuricemia around joints though some patients with hyperuricemia may not develop the illness. Bouts of gout may imitate joint infections and physicians who detect a joint infection rather than gout may also examine joint fluid for bacteria.

Physicians may confirm a diagnosis of gout by placing a needle in an inflamed joint and draw a sample of synovial fluid, which softens a joint. While uric acid crystals may not appear in an examination, this does not mean that a patient does not have gout.

Gout is treated with a number of therapies and the goals for these are to relieve the patient of pain associated with acute attacks, prevent future attacks, and avoid the formation of tophi and kidney stones. Common treatments include NSAIDs, oral colchicine, corticosteroids, weight loss, alcohol consumption and avoidance of high-purine foods.

The condition can be managed. Patients with gout can reduce the severity of attacks and lower their risk by taking drugs as prescribed. Gout is best treated with medications at the first sign of pain or swelling.

Patients are also encouraged to take other measures to treat gout include the following:

Inform the physicians about the drugs and vitamins taken and they will instruct whether any of them will boost their chances of hyperuricemia;
Conduct followup visits with physicians to monitor their progress;
Drink an abundance of fluids, including water and alcohol;
Practice physical exercise and keep a sound body weight, and;
Steer clear from foods high in purines.

Back Pain

To diagnose back pain, physicians and specialists will examine a patient’s medical history and conduct a physical exam. If needed, physicians may also request tests, which includes X-rays.

At the time of a patient’s medical examination, doctors will ask the following questions:

–Has the patient fallen or injured his or her back recently?
–Does his or her back feel better or worse when he or she lies down?
–Are there any activities or positions that ease or aggravate pain?
–Is the pain worse or better at a certain time of day?
–Does the patient or any family members have arthritis or other diseases that might affect the spine?
–Has the patient had back surgery or back pain before?
–Does the patient have pain, numbness, or tingling down one or both legs?

During an exam, physicians will watch patients stand and walk, check their reflexes to judge if they are slowed or heightened, test for fibromyalgia by checking their backs for tender points, watch for muscle strength and check for nerve root irritation.

These doctors may order the following tests: X-rays, MRIs, CT scans, blood tests, CBC, SED rates, CRP and HLA-B27.

Patients are asked to avoid back pain by exercising regularly, especially Tai Chi, yoga and weight-bearing exercise; keeping back muscles strong; maintaining a healthy diet, including one rich in calcium and vitamin D; practicing solid posture through supporting the back, and; avoiding heavy lifting whenever possible if this is not done by placing stress on the legs and hips.

They are also advised to visit the doctor only if back pain is accompanied by numbness, tingling, difficulty in urination, weakness, fever or unintended weight loss and a lack of pain relief from the use of medication or rest — as all of these symptoms are signs of more serious problems.

Back pain is typically treated based on whether it is acute or chronic. Treatments include pain relievers such as NSAIDs, acetaminophen, aspirin, ibuprofen, naproxen sodium, Tylenol, narcotics such as oxycodone or hydrocodone, and; creams, ointments and sprays such Zostrix, Icy Hot and Bengay.

Other solutions include physical exercises such as flexion, extension, stretching, aerobics and traction and; different categories of surgeries and medical devices such as hot and cold packs, corsets and braces, injections, nerve root blocks, facet joint injections, trigger point injections and prolotherapy, complementary and alternative therapies, spinal manipulation, TENS, acupuncture, acupressure, rolfing, and; surgical treatments such as laminectomy/diskectomy, microdiskectomy, laser surgery, spinal fusion and vertebroplasty, kyphoplasty, intradiskal electrothermal therapy or IDET, and; disk replacement.

Physical Therapy, Nutrition, NSAIDs, Creams, Surgeries, Medical Devices Target Forms of Arthritis, Experts Say (1 of 3)

by Vladimire Herard

Physical, message and alternative therapies, exercise, medical foods, nutrition, NSAIDs, DMARDs, corticosteroids, over-the-counter pain relievers, steroid injections, anti-pain creams, surgeries and medical devices are succeeding in treating senior patients with various forms of arthritis, researchers and experts say.

Through ongoing research and public policy, primary care physicians and specialists affiliated with the American Academy of Orthopedic Surgeons, the American College of Rheumatology, the Arthritis Foundation, the National Fibromyalgia Association, the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are finding and recognizing a number of effective treatments and therapies for senior patients with arthritis.

These solutions remedy such forms of arthritis as osteoarthritis, rheumatic arthritis, fibromyalgia, systemic lupus erythematosus, scleroderma, infectious arthritis, gout, polymyalgia rheumatica, polymyositis, psoriatic arthritis, bursitis and tendonitis and back pain.

Influencing research and public policy on these forms of arthritis and on hand to treat them and to apply solutions are teams of primary care physicians, family practice physicians, internal medicine physicians, osteopathic physicians, rheumatologists, orthopedists or orthopedic surgeons, physical therapists, occupational therapists, dietitians, nurse educators, physiatrists, also known as rehabilitation specialists, licensed acupuncture therapists, psychologists and social workers.

Various Forms of Arthritis

With most of these forms, about 46 million sufferers of arthritis of a percentage of 100 rheumatic diseases nationwide experience pain, stiffness, redness and heat in their bodies and the joints, where the bones intersect, NIAMS researchers say.

The patients’ hands, knees and shoulders are stricken with soreness, become difficult to move and grow swollen or inflamed. However, other parts of their anatomies are affected, too, such as their eyes, their chests, their skin, tendons, ligaments, bones and muscles.

Degenerative Joint Disease, Osteoarthritis

Osteoarthritis, also known as OA, the most widely known form of arthritis and a major cause of disability globally, affects 27 million adults nationwide, especially senior citizens and women, the American Academy of Orthopedic Surgeons reports.

Patients suffer from osteoarthritis of the hands, at the ends of fingers and thumbs, spine (neck and lower back), knees and hips, which negatively impacts their quality of life. This usually means joint pain and stiffness.

With the nation’s population aging, the number of individuals stricken with osteoarthritis will increase. NIAMS researchers predict that, as of 2030, 20 percent of the population — or at least 72 million people — will reach age 65 and may be
affected by arthritis. Specifically, half of those at that age will have osteoarthritis in at least one joint.

Degenerative joint disease, also known as DJD, entails the deterioration and ultimate loss of joint cartilage, experts say. Cartilage is a type of protein substance that cushions the bones of a joint. With osteoarthritis, cartilage deteriorates, allowing bones underneath to rub together.

This chronic disease is the chief cause of hip pain. The hip ranks as one of the human body’s biggest “weight-bearing” joints. It is called a “ball-and-socket” joint because the femur, also known as the “round ball-shaped head of the thighbone moves inside the cup-shaped hollow socket (acetabulumi) of the pelvis.”

DJD is a chronic illness targeting millions nationwide with reduced physical activity overtime as a consequence, researchers say. Aside from osteoarthritis, there are four other forms of degenerative joint disease.

Post-traumatic Arthritis

The first, post-traumatic arthritis, involves “a severe fracture or dislocation of the hip.” A second form known as rheumatoid arthritis, or RA, is an inflammatory arthritis of the joints.

Avascular Necrosis, Hip Dysplasia

A third form, avascular necrosis, is an ailment in which a healthy blood supply has been cut off from the “ball” or femoral head, leading to bone death and disfigurement. Hip dysplasia is an illness in which the bones around the hip are not properly formed and misalign the hip joint.

Rheumatoid Arthritis

Rheumatoid arthritis is connected to a malfunction of the immune system. RA attacks the synovium or the lining of the joints and bones, especially the hands and feet and can harm internal organs.

The 1.3 million individuals with rheumatoid arthritis are afflicted with pain, stiffness, swelling, fatigue, a general feeling of un-wellness, a fever, weight loss, breathing difficulties, rash, itch, joint damage and loss of joint. Additionally, these symptoms may be signs of illnesses other than arthritis, researchers say.

Polymyalgia Rheumatica

One form of rheumatoid arthritis, titled polymyalgia rheumatica, concerns the “tendons, muscles, ligaments and joint tissues.” As NIAMS researchers report, “symptoms include pain, aching and morning stiffness in the shoulders, hips, neck and lower back”. These symptoms are the first signs of giant cell arteritis, an illness of the arteries manifesting “headaches, inflammation, weakness, weight loss and fever.”

Polymyositis

Polymyositis, a form of rheumatic disease, leads to inflammation and weakness in the muscles. It can influence the function of the human body, causing disability.

Another class of arthritis linked to “infectious agents” such as bacteria or viruses includes parvovirus arthritis and gonoccocal arthritis. Some of the symptoms associated with this type of arthritis can be found in Lyme disease, an illness caused by bacteria in the bites of ticks. In these instances, early diagnosis and antibiotic treatment are key to ridding the joints of infection and effecting damage control.

Gout

Gout, another form of arthritis, develops from chalky deposits of needle-like crystals of uric acid, accumulating in the joints and in the rim of the ear. Sometimes, the crystals can form in the kidneys and can lead to kidney stones, researchers say. This causes inflammation, swelling and pain.

The big toe is the most impacted but other joints in a patient’s physique such as the insteps, ankles, heels, knees, wrists, fingers and elbows may also be affected and this set of circumstances are called podagra. Experts say about six million adults aged 20 and older are said to have experienced gout at some point in their lives.

Fibromyalgia

While not a true form of arthritis because it does not cause inflammation or damage to the joints, muscles or other tissues, fibromyalgia syndrome is a disorder that causes tissue pain in the bones and joints, stiffness, fatigue, sleep deprivation and “tender points” in the muscles and tendons, including the neck, spine, shoulders and hips. About five million individuals aged 18 and older are struck by this illness, causing limitations in regular physical activity, researchers report.

Lupus

Often times, arthritis coincides with other conditions, including lupus, an autoimmune disease in which an afflicted person’s immune system goes on the attack of its own healthy cells, tissues, joints, the heart, the skin, the kidneys and similar organs, experts say. This means “inflammation of and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain.”

Scleroderma

Scleroderma, also titled systemic sclerosis, impacts the skin, blood vessels and joints and internal organs such as the lungs and kidneys. With this condition, an excess amount of collagen, a fibrous protein, takes place in the skin and organs.

Psoriatic Arthritis

Psoriatic arthritis is a form of arthritis that accompanies psoriasis, a condition of scaly skin. It targets the “joints at the ends of the fingers and toes” and includes changes in the fingernails and toenails. Often, back pain may take place if the spine is affected.

Bursitis

Bursitis, another such condition, involves swelling of the bursae, “small, fluid-filled sacs,” that cut back on friction between bones and other structures in the joints. The inflammation may stem from arthritis in the joint or damage or infection of the bursae. The results are “pain and tenderness” that restricts movement of the joints.

Tendonitis

Tendonitis leads to the swelling of tendons, tough cords of tissue that link muscle to bone. This stems from overuse, injury or rheumatic illness. Like bursitis, tendonitis causes pain and tenderness and limits of joints.

Back Pain

Back pain is a common condition that, at best, is described as a persistent, blunt ache to immediate acute pain that debilitates its sufferer. It can be caused quickly by an accident, a fall or carrying heavy objects or can grow overtime from the aging of the spine. About 25 percent of adults nationwide will endure a day of back pain in a three-month period, researchers say.

Causes of Arthritis

Degenerative Joint Disease, Osteoarthritis

Degenerative joint disease, or DJD, and osteoarthritis of the knee, as a form of it, is caused by a variety of factors such as age, gender and genetics that influence the shape and functionality of the joints, researchers report. These factors include a prior hip injury, stress on the hip, joint dis-alignment and obesity.

The pain of degenerative joint disease of the hip and osteoarthritis of the knee is caused by the loss of cartilage or tissue lining. The cartilage acts as a cushion and makes for dexterity of the hip. When the cartilage deteriorates, the bones touch and rub together, causing swelling and stiffness.

Rheumatic Arthritis

Rheumatic diseases are caused by genetics and the environment, researchers report. This means that an individual may be born with a vulnerability to these conditions but elements in his or her environment will trigger their onset.

For rheumatoid arthritis and lupus, patients may have “a variation in a gene that codes for an enzyme called protein phosphatase nonreceptor 22.” Some viruses can awaken the disease in those genetically predisposed to it such as the link between the Epstein-Barr virus and lupus.

Gender also plays a role in the development of rheumatic diseases of patients. For example, lupus, rheumatoid arthritis, scleroderma and fibromyalgia are 80 to 90 more likely to take place in women and lupus is more likely to develop in African Americans and Hispanics than in whites. This means that hormones or gender differences factor into the progression of the condition.

Rheumatic diseases strike individuals of all races and ages with some conditions being more common among certain demographics than others. This form of arthritis takes place two to three times more in women than in men. Gout strikes men more than women but, after menopause, the likelihood of gout afflicting women starts to increase.

Gout

Gout, with its characteristic development of uric acid in the blood and crystals in the joints and kidney, also known as hyperuricemia, has multiple factors, experts report.

They include genetics with estimates ranging from 20 to 80 percent; gender with more men than women being stricken; obesity because of the presence of excess tissue making room for uric acid production; alcoholism; diet with foods rich in purines; exposure to lead poisoning; kidney failure; certain classes of medications such as diuretics and aspirin; niacin; cyclosporine or other such drugs that suppress the immune system, and levodopa in the treatment of Parkinson’s disease.

Other illnesses are connected to the high level of uric acid in the blood and they include high blood pressure, hypothyroidism, psoriasis, anemia, cancer, Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome.

Uric acid is an element that originates from the dissolution of purines. Purines are a part of all human tissue and can be found in different foods. Uric acid should be digested in the blood and removed through the kidneys in urine. However, if it is not eliminated, it builds up in the blood via the process of hyperuricemia and gout develops.

Foods high in purines include alcohol, anchovies, asparagus, beef kidneys and other organ meats, brains, dried beans and peas, game meats, gravy, herring, liver, mackerel, mushrooms, sardines, scallops and sweetbreads and some ought to be avoided, researchers say.

Fibromyalgia

Patients with certain rheumatic diseases, lupus, or ankylosing spondylitis, also known as spinal arthritis, are just as likely to cultivate fibromyalgia. NIAMS researchers have also found that women with family members with fibromyalgia will contract the illness themselves and it is unclear that this may be linked to genetics or environment or both.

Back Pain

A number of factors determine the onset of back pain, NIAMS researchers say.

The first factor involves advancing age, starting at age 30 to 40. The second one is fitness level, especially for individuals who do not regularly perform physical exercise and have weak back and abdominal muscles that do not support the spine.

A third factor is a diet high in calories and fat and leading to obesity, which places stress on the back. Genetics, as a fourth factor, also plays a role in terms of the likelihood of developing ankylosing spondylitis.

Race also factors in fifthly with African American women three to four times more likely than white women to develop spondylolisthesis, a disease in which a vertebra of the lower spine, also known as the lumbar spine, slips.

A sixth factor is the onset of other illnesses that cause or lead to back pain such as such as endometriosis; diskitis; fibromyalgia; kidney stones; osteoarthritis; osteomyelitis; osteoporosis, rheumatoid arthritis; ankylosing spondylitis; spinal stenosis, “a narrowing of the spinal column that” places stress on the spinal cord and nerves; and cancers and tumors throughout the body that may affect the spine.

Occupational risk factors as a seventh rank that involves heavy lifting, pushing or pulling. The twisting or vibrating of the spine that such activity entails can cause injury and back pain. Otherwise, a sedentary job or desk job may cause back pain with poor posture or uncomfortable seating.

An eighth and final factor is cigarette smoking because of its connection to develop low back pain with sciatica, a category that involves radiating pain to the hip or leg because of stress on a nerve.

For instance, smoking may block your body’s capacity to bring nourishment to the disks of the lower back or lead to back pain through excessive coughing, obesity, osteoporosis, accidents, falls, back injuries, back surgery or fractured bones.

Symptoms of Arthritis

According to NIAMS researchers, symptoms of the various forms of arthritis vary. This includes degenerative joint disease, arthritis in general, osteoarthritis, gout and fibromyalgia.

Degenerative Joint Disease

The major symptoms of degenerative joint diseases, especially of the hip, is pain in the groin, outside of the hip, the lower area of the back and a thigh to its knee.

Oftentimes, sufferers may confuse the pain in the hip area with back pain and this category of pain may be treated accordingly until a primary care physician, diagnoses it as degenerative joint disease.

Arthritis in General

The symptoms of arthritis in general are described by researchers as “swelling in one or more joints;” early morning joint stiffness that takes an hour; consistent pain or tenderness in a joint; limited capacity in using a joint, and; joint warmth and redness.

Osteoarthritis

The main symptoms of osteoarthritis, one of the major forms of degenerative joint disease, includes pain or stiffness while standing or walking for a short time, taking the stairs up or down and sitting in or getting up from chairs; pain during physical activity; pain or stiffness while being physical active in a chair; stiffness while climbing out of bed; swelling in one or more parts of the knee, and; a grinding feeling in the knee when in use.

Osteoarthritis is characterized as developing slowly. In the early stages of the disease, joints may be painful after physical labor or exercise. Hours or days later, joint pain may persist. Additionally, a patient may endure joint stiffness, especially when he or she wakes up in the morning or lies or sits in a particular position for too long.

While osteoarthritis can take place in any joint, it mostly impacts the hands, knees, hips and spine near the neck or lower back.

With the hands, osteoarthritis may present as “small, bony knobs at the end joints” near the nails of fingers. They are referred to as Heberden’s nodes. Related knobs, known as Bouchard’s nodes, can manifest themselves on the middle joints of fingers. Fingers grow swollen and gnarled with pain, stiffness and numbness. Additionally, the base of the thumb joint is stricken by osteoarthritis.

For the hips, just as with knee osteoarthritis, the symptoms of hip osteoarthritis are pain and stiffness in the joint, groin, inner thigh and buttocks as well as knees. Hip osteoarthritis may restrict movement, making day-to-day activity such as wearing clothes or shoes difficult.

Spinal osteoarthritis, which affects the spine, may appear as stiffness and pain in the neck and lower back. Frequently, arthritic spines can lay stress on the nerves where they are outside of the spinal column, producing weakness or numbness in the arms and legs.

Gout

Signs and symptoms for gout include hyperuricemia, the formation of uric acid in the blood and crystals in the joints; the presence of such crystals in joint liquid; more than one incident of arthritis; arthritis that is cultivated in the course of a day, resulting in a red, warm and swollen joint, and; a bout of arthritis in one joint, namely the toe, ankle or knee.

Fibromyalgia

Symptoms for fibromyalgia include “pain; fatigue; cognitive and memory lapses, also known as ‘fibro fog’; sleep disturbances; morning stiffness; headaches; irritable bowel syndrome; painful menstrual periods; numbness or tingling of the hands and feet; restless legs syndrome; temperature sensitivity, and; sensitivity to loud noises or bright lights.”

Often, individuals stricken with fibromyalgia also have other chronic pain disorders such as fatigue syndrome, endometriosis, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction and vulvodynia.

Proper Diet, Exercise, Smoking, Drinking Avoidance, Tests Promote Bone Health In Seniors, Federal Agencies Say (2 of 2)

A separate 2002 study published in the Journal of the American College of Nutrition instructs osteoporosis patients to take calcium with phosphorus to ward off deficiency in the latter mineral.

Researchers explain that patients suffering from osteoporosis ought to take calcium phosphate because, if they increase their intake of calcium without phosphorus, they heighten their risk for falls and deficiency in phosphorus, which lead to rendering calcium less successful in protecting bones from loss.

Phosphorus is needed to combine calcium with bone and this important task is completed in the intestinal tract, researchers explain.

The NIH, CDC and the U.S. Surgeon General also asks senior patients to make regular their intake of vitamin D, which is critical to the absorption of calcium and bone health. Vitamin D is created in the skin through exposure to the sun.

While most individuals receive sufficient vitamin D naturally through such foods as milk and mushrooms, research finds that the supply of vitamin D is lowered in seniors, especially those who stay home away from sunlight, and at wintertime. Doctors are urged by the agencies to recommend that the senior patients supplement their intake of vitamin without overdosing.

About 40 percent to 100 percent of male and female seniors nationwide and staying at home lack an adequate supply of vitamin D. A 2002 study of long-term care senior patients, aged 85 and older, found that 91 percent took vitamin D supplementation, nearly 50 percent were vitamin D-insufficient and 16 percent were outright vitamin D-deficient.

For the ambulatory senior population, aged 78 and older where most patients took vitamin D supplements, 81 percent were deemed to be vitamin D-insufficient or deficient.

A lower supply of vitamin D in seniors leads to muscle weakness as well as compromised bone health. Muscle weakness translates into lessened physical capacity, which means a greater risk of falling and bone fractures.

Studies of vitamin D found that the nutrient affects muscle cell growth and function by binding to a receptor. Seniors who improved their intake of vitamin D and supplementation enjoyed muscle strength, walking ability and overall physical capacity, reducing the incidence of falls and non-spinal bone fractures.

Lastly, a 2002 study at the National Cheung Kung University Hospital in Tainan, Taiwan found that seniors who drank tea regularly built strong bones and decreased their risk of contracting osteoporosis. The study appears in the Archives of Internal Medicine.

Namely, individuals who drank two cups per day of black, green or oolong tea were discovered to have more solid bone material. Researchers point to the presence of fluoride, caffeine and phytoestrogen, the ingredients of which all contribute to bone mineral density and strength.

University researchers questioned 497 men and 540 women, aged 30 and older, about drinking tea, and all were administered a bone mineral density test. About 48.4 percent of the participants were tea drinkers for at least 10 years.

They reported drinking mostly green or oolong tea without milk, removing the calcium content of a dairy product. The study found those who drank tea steadily for more than ten years had the highest level of bone mineral density. Their level was 6.2 percent more than in those who did not habitually consume tea.

Regular physical exercise

The NIH, CDC and the U.S. Surgeon General asks senior patients to start an exercise regimen to prevent and treat osteoporosis and bone fractures. Physical exercise improves bone health and increases muscle strength, coordination and balance, leading to a reduction in falls and greater maximum overall health, the agencies say.

They say individuals who exercise regularly gain more peak bone mass, particularly “maximum bone density and strength” than those who don’t. There are two types of physical exercise: weight-bearing exercise and resistance exercise.

Individuals aged 40 and older are asked to consult their doctors before starting and to select exercise specialists qualified in physiology, physical education, physical therapy and other disciplines to lead activities.

Patients benefit when they engage the first variety, weight-bearing exercise, in which their bones and muscles “work against gravity.” These activities include walking, climbing stairs, dancing and playing tennis.

The second category, resistance exercises, use muscles to build muscle mass and bone. Examples include weight training/strength training with free weights or weight machines.

Other activities include Tai Chi, hiking, jogging and gardening.

Research shows that both weight-bearing and resistance exercise boosts the bone mineral density and strength of the spine and walking by itself enhances the status of the hip and spine in postmenopausal women and seniors aged 85 and older.

However, both groups of seniors must undergo an exam to determine the most suitable regimen for their physical ability and level of illness, the agencies say. Patients should test for muscle strength, range of motion, level of physical activity, fitness, gait and balance problems before embarking on a plan of exercise.

Seniors are asked to steer clear from activities that put them at risk for falling such as skiing and skating and “those with too much impact such as jogging and jumping rope”.

While certain exercises can benefit the hips, for instance, of postmenopausal women, they also can lead to fractures of the spine so their intensity and resistance may be need to be re-adjusted, researchers say.

Meanwhile, the agencies say, patients should not succumb to fear of falling and avoid exercise altogether. To help overcome fear, they caution seniors to achieve proper posture, to use handrails on staircases and bend from the hips and knees and not from the waist when lifting.

They also advise against seniors wearing slippery shoes; slouching when standing, walking or sitting at desks; moving too quickly; taking part in sports that lend to twisting such as golf and bending from the waist such as sit-ups or toe touches.

Non-weight-bearing exercise examples include bicycling and swimming but, while both build strong muscles and contribute to heart health, they are not effective for building bones, the agencies say.

The Surgeon General and guidelines from the American Heart Association recommend that all seniors aged 65 and older take part in moderate-intensity aerobic exercise for at least 30 minutes five days a week or vigorous-intensity activity for 20 minutes three days of the week.
Avoidance of tobacco and alcohol

The agencies forbid tobacco consumption among seniors, especially those with osteoporosis, declaring it harmful to the bones as well as for heart and lung health. Research finds one year of having quit smoking substantially increased bone mineral density in the femoral bones and hips in postmenopausal women.

Additionally, ending tobacco use has lowered the risk of hip fracture in female seniors after 10 years of such cessation as compared with younger adult women who continue smoking.

Researchers also say a female senior who drink two to three ounces of alcohol per day damages her skeleton. The same applies to drinking in younger women and men. Those who drink most heavily are more vulnerable to bone loss and fractures because malnourishment leads to a greater risk of falls.

Review of chronic illness medications

The NIH, CDC and the Surgeon General also warns seniors, their families and their doctors to perform a review of medications taken to treat a variety of chronic diseases associated with old age that lead to bone loss through a risk of developing osteoporosis or suffering fractures.

These include glucocorticoids or a class of medicines that treat a range of serious illnesses such as arthritis, Crohn’s disease, lupus and disorders of the lungs, kidney and liver, researchers say.

Other types of drugs that cause bone loss include treatment with anti-seizure drugs such as phenytoin, commercially known as Dilantin, and barbiturates; gonadtropin-releasing hormones used to treat endometriosis; excess use of aluminum-bearing antacids; cancer therapies, and; excess thyroid hormone.

Specifically, the use of the commercial drug Prilosec, also known as omeprazole to treat acid reflux disease, may ultimately lead to the onset of osteoporosis, 2002 research from the University of Minnesota shows.

When taken with calcium carbonate, Prilosec decreases calcium absorption in women aged 65 or older, which may lead to developing osteoporosis. The drug works by holding down the backflow of acids from the stomach to the esophagus. Still, the human body cannot process calcium without acid.

According to the study, which was presented at a yearly meeting of the American Geriatrics Society, out of a total of 18 women over aged 65 and taking Prilosec, about 16 had lowered calcium absorption levels.

The agencies urge seniors to speak with their physicians about whether to continue, stop or change medications with medical assistance or on their own.

Federal research projects that nearly 30 percent of individuals aged 65 and older, who stay at home, will fall at least once a year with the fall rate being higher in nursing homes and other senior long-term or short-term care facilities. Most falls will cause fractures with the most severe category being hip fractures.

Over 50 scientific studies published after 1988 have sought to address the question of whether a variety of medications cause these falls and injury though few have been designed in this manner. Many flaws in study design complicate the ability to make the connection between drugs and falls.

Despite such challenges, federal research has made important findings on the topic. Some have found that patients taking psychotropic drugs have twice the risk of falling and enduring fractures, compared with those not consuming such medicines.

As a result, physicians, pharmacists and nurses may prioritize reducing the use of psychotropic drugs by seniors in nursing homes or other forms of senior long-term or short-term care. Additionally, researchers and policymakers who advocate “aging in place” for seniors may lobby against the use of psychotropic drugs among elderly individuals who choose to stay at home.

Other studies have found that the use of nonsteroidal anti-inflammatory drugs is linked to falling and are expanding their examination of this class of medicines.

Most especially, researchers point to antidepressants, a class of drugs that have been connected by every major study to falls. Studies are focusing on the effects of selective serotonin such as 5-hydroxytryptamine, also known as 5-HT, and reuptake inhibitors and tricyclic antidepressants on falls.

Benzodiazepines with their long-term effects may impact falls through dosage rather than through drug half-life. Researchers are still determining the effects of drugs that treat heart conditions on falls.

Meanwhile, diuretics have been identified as a class of drugs not associated with falls and, in fact, thiazide diuretics, may avoid fractures by delaying the development of osteoporosis.

Medical testing

All seniors, most especially those aged 85 and older, must take an exam for the secondary causes of osteoporosis as part of a larger review of osteoporosis, the federal agencies say.

In general, a bone mineral density (BMD) test is considered the best exam for measuring bone health. The BMD test can recognize osteoporosis, determine one’s risk for fractures and measure a patient’s response to osteoporosis treatment.

The World Health Organization (WHO) has set definitions of units of standard deviations (SD) for DXA test results based on the peak bone mineral density of a healthy 30-year-old adult and a patient is assigned a T-score. A score of 0 is considered a BMD comparable with the norm for a healthy adult.

The more standard deviations (SD) there are below 0, shown as negative numbers, the lower your BMD and the greater risk of fracture. Bone density within the positive 1 or negative 1 range of the young adult mean is normal.

Low bone mass is indicated by a BMD score between 1 and 2.5 SD below the adult mean. Osteoporosis is defined as testing for a bone mineral density of 2.5 score or more below the average for young adults BMD for premenopausal women.

Severe osteoporosis is defined at more than 2.5 SD below the adult mean and in the incidence of one or more bone fractures. This same value can be used for both women and men.

Researchers particularly recommend that physicians diagnose osteoporosis in the proximal femur with the most common BMD test known as the dual energy X-ray absorptiometry or DXA test even though other sites and other methods of testing are effective and can be used to project fractures.

A patient’s bone mineral density can also be compared to that of an individual of the same age. This form of measure gives him or her a Z-score. Because a low BMD score is common among seniors, comparisons with the BMD of an individual of the same age can be misguiding. As a result, a diagnosis of osteoporosis or low bone mass is based on A T-score. Still, a Z-score can be useful for determining whether a disease causes bone loss.

While hip fracture prediction with bone mineral density and strength testing in itself is as valid as blood pressure reading to determine a risk for stroke, the value of the bone mineral density can be improved by other factors such as the biochemical indexes of bone resorption and fracture risk factors.

Factors outside of bone mineral density include age, previous fracture, premature menopause, a history of hip fracture and the use of oral corticosteroids. Physicians are encouraged to use a 10-year probability of fracture as the most effective measurement to determine intervention levels.

Treatments are available affordably for men and women if hip fracture probability over 10 years averages from 2 percent to 10 percent, depending on the age of patients.

Use of medical devices and therapies

Seniors can offset the risk of bone loss, bone fractures and osteoporosis by using medical devices and therapies other than medication. For example, federal research finds that hip protectors lower the risk of hip fracture among individuals most at risk for falls. Most hip protectors are reusable underwear that are worn over the hips.

One side of the piece of clothing is a thin layer of lightweight foam plastic. Hip protectors are worn by individuals with balance and posture problems and those who fall down and damage their hips as opposed to the more typical fall forward with hands and knees taking the hit.

However, clinical studies have found that at least one-third of seniors would not wear hip protectors or wore them for only short periods of time because of their lack of comfort or physical fit.

SOURCES:

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“Bone-Building Hormone Approved as Treatment for Postmenopausal Women With Osteoporosis,” Medical Week staff, August 5, 2002.

Borgstrom, F., Burlet, N., Cooper, C., Delmas, P.D., Kanis, J.A., Reginster, J.Y., Rizzoli, R, “European guidance for the diagnosis and management of osteoporosis in postmenopausal women,” Osteoporosis International, Vol. 19, No. 4, April 2008, pp. 399-428.

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National Institute’s of Health Osteoporosis and Related Bone Diseases National Resource Center, Once Is Enough: A Guide to Preventing Future Fractions (patient factsheet guide), April 2015, https://www.niams.nih.gov/health_info/bone/Osteoporosis/Fracture/default.asp,

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Proper Diet, Exercise, Smoking, Drinking Avoidance, Tests Promote Bone Health In Seniors, Federal Agencies Say (1 of 2)

by Vladimire Herard

A proper diet, physical exercise, avoidance of tobacco and alcohol, use of medical devices such as hip padding and medical testing preserve bone health in senior patients, various units of the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Health and Human Services’ (HHS) Surgeon General and researchers say.

The federal agencies, NIH and CDC, the U.S. Surgeon General and researchers released guides, a report and findings of research studies about maintaining bone health among senior citizens, advising for proper nutrition, regular exercise, shunning of smoking and drinking, the use of protective devices and therapies and undergoing medical exams to test bone strength and density.

Particularly, the NIH’s Osteoporosis and Related Bone Diseases National Resource Center, a national health care provider and patient informational and policy clearinghouse about bone health, works to secure its educational material with:

–the National Institute of Arthritis and Musculoskletal and Skin Diseases;
–the National Institute on Aging;
–the Eunice Kennedy Shriver National Institute of Child Health and Human Development;
–the National Institute of Dental and Craniofacial Research;
–the National Institute of Diabetes and Digestive and Kidney Diseases;
–the NIH Office of Research on Women’s Health and the HHS Office on Women’s Health, and;
–university and medical researchers.

The guides and report are titled Exercise for Your Bone Health, Once Is Enough: A Guide to Preventing Future Fractures, Information for Patients About Paget’s Disease of Bone, Bone Mass Measurement: What the Numbers Mean and the Surgeon General’s Report on Bone Health and Osteoporosis: What It Means To You.

This body of literature is aimed at instructing seniors, their families and the primary care, internal medicine and family practice physicians, endocrinologists, rheumatologists, orthopedic surgeons, neurologists, ear, nose and throat physicians treating them.

Bone Health and Factors

Human bone is ever-evolving and living tissue, composed of collagen, a soft, structured protein, and calcium phosphate, a strengthening and hardening mineral. Both collagen and calcium strengthen bone but also allow it to be flexible.

In the course of a person’s lifetime, old bone is disposed of (resorption) and new bone replaces it (formation). During his or her youth, a person’s new bone grows faster than the rate at which old bone is discarded.

Bone formation proceeds at a speed faster than resorption until a person’s skeleton reaches peak bone mass, which translates into “maximum bone density and strength” at age 30.

After that age, bone resorption starts to surpass bone formation. The loss of bone material is quickest in the earliest years of menopause but continues past this period.

Bone Diseases

After menopause in women and, to a lesser extent, in men, bone becomes more fragile or brittle and vulnerable to breakage or injury. Among the most common bone problems are bone fractures, osteoporosis, Paget’s disease and chronic illnesses with complications that impact bone health.

Osteoporosis, Fractures, Bone Deformities, Menopause

Osteoporosis, also known as porous bone, is a form of bone illness featuring low bone mass and structural decline of tissue, leading to more brittleness and a greater risk of fractures of the hip, spine and wrist. Called the “silent disease,” it is characterized as effecting bone loss without any symptoms.

In fact, despite a series of policy changes and laws affecting health care delivery to senior patients, some individuals may still not be aware that they have osteoporosis until their bones weaken severely to the point that any strain, bump or fall leads to a hip fracture or to the collapse of a vertebra and sometimes it is not even acknowledged then.

Such were the findings of a June 16, 2002 study by the University of California’s San Francisco School of Nursing Institute for Health and Aging that appeared in a journal Medical Week.

Additionally, researchers with Osteoporosis International found that, aside from osteoporosis affecting primarily women, of all osteoporosis patients in the hospital, 80 percent were white and 75 percent were over the age of 65 years.

The organization also found that osteoporosis costs billions of dollars nationally with the majority of the expense connected to hip fracture. The U.S. Surgeon General reports that it may cost $18 billion a year to treat fractures from osteoporosis. Most treatment for osteoporosis was covered by Medicare and the greatest cost borne was for nursing home cost, amounting to 59 percent of all dollars spent.

The National Osteoporosis Foundation and Harris Interactive, too, found that, while most senior participants in a survey meant to honor National Osteoporosis Awareness and Prevention Month in 2011 knew about osteoporosis, its risks and prevention efforts, about 34 percent did not know about the disease.

Still, 70 percent of women survey participants stated they thought the onset of osteoporosis could be avoided, though only 50 percent recognized physical exercise as a means of prevention and only 27 percent realized diet had an influence.

A collapsed vertebra can present as severe back pain, a loss of a person’s height or deformities of the spine such as kyphosis or a extremely stooped posture.

The onset of osteoporosis takes place when bone resorption begins too rapidly or the formation of bone happens too gradually. Osteoporosis is more likely to take place if a person did not peak in optimal bone mass during youth and young adulthood.

Nationwide, about 10 million persons suffer from osteoporosis and an additional 34 million have low bone mass, making it a public health threat for 44 million individuals total and increasing the chances of those with low bone mass of developing the disease. Half of all women and one in eight men over the age of 50 stand to experience an osteoporosis-related fracture at least once.

Unless they change their diet and lifestyle, the U.S. Surgeon General predicts that half of all individuals nationwide over the age 50 may suffer from fragile bones.

Every year, osteoporosis causes nearly two million fractures, the U.S. Surgeon General and the National Osteoporosis Foundation reported, including 2.6 million visits to the doctor’s office, 500,000 hospitalizations, 800,000 emergency room trips, 180,000 nursing home placements, 300,000 hip fractures, nearly 700,000 vertebral fractures, 250,000 wrist fractures and over 300,000 fractures in other parts in the human body, causing disability, pain and other health issues.

NIH and CDC researchers have identified several risk factors for developing osteoporosis. Some individuals hold many of these risk factors but others have none. They include gender, age, body size, ethnicity, family history, sex hormones, anorexia, drug use, a lack of physical exercise, smoking and drinking.

With respect to gender, a woman is more likely to develop osteoporosis than a man. Women have less bone mass and are more likely to lose bone material than men because they are more likely to undergo menopause, which causes changes in their bodies leading to this loss.

By contrast, men with osteoporosis make up one out of every five patients with osteoporosis. However, their level of ill health and risk of death are higher than that of chronically ill individuals without this disease.

When testing men for the risk of bone fracture and osteoporosis, researchers say physicians should evaluate the mineral density and strength of their senior patients’ bones. The most method is to use central dual energy X-ray absorptiometry.

Doctors must also factor in secondary causes for bone fracture or osteoporosis in men such as a reproductive health and hormonal condition known as hypogonadism. Drugs should be administered to senior male patients with a background of low-trauma fracture or severe bone loss.

Because of the links among proper nourishment, including daily intake of bone-building calcium and vitamin D, smoking, alcohol use, an exercise regimen and fall prevention and optimal bone health, researchers recommend that male senior patients and their physicians take these factors into consideration when treating men with osteoporosis or at risk for cultivating this illness.

They also urge male patients and doctors alike to administer appropriate drug therapy for all men in danger of bone fracture, including the use of the medication alendronate, deemed “first-line therapy” because of its effectiveness and mildness, and the “second-line therapy” drug teriparatide for managing osteoporosis in “high-risk men.”

Teriparatide is considered “second-line” because of its high cost, difficult administration routine and safety risks. Moreover, calcitonin and testosterone are also included in a doctor’s arsenal of solutions for managing the risk or onset for bone fracture and osteoporosis in men.

The second factor for bone fractures and osteoporosis is age. In both men and women, bones become less thick and weaker as they age. As a result, physicians must be mindful of the risks and the advantages of detecting and addressing osteoporosis in seniors.

Federal research finds that senior patients are not frequently tested enough for bone mineral density and strength and medications or other therapies are not prescribed often enough for them when they do present with bone disorders or the risks for them.

More data is needed on the safety and effectiveness of drugs and therapies in seniors for osteoporosis and bone fractures otherwise, making managing bone-related illness difficult.

Researchers say not enough is known about the effectiveness and safety risk of drugs, various bone-related diseases and costs so as to bridge the gap between the number of seniors at risk for such illness and the number actually being addressed.

As with elderly male bone disorder sufferers, researchers urge testing with central dual energy X-ray absorptiometry, which is for all seniors.

Researchers ask doctors to teach their senior patients to lead lives that encompass bone health, including a program of a proper diet, especially one rich in calcium and vitamin D, physical exercise and private home safety and security but free from smoking and drinking.

Facts and figures from the National Health and Nutrition Examination Survey (NHANES) demonstrate that the incidence of osteoporosis based on hip bone density was calculated at 4 percent for women aged 50 to 59 versus 44 percent for women aged 80 or older.

The NHANES survey finds that the number of seniors aged 65 and older will rise from the 36.8 million it was in 2004 to 54.6 million by the year 2020. In that time period, the number of senior aged 85 and older will jump from 5.1 million to 7.3 million. The incidence of hip fractures and their costs could increase by two to three times by the year 2040. Similar findings are made for seniors worldwide.

The danger of bone fractures rises with age. Hip fracture risk increases after age 70. Research shows that hip fractures were 1.6 per 1,000 years for female seniors aged 65 compared to 35.4 per 1,000 years for women aged 95 or older.

In 2004, there were about 329,000 hospital discharges for hip fractures with 125,000 taking place in patients aged 85 years and older — compared with 116,000 in patients aged 75 to 84 and 48,000 in patients between aged 65 and 74.

Researchers say bone fractures in general boost health care expenses and lead to an increased risk of illness and death for older seniors. After an event of hip fracture, half of all patients fully recover. Additionally, about 3 to 5 percent of patients die during their first hospital stay for hip fracture and about 20 percent to 40 percent in a year.

Data demonstrates that seniors with osteoporosis are not administered medications. A study of nursing home residents, aged 80 and older, with diagnosed osteoporosis or hip fracture showed that 69 percent of them were given calcium and 63 percent vitamin D but only 19 percent received a bisphosphonate. In total, about 36 percent were prescribed drugs or hip protectors for osteoporosis.

For the third factor of body size, small or petite women with thin bones are most endanger of developing bone disorders.

With the fourth factor of race and ethnicity, white and Asian women are most likely to develop bone fractures and osteoporosis than African-American and Hispanic women. The latter two racial groups have a lower but still relatively substantial risk of cultivating such diseases.

The fifth factor involves family history. Part of the risk for developing bone disorders is genetic. Senior patients whose parents suffered from bone fractures and osteoporosis, too, may share their fate with declining bone mass and a great risk of injury.

Six more factors are recognized as responsible for bone fractures and the development of osteoporosis, however, researchers say, with these, the odds can be reversed.

They include sex hormones with the unusual absence of menstrual periods, also known as amenorrhea, the low estrogen levels commonly known as menopause and low levels of the hormone testosterone in men; a high incidence of the eating disorder known as anoxeria because its resulting loss of calcium and vitamin D in the afflicted person’s diet; use of such drugs to treat chronic conditions such as glucocorticoids and some classes of anticonvulsants; a lack of physical exercise; cigarette smoking, and; abuse of alcohol.

Drugs and Other Therapies

A series of studies published in Medical Week in 2002 point to a number of medications and other therapies that treat osteoporosis and bone fractures, including a special class of drugs known as bisphosphonates such as Actonel, Fosamax, Actone, Boniva and Zometa, a commercial form of calcitonin known as Oratonin, a hormone known as Forteo, another treatment by the drug parathyroid hormone (PTH), and a therapy known as vertebroplasty.

Additionally, the Food and Drug Administration (FDA) has long approved the hormone estrogen and the medications alendronate, raloxifene, and risedronate to both prevent osteoporosis and to treat the disease. Alendronate is meant to treat osteoporosis in men. Both alendronate and risedronate are to be used for men and women with glucocorticoid-induced osteoporosis.

A separate set of research that appeared in Medical Week in 2002 finds that the structural network in bones can disintegrate in a year in early postmenopausal women.

Research discovered that the network, known as the trabecular architecture, can deteriorate even with a small amount of loss in bone mineral density, leading to skeletal fragility. The findings were brought before a meeting of the Endocrine Society in San Francisco.

The bisphosphonate drug Actonel, taken once a week, is meant to protect the trabecular architecture in early postmenopausal women, boost bone mineral density and to prevent and treat postmenopausal osteoporosis. Fosamax, too, is taken once a week to prevent and treat the disease in postmenopausal women and to stimulate bone mass in men with osteoporosis.

Bisphosphonates are the nonhormonal class of drugs that stem bone loss, increase bone mineral density and decrease the danger of fractures.

Research involved women within six months to five years after menopause who were administered with Actonel, a total of 12 participants, or a substitute, a total of 14 such participants, for a year. The women who took part in the study did not receive calcium supplements throughout that time period.

A review of hip bone biopsy samples demonstrated that, after one year, the 12 women taking the placebo were already found to have the deteriorated microarchitecture of trabecular bone even with only a small loss in the lumbar spine bone mineral density.

At the same time, the 14 women who received Actonel were able to restore trabecular bone microarchitecture and experienced greater lumbar spine bone mineral density.

The drug parathyroid hormone (PTH) is anabolic and triggers bone formation. This medication is more potent than some anti-resorptive therapies, which are meant to halt bone resorption.

The boost in bone density in two to three years amounts to 15 percent with PTH instead of 6 percent with its rival therapies. The results of research and clinical trials of PTH were reviewed by the American Association of Clinical Endocrinologists.

Yet another drug, Oratonin, is an oral form of calcitonin to treat osteoporosis, which was once only available by injection or in nasal spray form. Calcitonin is a hormone generated in the thyroid gland that decreases the amount of calcium and phosphate in the blood and blocks the resorption of bone, lowering the risk of fracture in an individual suffering from osteoporosis.

Additionally, patients with the disease and who are enduring spinal fractures are relieved from their pain with a procedure known as vertebroplasty. This procedure stabilizes a fractured bone, relieving a patient from pain and averting further damage if the procedure is conducted early enough. The results of research and clinical trials of vertebroplasty were examined by the Society of Cardiovascular and Interventional Radiology.

Lastly, the hormone Forteo, a natural bone-forming substance, is administered to men with osteoporosis through daily injections. Forteo works by triggering new bone-building activity by boosting the number and activity of bone-creating cells known as osteoblasts. The result is a reduced risk of bone fractures and an increase in bone mineral density and strength. A study of the hormone was published in the New England Journal of Medicine.

Paget’s disease

Paget’s disease, a chronic disorder that results in bone pain, swollen and deformed bones, fractures and arthritis near the joints, involves “excessive breakdown and formation” of bone tissues leading to weakened bones. Compared with osteoporosis, which affects all of the bones, Paget’s disease is localized and affects one or more bones.

The condition is caused by environmental factors and family medical history, particularly a slow-acting virus. Most especially, the disease afflicts seniors and individuals of northern European descent.

Symptoms include pain in any bone impacted by the disease or arthritis; headaches and hearing loss when the illness strikes the skull; pressure on nerves; increased head size; the bowing of a limb; curving of the spine; hip pain, and; damage to the cartilage of joints.

The illness is diagnosed using X-rays but can also be detected with an alkaline phosphatase blood test and bone scans. Complications include osteogenic sarcoma that is known as a rare form of bone cancer, arthritis, hearing loss, heart disease, kidney stones, nervous system problems, sarcoma, loose teeth and vision loss.

Paget’s disease is treated with calcium and vitamin D supplementation, physical exercise, the class of drugs known as bisphosphonates, calcitonin from the thyroid gland and surgery to correct bleeding, fractures, severe degenerative arthritis and bone deformity.

Chronic illnesses

However, other chronic illnesses can cause bone disorders. Vitamin D deficiency causes a number of diseases such as rickets and osteomalacia, which can lead to bone deformities and fractures. Renal osteodystrophy, a form of kidney disease, can cause fractures. Illnesses such as osteogenesis imperfecta leads to abnormal bone growth and easy breakage. Overactive glands can cause endocrine disorders.

Prevention and Bone Health Enhancement

In order to prevent osteoporosis and bone fractures and to promote bone health, the NIH, CDC and the U.S. Surgeon General recommend a proper diet; regular physical exercise; avoidance of tobacco and alcohol; a review of medications to treat chronic ailments that compromise bone wellness; medical testing, and; the use of medical devices and therapies such as hip padding or protectors to avert injury or recover from bone disorders.

The agencies ask seniors and their doctors to lower the risks of falls that hamper bone health. Preventing falls is a prime consideration for men and women with osteoporosis as accidents can cause bone fractures in the hip, wrist, spine or other parts of the human skeleton.

Osteoporosis patients are urged to pay attention to any alterations in their physical balance or gait and they must be ready to speak with their primary care, internal medicine and family practice physicians, endocrinologists, rheumatologists, orthopedic surgeons, neurologists, ear, nose and throat physicians about these changes.

After consulting with their doctors, senior patients and their families may be called upon to protect their bones through a variety of activities:

–private home safety and security efforts such as removing loose rugs or extension cords, fixing unstable staircases, installing grab bars in the bathroom and enhancing lighting;
–examining and, if need be, correcting their vision;
–determining whether they need canes, walkers and assistive devices;
–treating heart conditions that lead to falls such as orthostatic hypotension or arrhythmias, and;
–properly managing drugs that boost the danger of falls such as antipsychotic agents, benzodiazepines, anti-depressants, anti-hypertensives and diuretics.

Proper Diet

Senior patients are to consume a diet high in calcium, protein and vitamin D as these nutrients are proven to improve bone mineral density and strength, according to research by the federal agencies and Tufts University in Boston that has appeared in the American Journal of Clinical Nutrition.

If calcium and the other minerals and vitamins are lacking in the diet, their absence is linked to low bone mass, quick bone loss, high rates of fracture and the development of osteoporosis. National nutrition research finds that individuals of any age take in less than their recommended daily amount of calcium.

Aside from mineral supplements, the U.S. Surgeon General reports that seniors can increase their intake of calcium in certain foods such as almonds, baked beans, broccoli, ready-to-eat cereal, cheese, cheese pizza, cottage cheese, ice cream, lasagna, milk, fortified oatmeal, fortified orange juice, pudding, salmon, sardines, soy or rice milk, soybeans, spaghetti, tofu, turnip greens, fortified waffles and yogurt.

If possible, seniors may also increase their intake of other bone-building vitamins and minerals such as boron, collagen, dried plum, magnesium, especially magnesium citrate, manganese, silica, silicon, vitamin K2 and zinc.

And doctors are requested to play their role in convincing their patients to adopt sound nutritional habits for healthy bones. A 2002 study in the journal Menopause found that mere minutes of osteoporosis prevention education in the physician’s office prior to an appointment can encourage more women to take calcium or supplements.

For the study, a group of patients with the Women’s Health at the University of Medicine and Dentistry of New Jersey were subject to viewing a 10-minute osteoporosis education video before seeing their doctors. After watching the video, over 25 percent started their calcium supplements while only 4.9 percent of those who visited their physicians without watching the video did so.

Additionally, researchers ask patients to combine calcium and vitamin D to avoid the development of osteoporosis.