Building bones

We tend think of our bones as just the scaffolding that holds us together, but they also protect our vital organs. And as we age, we need to continue getting calcium and to exercise to keep our bones healthy.

So when you're pumping iron at the gym or climbing a fourteener, you're doing it not only for your heart and overall health, but for your bones, too. Bone requires stress and strain to stay dense and strong, so walking, hiking, racquet sports and weight lifting are good exercises.

Bones are living tissue with the ability to renew and repair themselves. While they feel hard on the outside, bones have a spongy honeycomb of busy cells inside that are hard at work demolishing old bone and rebuilding with new. This process, known as "remodeling," can last three to six months, which is why a broken bone seems to take forever to fully heal.

The keys to keeping bones strong and resilient are proper nutrition and weight-bearing physical activity.

Calcium is the obvious and most important nutrient in building strong bones. Good sources are dairy foods such as yogurt, skim milk, cheese and cottage cheese, as well as spinach, collards, oranges, canned salmon, nuts, beans and peas.

Many orange juice companies fortify their products with calcium because it absorbs well in the presence of vitamin C.

But vitamin D is the real workhorse because without it calcium does not absorb properly. We produce vitamin D when our skin is exposed to sunshine and ingest it from food and supplements. Primary food sources are fish liver oils, fatty fish (such as salmon, mackerel, catfish, sardines, tuna) mushrooms and whole egg.

Past 50, our bodies become less adept at absorbing vitamin D. Other groups at risk for reduced vitamin D absorption are people in northern climes where there is less seasonal sunshine and those with high skin pigmentation (particularly people of African descent). For these three groups in particular, attention to diet and supplementation becomes crucial.

Potassium and vitamins C and K — found in fruits and vegetables — are also essential for bone health, along with magnesium, which is found primarily in nuts and seeds. A minimum of five servings of fruits and vegetables a day and a small serving of nuts and seeds (pumpkin is the best) are important for preserving bone.

Fruits and vegetables are important because they are alkaline and serve to neutralize the acid produced by grain-based and protein foods, writes Bonnie Liebman in the Nutrition Action Health Letter's January-February issue. Liebman is director of nutrition for Center for Science in the Public Interest. If the body is too acidic, it will dissolve bone (an alkaline reservoir) to neutralize the acid. This is true whenever your body signals that it needs more calcium — it takes what it needs from your own bone if it is not supplied from the diet and/or created by weight-bearing exercise.

The National Osteoporosis Foundation compares bone maintenance to a savings account: There is only as much in the account as you deposit, primarily from before puberty until about age 30. The body has all the calcium it needs in the bones and teeth but allowing these withdrawals from your bone bank will cause osteoporosis. This is a debilitating disease where the bones become frail and brittle and often leads to severe disability if a bone breaks after a fall. Women in particular need to "deposit" as much bone mass as possible into their "account" because, of the 10 million Americans with osteoporosis, 8 million are women.

Healthy bones require stress and strain. The pulling action of the muscles and their connective tissues against the surface of the bone causes the bone-making cells (osteoblasts) to make bones dense and strong. Walking, jogging, dancing, hiking, snowshoeing, racquet sports (tennis, racquetball, squash), and especially weight lifting are good exercises. Swimming and bicycling don't put stress on the bones, so they're not considered good for building bone strength.

According to a study on the effects of strength training on bone density, published in 1994 in the Journal of the American Medical Association, post-menopausal women who strength-trained twice a week for a year increased their bone density compared with a sedentary control group. The study was conducted by Miriam Nelson, director of the Center for Physical Fitness at the School of Nutrition Science and Policy at Tufts University, and her colleagues. "High-intensity strength training exercises are an effective and feasible means to preserve bone density while improving muscle mass, strength and balance," the study found.

Physicians typically schedule a bone-mass measurement test to establish a baseline for bone density when a woman is entering menopause. This is important because estrogen, among other functions, stimulates bone-building osteoblasts and suppresses bone- dissolving osteoclasts. As estrogen levels decline, the balance tips towards the bone-destroying osteoclasts. By establishing a baseline, a physician can monitor bone mineral density more effectively.

Some bone-density machines measure hip, spine and whole body, and others are designed to measure peripheral bones such as wrist, finger, shinbone and the heel of the foot. They typically require only that you lie or sit down, depending on the type of machine recommended for you.

Testing will let you know what shape your bones are in. Then it's up to you to get the calcium, vitamins and exercise to keep them strong.

Resources
"Strong Women, Strong Bones," by Miriam E. Nelson, Ph.D. (Perigee, 2000, $14.95)

"Ageless Spine, Lasting Health," by Kathleen Porter (Synergy Books, 2006, $24.95)

"Physical Activity and Bone Health," by Karim Khan (Human Kinetics, 2001, $69)

National Osteoporosis Foundation, 800-223-9994

Linda J. Buch is a certified fitness trainer in Denver; linda@LJbalance.com

Source: http://www.denverpost.com/fitness/ci_8411857

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Childhood Arthritis Raises Risk Of Broken Bones

Childhood arthritis increases the risk of fractures, particularly during adolescence, according to a large study of British patient records. The researchers say that more targeted treatments promoting bone health would benefit patients with childhood-onset arthritis throughout their lifespan.

In addition to raising the risk of fracture during childhood, the researchers also found that childhood-onset arthritis potentially heightens fracture risk after age 45.

A research team led by pediatric rheumatologist Jon M. Burnham, M.D., of The Children's Hospital of Philadelphia and the University of Pennsylvania, analyzed the medical records of 1,959 patients in the United Kingdom who first experienced arthritis between ages one and 19. The researchers compared those patients to a larger control group of 207,000 patients in a primary care database.

The study appeared online in the Annals of the Rheumatic Diseases on April 21. It was the first research to examine, in a population-based study, the risk of fractures in childhood arthritis patients.

Juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis, is the most common pediatric rheumatic disease, affecting approximately one in 1,000 U.S. children. It was already known that low bone mass occurs in patients with JIA, because of risk factors such as chronic inflammation, delayed puberty, malnutrition, weakness, inactivity and treatment with steroid medications.

"The goal of this study was to determine if the bone abnormalities seen in JIA are clinically significant, resulting in higher fracture rates, and that is exactly what we found," said Dr. Burnham. "The low bone mass in JIA is associated with skeletal fragility, and causes both short-term and long-term health problems. Someone who fails to attain peak bone mass during adolescence and young adulthood is more vulnerable to fractures in later life, when bone mass inexorably declines."

Fractures are not unusual in healthy, active children, and the researchers compared the records of patients who had juvenile-onset arthritis with those of control subjects. Their data source was the United Kingdom General Practice Research Database, representing primary care records from 1987 to 2002.

The researchers found that 6.7 percent of patients with JIA sustained first fractures, compared to 3.3 percent of control subjects with first fractures, during an average follow-up period of four years. The comparative risk for patients with arthritis was highest at ages 10 to 15 and peaked again after age 45. Patients with arthritis were significantly more likely than controls to suffer fractures in their arm and leg bones.

Dr. Burnham added that the study findings should encourage physicians caring for children with arthritis to more closely monitor their patients for signs of osteoporosis, and to focus on nutritional steps that promote bone health, such as increasing regular intake of calcium and vitamin D.

Because bone health is affected by a combination of factors, including inflammation, inactivity, delayed puberty, impaired nutrition and the use of steroid medications, he added, further studies should concentrate on determining how JIA interacts with these risk factors, and how specific therapies might benefit JIA patients. Dr. Burnham is currently leading multidisciplinary research on bone and muscle strength in JIA and other inflammatory diseases.

Source: http://www.medicalnewstoday.com/articles/43062.php

Do broken hearts lead to broken bones?

OBJECTIVE: Mental distress may entail increased risk of hip fracture, but it is uncertain whether the effect consists solely of an indirect effect through use of medication, or whether it is also mediated through other mechanism. The purpose of this study was to examine the association between mental distress and risk of hip fracture in women, adjusted for medication (that is, use of tranquillisers/sedatives or hypnotics).

DESIGN: A three year follow up of hip fracture was conducted on 18,612 women, consisting of 92.5% of all women aged 50 years or older in a Norwegian county. Three hundred and twenty nine suffered a hip fracture. A mental distress index was based on questions about life dissatisfaction, nervousness, loneliness, sleep disorders, troubled and uneasy feelings, depression and impairment attributable to psychological complaints. Relative risk with 95% confidence intervals (CI) of hip fracture with respect to mental distress were controlled for medication, age, body mass index (BMI), smoking, physical inactivity, and physical illness by means of Cox regression.

RESULTS: The 10% of women with the highest mental distress had more than twofold increased risk of hip fracture compared with the 10% of women with the lowest mental distress, after adjustment for age and medication. The relative risk was 1.95 (95% CI 1.2, 3.3) after additional control for BMI, smoking, physical inactivity, and physical illness. The relative risk of hip fracture for daily users of medication compared with never users was 2.1 (95% CI 1.6, 2.9). After adjusting for mental distress it was 1.5 (95% CI 1.0, 2.2).

CONCLUSIONS: Risk of hip fracture was positively related to mental distress, also after adjustment for medication use. The effect of tranquillisers/sedatives or hypnotics on hip fracture risk may be overestimated in studies with no adjustments for mental distress.

Source: http://jech.bmj.com/cgi/content/abstract/53/6/343

Male exercise reduces broken bone chances later in life

Bone fractures and other bone problems later in life can lead to dire consequences. After all, limiting mobility later in life is not a good thing from a physical and psychological perspective. Can it be prevented? Calcium intake and eating the right way can surely enhance bone density and help prevents these kinds of problems.

While much of the attention goes to women and possible causes of osteoporosis, I don't hear that much about men and possible bone problems later in life. But, osteoporosis can happen to men as well. But, just like with women, there are ways to prevent it.

The solution? Get regular doses of exercise throughout your early life. Prepare those bones and muscles to be as strong as possible for later in life as a result, and perhaps you won't have to deal with something as life-changing as a hip replacement.

Source: http://www.thatsfit.com/2007/06/19/male-exercise-reduces-broken-bone-chances-later-in-life/

Bone group in plea for help

A SUPPORT group is calling for dedicated facilities in York for sufferers of a bone deteriorating disease.

The appeal comes after one woman said she had to wait four years before being given a vital scan.

Pauline Bartle, who has osteoporosis, said that before she had the DEXA scan - used to measure bone density - she was put on the wrong medication and her condition deteriorated.

Enid Webster, of the York Support Group of the National Osteoporosis Society, said the group was pushing for a scanner at York Hospital.

Enid, 78, of Osbaldwick, said: "Many members have been advised a scan is only available privately at the Nuffield Hospital, in York, or through a referral from a hospital consultant which they say is difficult to get.

"We do have problems with different doctors giving out different advice. The procedures need to be made clear to everyone to prevent any patients suffering unnecessarily."

The group is also pushing for a specific osteoporosis consultant at the hospital rather than being treated by consultants from related disciplines.

Pauline, 71, of Hull Road said: "I was put a drug to treat osteoporosis and I was advised by my GP that in three years time I should go for a scan.

"When the three years came up, I returned to my doctor and was told I could not have the scan because the service had been removed under the PCT.

"It was only with the help of the York osteoporosis support group that meant I kept on pushing for the scan that I eventually got one through a hospital consultant.

"After I had the scan the results showed that my condition had deteriorated and I had three fractured vertebrae, rather than two as before.

"I think it is 100 per cent imperative that everyone who needs it is given the option to have a scan at York Hospital and they should be referred by their GP."

Dr Geddes for the North Yorkshire and York NHS Primary Care Trust said: "I cannot comment on a particular case but while there is not a scanner at York hospital, patients at risk of osteoporosis can be referred by their GP to the Nuffield Hospital for a scan.

Dr Ian Woods, medical director at York Hospital said: "It would be unusual for a hospital this size to have its own osteoporosis specialist because osteoporosis shows itself in many different ways.

"It may become clear from someone who has broken a bone, or someone taking hormone replacement therapy, or from a problem with a person's metabolism.

"Because it can come up as a condition in many different areas of the hospital, its treatment is covered by people such as orthopaedics, dieticians, and occupational therapists."

What is osteoporosis?

Osteoporosis is a condition that affects the bones, causing them to become thin and weak. It happens more commonly in old age when the body becomes less able to replace worn out bone.

In some cases osteoporosis can be severe. About three million people in the UK have osteoporosis and there are over 230,000 fractures every year as a result.

Source: http://www.yorkpress.co.uk/news/yorknews/display.var.1588733.0.bone_group_in_plea_for_help.php

Diagnosing Osteoporosis - Solving The Broken Bones Mystery

Osteoporosis can occur when there is a loss of bone density and strength due to a variety of factors.

Osteoporosis may be related to aging, certain types of medications, or other health related conditions. A diagnosis of osteoporosis is often made while diagnosing a fracture.

It is important that osteoporosis is diagnosed early so that accurate and aggressive treatment management can occur in order to reach the best outcome.

Not only the financial cost but the health costs associated with a missed diagnosis of or even an inaccurate diagnosis of osteoporosis can be very high. The health consequences associated with an inaccurate or omitted diagnosis of osteoporosis can be seen for years to come.

When initially diagnosed saying osteoporosis, your physician must make the determination of whether the osteoporosis is a primary or secondary diagnosis. Primary osteoporosis means it that the diagnosis is a stand-alone diagnosis, meaning that there is no other health issue that is causing it.

However, with a secondary diagnosis of osteoporosis this means that there is another health condition which is causing the osteoporosis. Some other health conditions which can lead to a secondary diagnosis of osteoporosis include conditions such as multiple myeloma, lymphoma, diabetes, Cushing's disease, hyperthyroidism, osteogenesis imperfecta, and even Marfan's syndrome.

The best medical test on today's market for diagnosing osteoporosis is the DEXA scan. Considered the gold standard by many healthcare providers, the DEXA scan is completely painless for patients and only takes about 10 minutes to perform. The scan uses limited amounts of radiation to scan the bones of the wrist, the spine or the hip to assess general bone density.

This can help your physician to make a definitive diagnosis of osteoporosis as well as help your physician to determine if compared to others in your age and gender control group you have a higher risk of developing an osteoporosis related fracture.

Diagnosing osteoporosis is a fairly straightforward procedure that your general healthcare provider can handle. But even though it is an easy diagnosis to make, it is one that is critical to your overall health.

So as you age and particularly if you are female or if you have other health conditions that put you at risk for osteoporosis, make sure that you work closely with your physician to make sure that you are appropriately screened for osteoporosis.

Diagnosing osteoporosis is one diagnosis that you can't afford for your healthcare provider to miss.

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