FAQ Category: General

The link between corticosteroids and bone loss leading to osteoporosis and fracture risk is complex. The mechanisms behind bone formation and bone resorption when taking steroids remains complex and are not fully understood.

Lab studies show that patients taking corticosteroids start to have less calcium in their bloodstream. At the same time, there is a disruption in the body’s vitamin D activation. The kidneys help keep the right amount of calcium in the body by resorbing some of the calcium from the blood stream. But this is changed, too.

With changes in the amount of available serum calcium and the altered vitamin D, the gastrointestinal (GI) system is unable to absorb calcim needed for bone production. The end-result is a loss of bone mineral density.

Further bone loss occurs when low serum calcium levels lead to hyperparathyroidism. The hyperparathyroidism acts in the body to cause even more bone resorption. Without medical intervention, it can be a vicious cycle.

You may have to call the sponsoring clinic or agency to find out what their requirements are for free screenings. It may have to do with whether or not you have ever had testing done before, your age, and if you are pre- or postmenopausal. There are several groups who recommend all women over the age of 65 should be screened for osteoporosis.

Screening involves assessing risk factors and personal/family history and testing bone density. General risk factors include sex (women are at greater risk than men), age (increasing age increases risk), cigarette smoking, alcohol abuse, and being tall or underweight.

More specific risk factors include hip fracture in a parent, postmenopausal status, and personal history of a fragility fracture.

Screening technologies such as dual-energy X-ray absorptiometry (DXA) scanning are also useful in the screening process. Studies have been done to identify normal bone density at various ages based on height and weight. Your bone density score would be compared to these norms. A range of scores has been determined to help you know if you have osteoporosis or are at risk for osteoporosis.

The DXA measures bone density throughout the entire body. Some scans are just done of the heel or wrist. Most health fairs do not offer the full body scan. If the scan of your heel or wrist is low, you will probably be referred to your primary care physician for a more thorough screening test.

Bisphosphonates such as Fosamax, Actonel, andBoniva are agents that prevent bone resorption. Bone resorption is the process by which bone is broken down. In the process minerals are released and calcium is transferred from the bone into the blood.

In postmenopausal women, the lack of estrogen results in an increase in bone resorption. This can lead to osteoporosis (decreased bone density) and bone fractures. Bisphosphonates are the first-line of pharmacologic (drug) treatment for osteoporosis.

All drugs have potential side effects. Bisphosphonates can cause severe bone, muscle, and joint pain. In a small number of cases, bisphosphonates have been linked to osteonecrosis (death of bone) in the jaw.

Many people have assumed that anyone on a bisphosphonate is at risk for jaw osteonecrosis. This simply isn’t true. Patients at increased risk for jaw osteonecrosis are cancer patients receiving intravenous bisphosphonates. It is a very rare adverse event but one to be aware of.

Other possible side effects of bisphosphonates include GI upset such as esophagitis, difficulty swallowing, or gastric ulcers. The risk of GI involvement can be decreased by taking the pill first thing in the morning (or day) with a full eight-ounce glass of water away from food or other drinks. Patients are advised to remain in an upright position (standing or sitting) for at least one-half hour after taking the drug.

If you are immobilized for any reason and cannot follow these directions, some other antiresorptive drug may be better for you. Your doctor will be able to advise you what’s best given your health information and DXA scores.

A recent study of healthy males estimated a 15 percent reduction in forces on the buttocks when falling onto 4.5 cm. closed cell foam. This may be enough to lower the threshold for fracture. The reduction in force was 20 percent for 7.5cm foam, and 24 percent with 10.5 cm thickness foam padding.

It’s very likely that your mother has what is called limited joint mobility or LMJ. This could be mistaken for arthritis if you’re looking at her hands and how she is limited as to how she can bend her fingers. However, this is a different issue. In LMJ, there doesn’t seem to be pain, just the inability to straighten out the fingers as much as before. For example, if someone without LMJ or any joint problems puts their hand palm down flat on a table, their fingers would naturally spread out as the hand goes flat. For someone with LMJ, if they put their hand flat, their fingers won’t spread out and they can’t put their fingers and palm on the table at the same time.

When a patient receives a joint replacement, either the hips, knees, or even fingers, there are some problems or complications may result. The effectiveness of the replacements depend on several things, including the type of replacement, surgical technique, patients’ health, and patients’ activity after surgery.

The complications that can happen include the types that may occur after any type of surgery, including infections. But with replacements, the biggest issue is if the replacement can hold and not break down, which will then mean that a revision surgery is needed.

Traditional surgery involves making an incision big enough for a surgeon to see inside the body and to manipulate the instruments needed to perform the task. While this allows for a good view of the area being worked on, open surgery incisions can be quite large and require more time and care for healing.

Arthroscopic surgery involves making a few tiny incisions, perhaps only a few centimeters long, and using long slender instruments and a camera to see inside the body. The surgeon inserts the instruments and the camera and performs the surgery without putting his or her hands inside the body. The advantages to this type of surgery include faster healing time because the incisions aren’t as large and the inside of the body has not been handled and manipulated as much as they would be with a traditional open surgery.

Arthroscopic surgery, which involves making a few tiny incisions, perhaps only a few centimeters long, and using long slender instruments and a camera to see inside the body, has many advantages over traditional open surgery where a large incision is made and the surgeon reaches inside to perform the repair. However, some surgeries are on too big a scale for arthroscopy and some do not have the same results, open surgery is more effective.

When a surgeon is deciding how to approach a surgery, he or she will take many things into consideration. For example, removing an appendix is done very frequently using arthroscopic surgery. However, if the appendix is threatening to burst or has burst, it must be removed using an open technique because of the work involved in ensuring every thing has been taken care of properly.

While both rheumatoid arthritis (RA) and osteoarthritis (OA) affect the joints, there isn’t much more similarity. RA is the type that most people seem to be familiar with. This type of arthritis results in joints becoming red, warm to touch and eventually deformed. This is caused by inflammation inside the joints, particularly the hands. OA, on the other hand, is called the wear-and-tear arthritis or degenerative arthritis. It’s usually the weight-bearing joints, like the knees, hips, and even back, that develop OA. In OA, the cartilage, tough elastic material that covers and protects the bones, breaks down. Bits of cartilage may break off, causing pain and swelling in the joint. Eventually, the cushioning material may break down completely and bone may start rubbing on bone.

While it may seem like an easy fix, a joint replacement is not always the right answer to the pain and disability of arthritis. When joints are replaced, surgeons take into account the condition of the joint, the bones that will have to hold the replacement, the overall health of the joints near the affected joint, and previous history of the joint.

The other issue is that a joint replacement is major surgery with all the potential risks and complications. Surgeons have to ensure that patients are healthy enough to withstand going under anesthetic, as well as the surgery and the recovery and rehabilitation. Complications from replacements can include infection and failure of the replacement.

Osteoporosis prevention begins early in life. Building good bones at a young age is extremely important. Getting adequate nutrition and exercise is a key to putting bone cells in the bank so to speak.

The National Osteoporosis Foundation (NOF) offers some important guidelines for all ages regarding calcium and vitamin D intake. The first source of calcium is from calcium-rich foods such as dairy products and dark green, leafy vegetables. Taking a supplement is just that — it’s supposed to supplement what we don’t get in our diet.

A major source of Vitamin D is sunshine. Spending at least 10 minutes everyday in the sun (longer if sunscreen is used) is recommended. Vitamin D helps calcium absorption and bone formation. A vitamin D supplement is essential for those who live in northern areas where sunlight is limited, especially in the winter.

Some calcium supplements come with vitamin D so be sure to read the label to get the right amount for your age and sex. Experts recommend 1200 mg/d of calcium and 800 to 1,000 IU/d of vitamin D for adults age 50 and older. These values are slightly different for children up to age 17, young adults, women in the childbearing years, and postmenopausal women.

Exercise is also important. The American College of Sports Medicine has published a Position Stand on physical activity and health. Type of exercise, frequency, intensity, and duration are advised based on age (children and teens versus adults).

High intensity exercise is needed for bone loading. Weight training and weight bearing activities are best. Regular exercise is required to maintain results. This means at least three times per week (five to seven times each week is best) for at least 10 minutes per session (more is definitely better).

The best way to test for osteoporosis is a special test called dual-energy X-ray absorptiometry (DEXA). This test measures bone mineral density (bone mass). Computer software can use the T-score generated by the DEXA and calculate a person’s fracture risk in seconds. The physician uses this information to counsel patients and advise when to take osteoporosis medication.

Osteoporosis is a fairly silent disease. It may not be evident until a fracture occurs. In some cases, loss of height or forward curvature of the spine is a sign of decreased bone density.

However, it is possible to look at risk factors and predict fracture risk and even risk for osteoporosis. Anyone at risk should have a baseline study done. This will help him or her see any changes that might occur in the future and seek treatment sooner than later.

Some of the nonmodifiable risks (things you can’t change) include age, ethnicity (Caucasians and Asians have a higher risk), family history of osteoporosis, and menopause. Long periods of inactivity or immobilization can also result in loss of bone density.

Modifiable risk factors include excess intake of alcohol, tobacco, or caffeine. Certain drugs such as blood thinners, antiinflammatories, and antiseizure meds are risk factors. Diet and nutrition is a leading cause of calcium and magnesium deficiency leading to osteoporosis.

For men around age 50, a review of risks and DEXA testing is a good idea. This should be updated at an annual medical exam.

Sleep labs have shown conclusively that sleep deprivation creates all kinds of problems in humans. Depression, increased pain, daytime sleepiness, and disturbed body functions are just a few of the things that can go wrong with too little nighttime sleep.

Interestingly, they also found that too much sleep can raise daily pain levels as well. So, how much is too much or too little? According to one study less than six hours or more than nine hours of sleep in any given night will result in increased pain the next day.

In their study, they found that the amount of sleep one night could even predict rising rates of pain the next day. But there were other factors to consider. The presence of other mental health issues and emotional disorders also interfered with sleep and pain. The use of prescription medications is another risk factor for poor sleep.

Most experts agree that between seven and nine hours of sleep is really needed by most humans. Many people claim that isn’t true for them — they really only require four to five hours sleep. Humans can get on without adequate sleep in the short-term but over the long-term the effects of sleep deprivation start to show up.

Myofascial pain syndrome (MPS) is an overuse or muscle stress syndrome. MPS is diagnosed by the presence of myofascial trigger points (TrPs). These are irritable spots within a tight band of muscle.

When pressing any of these points, a typical pattern of local and referred pain occurs. Referred pain means pain develops at quite a distance from the points of local tenderness.

The examiner may also feel a ropelike area within a muscle. Sometimes pressing on this nodule causes crackling or grating called crepitus. Inside the area in question, there may be fibrotic tissue present resembling a small pea. This spot is usually very, very tender spot.

Using the hands to feel the tissues is really the main diagnostic tool doctors and therapists use to identify TrPs. Besides reproducing the patient’s pain, palpation of the TrP can also cause a local twitch response. You and the examiner can see the muscle twitch causing some part of the anatomy (e.g., finger, wrist) to move involuntarily.

The same test method also causes a jump sign. When pressure is applied to the trigger point, the patient yells ouch and jumps away from the examiner. These two signs are usually present, observable, and reproducible in anyone with TrPs from MPS.

Besides the pain, there may be reduced range of motion for joints under the control of the involved muscle along with muscle weakness. The patient may report numbness or paresthesia rather than pain.

The absence of certain symptoms is also diagnostic. There are no neurologic abnormalities. Systemic signs and symptoms are absent (no fever, chills, nausea, vomiting, and so on).

There may be some changes in motor function caused by TrPs. These can include spasm of other muscles, weakness of the involved muscle function, loss of coordination by the involved muscle, and decreased work tolerance of the involved muscle.

All in all, the clinician begins with palpation as the main exam tool. But a global assessment is needed. This type of diagnostic eval includes patient report of pain and pain patterns and the presence of a local twitch response and/or the jump sign.

You may have pinpointed an active trigger point (TrP) in a muscle. What you are seeing is called a twitch response. Trigger points are described as hyperirritable spots in a muscle. They are accompanied by nodules you can feel in taut bands of muscle fibers.

These pea-sized nodules are said to be small knots of contracted tissue. In a constantly contracting muscle there isn’t the normal massaging contract-relax response. Waste products from cellular metabolism start to build up. Pain is the final result.

The local twitch response you’re seeing is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle contracting at one time and staying contracted. The local twitch response only involves a small twitch of the muscle – not a full contraction.

The mechanism of trigger points remains a matter of hot debate. Immobilization of muscles (e.g., in a cast or splint) and repetitive overuse seem to be two risk factors. With treatment, that twitch and the muscle pain can both be eliminated. A physical therapist can help you by treating the TrPs to eliminate the painful symptoms and the local twitch response you are having.

It’s not always clear what the true reason is for disability or loss of function in patients with osteoarthritis (OA). Sometimes their symptoms are much greater than might be expected for the degenerative changes seen on the X-rays.

In other cases, just the opposite happens: the X-rays show severe joint degeneration and the person is out kicking up his or her heels. Certainly, pain and loss of strength or decreased joint motion can keep some folks off the dance floor.

But studies show that it’s more than just the physical problems that lead to disability. Psychosocial, emotional, and mental factors play a role, too. But how these factors contribute to disability exactly remains a mystery. Research shows that it’s likely a combination of factors and not a single issue at all.

It’s always true that perceptions outweigh reality. It’s not so much what’s really happening as it is how the process is perceived by the person. Psychologic well-being, coping strategies, and quality of life are all important factors as well.

Educational level has been shown to be linked with both pain and physical function in patients with osteoarthritis (OA). People with higher levels of education seem to have lower pain levels. They also have increased levels of function compared to similar patients with lower levels of education.

One reason for this may be the difference between white collar workers (higher education level, less manual labor) and blue collar workers (lower education level and higher manual labor).

Other factors (unrelated to education) may be important. These could include the presence of other diseases, pain from knee OA, and life satisfaction. Another factor may be body mass index (BMI). For example, patients with higher body weight in proportion to body type don’t have more pain but they do have less function.

Decisions as to what type of cast to use for a broken arm depend on where in the arm the break is. Obviously, the upper arm will require a much larger cast than the wrist. However, there are times when a break closer to the wrist will still be treated with a longer cast.

The issue with casting is to keep the broken bone as stable as possible. If the break is in such a place that too much movement from the elbow may keep the break from healing, a decision will be made to use the longer cast.

Choosing the right size cast is important. The plaster casts are very heavy and if a long cast isn’t medically necessary, it shouldn’t be used because of the stress it can place on the nerves and muscles in the shoulders.

Tendons are very tough, fibrous tissues that connect muscle to bone, but they can become injured due to overuse or from a sudden trauma to the area.

Tendonitis, or tendinitis, is an overuse injury of the tendon. If a tendon is forced to do the same motions over and over again, it can develop irritation and inflammation that can cause enough pain to become disabling.

The most serious injury that can occur with a tendon is if it ruptures or tears. This can happen through sudden force (as with an Achilles tendon rupture) or from injury while lifting something heavy (triceps tendon injury).

Antibiotic beads have been available since 1974. They are used most often for bone and soft tissue infections. Applying antibiotic directly to the wound bed delivers higher concentrations of the drug.

In fact, this type of local application of antibiotic is 200 times more potent than oral (pill form) antibiotics. The patient gets the benefit of the anti-bacterial drug without systemic side effects (such as killing the natural, healthy bacteria in the gut).

The antibiotic is mixed with cement powder to form a smooth, soft paste-like dough. Some surgeons roll the substance by hand into a ball. They must work quickly to avoid too much exposure to the fumes. And the cement sets up quickly requiring fast formation of the beads.

The beads are placed inside the wound and left for two weeks. That’s about how long the bactericidal levels last. After four weeks, the body starts to see the beads as a foreign substance. The immune system mounts an attack to them. This reaction is avoided by removing or replacing the beads when needed.