How To Have Healthy Bones

As I said before, I am simply exploring how to be healthy and I want to start with our bones. By exploring I mean that I shall be looking at the views and opinions of the experts and I shall also include the experiences and stories of people who have issues with their bones.
This section deals with the most important element of our body - the framework that holds the muscles, flesh and vital organs together. So it is of paramount importance that we have optimum bone health.

When we discuss exercise most individuals immediately think of losing fat and toning or gaining muscle. It is true that with regular exercise you will lose inches and gain strength in muscles but the importance of exercise on a regular basis really offers many more important health benefits then being able to fit into your skinny jeans or being able to flex an impressive looking bicep.

Another extremely important benefit from exercise which is often over looked until problems begin to occur is bone health. Most individuals do not give their bones much thought until they or a loved one is face with the reality of failing bones which can be detrimental because it will ultimately lead to immobility.

All of us reached our maximum bone mass in our twenties and if prevention is not a focus it is down hill from that point on. The important thing to remember is it is never to late to start.

Although there has been a focus on women's bone health in recent years with the discussion of osteoporosis men are not immune to the adverse affects of bone loss. Women are prone to increased bone loss or osteoporosis during and after menopause caused by the loss of estrogen; at the same time men as they age will also experience increased bone loss associated with the loss of testosterone. Although women in general are more prone to bone disorders such as osteoporosis men are by no means off the hook.

With that being said most bone loss actually occurs from disuse atrophy. Bone tissue is the same as any other tissue in the body; if you do not use it you will lose it. Your body does not waste energy maintaining something that is deemed important or necessary such as muscle or bone that is not worked. It is also important to recognize that the loss of muscle directly affects the health of your bones.

Maintaining lean muscle mass is essential to keeping our bones healthy because this lean muscle puts good stress on our bones that in turn causes them to strengthen or in other words signals the body that our bones are important and need to be maintained. The best way to do this is to incorporate resistance training into your life two or three times a week.

Weight training does fall into the resistance training category however if lifting weights does not appeal to you there are many different options that can be done inside or outside of your home. Resistance training includes any activity that works and strengthens your muscles which in turn put the much needed stress on your bones. The possibilities are endless your workout can include any of the following: Pilates, using resistance bands, using the now popular exercise ball, yoga or simply using your own body weight. Try doing a lunge or yoga pose; when you do you will see that you do not need a fancy gym or tons of equipment to get a workout. The important thing is to find an activity or activities that you enjoy, embrace it and make it a part of your life.

Other important steps that you need to take in order to ensure you have healthy bones are; quit smoking, avoid excess drinking and ensure you are getting adequate amounts of calcium, vitamin D and vitamin K2 in your diet. You are not getting your daily requirements of the necessary mineral and vitamins then take supplements.

Healthy bones are not always our top priority but by making a few changes to our lifestyle we can help assure we will not only live longer but can enjoy independence and mobility far into our twilight years.


Saturday, December 12, 2009

Drugs For Osteoporosis


Drugs for osteoporosis
The Doctor Says
By MILTON LUM


Various drugs are used to treat and manage osteoporosis.
BISPHOSPHONATES reduce the activity of cells that cause bone loss with little or no effect on cells that build up bone. They are effective in preventing and treating osteoporosis. They are taken on an empty stomach with plain water only daily or once a week. One should not take mineral water, coffee, tea, juice or dairy products before taking the tablet, which should be swallowed and not chewed or sucked.
If there is chest pain, heartburn, difficult or painful swallowing, one should stop taking the tablet and consult the doctor. Other side effects include abdominal discomfort, nausea, vomiting, diarrhoea, constipation, gas, headache and muscle, bone, or joint aches.
Bisphosphonates are not suitable for those who have problems in the oesophagus, kidneys that are not functioning well, low or high levels of blood calcium, cannot stay in an upright position for at least 30 minutes or are allergic to it.
•Risedronate is used to prevent and treat osteoporosis in women after menopause as well as women and men who are starting or continuing steroids for chronic medical conditions. It increases bone density and reduces the risk of spinal and non-spinal fractures. It helps preserve bone micro-architecture, provides sustained spinal fracture reduction over five years and reduces non-spinal fractures significantly over three years.
•Alendronate is used to prevent or treat osteoporosis in women after menopause, increase bone mass in men with osteoporosis and to treat women and men who are taking steroids. It increases bone density in both the spine and hip. There are reports that a combination of alendronate and oestrogen is more effective than either taken separately. Side effects are generally mild.
•Ibandronate is used to treat and prevent osteoporosis in women after menopause. It increases bone density in the spine and hip, and reduces the risk of spine fractures. It is available in a daily, monthly or three monthly dose. Side effects are generally mild.
•Etidronate is a bisphosphonate used to treat and prevent osteoporosis in women after menopause. It increases bone density at the lumbar spine and hip, and reduces the incidence risk of spine and hip fractures. The dose is daily for two weeks every three months. Continuous daily use will result in demineralisation.
Selective Oestrogen Receptor Modulators (SERMs)
These compounds bind to oestrogen receptors and bring about an oestrogen-like (agonist) effect in some tissues and an oestrogen-blocking (antagonist) effect in other tissues. There are two main types of oestrogen receptors. Each SERM binds the receptor in a unique configuration and depending on the tissue which the SERM binds to the receptor, it either blocks or activates its function. SERMs have no beneficial effect on menopausal symptoms while its effects on brain function are not yet known.
They are only prescribed after menopause and to those with few or no menopausal symptoms. It is unknown whether a combination of hormone and a SERM provides any advantage or loss of an individual effect, and their combined use is not recommended.
Raloxifene is a second generation SERM that mimics the oestrogen effects on bones but does not have oestrogen’s effects on the breast or uterus. It prevents bone loss, has beneficial effects on bone mass and reduces the risk of spine fractures. It is most suitable for osteopenic or osteoporotic women, who have breast or uterine problems, concerns about hormones or no major menopausal symptoms. It is taken once daily. It has a small increased risk of thromboembolism (VTE) similar to oral oestrogen. However, no cases of VTE have been reported in postmenopausal Asian women on raloxifene.
Calcitonin
This hormone is involved in calcium regulation and bone metabolism. It is taken as a single daily nasal spray or as an injection under the skin. In women who are at least five years postmenopausal, it slows bone loss and increases spinal bone density. Some patients also report pain relief from bone fractures. Injected calcitonin may cause an allergic reaction, flushing of the face and hands, nausea, increased urinary frequency and skin rash. The side effects are a runny nose and other signs of nasal irritation.
Strontium Ranelate
This compound has a novel action as it increases bone formation and at the same time reduces bone loss. It is used for treating postmenopausal osteoporosis and reduces the risk of spinal and non-spinal fractures. In addition, strontium ranelate has demonstrated reduction in fracture risk in a wide range of patients, from those with mild osteoporosis (osteopenia) to those above 80 years, regardless of severity of the condition. It is taken daily with a glass of water. The common side effects are nausea and diarrhoea.
Parathyroid hormone
Parathyroid hormone and its analogue teriparatide, which is a recombinant human parathyroid hormone, increases bone turnover, stimulating bone formation to a greater extent than bone loss. It increases bone density in the spine and hip and reduces the risk of spinal fractures significantly. It is used to treat individuals with severe osteoporosis especially after a fracture. Most doctors stop the bisphosphonates before starting teriparatide.
It is given as a subcutaneous injection daily. The common side effects include pain in a limb, anaemia, depression, vertigo, nausea, dizziness and muscle cramps. It cannot be given to those who have prior radiation to the skeleton, bone cancers and metabolic bone conditions other than osteoporosis.
Managing osteoporotic fractures
Surgery is used early in most instances today as conservative treatment results in myriad problems such as respiratory problems, thromboembolism, pressure ulcers, additional bone loss.
The majority of osteoporotic spinal fractures are stable. Operative treatment is carried out if there is spinal cord or nerve root compression. It may be used in chronic backache and progressive spinal deformities. Supportive braces may be used temporarily.
The relief of spinal pain can be problematic. Narcotic analgesics may be needed. Calcitonin is useful in providing pain relief. Physiotherapy and a brace can provide significant pain relief. Healing can be aided by adequate intakes of calcium, vitamin D and protein. Parathyroid hormone is prescribed in severe osteoporosis especially after a fracture.
Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

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