Them Bones, Them Bones, Them Crazy Bones!
By Ronald Musto, MD, MPH
The foot bone’s connected to the leg bone’s connected to……well, you know the rest. Our skeleton – bones and joints – give us stability and mobility. Otherwise we’d be jellyfish! There are many bone and joint disorders but the commonest ones – osteoarthritis and osteoporosis – effect upwards of half the U.S. population. Osteoarthritis involves the loss of joint cartilage. (That’s the Teflon-like substance that lines our joints). A sixth of people younger than age 65 and a third of people older than 65 have symptoms of osteoarthritis. Osteoporosis is weakening of bone structure. A third of people (including women and men) have osteoporosis and more than a third of those will have one or more bone fractures as a result. The direct and indirect health care costs are tens of billions of dollars yearly.
Many factors lead to osteoarthritis and osteoporosis. Some we know and some we don’t. Some factors we can’t change (like age, gender and genetics). Here are the ones that are well within our control.
Adequate lifelong adequate calcium intake helps preserve bone strength. For adults, this means at least 1000 mg. daily of calcium. We get calcium from dark green leafy vegetables, low fat dairy products and from nuts. As we age it is often easier to take an over the counter calcium supplement. Vitamin D is also important. Fifteen minutes per day of sun exposure makes our body manufacture enough vitamin D but, again, as we age we often need a daily supplement containing 800-1000 vitamin D units.
Bones and joints are highly metabolic and they respond to activity – or lack of it. Activity is essential at every age. Children need more exercise than adults. Adults need at least 2-1/2 (preferably 5) hours, spread over the week, of moderate low impact aerobic exercise and two weekly sessions of strength training. Low impact aerobic activities include walking, swimming, biking, social dancing, conditioning machines, Tai Chi and Yoga. Strength activities include weight training and resistance bands. Inactivity just makes arthritis pain and bone fragility worse. You must use it or lose it!
Overweight contributes to both the cause and the disability of osteoarthritis – particularly in the hips and the knees. Achieving an ideal or at least a lower body mass both relieves pain and improves function.
Controlling pain sometimes requires medication so that you may be active with reasonable comfort. The first line of treatment involves non-prescription medications like acetaminophen taken as directed on the package label. Topical arthritis creams containing capsaicin or salicylate may also help. Glucosamine with chondroitin have been useful especially for knee arthritis. Non-steroidals (ibuprofen, naproxen) are helpful but should not be used without your doctor’s approval.
Finally, your doctor has additional suggestions for detecting and treating osteoporosis and osteoarthritis. Take care of your skeleton and it will take care of you. Make no bones about it!
Ronald V. Musto MD, MBA, MPH is certified by the American Board of Internal Medicine, the American Board of Preventive Medicine in Occupational Health and by the American Board of Independent Medical Examiners. Dr. Musto practices at Capital Healthcare Associates, 2001 Fifth Avenue, Troy, NY. For more information or to make an appointment, please call 274-9126 or visit www.communitycare.com. Capital Healthcare Associates is a member of Community Care Physicians, PC.