One of the normal consequences of aging is that our bones and joints wear out. The two processes that naturally occur are osteoporosis and osteoarthritis.  More than half of all Americans over age 65 show evidence of osteoarthritis in at least one joint, and more than half of Americans over age 50 have osteoporosis.

Osteoporosis — the "silent disease"
Although the number-one “silent disease” is high blood pressure, osteoporosis is an important silent disease affecting millions of Americans, especially older ones.  Osteoporosis is the gradual loss of calcium and bone that occurs over time beginning around age 40, greatly increasing in women at or around the time of menopause. By the time people reach their 70s, the rate of bone thinning in men equals women.

Bone is living tissue, and like most tissue, it dies and is replaced. However, as people age, tissue dies at a faster rate and does not have time to be fully replaced. As a result, bones become less dense and less strong each year. This bone loss leads to easy fractures, often alerting people for the first time of their osteoporosis.

People at greatest risk of osteoporosis are those who:

• have a family history of the disease
• have not gotten enough calcium throughout their lives
• had an early menopause
• had surgery to remove their ovaries
• had extended bed rest
• used certain medicines for a long time
• have small body frames

Approximately 10 million people have osteoporosis, and 80 percent of these people are women. Therefore, women more commonly suffer fractured hips, which may require hospitalization and surgery.

To test for this “silent disease,” ask your doctor for a bone density examination. This examination is performed by dual-energy x-ray absorptionmetry, commonly called DEXA-scan, which is a painless and quick diagnostic study. DEXA-scan can tell you and your physician if you have osteoporosis or osteopenia — an early form of osteoporosis.

Osteoporosis may be treatable and even preventable. Diet rich in calcium and vitamin D, as well as certain lifestyle routines, can help prevent osteoporosis. Calcium is in low-fat dairy foods, canned fish, green vegetables and calcium-fortified foods such as orange juice. Vitamin D comes from sun exposure and can be taken as a supplement. Consult with your doctor about how to get the right amount of calcium and vitamin D.

Exercise has been proven to prevent bone loss. Everyone who reads this column knows that weight bearing exercise at least three times a week is something I recommend for many diseases, and it is important in preventing or treating osteoporosis as well. Exercise can range from walking to much more strenuous forms of exercise including running or tennis. The important thing is to exercise regularly. 

Medicine can be prescribed for the prevention and treatment of osteoporosis. Ask your doctor if medicine is right for you. If bone density is restored or further loss prevented, the risk for bone fractures is reduced.

Osteoarthritis
Unlike osteoporosis, people who develop osteoarthritis know they have it because they have pain in their joints. The main three of approximately 100 forms of arthritis include rheumatoid, osteoarthritis and gout.

Osteoarthritis commonly leads to joint replacement surgery and is the most common type of arthritis in older people. It mostly affects the cartilage in and around the joints and usually affects one or more of the hands or large weight-bearing joints including knees and hips. Cartilage, which cushions the ends of bones within joints, doesn’t provide sufficient cushioning when it is worn down or calcified. In severe cases, the bones in the joint rub directly against each other.

Symptoms of osteoarthritis range from stiffness and mild pain that comes and goes to severe joint pain. Before age 45, it is more common in men, but by age 65, more than half of the population has x-ray evidence of osteoarthritis in at least one joint. Simple joint use is the most common cause, but over-use or injury may also cause osteoarthritis. 

Treatment of osteoarthritis is rest, gradual exercise, a well-balanced diet, and instruction on the right way to use joints. Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen are very helpful in controlling osteoarthritis, but they don’t cure it. Any over-the-counter or prescription drug should be discussed with your doctor since they all carry potentially serious side effects.

Glucosamine, a naturally occurring compound made by our bodies to stimulate and repair joint cartilage, is used by some arthritis sufferers. However, there are no definitive studies to prove that this dietary supplement affects the process of osteoarthritis. Some studies show that glucosamine can assist in the pain of osteoarthritis. This supplement is not regulated by the FDA, and its safety or contents cannot be guaranteed.

Joint replacement surgery may be indicated in serious cases of osteoporosis.

In next month’s Part II, we will learn about hip and knee replacement surgery. We also will learn about two problems that contribute to joint problems.

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