May 21, 2008 > Arthritis and Osteoporosis Awareness Month: Caring for Your Joints and Bones
Arthritis and Osteoporosis Awareness Month: Caring for Your Joints and Bones
As we age, it's not uncommon to experience more aches and pains in our joints. It's also a fact that our bones become more prone to fractures. The culprits behind these two problems? Arthritis and osteoporosis.
The word "arthritis" comes from the Greek word arthron, which means "joint," and arthritis literally means joint inflammation. "There are actually more than 100 different types of arthritis," says Dr. Barry Shibuya, a rheumatologist at Washington Hospital who specializes in the treatment of arthritis and osteoporosis. "The two main types of arthritis are osteoarthritis - often called 'wear and tear arthritis' - and rheumatoid, or 'inflammatory,' arthritis. Both of them are chronic conditions that cause pain, stiffness, loss of movement and perhaps deformity of the affected joints."
The term "osteoporosis" is derived from the Greek words for bone (osteon) and passage (poros). "Osteoporosis is a disease in which the bones become extremely porous, which causes them to become progressively more brittle," Dr. Shibuya explains. "Osteoporosis generally has no symptoms. Oftentimes, people are not even aware they have osteoporosis until a bone breaks."
The Centers for Disease Control and Prevention (CDC) estimates that 27 million Americans have osteoarthritis, 1.3 million have rheumatoid arthritis, and more than 28 million Americans have osteoporosis. While those numbers are sobering, the good news is that these diseases can often be managed with lifestyle changes and medications.
Osteoarthritis results from the breakdown of cartilage in the joints that cushions the ends of the bones. This breakdown of cartilage causes the bones to rub against each other. The joints most commonly affected by osteoarthritis are found in the neck, lower back, hips, knees and hands.
"There isn't any single known cause of osteoarthritis, but there are various risk factors associated with the condition, including age, joint injury or overuse, muscle weakness, and genetic predisposition," Dr. Shibuya says. "A diagnosis of osteoporosis is based on a clinical exam, along with blood tests and X-rays to rule out inflammatory rheumatoid arthritis or other causes of the pain such as a fracture or bone cancer."
Just as there is no known cause for osteoarthritis, there also is no known cure.
"The goal of treatment for osteoarthritis is to reduce pain and improve the patient's ability to function in daily activities," says Dr. Shibuya. "Treatment often includes recommendations for exercise, weight control and joint protection, as well as physical and occupational therapy.
"There also are a variety of medications that can ease the symptoms," he adds, "including pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, and Cox-2 inhibitors such as Celebrex that are safer on the stomach than NSAIDs. Because some previous Cox-2 drugs raised concerns about increased risks of cardiovascular problems, you should always talk with your physician about the risks and benefits of any medications."
While some patients believe that glucosamine and chondroitin sulfate supplements help alleviate their arthritis symptoms, Dr. Shibuya notes they may not work for most people. "Two large studies by the National Institutes for Health didn't show any significant benefit," he explains. "However, it might be more helpful in mild cases than in people with severe osteoarthritis. I tell patients that if they think it helps and their bodies tolerate the supplements, to go ahead and take them."
The cause of inflammatory rheumatoid arthritis also is unknown, but there are several theories. "It is generally believed that rheumatoid arthritis is related to abnormal activity of the immune system," says Dr. Shibuya. "Also, there may be some genetic predisposition, and it is more common in women than men by a ratio of 3 to 1. We don't know what triggers the onset of rheumatoid arthritis in a given individual - it could be an infection, stress, hormones, or some other factor."
Rheumatoid arthritis generally causes joint pain, swelling and stiffness in the fingers, wrist, feet and ankles. It also may produce fatigue and flu-like symptoms including a low-grade fever. Diagnosing the problem entails evaluating the patient's medical history and conducting a physical exam, lab tests and X-rays.
"There is a blood test for rheumatoid factor (RF), but the test alone is not conclusive," Dr. Shibuya notes. "Other lab tests can help rule out other conditions that can cause a false-positive RF test, such as viral hepatitis."
Treatment of rheumatoid arthritis symptoms can involve some of the same medications used for osteoarthritis. In addition, a category of medications called disease modifying anti-rheumatic drugs (DMARDs) may be prescribed.
"DMARD medications interfere with the long-term damaging effects of the disease," he explains. "For example, methotrexate can help prevent future bone damage. Also, glucocorticoids or prednisone may be prescribed in low doses to slow joint damage caused by inflammation."
"There are approximately 1.5 million bone fractures each year due to osteoporosis, primarily of the vertebrae in the back, of the hip or the wrist," Dr. Shibuya says. "That's why it is so important for people to learn how to prevent osteoporosis and to have screenings for bone density. In many cases, early intervention and treatment can make a big difference."
There are many imaging technologies available to evaluate bone density, including ultrasound, CT scans and MRI, but the "gold standard" for bone-density testing is dual-energy X-ray absorptiometry - or DEXA. "DEXA screening is generally performed on the hip and the spine, where bone loss can be detected in the early stages," he says. "DEXA can also help diagnose osteopenia, where bone density is lower than normal, but not low enough to be classified as osteoporosis. A person with osteopenia has a greater risk of developing osteoporosis."
In addition to imaging studies, physicians may conduct blood tests to help evaluate secondary causes of osteoporosis such as medications that contribute to bone loss. Blood tests also can detect Vitamin D deficiencies that result in insufficient absorption of calcium, which is crucial to bone strength.
For people with osteoporosis, there are a variety of treatment options, including:
* Calcium and Vitamin D supplements.
* Estrogen-like medications such as Evista that help decrease the rate of bone resorption.
* Bisphosphonates such as Fosamax, Actonel and Boniva that slow the activity of "bone-eating" cells.
* The anabolic agent Forteo, which stimulates bone-forming cells.
In addition to medical interventions, fall prevention is another aspect of care for people with osteoporosis. "It's important for people with osteoporosis to eliminate hazards around the home that could cause a fall because most fractures result from thin bones and a fall," Dr. Shibuya advises.
Women's Center Lecture on Caring for Your Bones
If you or someone in your family is concerned about osteoporosis, you should plan to attend a special evening lecture by rheumatologist Dr. Barry Shibuya on Tuesday, June 17 from 6:30 to 8 p.m. at the Washington Women's Center. He will discuss various ways you can protect and nurture your bones and prevent fractures.
Dr. Shibuya will review how to use the new "Fracture Risk Calculator," which incorporates all of your risk factors in addition to your bone density T-score. "Most fractures occur in patients with osteopenia - those who have a T-score between -1.0 and -2.5," he says. "By using the Fracture Risk Calculator, we will be better able to predict which patients with osteopenia should be treated to prevent fractures."
If you have a copy of your bone density test, please bring it with you to the lecture.
The Women's Center is located at 2500 Mowry Avenue, across the street from Washington Hospital. To register or to obtain more information about the Women's Center programs such as the monthly Evening Lecture Series for Women and a variety of special events and support groups, call (510) 608-1356. Or you can visit the Washington Hospital website at www.whhs.com, click on the link for Women's Health under "Programs and Services," and then click the link for Wellness Classes and Services.