What should I tell my family about osteoporosis Will it curtail activities with them

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If you have been diagnosed with osteoporosis, you should definitely discuss the diagnosis with your partner. First, your partner should know if you are on any new medications, so he or she can help support you in following the new regimen and watch for reactions. Second, you and your partner should discuss how your lives might be affected by osteoporosis.

New medications can present some challenges to your schedule and that of your partner. If you are taking one of the bisphosphonates, you will need to establish the appropriate timing for taking your new medication. Sometimes, it's helpful for a partner or spouse to know that you must take the medication on first rising, to remain upright after taking it, and to avoid all other food, drink, and medication for at least 30 minutes to 2 hours. If your children are still living at home, they may help remind you as well. Sometimes, until the routine of taking certain medications gets ingrained in us, we may forget and take all of our medications at one time, which can cause serious side effects or reactions.

If your clinician has restricted your activity, discuss these restrictions with your partner or spouse. It is unlikely that you will be restricted from specific activities unless they are new to you (e.g., ice skating, skiing, skydiving). If you don't exercise regularly, this is a good time to discuss a new routine of exercising with your partner. Osteoporosis should not limit your activities or your thinking. Consider taking a class together for dancing, yoga, or tai chi.

A diagnosis such as osteoporosis also gives you the opportunity to discuss other lifestyle changes that may be helpful to both you and your partner's bone health and general health. Plan meals that will enhance your calcium and Vitamin D intake. Quit smoking together. Make a pact to restrict alcohol to one glass of wine with dinner, or one cocktail or beer per day.

In addition to routines around exercise and medications, this might be a good time to assess your environment for the risks associated with falling. Take a good look at the inside and outside of your house or living space. Even if you think you're not old enough to be at risk for falling, everyone can benefit from removing clutter and putting up railings and good lighting (see Table 17 in Question 79).

Learning that you have osteopen ia or with osteoporosis does represent an opportunity to help yourself and educate others.

98. My friends are all very health-conscious, and I believe they will think it's my fault that I have osteoporosis. My friends enjoy adventures like hiking, rock-climbing, and cross-country skiing. Must I decline their invitations to go with them?

Like other medical conditions and diagnoses, there are many factors that can put you at risk for osteoporosis. Most of them are not factors that you can control. Your friends should not blame you for having osteoporosis, nor should you blame yourself. Blame serves no useful purpose. Learning that you have osteopenia or being diagnosed with osteoporosis does represent an opportunity to help yourself and educate others.

People who take adequate calcium and Vitamin D and exercise regularly still get osteoporosis. So even though your friends are health conscious, it's possible for any of them to have or develop osteoporosis, too. Depending on your comfort level with discussing personal health information, it may be helpful to discuss your diagnosis with your friends. You might start the conversation with, "I just had one of those tests that measures bone density. Have any of you had one yet?" You will probably be surprised with their answers: "My doctor says I don't need one yet, but he also said I should increase my calcium," or "My mother just started using a nasal spray for a fracture in her back that happened because she has osteoporosis," or "No. How was the test? Was it painful?"

You can let your friends know what your clinician said, for example, lifestyle changes; medications, foods, and supplements to take; and the types of exercise that are appropriate. Then, if your adventurous friends invite you to an activity that you cannot engage in, you are able to say, "Remember when I got the diagnosis of osteoporosis? I'm not able to go skiing [for example], but I could join you for dinner afterward." Or better yet, suggest and organize activities that you know will not prevent your participation. For example, you could organize a group to join a walk-a-thon, which would not only benefit each of you in terms of exercise and social interaction, but would also benefit worthy charities.

An open discussion of your diagnosis might even prompt your friends to ask their own clinicians about being tested or about making some changes in their own lifestyles. It's a blessing to have friends who want to be active, so don't let osteoporosis interfere with sharing many new adventures with your friends.

99. Osteoporosis seems to be featured in the news almost daily. What are some of the future treatments? Are there any new drugs that are being evaluated in clinical trials for the treatment of osteoporosis?

Osteoporosis and bone health are receiving much more notice in the news. Studies of the bones of certain animal species are spurring newer studies to see if those results are applicable to humans. There are several examples. The majority of growth in the bones of lambs takes place during the night when the lambs are sleeping, presumably when there is less pressure on their bones. This might account for children's complaints of growing pains at night. Purring is believed to be one of the factors responsible for the fast healing experienced by cats. Sound treatment in the same sound range as a cat's purr is being investigated to improve bone growth in the elderly.

Zometa® (zoledronate, a bisphosphonate) is being studied to determine if it can help prevent glucocorticoid-induced osteoporosis (GIO) in men and women. This medication, which is administered through the vein into the bloodstream (intravenous or IV) annually, is also being studied to determine its role in preventing future hip fractures in men and women who have recently had hip fracture repair. Annual administration of IV zoledronate seems to provide equivalent results in bone mineral density improvement as do the daily oral dosing of other bisphosphonates. Currently, zoledronate or zoledronic acid is approved only for use in the prevention of bone metastases in patients with advanced cancers such as breast cancer and multiple myeloma. It is speculated that the yearly dose of IV zoledronate may be particularly useful for those who cannot tolerate the side effects of daily, weekly, or even monthly dosing of other bisphosphonates and in those for whom sticking to the schedule for taking medicine is an issue.

The role of fluoride in building good bone has been evaluated in large scale studies, but with discouraging results. Sodium fluoride as a supplement in baby vitamins and in drinking water has been around for years, and is responsible for helping to prevent tooth cavities. It is not clear from the studies if fluoridated drinking water affects bone mineral density. In one study of postmenopausal women in the Midwest, hip and vertebral fractures were decreased but wrist fractures were increased. A certain amount of fluoride is important for strong bone development, but excessive amounts are believed to cause the bones to become brittle because fluoride increases bone density but produces bone of very poor quality. Fluoride supplements are not currently recommended for the treatment of osteoporosis.

Livial (tibolone) is a synthetic steroid compound that has estrogen-, testosterone-, and progestin-like activity but does not contain any of these hormones. Although prescribed in 70 other countries, the FDA has not approved it, so it is not available in the United States. Studies have shown that tibolone used by postmenopausal women can increase bone mineral density and decrease bone turnover. Tibolone also significantly reduces hot flashes in postmenopausal women and is being studied as a medication to treat sexual dysfunction because of its androgenic effects. So far, there have not been any completed studies that demonstrate a decrease in fracture risk. Since many women are seeking an alternative to estrogen therapy, it is hoped that tibolone will be available soon in the United States. Like all drugs, tibilone has some risks; a study done in the United Kingdom showed an increase in breast cancer among tibolone users.

Osteoprotegerin is a substance known to decrease bone breakdown by preventing osteoclast formation (the cells that break down bone). Some research shows that human estrogen (17-p estradiol) and dietary phy-toestrogens (see Question 55) can increase levels of osteoprotegerin and therefore reduce bone breakdown. Further research is needed before increased phyto-estrogen intake can be recommended. A synthetic isoflavone (one of the phytoestrogens) called ipri-flavone is still being studied for its long-term effects because, while there is evidence that it increases bone density, other evidence shows that ipriflavone may cause abnormally low white blood cell counts.

AMG-162 is an investigational drug in Phase 3 clinical trials for the treatment of osteoporosis, rheumatoid arthritis, and bone metastases. AMG-162 is a monoclonal antibody that inhibits bone resorption, thereby allowing less bone turnover and increasing bone mineral density. The latest trials were begun in 2004, and researchers are still recruiting women who are 70 to 90 years old to participate.

Preos, another parathyroid hormone in development, is being investigated for its effects on building bone. It is being evaluated for use in a cyclic dose (once-a-week injection after three months of daily injections) and also for its effects when used in combination with other therapies such as bisphosphonates.

Pamidronate, another bisphosphonate, is currently used in the treatment of high calcium levels and bone problems associated with some cancers, but is being studied as a treatment for osteoporosis, particularly in the population undergoing dialysis. Men and women who have chronic kidney disease have significant problems with calcium regulation and bone loss. Pamidronate has been effective in increasing bone density in healthy post-menopausal women when it was administered every three months, and studies have shown that a small protective effect on bone density persists after the medication is stopped. Pamidronate is usually given intravenously.

Although not yet approved by the FDA for use in the United States, strontium ranelate, a radionuclide, has been studied in Europe and Australia. Research shows that oral strontium ranelate not only increases bone mineral density but also decreases both vertebral and nonvertebral fractures. This new medication represents an alternative for postmenopausal women who cannot tolerate other treatments for osteoporosis.

Another new possibility is a combination of medications manufactured in one tablet. One such combination currently under investigation combines estrogen and a new SERM. While taking Evista (ralixifene) and estrogen together is contraindicated because the medications compete for the same receptor sites, new SERMs that do not carry this contraindication are under investigation. A new SERM that is more selective is being evaluated for combination with estrogen (in the same pill) for the treatment of postmenopausal osteoporosis in women who are also experiencing menopausal symptoms.

It's also important to keep your eyes and ears open for health care developments that are not specifically related to osteoporosis. For example, the statin drugs long used as treatment for high cholesterol levels may still prove to increase bone density, an indirect and positive result of drugs intended to lower unhealthy levels of cholesterol. And, there is news in the nutrition world almost daily. For example, a recent study on rats showed less bone loss in the rats fed a particular substance (GPCS) found in white onions. Also, people who have gluten intolerance (celiac disease) have high rates of osteoporosis because they cannot effectively absorb calcium and Vitamin D through their intestines. The gluten intolerance causes diarrhea, making it difficult for nutrients to be absorbed from the intestines because foods move through too quickly. When placed on gluten-free diets, the diarrhea stops and normal amounts of calcium and Vitamin D can be absorbed, thereby improving bone density.

Figure 17 Many women have this degree of kyphosis. It can progress to a severe form in which organs are compressed and disability can be significant as shown in Figure 18. Photo courtesy of Janet Wise.

Figure 18 Woman with severe kyphosis (also known as "dowager's hump").

Figure 17 Many women have this degree of kyphosis. It can progress to a severe form in which organs are compressed and disability can be significant as shown in Figure 18. Photo courtesy of Janet Wise.

Figure 18 Woman with severe kyphosis (also known as "dowager's hump").

There is more osteoporosis news for men, too, particularly for those over the age of 65 who are trying to lose weight. Men in this age range should be wary about weight loss because it is associated with bone loss in the hip. Their clinicians should be monitoring both weight loss and bone loss. Although further study is needed, the potential for bone loss and the increased risk of fracture should be a topic of discussion between you and your clinician when weight loss is being recommended.

It is quite common for an aging spine to look like the one featured in Figure 17, but it's more difficult to imagine that this spine can eventually look like the one in Figure 18. There is no instant cure for a disease that can cause such a deformity. Even future treatments will not be a cure. Bones will still require, at the very least, calcium, Vitamin D, and exercise to stay strong. As addressed in Part Three, there are lifestyle changes and various therapies that can improve your bones now without waiting for researchers to develop future treatments.

Bones will still require, at the very least, calcium, Vitamin D, and exercise to stay strong.

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Why Gluten Free

Why Gluten Free

What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.

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