Chronic Pain, Osteoporosis, and Bone Density Testing

Chronic Pain, Osteoporosis, and Bone Density Testing

Written by E. Michael Lewiecki, MD, FACP | Article Featured on PPP

Osteoporosis is a disease manifested by low bone density and poor quality of bone, resulting in skeletal fragility and increased risk of fracture.1 While osteoporosis is generally a silent and asymptomatic disease until a fracture occurs, pain and osteoporosis are often associated. Fractures usually cause sudden and severe pain, with non-union fractures and some vertebral fractures resulting in chronic pain. Recent evidence suggests that pressure-induced tibial pain may be an indicator of low bone density in patients without fracture.2 Some metabolic disorders that cause low bone density, such as vitamin D deficiency and osteomalacia, can cause bone and muscle pain,3 proximal muscle weakness, and postural instability4 in the absence of fracture. Chronic pain is associated with many risk factors for osteoporosis and fragility fractures. These risk factors may be categorized according to whether they are due to the underlying disease, the pain itself, or the treatment for pain (see Table 1).

Risk Factors

Diseases associated with chronic pain and osteoporosis include prevalent vertebral fracture, rheumatoid arthritis, inflammatory bowel disease, multiple myeloma, and insulin-dependent diabetes5 with diabetic neuropathy. Regional bone loss may occur with painful disorders such as reflex sympathetic dystrophy6 (Sudeck’s atrophy, algodystrophy) or immobilization of a limb due to trauma — with or without fracture.7

Chronic pain and its associated diseases may result in poor nutrition, impaired cognition, elevated serum cortisol8 or high levels of inflammatory cytokines,9 with potential adverse effects on bone density.

Some treatments for chronic pain disorders, such as glucocorticoids10 and anticonvulsants,11 may be harmful to bone. Other medical treatments, such as narcotics and antidepressants, may impair balance and mobility, resulting in increased risk of falls and fractures.12 Hypogonadism, another risk factor for osteoporosis, has been reported in men13 and women14 treated with opioids.

The consequences of a fracture may include additional acute and chronic pain, limited ambulation, disability, loss of independence, increased risk of future fractures and death.15 Chronic pain patients at risk for osteoporosis should be considered for bone density testing so that appropriate therapeutic intervention may be started to prevent fractures and their clinical consequences.

“…dual-energy X-ray absorptiometry (DXA) of the spine and hip is the recommended method for diagnosing osteoporosis and monitoring the effects of therapy.”

 

Bone Density Testing

Bone density testing is a non-invasive technique used to diagnose osteoporosis or low bone density, predict the risk of fracture, and monitor the effectiveness of therapy for osteoporosis. While measurement of bone density at peripheral skeletal sites with a variety of technologies is useful to increase osteoporosis awareness and predict fracture risk, dual-energy X-ray absorptiometry (DXA) of the spine and hip is the recommended method for diagnosing osteoporosis and monitoring the effects of therapy. The key to effective clinical management is the identification of high risk patients before the first fracture occurs, so that therapy can be initiated to reduce the risk of fracture.

Dual-energy X-ray Absorptiometry

DXA is used to measure bone mineral density (BMD) at the spine and proximal femur. With appropriate software, many DXA instruments can also measure BMD at the forearm and total body. DXA measures areal BMD (aBMD in g/cm2) by using ionizing radiation with photon beams of two different energy levels. DXA is the “gold-standard” method for the diagnosis of osteoporosis and monitoring the effects of therapy for the following reasons:

  • biomechanical studies have shown a correlation between mechanical strength and BMD measured by DXA,16
  • epidemiological studies have established a strong relationship between fracture risk and BMD measured by DXA,17
  • the World Health Organization (WHO) classification of BMD for the diagnosis of osteoporosis and osteopenia is based on reference data obtained by DXA,18
  • randomized clinical trials showing a benefit with pharmacologic intervention have selected subjects based on low BMD measured by DXA,19
  • there is a relationship between reduction in fracture risk with pharmacologic therapy and BMD increase as measured by DXA,20
  • the accuracy and precision of DXA is excellent.21

DXA is widely available in the United States, with an estimated 10,000 instruments in operation. Radiation exposure from DXA is extremely small,22 typically about the same as the normal daily level of background radiation. Conventional radiography, on the other hand, is an insensitive and subjective technique for evaluating bone density at any skeletal site, requiring 30-40% bone loss before a problem is detected. The best use of standard X-ray in the management of osteoporosis is to diagnose fractures, to monitor the healing of fractures, and to evaluate for some secondary causes of osteoporosis. If an X-ray is suggestive of low bone density, a quantitative measurement of BMD by DXA should be done.

When to Order a Bone Density Test

As with any clinical test, bone density measurement should only be done when the potential benefits outweigh the risks, and when the results are likely to play a role in making patient management decisions. The risks of bone density testing are extremely low. Pregnancy should be considered an absolute contraindication to doing any X-ray-based bone density test. Many organizations have developed guidelines to aid in the selection of those at risk for low BMD who most likely to benefit from knowledge of the results. The most comprehensive guidelines are those of the International Society for Clinical Densitometry23 upon the recommendation of an international panel of experts (see Table 2).

Osteoporosis/FractureRisk Factors
Due to Underlying Disease
Rheumatoid Arthritis
Insulin Dependent Diabetes Mellitus
Inflammatory Bowel Disease
Fragility Fracture
Reflex Sympathetic Dystrophy
Multiple Myeloma
Due to Effects of Pain
Elevated Cortisol
Poor Nutrition
Weight Loss
Poor Balance
Cognitive Impairment
Due to Pain Treatments
Narcotics
Antidepressants
Anticonvulsants
Immobilization

Diagnosis of Osteoporosis

A clinical diagnosis of osteoporosis may be made in a patient with a fragility fracture, provided other causes of fracture have been excluded. A fragility fracture is usually defined as a fracture resulting from a fall from the standing position. It is preferable, however, to identify patients at high risk for fracture before the first fracture occurs, just as risk factors for stroke and myocardial infarction should be identified and managed before a critical event occurs. The World Health Organization (WHO) classification of BMD uses the standard deviation (SD) difference between the patient’s BMD and the mean BMD of a young healthy population (Table 3). This is usually expressed as a T-score, which is calculated by subtracting the mean BMD of the reference population from the patient’s BMD and dividing by the SD of the reference population. A T-score of -2.5 or less is used for a densitometric diagnosis of osteoporosis in a postmenopausal woman.

“If a fracture has occurred, the goal of therapy is to stabilize the fracture, relieve pain, return the patient to pre-fracture levels of activity as soon as possible, and prevent future fractures.”

BMD and Fracture Risk

There is an exponential relationship between BMD and fracture risk, with fracture risk approximately doubling for every 1 SD decrease in BMD.24 Low bone density at any skeletal site is predictive of fractures at any skeletal site although, in general, site-specific fracture risk is best predicted by BMD measurement at that skeletal site. This principle does not hold true with spine BMD and spine fracture risk in the elderly, who often have degenerative arthritis in the spine that may result in an artifactual increase in spine BMD. There is no “fracture threshold.” Instead, there is a continuous relationship between BMD and fracture risk, so that fracture risk is never zero, regardless of how high the BMD, and it is never certain that a fracture will occur, regardless of how low the BMD. In clinical practice, patient management decisions must consider factors in addition to BMD that may affect fracture risk. The most important of these non-BMD risk factors are age25 and previous fracture.26 Fracture risk increases with age, even when BMD remains the same. Other clinical risk factors, such as family history of hip fracture, poor health, low body weight, and frailty, play a role as well. Since most hip fractures occur as a result of a fall, frailty and falling are potent predictors of hip fracture, independent of bone density. The risk of falling is affected by factors that include balance, mobility, strength, reaction time, visual impairment, medications, and cognitive impairment.

When to Repeat a Bone Density Test

A bone density test should be repeated when the expected amount of change in bone density equals or exceeds the Least Significant Change (LSC) — if knowledge of this change is likely to influence clinical management. The LSC is established for each technologist for each instrument used according to well-established guidelines,27 and is best expressed as an absolute value (g/cm2) with a 95% level of confidence. Values for precision error supplied by the manufacturer of the DXA instrument, which are automatically included on some computer printouts, are generally more optimistic than what is achievable in bone densitometry centers and should not be used. It is reasonable to repeat a DXA study 1-2 years after starting pharmacologic therapy to be sure that BMD is stable or increasing, and then repeat the study at intervals of 2 or more years to assure continuing response to therapy. In patients at risk for rapid bone loss, such as those being started on high dose glucocorticoid therapy, it is appropriate to repeat the DXA study every 6 months until stable. For elderly patients in whom a typical age-related bone loss of 0.5-1.0% per year is expected, it may take 3-6 years before a statistically significant change in BMD can be detected.

Indications for Bone Density Testing
  • Women aged 65 years and older.
  • Postmenopausal women under age 65 years with risk factors for osteoporosis.
  • Men aged 70 years and older.
  • Adults with fragility fracture.
  • Adults with a disease or condition associated with low bone mass or bone loss.
  • Adults taking medication associated with low bone mass or bone loss.
  • Anyone being considered for pharmacological osteoporosis therapy.
  • Anyone being treated for low bone mass to monitor treatment effect.
  • Anyone not receiving therapy in whom evidence of bone loss would lead to treatment.

Women discontinuing estrogen should be considered for bone density testing according to the indications listed above

Implications for Therapy

Non-pharmacologic therapy for patients at risk for osteoporosis and fragility fracture includes regular weight-bearing exercise as tolerated; good nutrition with adequate daily intake of protein, calcium, and vitamin D; balance training, fall prevention, and hip protectors for those with high risk of falling; and avoidance of bone toxic agents, such as cigarette smoking and excess alcohol. Pharmacologic therapy with FDA-approved agents can be expected to stabilize or increase BMD, and reduce the risk of fragility fractures by approximately 50%.28 If a fracture has occurred, the goal of therapy is to stabilize the fracture, relieve pain, return the patient to pre-fracture levels of activity as soon as possible, and prevent future fractures. Vertebroplasty and Kyphoplasty may offer pain relief for selected patients with vertebral fractures, although the indications for these procedures and the long-term benefits and risks are not well defined.29

World Health Organization Classification of Bone Mineral Density
Classification T-score
Normal -1.0 or greater
Osteopenia Between -1.0 and -2.5
Osteoporosis -2.5 or less
Severe Osteoporosis -2.5 or less with a fragility fracture

Conclusions

Patients with chronic pain may be at increased risk for osteoporosis and fragility fractures due to the underlying disease or disorder causing the pain, as well as factors associated with the pain itself and treatments given for the pain. BMD testing is an essential tool for the early diagnosis of osteoporosis or low bone density, allowing for identification of high risk patients and selection of appropriate therapy. Currently available therapy can reduce the risk of future fracture and its clinical consequences.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Benefits of Exercising With Osteoarthritis

IF YOU’RE ONE OF THE more than 30 million Americans who, according to the Centers for Disease Control and Prevention, have osteoarthritis – the degenerative wear and tear and most common form of arthritis – you might be reticent to exercise.

“Joint pain can accompany osteoarthritis, so people assume that movement will worsen the condition,” says Katrina Pilkington, a Nevada-based National Academy of Sports Medicine certified personal trainer and corrective exercise specialist.

However, lack of exercise can actually increase joint stress and degeneration. Meanwhile, regular exercise can not only ease symptoms, but actually slow progression of the joint disease, according to a 2018 review published in the Journal of Exercise Rehabilitation.

Here are five science-backed ways that exercise improves the symptoms and progression of osteoarthritis:

  • Lubricating joints.
  • Replacing damaged cells with new, healthy ones.
  • Strengthening muscles.
  • Reducing excess body weight.
  • Relieving symptoms of depression and anxiety.

Learn more about the benefits of exercising with osteoarthritis.

Lubricating Joints

A soft tissue called synovial membrane surrounds your joints and produces a fluid that acts like gear oil for your joints. This synovial fluid reduces friction to prevent further damage to the cartilage and bone – and exercise stimulates its production, Pilkington explains. Plus, by increasing the flow of oxygen- and nutrient-rich blood to the synovial membrane, your joints are able to stay lubricated both during and between your workouts.

Synovial fluid also prevents the collection of inflammatory proteins within joints that can lead to osteoarthritis’ trademark pain, says physical therapist William Behrns, a board-certified Orthopedic Clinical Specialist at the Hospital for Special Surgery in New York City.

Replacing Damaged Cells With New, Healthy Ones

In osteoarthritis, cartilage wears down, degrades and stops cushioning the joints. However, a 2019 animal study published in the International Journal of Molecular Medicine suggests that exercise stimulates cartilage autophagy, the process by which the body clears out and recycles old, damaged cells so that new ones can take their place.

Joint movement during exercise may also activate genes associated with cartilage rebuilding, according to the Arthritis Foundation.

Strengthening Muscles

Even if you’ve never considered yourself a bodybuilder, when it comes to managing osteoarthritis, there’s good reason to pick up some weights, says Chris Kolba, Ph.D., a physical therapist with the Ohio State University Wexner Medical Center. Your muscles are in charge of both bracing the joints as well as absorbing shock when you walk, jog or do anything that involves impact.

“The stronger your muscles are, the more protected your joints will be,” Behrns says. That’s especially true of the knees and hip joints, which constantly support the weight of your entire body.

Reducing Body Weight

Maintaining a healthy body weight is important to making sure that those knees and hips aren’t under any excess stress.

“Joint stresses are directly related to the amount of weight placed on the joint during an activity,” Behrns says. “The less you weigh, the less joint stresses will exist.” He explains that every pound lost results in a four-fold decrease in stress placed on the knee.

If you’re already at a healthy body weight, you’re already enjoying this benefit and losing more weight is not advised.

Relieving Symptoms of Depression and Anxiety

One in five adults with arthritis suffers from anxiety, while depression symptoms occur twice as often in people with arthritis than in those without the disease, according to a 2018 analysis from the Centers for Disease Control and Prevention. Pain, mobility limitations and side effects from pain and anti-inflammatory medications are leading reasons for an increase in depression and anxiety in men and women with arthritis, according to the Arthritis Foundation.

Exercise is an established method for treating mood disturbances and mental health disorders, and a 2003 analysis published in Exercise and Sport Science Reviews concluded that, “in osteoarthritis, the psychosocial benefits of exercise are as important as physiological improvements.”

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Osteoporosis: Investigating the role of a common antibacterial chemical

A recent study finds a relationship between a chemical that is in a wide array of personal care products and a reduction in bone mineral density. Osteoporosis is a disease that causes weak bones and an increased risk of fracture.

Worldwide, an estimated 200 million people currently have osteoporosis. More than 10 million of these people live in the United States. Osteoporosis predominantly affects people as they age, so as the population of the U.S. is growing older, the condition is likely to become more prevalent over time.

Although there are several causative factors, including genetics, certain medications, and body mass index (BMI), some researchers are interested in the potential role of environmental chemicals.

A new study, the findings of which appear in the Journal of Clinical Endocrinology & Metabolism,investigates a chemical called triclosan.

What is triclosan?

Triclosan is an antibacterial compound. The Food and Drug Administration (FDA) recently banned its use in over the counter hand sanitizers, but manufacturers still add it to a range of goods, including toothpaste, soap, and mouthwash. They also add it to some textiles and kitchenware.

As an insight into how prevalent this chemical is, in one U.S. study, scientists detected triclosan in the urine of almost three-quarters of their 2,517 participants. The corresponding author of the new study, Yingjun Li, Ph.D., from Hangzhou Medical College School of Public Health in China, explains why the team chose to investigate triclosan’s role in osteoporosis:

“Laboratory studies have demonstrated that triclosan may have potential to adversely affect the bone mineral density in cell lines or in animals. However, little is known about the relationship between triclosan and human bone health.”

Doctors use bone mineral density tests to diagnose osteoporosis and determine fracture risk. Li believes that their research is the first to “investigate the association between triclosan exposure with bone mineral density and osteoporosis in a nationally representative sample from U.S. adult women.”

Bone data

Li and colleagues took data from the National Health and Nutrition Examination Survey, which the researchers had collected during face to face interviews. The questions covered demographics, diet, and general health. Medical professionals also gave each participant physical examinations and took blood and urine samples.

In the new study, the researchers analyzed data from 1,848 women aged 20 years or older who were living in the U.S. The researchers tested for triclosan in the urine samples, measured bone mineral density, and assessed the participants for osteoporosis.

During the analysis, the team controlled for a number of variables that had the potential to skew the results, including age, ethnicity, level of physical activity, smoking, calcium intake, BMI, and history of diabetes.

Overall, the analysis showed that women with higher levels of urinary triclosan had reduced bone mineral density in comparison with women with lower levels of urinary triclosan.

This relationship was more pronounced in postmenopausal women and was not significant in premenopausal women.

Triclosan and osteoporosis

When the scientists investigated the relationship between triclosan and osteoporosis, the results were less clear. This finding may partly be due to the number of individuals with osteoporosis being relatively low — only seven women in the premenopausal group, for instance.

The researchers evaluated four bone regions for the presence of osteoporosis. For three of the four regions, there was no relationship between triclosan and osteoporosis.

However, higher levels of triclosan did predict an increase in osteoporosis in the intertrochanter region, which is the upper part of the thigh bone.

Although the links between triclosan and osteoporosis were not as strong as the authors had expected, the chemical does appear to affect bone density in some way.

However, the authors note certain limitations. First and foremost, the study design does not allow the authors to prove cause and effect. They also explain that the excretion of triclosan is quite rapid. Therefore, because they only measured urinary triclosan once, it is probably not a fair representation of average triclosan levels throughout the decades.

As is always the case, scientists will need to carry out much more research using a larger group of participants to confirm these findings.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of Your Body

More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of Your Body

Article by Mary Anne Dunkin | Featured on Arthritis.org

The inflammation that characterizes RA can impact organs and systems, too.

You know that arthritis affects your joints. Painful, swollen knees or fingers are impossible to ignore. But did you know that other parts of your body – your skin, eyes and lungs, to name a few – may also be affected?

Rheumatoid arthritis is a systemic disease, meaning it can affect many parts of the body. For that matter, so can some of the drugs used to treat RA. Following is a listing by body part of the ways RA (and sometimes the drugs used to treat it) can affect you.

Many of these problems – such as bone thinning or changes in kidney function – cause no immediate symptoms so your doctor may monitor you through lab tests or checkups. For other problems – such as skin rashes or dry mouth – it’s important to report any symptoms to your doctor, who can determine the cause or causes, and adjust your treatment plan accordingly.

Skin

Nodules. About half of people with RA develop rheumatoid nodules – lumps of tissue that form under the skin, often over bony areas exposed to pressure, such as fingers or elbows. Unless the nodule is located in a sensitive spot, such as where you hold a pen, treatment may not be necessary. Nodules sometimes disappear on their own or with treatment with disease-modifying antirheumatic drugs (DMARDs).

Rashes. When RA-related inflammation of the blood vessels (called vasculitis) affects the skin, a rash of small red dots is the result. In more severe cases, vasculitis can cause skin ulcers on the legs or under the nails. Controlling the rash or ulcers requires controlling the underlying inflammation.

Drug effects. Corticosteroids, prescribed to reduce inflammation, can cause thinning of the skin and susceptibility to bruising. Non-steroidal anti-inflammatory drugs (NSAIDs), which treat pain and inflammation, and methotrexate, a widely prescribed DMARD, can cause sun sensitivity. People taking biologics, a sub-category of DMARDs designed to stop inflammation at the cellular level, may develop a rash at the injection site.

Bones

Thinning. Chronic inflammation from RA leads to loss of bone density, not only around the joints, but throughout the body, leading to thin, brittle bones. Exercise, a high-calcium diet and vitamin D can all help bones, but in some cases your doctor may need to prescribe a drug to stimulate bone growth or prevent bone loss.

Drug effects. Corticosteroids can also cause bone thinning.

Eyes

Inflammation and scarring. Some people with RA develop inflammation of the whites of the eyes (scleritis) that can lead to scarring. Symptoms include pain, redness, blurred vision and light sensitivity. Scleritis is usually treatable with medications prescribed by your doctor, but in rare cases, the eye may be permanently damaged. RA can also cause uveitis, an inflammation of the area between the retina and the white of the eye, which, if not treated, could cause blindness.

Dryness. The inflammatory process that affects the joints can also damage the tear-producing glands, a condition known as Sjögren’s syndrome. The result is eyes that feel dry and gritty.  Artificial tears, which are available over the counter, as well as medications your doctor prescribes, can keep eyes more comfortable and help prevent damage related to dryness.

Drug effects. Corticosteroids may cause glaucoma and cataracts. Hydroxychloroquine, in rare cases, causes pigment changes in the retina that can lead to vision loss. As a rule, people with RA should get eye checkups at least once a year.

Mouth

Dryness. Inflammation can damage the moisture-producing glands of the mouth as well as the eyes, resulting in a dry mouth. Over-the-counter artificial saliva products and self-treatment often helps. If not, your doctor may prescribe a medication to increase the production of saliva. Good dental hygiene is a must, as bacteria tend to flourish in a dry mouth, leading to tooth decay and gum disease.

Drug effects. Methotrexate can cause mouth sores or oral ulcers. For treatment, try a topical pain reliever or ask your doctor or dentist for a prescription mouthwash.

Lungs

Inflammation and scarring.  Up to 80 percent of people with RA have some degree of lung involvement, which is usually not severe enough to cause symptoms. However, severe, prolonged inflammation of the lung tissue can lead to a form of lung disease called pulmonary fibrosis that interferes with breathing and can be difficult to treat.

Nodules. Rheumatoid nodules might form in the lungs, but are usually harmless.

Drug effects. Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. Less common drugs, including injectable gold and penicillamine, can cause similar pneumonias. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.

By suppressing your immune system, corticosteroids, DMARDs and biologics may increase your risk of tuberculosis (TB), a bacterial infection of the lungs. Your doctor should test for TB before initiating treatment and periodically after.

Heart and Blood Vessels

Atherosclerosis. Chronic inflammation can damage endothelial cells that line the blood vessels, causing the vessels to absorb more cholesterol and form plaques.

Heart attack and stroke. When plaques from damaged blood vessels break lose they can block a vessel, leading to heart attack or stroke. In fact, a 2010 Swedish study found that the risk of heart attack for people with RA was 60 percent higher just one year after being diagnosed with RA.

Pericarditis. Inflammation of the heart lining, the pericardium, may manifest as chest pain. Treatment to control arthritis often controls pericarditis as well.

Drug effects. While many RA medications, including methotrexate, other DMARDS and biologics may reduce cardiovascular risk in people with RA, other medications – chiefly NSAIDs – may increase the risk of cardiovascular events including heart attack. Your doctor will need to evaluate your risk when prescribing treatment for your RA.

Liver

Drug effects. Although RA doesn’t directly harm the liver, some medications taken for RA can.  For example, long-term use of the pain reliever acetaminophen (Tylenol) is considered a leading cause of liver failure. Liver diseases may also occur with long-term methotrexate use. Working with your rheumatologist to monitor your blood is key to preventing problems.

Kidneys

Drug effects. As with the liver, drugs taken for arthritis can lead to kidney problems. The most common offenders include cyclosporine, methotrexate and NSAIDs.  If you are taking these drugs long term, you doctor will monitor your kidney function to watch for problems.

Blood

Anemia. Unchecked inflammation can lead to a reduction in red blood cells characterized by headache and fatigue. Treatment consists of drugs to control inflammation along with iron supplements.

Blood clots. Inflammation might lead to elevated blood platelet levels, and blood clots.

Felty syndrome. Though rare, people with longstanding RA can develop Felty syndrome, characterized by an enlarged spleen and low white blood cell count. This condition may lead to increased risk of infection and lymphoma (cancer of the lymph glands). Immunosuppressant drugs are the usual treatment.

Drug effects. Aggressively treating inflammation with corticosteroids may cause thrombocytopenia, an abnormally low number of blood platelets.

Nervous System

Pinched or compressed nerves. Although RA does not directly affect the nerves, inflammation of tissues may cause compression of the nerves resulting in numbness or tingling. One relatively common problem is carpal tunnel syndrome, a condition in which the nerve that runs from the forearm to the hand is compressed by inflamed tissue in the wrist area, resulting in tingling, numbness and decreased grip strength.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

16 Ways You May Be Hurting Your Joints

16 Ways You May Be Hurting Your Joints

Your joints link bones together so you can bend your knees, wiggle your hips, and move your body. Learn how you might be preventing your joints from working their best.

Carry Extra Weight

Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet. That causes wear and tear that can lead to damage, aches, and pain. Being overweight also triggers inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.

Text Too Much

‘Texting thumb’ is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles. If you bend your neck so far that your chin touches your chest, it’s as if your neck has to support the weight of 5 heads instead of just one.

Steep Price of High Heels

They might look fab, but the higher they rise, the more your weight tips forward. Your thigh muscles have to work harder to keep your knee straight, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you boost your odds for osteoarthritis. That’s when the bones and the cushioning between the bones break down.

Wear the Wrong Shoes

Worn-out shoes don’t support your feet and ankles enough. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains. But don’t go overboard. Too much cushion or arch support means your foot can’t move naturally, which could keep you in a cycle of pain.

Crack Your Knuckles

That satisfying pop comes from tiny bubbles bursting in the fluid around your joints. Or from ligaments snapping against bone. Despite what annoyed adults might have warned you, it doesn’t cause arthritis. Still, it might be smart to stop. One study showed that this habit may cause your hands to swell and weaken your grip.

Lug a Big Bag

Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints. If you do that every day, your body’s going to let you know loud and clear.

Use Wrong Muscles for the Job

When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles. When you carry something, hold it close to you in the palms of your hands instead of stressing your fingers.

Sleep on Your Stomach

It might help with snoring, but not so much with the rest of your body. Lying on your tummy pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back. All that puts pressure on other joints and muscles.

Skip Stretching

You don’t need to be a yogi, but regular stretching can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better. That’s key to healthy and stable joints.

Skimp on Strength Training

Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt.

Smoke and Chew Tobacco

Here’s another reason to quit: Your joints will thank you. Nicotine from cigarettes and chewing tobacco cuts down on blood flow to your bones and to the cushioning discs in your back. It limits how much bone-building calcium your body can take in. It also breaks down estrogen, a hormone you need for bone health. And it slows new growth that thickens bones. All that makes your joints weaker and your hips more likely to break.

Don’t Get Quality ZZZs

You may wonder how poor sleep can affect your joints. One study found that people with arthritis felt more pain after restless nights. That made them take a closer look. One theory is that when you don’t sleep well, it triggers inflammation in your body. That might lead to joint problems over time. More research is needed, but in the meantime, it sure won’t hurt to get good shut-eye.

Slouch and Slump

Your body’s at its best when you work with it, not against it. That’s why posture matters. When you slump in your chair, it puts more stress on your muscles and joints and tires them out. It’s like always jamming on your car brakes when you could just ease down on the pedal instead. So keep your back straight and those shoulders back and down.

Ignore Pain

When you work out, you might think you just need to power through it. After all, no pain, no gain, right? It’s true that some muscle soreness is OK. But not if it lasts for days or if your muscles are swollen or too sore to move or to touch. Joint pain isn’t normal, so pay attention to it. If you think you overdid it, ease up on your exercises. If the pain won’t go away, check with your doctor.

Too Much Computer Time

It can literally be a pain in your neck — and your elbows, wrists, back, and shoulders. The problem isn’t just bad posture, but that you hold it for too long. That overworks your muscles. It also puts pressure on the discs in your back. If you’re in a soft chair, prop up your arms with cushions to take the load off your shoulders and your neck. Be sure to get up and move every hour.

Repeat Poor Form

When you run, bike, or play tennis, you use the same motions over and over. But if your form is bad, you’ll stress your body in all the wrong places. If you overload your muscles, it puts more pressure on your joints, and you can end up with an injury like tennis elbow.

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Best Low Impact Cardio Exercises for People with Bad Knees

5 Best Low Impact Cardio Exercises for People with Bad Knees

Article By Francesca Menato | Featured on Women’s Health

Anyone with a knee injury, new or old, will know how easy it is to feel it flair up with extreme cardio. Running, in particular, is very tough on the knees – so what exercises can you do to get the heart rate up, without hurting already bad knees?

We caught up with Lorraine Furmedge, Fitness First PT Ambassador, to find out the best workouts and exercises for bad knees.

Before you lace up your running shoes and risk another niggle, try these.

1. Swimming

If you’re on the search for cardio exercises for bad knees, head to the pool. Swimming provides a great workout that is low impact, versatile and burns calories fast. Whether you’re doing the butterfly or backstroke you’ll work all major muscle groups in your body including your glutes, abdominals and chest muscles.

Wondering which is the best stroke?

Freestyle, which tends to be the fastest stroke, can burn 100 calories every 10 minutes – more than jogging – but all of them will work your whole body.

2. Elliptical

Opt for an elliptical over a treadmill for minimal risk of knee injury. Your feet never leave the pedals, which means there is less of a chance to injure your knees, back, neck or hips. You’ll also get your heart rate up, making you work up a sweat! Increase the resistant to really test your endurance.

There’s a lot of discussion around which cardio machines burn more calories, and generally, the treadmill does tend to come out on top given you are moving whilst also supporting the full weight of your body but elliptical trainers are fantastic for getting in a great cardio workout with a bit more support.

With any form of exercise, you get out what you put in so it all depends on how hard you push and challenge yourself.

3. Stationary rowing

Rowing is a great way to burn calories without placing stress on your knee joints. Not only will you get a total body workout, you’ll also maximise your core strength with every pull.

Amp up the intensity by increasing the resistance while maintaining speed for a real cardiovascular challenge.

The more you train on a certain machine, the more stamina and strength your body will gain in that particular area, meaning the harder you have to work each time to continue challenging yourself.

If calorie burning is your main aim, switch up your routine and use a mixture of machines and freestyle training – it will keep your body guessing and will test you in different ways.

4. Cycling

Whether you prefer hitting a stationary bike indoors or riding your bicycle outside, you’ll get a fantastic fat-burning workout that will gradually improve your knee flexibility and strength.

To ensure you don’t put pressure on your knees, avoid hills and stick to a flat terrain. Raise your seat level slightly to decrease any pressure on your kneecap.

Wondering what resistance you should use? When it comes to cycling with resistance, there is no right or wrong answer.

Low resistance is great for those people who are just getting into fitness as it allows you to start building up your stamina without over-exerting yourself. Likewise, those suffering with knee injuries may find this an effective and low impact way of getting their regular exercise sessions in without causing further damage.

Medium and high resistance is more suited to those with higher fitness levels and works really well when it comes to building strength in your legs and lower body. If you’ve recently recovered from a knee injury consider using resistance to increase your strength and safeguard against any further damage.

To combine cardio and strength try some interval training and switch between low resistance sprints and medium-high resistance climbs.

Wondering about spin classes? Don’t fret. All good spin instructors will check for injuries before the class begins so let them know and they’ll be able to advise on how to best tackle the session.

Plus, the beauty of spin is that you can carry out the class at your own pace. Remember, you are in control and can adjust your pace according to your ability.

5. Step ups

For a low-impact cardio workout, turn to an aerobic step bench.

Step up onto the step with your right foot. Tap your left foot on the top of the step and then lower.

As you step up, your knee should be directly over your ankle to ensure you’re protecting your knees.

Repeat 10 times for a great calorie burn.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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The Link Between Weight Loss and Knee Pain

Article Featured on Healthline

Why does my knee hurt?

Knee pain is one of the most common complications of being overweight or obese. If you’re among the millions of people who experience chronic knee pain, even a small weight loss can help reduce pain and lower the risk of osteoarthritis (OA).

According to a 2011 report from the Institute of Medicine (IOM), of the roughly 100 million American adults who experience common chronic pain, nearly 20 percent, or 20 million people, have knee pain. This is second only to the number of people with lower back pain.

More than two-thirds of people in the United States are either overweight (with a BMI between 25 and 29.9) or obese (with a BMI of 30 or higher).

Those extra pounds increase the stress on your knees. That stress can cause chronic pain and lead to other complications such as OA.

How weight loss affects knee pain

Maintaining a healthy weight has many health benefits, including reduced risk of a number of diseases that include:

  • heart disease
  • type 2 diabetes
  • high blood pressure
  • certain types of cancers

Losing weight benefits knee pain in two ways.

Decreases weight-bearing pressure on the knees

Each pound of weight loss can reduce the load on the knee joint by 4 pounds. Lose 10 pounds, and that’s 40 fewer pounds per step that your knees must support. And the results add up quickly. Less pressure means less wear and tear on the knees. This lowers the risk of OA.

Reduces inflammation in the body

For years, OA was considered a wear and tear disease caused by prolonged excess pressure on the joints, particularly the knees, which, in turn, caused inflammation.

But recent research suggests that inflammation is a key OA risk factor, rather than a consequence of OA. Being overweight may increase inflammation in the body that can lead to joint pain. Losing weight can reduce this inflammatory response. One study suggests that just a 10 percent reduction in weight can significantly lower inflammation in the body. Another study found that even simply overeating triggers the body’s immune response, which increases inflammation.

The link between weight gain and OA

Being overweight or obese significantly increases a person’s risk for developing OA.

According to John Hopkins Medicine, women who are overweight are four times more likely to develop OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.

But losing even a small amount of weight can be beneficial. For women who are overweight, every 11 pounds of weight loss can reduce the risk of knee OA by more than 50 percent. Men who drop into the overweight category (BMI below 30) and men who drop into the normal weight category (BMI below 26) can reduce their risk of knee OA by 21.5 percent.

Easy ways to lose weight

There are steps you can take to start shedding pounds, including:

  • reduce portion sizes
  • add one vegetable to your plate
  • go for a walk after a meal
  • take the stairs rather than the escalator or elevator
  • pack your own lunch instead of eating out
  • use a pedometer

Taking the necessary steps to manage your weight can help protect your knees from joint pain and reduce your risk of OA.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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When it Comes to Weight Loss in Overweight and Obese Adults with Knee Osteoarthritis, More is Better

Article Found on ScienceDaily

Researchers previously showed that overweight and obese individuals with knee osteoarthritis can reduce pain by 50% and significantly improve function and mobility with a 10% or more weight loss over an 18-month period. The investigators’ latest findings, which are published in Arthritis Care & Research, reveal that a 20% or more weight loss has the added benefit of continued improvement in physical health-related quality of life along with an additional 25% reduction in pain and improvement in function.

The results come from a secondary analysis of diet-only and diet plus exercise groups in the Intensive Diet and Exercise for Arthritis (IDEA) randomized controlled trial. A total of 240 overweight and obese older community-dwelling adults with pain and knee osteoarthritis were divided into four groups according to weight loss achieved over an 18-month period: less than 5% (<5% group), between 5 and 9.9% (?5% group), between 10 and 19.9% (? 10% group), and 20% and greater (?20% group).

The researchers found that the greater the weight loss, the better participants fared in terms of pain, function, 6-minute walk distance, physical and mental health-related quality of life, knee joint compression force, and IL-6 (a marker of inflammation). Also, when comparing the two highest groups, the ?20% group had 25% less pain and better function than the ? 10% group, and significantly better health-related quality of life.

Obesity is a health issue worldwide and a major and modifiable risk factor for many of the more than 250 million adults with knee osteoarthritis. “Currently, there is no treatment that slows the progression or prevents this debilitating disease; hence, research has focused on improving clinical outcomes important to the patient,” said lead author Stephen Messier, PhD, of Wake Forest University, in Winston-Salem, NC. “A 10% weight loss is the established target recommended by the National Institutes of Health as an initial weight loss for overweight and obese adults. The importance of our study is that a weight loss of 20% or greater — double the previous standard — results in better clinical outcomes, and is achievable without surgical or pharmacologic intervention.”


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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Caring for Someone With Arthritis

Article by Brett Sears | Found on VeryWell

Caring for a friend or family member with arthritis can be a challenging—yet rewarding—experience. Your loved one may have difficulty managing various components of the disease process, and being available as a trusted ally in their care can make a positive difference. But what are the best ways to help someone with arthritis?

If you have arthritis, then you know how the stiffness and pain can limit your ability to move and function properly.

The pain from arthritis can prevent you from walking properly, using your hands and arms, and enjoying your normal work and recreational activities. Encouraging family members and friends to help with your care can ensure that you manage your condition well and remain functionally independent as long as possible. Read more

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Osteoarthritis: Could Researchers Have Found the Key to Prevention?

Article Found on MedicalNewsToday

A new study may have revealed a possible new prevention and treatment strategy for osteoarthritis, which is one of the most common and debilitating age-related diseases in the United States.

Researchers at The Scripps Research Institute (TSRI) in San Diego, CA, reveal that proteins called FoxO are key for joint health.

By boosting the levels of these FoxO proteins, they believe that it might be possible to treat osteoarthritis, or even stop the disease from developing. Read more