Wednesday, December 12, 2018

Brain & Spine Disorders

Osteoporosis Prevention

The most fundamental suggestion is to increase your calcium intake, either through dietary changes or supplemental pills. It is best for people to begin adequate calcium intake at an early age, as bone mass begins to decrease around the age of 30. After age 30, calcium helps decrease bone loss, strengthen bones, and decrease the risk of fractures.

The recommended daily intake for women age 25 to 50-and women over 50 who take hormone replacements-is 1,000 mg (milligrams) per day. Women over 50 who do not take hormone replacements should have 1,500 mg per day. Men ages 25 to 65 years old should have 1,500 mg per day. And men and women over 65 should have 1,500 mg per day.

If you take calcium supplements, make sure they contain Vitamin D, as this helps with absorption. Calcium citrate is absorbed better than calcium carbonate. If you take the carbonate form, make sure to take it with food.

Vitamin D
A vitamin D deficiency may contribute to bone loss and fracture. At least 800 mg per day is recommended for all adults. Many calcium supplements contain vitamin D. You can also get vitamin D through foods such as egg yolks, fish, and fortified milk and cereals. Fish sources include halibut, mackerel, sardines, shrimp, pink salmon, and cod liver oil.

Exercising five days a week for at least 30 minutes helps reduce bone loss. The best exercises for maintaining bone mass are weight-bearing exercises like walking, low-impact aerobics, and safe forms of dancing.


Currently, four medications have approval from the Food and Drug Administration (FDA).
  • Hormone Replacement Therapy (HRT)
  • Bisphosphonates
  • Calcitonin
  • Selective Estrogen Receptor Modulators (SERMS)
Hormone Replacement Therapy (HRT)
Hormone (estrogen) replacement therapy (HRT) is used for both prevention and treatment of osteoporosis. HRT can reduce bone loss, increase bone density in the spine and hips, and reduce the risk of hip and spinal fractures in postmenopausal women.

HRT is usually given as a pill or skin patch. It is effective even when started after age 70. Estrogen taken alone can increase the risk of developing endometrial cancer (cancer of the uterine lining). For this reason another hormone called progestin is usually prescribed in combination with estrogen for women whose uterus is intact.

Side effects of HRT can include nausea, bloating, breast tenderness, and high blood pressure. Some studies indicate a relationship between estrogen use and breast cancer, while other studies do not. Make sure to discuss the pros and cons of estrogen replacement therapy with your doctor.

These compounds inhibit breakdown of bone and slow down bone resorption. They've been shown to increase bone density and decrease the risk of hip and spine fractures. Alendronate is the bisphosphonate that has been approved by the FDA for preventing and treating osteoporosis in postmenopausal women. The strongest side effect of alendronate is gastrointestinal problems. To avoid these problems it should be taken on an empty stomach. Also take it with a full glass of water and remain in an upright position for at least thirty minutes afterward.

Calcitonin is used for women who cannot or choose not to take estrogen. For women who are at least five years past menopause, calcitonin can increase spinal bone density and slow bone loss. Calcitonin is a protein, so it cannot be taken orally because it would digest before it goes to work. It is available as an injection or nasal spray.

Selective Estrogen Receptor Modulators (SERMs)
SERMs are compounds that have effects similar to estrogen in some parts of the body, such as the spine and hip. SERMs seem to prevent bone loss of the spine, hip, and total body. Raloxifene is the SERM drug currently approved by the FDA for prevention of osteoporosis. Its impact on the spine does not appear to be as powerful as either estrogen replacement therapy or alendronate. There are no common side effects with raloxifene. Some women have experienced hot flashes and deep venin thrombosis (DVT).

Lifestyle Risk Factors
  • Low Calcium Intake. Consumption below 300 mg per day (which is equal to one glass of milk) is considered low.
  • Low (or no) Vitamin D in Your Diet. Vitamin D comes from sunlight and foods such as egg yolks, fortified milk and cereals, and some types of fish.
  • High Caffeine Intake. More than two to three cups of caffeinated coffee each day is considered high if you have a low calcium intake.
  • Tobacco Use. This includes current use as well as past use of tobacco.
  • Alcohol Use. More than 7 oz. of alcohol per week can slightly increase the risk of hip fractures.
  • Low Activity. Your activity rate is considered low if you do not walk or exercise regularly.
Biological and Medical Risk Factors
  • Biological Sex. Women have a greater chance of developing osteoporosis.
  • Race. Caucasians and Asians are at greater risk of having osteoporosis.
  • Age. Since bone loss begins at around age 30, the risk of osteoporosis increases with age.
  • Family History. If others in your family have experienced hip or spine fractures or become hunched over as they age, you are at greater risk of experiencing the same symptoms.
  • Body Frame. A thin body frame with low body weight for height will increase the risk of osteoporosis.
  • Post Menopause. Women who are past menopause have reduced estrogen, so their chances of losing bone mass increase.
  • Low Estrogen. There is more risk if women have had a low rate of estrogen over their lifetime. The deficiency can be the result of late onset of puberty/getting their period, early menopause (before 40), or an absence or suppression of menstruation.
  • Medication Use. Certain medications increase the risk of osteoporosis because they contribute to loss of bone mass when used long term. These drugs include steroids, inhaled steroids, anti-epileptic drugs, immunosuppressants, anticoagulants, and thyroid hormone suppressive therapy.
  • Nutritional Conditions. Conditions such as anorexia nervosa, chronic liver disease, malabsorption syndromes, or malnutrition can increase the risk of osteoporosis.
  • Endocrine Disease or Metabolic Causes. These could include thalassemia, diabetes, or hemochromatosis.
  • Other Medical Disorders. Conditions such as Down's syndrome, mastocytosis, myeloma and some cancers, renal tubular acidosis, rheumatologic disorders, and immobilization add to the risks.

Rheumatoid & Degenerative Disease of the Spine

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