osteoporosis

Positive vibration, whole body vibration

Posted by Liz on May 21, 2012 in bone health, osteoporosis | 0 comments

I have been intrigued by whole body vibration (WBV)  for a few years now. If you’ve caught earlier posts, you’ll recall that whole body vibration was developed in India and then passed onto the Greeks to improve overall functioning. More recently, it was used  by the Russians to rehabilitate astronauts who may have lost muscle and bone mass during space missions. Now, however, it’s embraced by many sports medicine clinics and fitness facilities and gaining widespread popularity as strategy for improving leg muscle strength (and by default, balance and mobility) among adults as they age.

Positive evidence continues to accumulate in favour of WBV and in fact, researchers have conducted an extensive review of existing studies to assess whether or not WBV training can decrease the risk of falls and fractures. This is important since women as young as 35 years start to lose bone density and strength and by the time they reach the age of 50, they have a 40% risk of suffering a fracture due to osteoporosis during the rest of their lifetime. Moreover, during the first five years after menopause, women can experience as much as a 30% loss of bone density.

A bit of detail….this specific analysis included 15 studies enrolling both men and women between the ages of 64 and 82. Half of them included women only. WBV was conducted between 1 and 5 times per week over a period of 6 weeks to 18 months, and vibration was delivered during the sessions from anywhere to 15 seconds to 3 min for up to 27 times. The techniques were either vertical vibration (in which one stands on the platform and the vibration is delivered upwards), or side-alternating (in which the vibration is delivered side to side; this strategy apparently mimics a see-saw and the natural human gait.

Overall, they found that WBV may help to improve basic balance ability (i.e. sitting and standing balance) and offer significant benefit in terms of overall functional ability, especially in frailer individuals. Less clear, however, is whether or not it is effective in ultimately preventing falls; in this case, one could argue that by improving balance, WBV lowers fall and fracture risk but it isn’t so clear cut. What may actually be the case is that WBV plus an exercise program can help to do both.

So clearly, the verdict is still out on the usefulness of WBV. What’s more? The exact regimen that offers the most benefit remains unknown. Still, it’s clear that some data suggest that as we age, there are strategies other than drugs that might help to keep us walking and balanced.

As always, there is no time like the present to get moving on exercise and bone health awareness. You may be in your mid-30s and believe that nothing is going to change, but the stats are stacked against you without some sort of self-intervention.

Positive vibration? You bet!

Use it or lose it – more on osteoporosis

Posted by Liz on Jul 15, 2011 in bone health, osteoporosis | 0 comments

Bone health and osteoporosis. Yes, I know I keep writing about it. The reason is simple: you ARE at risk of losing your bone density and strength, especially if you are a woman over the age of 35. And if you are 50 or older? You have as much as a 40% risk of suffering a fracture due to osteoporosis during the rest of your lifetime. Moreover, during the first five years after menopause, women can experience as much as a 30% loss of bone density.

I can’t emphasize it enough. The risk is there. It is inevitable. However, you can reduce your risk a little bit by incorporating the following message into your life:

Use it. Or lose it.

In other words, you need to move.

The latest news out of the esteemed Cochrane Collaboration (an international organization that extensively reviews medical research) is that exercise specifically designed to promote bone growth and preserve existing bone mass, namely the type that places mechanical stress on the body, is necessary.  The newly-published review of 43, scientifically sound (i.e. randomized, controlled studies) is an update of a review that appeared in 2000. Of the 4,320 postmenopausal women included in the reviewed trials:

• Those who engaged in any form of exercise had slightly less (0.85%) bone loss than women who did not.
• Those who performed combinations of exercise types, i.e. walking, jogging, dancing, progressive resistance training, vibration platform had, on average, as much as 3.2% less bone loss than those who did not exercise.
• Non-weight bearing exercise, such as progressive resistance strength training targeting the lower limbs, was shown to slightly preserve bone mineral density at the hip, while the combination of exercise, per above, was most beneficial for slightly preserving bone mineral density at the spine. (Did you know that spine and hip fractures are the most common among women with osteoporosis?)

The conclusions are pretty clear: long periods of inactivity lead to reduced bone mass.However, here is a simple way to mitigate some of this loss, albeit slightly, and even help reduce the costly effects of osteoporosis: Exercise.

The best exercises? Those that stress or mechanically load the bones, meaning the type that make the bones support body weight or resist movement, such as aerobic or strength training, walking, or Tai Chi.

Ultimately, your goal is prevent osteoporosis from occurring in the first place. While some amount of bone loss is part and parcel with aging, resistance training is critical.

Move it or lose it.

Wednesday Bubble: wrinkles and bone density – what’s the connection?

Posted by Liz on Jun 8, 2011 in bone health, menopause, osteoporosis | 5 comments

There’s a connection between wrinkles and bones? When I caught wind of the research, I thought immediately of a Wednesday Bubble. But this one appears to be the real deal.

Researchers presenting at The Endocrine Society’s Annual Meeting this past weekend say that severity of facial wrinkles during the early years of menopause may indicate a low bone density (thereby leading to an increased risk for osteoporosis). Wow!

This information comes out of the ongoing Kronos Early Estrogen Prevention Study (KEEPS), which is looking at the effect of oral and transdermal estrogen therapy on measures of the carotid artery that might indicate thickening of the arteries (and eventual heart disease) as well as the build up of calcium in the blood. A subgroup of 114 women in their late 40s and early 50s and within three years of starting menopause were examined for this part of the trial.

The researchers looked at and scored severity and depth of skin wrinkling based on number of sites on the face and neck. They also measured skin rigidity (or firmness) on the forehead and cheek. Additionally, they evaluatd total body bone mineral density as well as at the lumbar spine and left hip.

The findings? Higher wrinkle scores (meaning more severe wrinkles) were associated with lower bone density measures at all sites, while firmer skin on the forehead and face were related to greater bone density, especially at the hip and spine.

The connection? Pun unintended but the researchers say that collagen, protein that naturally occurs in connective tissue in tendons, ligaments and even bones, is the common factor. They add that as women age, changes in collagen not only contribute to sagging skin and more facial lines but may also negatively affect both the quality and quantity of bone.

Although more research is needed, it might be worthwhile to obtain a dermatologic and bone density assessment at the start of menopause to see where you stand. And then speak to your health practitioner about the need for regular follow up and monitoring to insure that fragile bones don’t lead to fractures. Ultimately, if the link between wrinkling and bone quality is proven, it might eliminate or at least lessen the need for costly DEXA ( dual energy X-ray absorptiometry)  that are currently used to measure how tightly calcium and other minerals are packed into bone.

Who would thunk that wrinkles could actually be useful?!

Wednesday Bubble: is there a connection between dry mouth and osteoporosis?

Posted by Liz on Jun 1, 2011 in bone health, dry mouth, osteoporosis | 0 comments

This week’s bubble is neither burstable or good news. But it is important:

Dry mouth and bone mineral density appear to be related.

Say what?!!!

A bit of background is needed…

Osteoporosis is fast becoming a major health problem and as I’ve written time and again on this blog, is a significant characteristic of menopause, namely as the result of waning estrogen levels that lead to an imbalance between the build up and turnover of bone cells. Parathyroid hormone and cortisol have also been linked to bone turnover.

Dry mouth (i.e. a feeling of dryness in the mouth and need to use liquids while eating) and burning mouth syndrome (i.e. burning in the tongue or oral mucus membranes and taste alterations) are also common during menopause, affecting up to 40% of women. Until now, experts have not been able to adequately determine why these symptoms occur and more importantly, effective management strategies.

The link? Recent data have shown that estrogen levels may be significantly lower and both parathyroid and cortisol levels significantly higher in menopausal women who complain of dry mouth. Moreover, as the results of a new study in Menopause show, there may be a true relationship between these two conditions and that bone loss may be the actual cause of oral dryness and related symptoms. In this study, researchers evaluated 60 women in menopause (mean age 56) for the presence and severity of dry mouth and then based on their results, divided them into two groups. Dry mouth was confirmed by responses to a scientific questionnaire and collections of saliva. The researchers also measured bone mineral density at the spine.

Importantly, the participants were not particularly active and none engaged in any sports activity, except walking. The women were also matched by body mass index, age, or years of menopause. And yet, women with low bone mineral density, including relationship to other women in the same age group and 30 years younger, were significantly more likely to experience dry mouth and had significantly less saliva when their appetites were not stimulated.

Clearly, more research is needed. However, there are some things you can do now. The first strategy to combat osteoporosis and bone loss is to get measured for bone loss and disease markers. Steps like calcium supplementation, a healthy diet and regular exercise are critical. And if you suffer from dry mouth? You may want to speak to your dentist about a referral for a bone mineral density scan or better yet, have him or her contact your gynecologist or regular health practitioner for a pow wow. Not only may you help your bones, but you may actually change that dry feeling.

Estrogen: Worth the risk?

Posted by Liz on Apr 6, 2011 in breast cancer, estrogen, heart disease, osteoporosis | 9 comments

Any regular reader of this blog knows that I am not a fan of hormone replacement therapy (HRT) nor the health risks associated with it. Nevertheless, although I espouse alternative strategies for dealing with menopause, I do feel that sharing news about HRT is important; accurate information leads to informed and shared decisionmaking.

So, do they (i.e. hormones) or don’t they (cause harm)? Undoubtedly, important variables come into play, including current age, how close to menopause hormones are started, current health status, whether or not a woman has had a hysterectomy, smoking history, etc. Also important is whether estrogen is used alone or in combination with progesterone. And yet despite these factors, many medical organizations continue to recommend that HRT be used for the shortest time period possible if at all.

Still, researchers continue to delve into data from the now infamous Women’s Health Initiative Study to tease out the bad, ugly and even the good.

This week,  they are reporting on over 7,600 women who had taken estrogen alone for approximately 6 years, had had prior hysterectomies and were followed for an average of 10 years after the trial ended. If you recall, there has been some controversy as to whether or not estrogen alone is safer than combined HRT and actually lowers the risk for breast cancer in particular, which is why these data are particularly intriguing.

The researchers report that age at the time that hormone therapy (in this case, estrogen alone) is started is important. In fact, women who started estrogen therapy in their 50s, an increased risk for stroke and embolism, which appeared while taking estrogen, actually disappeared in the years that followed. Unfortunately, so did protection against hip fracture. Moreover, earlier reports of a decline in breast cancer risk were upheld despite body mass indices. However, the researchers say that this finding in particular, runs contrary to the preponderance of evidence from the majority of observational studies which show that estrogen use increases the risk of breast cancer, especially in lean women and after a long time period of use.

In an accompanying editorial, also in JAMA, the authors point out that more than 80% of women who took estrogen as directed only used it for an average of 3.5 years. Their point is that the results don’t directly address the “balance of risk and benefits associated with longer term estrogen use.” They also point to a larger review of data that show duration is an important factor when it comes to breast cancer risk, especially among lean women. Additionally, they say that tamoxifen, which actually antagonizes estrogen, has been shown to reduce breast cancer by 50%, which has led the International Agency for Research on Cancer to “conclude that unopposed estrogen therapy and combination HRT are carcinogenic.”

Are you confused yet?

Both set of researchers say that the decision to use estrogen or not is one that should be made between a woman and her doctor. Don’t forget: study findings continue to contradict. They add that while “there may still be a role for short-term use of unopposed estrogen for treating some women with menopausal symptoms, this role may be vanishing as existing and emerging data continue to be better understood in terms” of patients.

My thoughts? Err on the side of caution. Always.

Soy. Is it safe?

Posted by Liz on Jan 3, 2011 in diet, herbal medicine, osteoporosis | 0 comments

For years, researchers have been exploring the potential of soy isoflavones — naturally-occurring plant estrogens — for alleviating menopausal symptoms such as hot flashes, atrophy and bone loss. Thus far, certain components of soy, including genestein and S-equol have shown the most promise. However, are they safe?  And, as the adoption of soy as a viable alternative to risk-ridden hormone replacement therapy continues to grow, and women turn to supplements rather than food-based soy, is there anything that they need to worry about in terms of side effects?

Researchers recently evaluated this question in a study of 403 postmenopausal women who took  either 80 mg soy tablets, 120 mg soy tablets or placebo tablet daily for  two years. The particular type of soy isoflavones used were hypocotyl isoflavones, which are a byproduct of soy protein and (very rich in daidzein – the second most plentiful isoflavone in soy. The effects of the supplements were measured at the study’s start, at one year and at the end via blood tests and a well-woman examination (i.e. mammogram, pap smear, x-rays to measure bone density). A smaller group of women also had ultrasounds done to determine any possible effects on the lining of the uterus or development of fibroids.

Although the primary goal of the study was to determine the effects of this type of soy supplement on osteoporosis and bone loss, the researchers discovered that taking soy supplements during this time period did not present any major risk to health and did not affect thyroid function. Although one participant developed breast cancer during the study and one, endometrial cancer, 1) utrasounds in the subgroup of women who received them did not show any uterine thickening and 2) the rate of cancer development in this study, only two women over a two year time period, was considerably lower than statistically likely in a general population of women. Both of these factors support the contention that soy isoflavones are not likely to promote either cancers.

So, is soy safe over the long-term? It appears that it is. HOWEVER, bear in mind that the type of soy used in this study is are very different that the type that is commonly sold over the counter, which commonly contain higher percentages of genistein, the most plentiful isoflavone component in soy.

And what about osteoporosis? This particular paper did not address those specific results, although others have. Thus far, the results have been mixed. However, this particular study, better known as OPUS (Osteoporosis Prevention Using Soy)is one of the largest and most comprehensive to date and those findings are likely to come to light soon.

In the interim, if you are going to be taking soy in supplement form, be mindful that your exposure is likely to be as one to four times that a typical Asian diet and as much as 100 times that of a typical Western diet. While these level do not appear to be harmful, herbal and plant medicines are not without risk so as always, the rule of thumb is be vigilant and speak to a health practitioner first.