Ann Alexander is the Bionic Woman.
“Both hips replaced, two rods, six screws in my back, tailbone removed, cadaver ankle on my right, left ankle redone,” says the York County resident. “I’m done falling apart.”
Alexander’s spirited humor masks the severity of her condition—osteoporosis that has deteriorated her bones and, compounded by arthritis, confined her to a wheelchair for life. She is 53 years old.
Many people think that osteoporosis and arthritis are related. They’re not, but both affect movement, especially as we age. And though treatment differs, both can be prevented or hastened by lifestyle choices.
“They do commonly coexist in our older population, but they are two distinct entities,” says Dr. Steven J. Triantafyllou of OSS Health (ossortho.com), an orthopedic care provider with offices in York, Adams and Dauphin counties.
What they are
Latin roots define the word “osteoporosis”—osteo means “bone,” and porosis means “porous.” “Osteoporosis is weak bone,” says Triantafyllou. Older women, especially, are at risk as the body stops producing bone-protecting estrogen.
The most common form of arthritis, osteoarthritis, is a wearing down of the cartilage that cushions joints. It creates inflammation of the hips, knees, fingers, and even the spine.
As a woman, you are at more risk postmenopausally of developing osteoporosis fractures than heart attack, stroke or breast cancer—combined.
While arthritis manifests itself in pain and swelling, osteoporosis is known as “the silent epidemic.” Only a bone scan, known as a DEXA scan, can reveal osteoporosis or its precursor, osteopenia. In the U.S. every year, osteoporosis causes 1.5 million fractures of the spine, hip, wrist, and other bones.
“That’s astronomical because it’s one every 30 seconds,” says Triantafyllou. “As a woman, you are at more risk postmenopausally of developing osteoporosis fractures than heart attack, stroke or breast cancer—combined.”
With osteoporosis, a simple move can turn subtle bone cracks into breaks, says Kathryn Mueller, physician’s assistant at Camp Hill’s Orthopedic Institute of Pennsylvania (oip.com). Old spinal compression fractures can show on x-rays, even if the patient doesn’t know how they happened.
Prevention
Arthritis affects men, women and people of different races and ethnicities equally.
Osteoporosis discriminates, targeting women because men have more bone in the first place. Thinner white women are considered at higher risk, and genetics “plays a big part,” says Mueller. “What happens to your mother and your aunts and your sister and how you’re built matters. Tall, skinny people, they might be able to find jeans that fit, but they also get way more osteoporosis.”
Triantafyllou tells patients “that we have a bone bank. When we’re young, we store up bone through nutrition, Vitamin D, calcium and exercise. From 30 on, we begin to lose bone. The stronger your bone is, the more bone you’ll have to spend in your older years.”
Weight-bearing exercise—actually stressing the skeleton—is one of the best osteoporosis preventers, says Dr. William T. Monacci of Lancaster NeuroScience & Spine Associates (lancasterneuroscience.com).
The right amount of calcium and Vitamin D —and not necessarily extra calcium—helps build bone. Usually, that’s 1,000 to 1,200 milligrams a day, depending on age (find guidelines from the National Osteoporosis Foundation, www.nof.org). Plus, calcium needs help to make a difference. “The calcium doesn’t get into bones unless it’s forced,” says Monacci. “That’s typically done by hormonal production, and it’s triggered by stress on the bones.”
Drinking alcohol in moderation and avoiding smoking also help prevent osteoporosis.
Weight-bearing exercise—actually stressing the skeleton—is one of the best osteoporosis preventers.
Patient Ann Alexander has no family link to osteoporosis. Hers was discovered through a DEXA scan before a knee replacement. She used to ride horses and hike but never realized the importance of nutrition.
“It’s something that women should be taught to be aware of,” she says. “It can be a whole turnaround of your life. You are confined. Once your bones start going, there’s no turning back.”
Like osteoporosis, arthritis can be stalled with activity and moderate exercise. Although a little extra weight can protect the bones and help prevent osteoporosis, obesity can worsen arthritis by stressing joints.
Maintaining the range of motion through stretching can ease arthritis symptoms, says Monacci. Physical therapists can help patients walk the fine line between too much exercise and not enough.
Treatments
People who develop osteoporosis should keep exercising and taking calcium and Vitamin D, while medications such as Fosamax and Boniva might slow or reverse bone loss, says Triantafyllou.
Arthritis patients are typically treated with anti-inflammatory prescriptions or OTC pain relievers. When bone rubs on bone, it’s time for a joint replacement. But joint replacements are tricky for osteoporosis patients such as Alexander, who has arthritis in her knee but little quality bone left for attaching a new joint.
Alexander recalls the back problems that started at age 18, “but nobody knew what it was.” She urges friends to get the DEXA scan, which is painless and quick.
“Just go get it done,” she tells them.
Mueller believes that the bone-health message should go to “the people who are not interested at all, which is younger people. Once you’ve crossed into menopause, you can’t really regain that ability to form bone that you had as teens.”
Alexander agrees.
“I wish I had somebody that opened my eyes then and told me about it before it was too late,” she says. “I’d have done things a lot differently.”