Post-Polio Health (ISSN 1066-5331)
Vol. 16, No. 1, Winter 2000
More about Osteoporosis
Osteoporosis is a debilitating disease in which bones become fragile and are more likely to break. In most cases, it can be prevented and treated but if steps are not taken, it progresses painlessly until a bone breaks.
Osteoporosis affects more than 28 million Americans, 80% of whom are women. In the United States today, 10 million already have osteoporosis and 18 million more have low bone mass placing them at increased risk for developing it.
People need to know whether they are at risk for developing osteoporosis or whether they already have lost so much bone that they already have osteoporosis. While risk factors* can alert a person to the possibility of low bone density, only a bone mineral density (BMD) test can measure current bone density, diagnose osteoporosis and determine fracture risk. There are many different techniques that measure BMD painlessly and safely. The majority of these machines use extremely low levels of radiation while ultrasound machines use sound waves instead.
Medicare and many private insurance carriers cover bone density tests to detect osteoporosis for individuals who meet certain criteria. Talk with your doctor about whether or not this test would be appropriate for you.
Depending on the results of the test, you and your physician may decide that you should begin a Food and Drug Administration (FDA) approved medication for osteoporosis to stop bone loss, improve bone density and reduce fracture risk.
Several medications have been developed to help manage osteoporosis and to strengthen bones in women at high risk for the disease. Hormone replacement therapy (HRT - estrogen and progesterone) helps to prevent osteoporosis by slowing bone loss. However, HRT carries certain risks, most notably an increased risk of breast cancer, and may not be the best choice for some women.
Other medications are available to prevent and manage osteoporosis without the risks associated with HRT. Alendronate, a drug known as a bisphosphonate, slows bone loss and increases bone density. Another medicine, calcitonin, has been shown to improve bone density and lessen back pain due to osteoporosis. Raloxifene, developed to help prevent osteoporosis, belongs to a class of drugs called SERMs, or "selective estrogen receptor modulators." Raloxifene has been shown to build bone without increasing the risks of breast or uterine cancer.
You can do your part to protect bone health by following osteoporosis prevention and treatment strategies.
- Consume a calcium-rich diet that provides 1200 mg of calcium from a combination of foods and supplements.
- Obtain between 400 and 800 IU of vitamin D each day.
- Participate in weight-bearing and resistance-training exercises three times a week. This recommendation by the National Osteoporosis Foundation needs to be modified for polio survivors. Each polio survivor must determine what is a beneficial level of exercise and what could be deleterious. (See "Aspects of Muscle Compensatory Processes and Physical Activity in the Survivors of Polio.")
Prevention of Falls and Fractures
Safety First to Prevent Falls
At any age, people can improve their environments in ways that reduce their risk of falling and breaking a bone.
Outdoor Safety Tips
- In nasty weather, use a walker or cane for added stability.
- Wear warm boots with rubber soles for added traction.
- Look carefully at floor surfaces in public buildings. Many floors are made of highly polished marble or tile that can be very slippery. When floors have plastic or carpet runners in place, stay on them whenever possible.
- Identify community services that can provide assistance, such as 24-hour pharmacies that deliver, grocery stores that take orders over the phone and deliver, especially in poor weather.
- Use a shoulder bag, fanny pack or backpack to leave hands free.
- Stop at curbs and check height before stepping up or down. Be cautious at curbs that have been cut away to allow access for bikes or wheelchairs. The incline up or down may lead to a fall.
Indoor Safety Tips
- Keep all rooms free from clutter, especially the floors.
- Keep floor surfaces smooth but not slippery. When entering rooms, be aware of differences in floor levels and thresholds.
- Wear supportive, low-heeled shoes even at home. Avoid walking around in socks, stockings or floppy, backless slippers.
- Check that all carpets and area rugs have skid-proof backing or are tacked to the floor, including carpeting on stairs.
- Keep electrical cords and telephone lines out of walkways.
- Be sure that all stairwells are well lit and that stairs have handrails on both sides. Consider placing fluorescent tape on edges of top and bottom steps.
- For optimal safety, install grab bars on bathroom walls beside tubs, showers, and toilets. If you are unstable on your feet, consider using a plastic chair with a back and non-skid leg tips in the shower.
- Use a rubber bath mat in the shower or tub.
- Keep a flashlight with fresh batteries beside your bed.
- Add ceiling fixtures to rooms lit by lamps only or install lamps that can be turned on by a switch near the entry point into the room. Another option is to install voice- or sound-activated lamps.
- Use at least 100-watt bulbs in your home.
- If you must use a step stool for hard to reach areas, use a sturdy one with a handrail and wide steps. A better option is to reorganize work and storage areas to minimize the need for stooping or excessive reaching.
- Consider purchasing a portable phone that you can take with you from room to room. It provides security because not only can you answer the phone without rushing for it, but you can also call for help should an accident occur.
- Do not let prescriptions run low. Always keep at least one week's worth of medications on hand at home. Check prescriptions with your physician and pharmacist to see if they may be increasing your risk of falling. If you take multiple medications, check with your physician and pharmacist about possible interactions between the different medications.
- Arrange with a family member or friend for daily contact. Always have at least one person who knows where you are.
Source: National Osteoporosis Foundation, 1232 22nd Street NW, Washington, DC 20037 (202-223-2226, www.nof.org).
Memory and Aging
Not all changes in memory are due to disease, but some that accompany normal aging may be amenable to forms of treatment that are also under study as possible Alzheimer therapies. One involves the hormone estrogen, thought to protect against a variety of conditions including osteoporosis and cardiovascular disease, but doctors are cautious about its use because it may increase the risk of breast cancer.
In recent years, studies have suggested that estrogen protects memory. In 1998, an observational study of more than 700 healthy post-menopausal women, led by researchers from Columbia University College of Physicians and Surgeons, found that those who used estrogen replacement therapy scored significantly higher than non-users on memory tests, and also on tests of language and abstract reasoning. Moreover, the estrogen-users' performance on a test of verbal memory improved slightly during an average 30 months of follow-up, as they continued on estrogen replacement therapy. These preliminary results suggest the time may be ripe for clinical trials of estrogen as a memory strengthener during healthy aging (Jacobs et al, 1998).
SOURCE: The Dana Alliance for Brain Initiatives' "Delivering Results: A Progress Report on Brain Research, Update 1999: New Connections."
