Osteoporosis and Hip Replacement Surgery

Osteoporosis is a very common condition, affecting more than 25 million Americans. It is especially prominent in women over the age of 50, but 10 to 15 percent of men over 70 are also affected. Characterized by loss of bone density and strength, osteoporosis causes brittle, weak bones that are easily broken. The most common fractures in osteoporosis sufferers are in the wrist, spine and hip. When hip fractures or joint deterioration happen due to osteoporosis, hip replacement is often necessary.

Osteoporosis and Hip Fractures

Osteoporosis is a marked loss of bone mass, resulting in porous and brittle bones. Bones go through a process called remodeling constantly throughout our lives. This process breaks down bone tissue and rebuilds it on a regular basis. Early in life, that remodeling process is very efficient, building more new bone than is broken down, but once a person reaches their mid-30s, new bone growth slows. In osteoporosis, that new bone growth slows to the point that bone tissue is broken down faster than it is replaced, leading to a steady decline in bone health.

Weakened bones become more prone to breakage, making everyday incidents that would typically cause simple bruising a hazard for bone fractures. Among the most common osteoporosis-related fractures are hip fractures, which are always very serious events and often life-changing ones.

Hip fracture almost always requires surgical intervention, which can range from repairing the natural joint to partial or total hip replacement. Joint replacement is typically done when the type of fracture or degenerative changes in the joint make repairing the natural bone impractical.

Hip Replacement Surgery

In 2010, hip replacement procedures numbered more than 458,000 in the United States. Since most of these procedures are done in people over the age of 65, many involved osteoporosis damage and hip fracture. While this surgery has become fairly routine and is among the most successful orthopaedic procedures, it is still major surgery and does involve risk.

In recent years, risk of complications with hip replacement has been a bit higher due to faulty hip implant systems, several of which have been recalled. The most recent recall involved the Stryker Rejuvenate implant, which was pulled from the U.S. market by the manufacturer in July 2012. Stryker has since discontinued the production and sale of these implants globally.

The Stryker Rejuvenate implant was plagued with some of the same issues that caused the recall of several metal-on-metal hip replacement systems over the last few years, including metallic contamination from implant debris.

That contamination can cause a serious condition called metallosis, which can lead to severe inflammation and pain at the implant site as metal particles collect in the soft tissues, as well as tissue death and bone loss. Revision surgeries are done in many of these patients to replace faulty implants and repair joint damage. This type of trouble can be particularly hard on joints affected by osteoporosis, so reviewing all available options to ensure the safest and most durable implant is used is very important. This also ensures that the patient won’t have to file a hip lawsuit, due to the expensive revision procedures.

 

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

Preventing Osteoporosis

Preventing osteoporosis is way easier than treating it. The good thing about preventing osteoporosis procedure is that they also ensure you a healthy lifestyle, which means an overall healthy body that lives with you with minor maintenance.

Preventing osteoporosis depends on several factors, including how old you are now. I know that since you are reading this you most probably have already been diagnosed to have osteoporosis, but you can pass the information to those around you who you care about.

For young people (under the age of 25) it’s their chance of precipitating as much calcium and building as solid bones as they possibly can in their whole lives. The peak bone density is measured at the age of 25. The higher the bone density at this point that slower the decay would be with aging.

After the age of 25 and until 30 you still can deposit some calcium in your bones (according to some of the doctors who treated me in the past 10 years). So young people missed up on this in their early “golden age” they can still catch up until they are 30.

After the age of 30 the process naturally starts to reverse, where the break down of bone mineral matrix tends to occur more frequently than the matrix depositing process by the bone cells (osteoclasts). According to my understanding you can not prevent the break down as this is important for your bone quality and health. But you can push your body to build more bone matrix (the mineral hard material that connects bone cells together and consists mainly of calcium deposits) and make up the loss.

This is what can be considered the “bone density maintenance”. And it should be done on 3 levels:

1. Nutrition

2. Lifestyle

3. Medical care

In future articles I’ll be writing more about nutrition and lifestyle, and to some extent about the medical care in terms of your options as this blog is not meant to give any medical advise of any kind.

Osteoporosis Dental Concerns

Osteoporosis dental complications are pretty obvious. Your teeth are supported by your jab bones. If you happen to have osteoporosis your jaw bones become less able to support your teeth. This leads to loose teeth and probably some teeth loss.

Dental implants in an osteoporosis patient’s mouth are also prone to be unstable, hence you need to watch out for what you are chewing.

Osteoporosis dental frequent check ups are highly recommended. But this is not the whole story.

Some osteoporosis patients are being treated with Bisphosphonates (BPs) which helps in the absorption process of calcium by the osteoclasts (the cells that build the bone mineral skeleton). It was reported that 1 out of 100,000 osteoporosis patients might have some gum complications due to this treatment with bisphosphonate, like Osteonecrosis of the Jaw (ONJ) (O’Neil et al., 2008).

Osteoporosis dental care has to be unique and, in my opinion, like there is a physiotherapist specialized in treating osteoporosis patients, a dentist might be specialized in osteoporosis as well. For example if an osteoporosis patient is having a dental implants, the normal procedure followed in normal patients will not result in the same quality of the outcome when operated on a normal patient. Our jaws as osteoporosis patients are weaker and there should be a special treatment for us.

Update on Osteoporosis and Exercises

I was talking to my dentist, who’s also my sister in law, about my condition and how it was affecting my teeth. In another post I’ll write about what she told me about how osteoporosis affects the dental health, but for now I’ll only mention what she told me about osteoporosis exercises.

Anabolism (building metabolism) increases in general with exercises. This increase in anabolism extends to the osteoclasts (the bone cells that carry out the bone-building process). When these cells are activated they build more bone mass than before. This “bone-building” process slows down the decline in bone mass.

She called a physiotherapist specialized in osteoporosis and she confirmed these information. But that’s not all.

Get this: The physiotherapist added that she witnessed cases of osteoporosis that had been REVERSED. The common thing among those cases was that the patients were exercising.

Can you imagine how nice that felt? After I talked to a bone specialist in the emergency room after having a fracture in my foot and he told me that had never seen an osteoporosis case reversed before, I am kind of got the hope again that I might be able to live a normal life shortly (in a few years that is) if I exercise regularly!

As promised I’ll post here all what I know about the kinds of exercises that help rebuild the bones. I am not a specialist, but I’ll share with you what works for me. May be you can discuss what you see here with your doctor and get to put a routine that fits you more.

Benefits of Osteoporosis Exercises

Osteoporosis exercise is a special set of body movements using certain muscles and moving certain joints with calculated levels of resistance. The purpose of osteoporosis exercise is to help osteoporosis patients in two areas:

1. Strengthen their muscles that help in:

a. balancing to avoid falls, and

b. protect (cushion) the bones from the impact of hits to a certain level.

2. Put a straine on the bones that’s required to induce the building of new bones.

Some sources claim that the anabolic effect of exercise can “reverse” osteoporosis. This claim (where I found it on Wikipidia) was not supported by a reference at the time of writing this article. But at least they are documented to help in reducing the speed by which bone mass is lost.

In the following articles on this website I’ll be doing more research and interviewing osteoporosis specialists around this issue. I am hopeful that I’ll find a solid evidence that exercising can reverse osteoporosis for at least a cergain category of osteoporosis patients.

Until I am done with my research there are three things that I want to share with all fellow osteoporosis patients:

1. Preventing falls has a higher priority than finding a cure. Let’s face it. Our bones are fragile and a simple low impact fall might be enough to send us home if it was in the hips or the spine. Until someone figures out how to reverse it, and until the cure works on us we need to preserve what we have.

2. The anabolic effect of exercise is not only important in preserving our bones, it also helps maintain the heart and brain cells. (An insulin-like growth factor that’s induced in the muscles during an exercise [Scheett et al., 1999]). But please don’t start exercising until you discuss your options with your doctor.

3. Exercise without nutrition is worthless. Well .. not 100% worthless, but won’t be as effective as when accompanied by the right nutrition. If you have access to a nutritionist specialized in osteoporosis diets that will be great. If not, please hang around until I finish my research and post it somewhere on this website.

Symptoms of Osteoporosis

Symptoms of osteoporosis are mainly consequences of bone density loss. This process; the loss of bone density, is a slow gradual process. Hence, there are no early symptoms of osteoporosis.

Osteoporosis is one of the “silent thieves” that progress without you noticing their existence. While you are reading this now, if you are above 25 then your bones are losing density already. How dense or thin your bones are depends on several factors, including your bone density at the age of 25 (your peak bone density age), your life style, your diet, where you are in the world, and your genes.

Regardless of all of these factors, osteoporosis has no symptoms until it’s already progressed enough to be a disease that needs treatment.

There are 3 symptoms of advanced osteoporosis:

1. Fractures (makes sense) in the wrist, hips, or the spine areas

2. Lower back pain

3. Muscle ache

Although these symptoms start to show mostly in elders, recently the ratio of young men and women with osteoporosis is increasing significantly. One example from life, when I went to see the osteoporosis doctor for the first time we were a group of 5 people. I was in the late thirties, 3 girls in their mid and late twenties, and an elder man. My doctor also confirmed to me that most of her patients are young people.

Back to the issue of osteoporosis symptoms:

One thing I’d like you to know before I go any further with more symptoms, is that you have two types of bone tissues in your body: trabecular (spongy and porous) and compact (thick and hard) tissues. Your rips, hip, wrist and spine are made mostly of the spongy tissues surrounded with a thin layer of the compact tissue, while the long ones are made mostly of thick hard tissues from the outside, and a spongy lining.

Why this piece of information is important? Because fractures in mostly spongy bones are 70% less painful than fractures in the hard bones. What does that mean?

It means that you could have fractures in your spine without knowing it. This type of compression fractures causes your vertebrae to take a new missed up shape that causes your spine to become 1) shorter, and 2) malformed. The net result is losing height and having a hump or any noticeable change in posture.

So, if you are losing height, or when you get comments from friends about your posture, see your doctor.

One more thing I started to relate with osteoporosis. When I was younger and exercising with heavy weights, when I go beyond a certain weight in the biceps curl I used to feel pain in the middle of my radius ulnar (the fore arm bone).

Fractures deserve another post of its own, so I’ll leave it here for now.

OSTEOPOROSIS

Osteoporosis is a disease that affects bones, making them lower in density and mineral composition, and more fragile and susceptible to fractures from low impacts. The micro-architecture of the bones of osteoporosis patients changes in a way that makes it more fragile.

80% of osteoporosis patients are women, most of them are in the menopause, either naturally or surgically. In most cases the hormonal changes at the menopause play the biggest role in causing osteoporosis to women.

Men represent 20% of the osteoporosis community. Common causes of osteoporosis in men and young women include hormonal imbalances (especially the parathyroid), treatment with corticosteroids, and chronic diseases.

Life style, nutrition, and genetics play significant roles in developing osteoporosis. Low activity, deficiency in calcium and vitamin D, smoking, and alcohol consumption all contribute to osteoporosis. Asians and Caucasians are the most susceptible people to osteoporosis, while Africans are the least to develop it.

Osteoporosis can be prevented, even if your genes work towards establishing it. An active smoke- and alcohol-free life with regular exercising, consuming excess amounts of vitamin D, calcium, and magnesium all work towards developing and maintaining healthy bones.

Usually the peak of bone mass is in the early twenties. If you can reach a high bone mass at the age of twenty, and maintain that mass through the age of 30, you are doing your bones the biggest favor you can ever do to them.

Osteoporosis treatment also include changes in life style to adopt healthier and more active practices, in addition to some medications.