Apr 14, 2023 | Healthy Aging, Medical Conditions, Medications, Nutrition, Patient News
Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.
Who’s at Risk for Osteoporosis?
Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.
Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.
How Osteoporosis is Diagnosed
A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.
Osteoporosis Medications
A number of medications are available to treat osteoporosis.
- Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
- Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
- Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
- Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
- Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.
Managing Osteoporosis
Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.
Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:
- Walk or run on level ground or a treadmill
- Dance
- Climb stairs
- Lift weights without straining your back
- Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
- Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
- Tai Chi: combines slow movements, breathing exercises, and meditation
Nourishment Know-How for Bone Health
For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.
Selected sources with calcium and/or Vitamin D:
- Dairy products
- Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
- Dark green, leafy vegetables
- Fish such as salmon, trout, mackerel, tuna, sardines
- Egg yolks
- Sesame or chia seeds, figs, almonds
Fall Prevention Measures for Those with Osteoporosis Include:
- Avoid ladders, step-stools and roof work
- Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
- Be careful around pets and leashes
- Use good lighting, night lights, update glasses and eye care to optimize vision
- Stay fit with regular strengthening and balance exercises
- Wear non-slip shoes
- Install handrails and grab bars in the bathroom
Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.
Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.
Apr 1, 2022 | Medical Conditions, Patient News, Wellness
Breaking the Cycle of Anxiety, Insomnia and Sleep Anxiety
A good night’s sleep does more than refresh and revitalize. It’s essential to your health, so make it a priority to understand what’s keeping you up at night.
“Healthy sleep is as important as proper nutrition and regular exercise for our physical and mental well-being,” says Kannan Ramar, MD, sleep medicine physician at the Mayo Clinic’s Center for Sleep Medicine and immediate past president of the American Academy of Sleep Medicine. “Lack of sufficient sleep is associated with increased risks of type 2 diabetes, high blood pressure, cardiovascular disease, depression and anxiety.”
The sleepless nights and drowsy days previously experienced by one out of three Americans with insomnia rose to pandemic highs of almost 60% in 2021, sounding a wake-up call to address this treatable condition which profoundly impacts both mental and physical well-being.
Sleep disturbance is intricately interconnected with the presence of issues such as anxiety and depression, each influencing the others, so it’s not always possible to determine which came first. Behavioral changes that result from chronic insomnia include feelings of being overwhelmed, inability to concentrate, irritability, nervousness, restlessness, and a sense of impending danger or doom.
Of adults diagnosed with depression, 75% experience insomnia and 20% have obstructive sleep apnea. Similarly, anxiety can make it harder for the body to relax and fall asleep.
Research suggests that anxiety can also affect rapid eye movement (REM) during slumber and trigger vivid, disturbing dreams that wake the sleeper.
Completing the loop is sleep anxiety — apprehension or fear about going to sleep — which is commonly seen in those with insomnia, narcolepsy, sleep apnea or restless legs syndrome.
While insomnia can seem never-ending, a number of strategies can effectively break the cycle.
The Basics:
- Set boundaries for blue light exposure by turning off tv, tablets and phones at least 30 minutes before bedtime.
- Limit large meals, caffeine and alcohol within 3 to 4 hours of bedtime, which can disrupt sleep. Alcohol allows you to fall asleep quickly but not stay asleep throughout the night.
- Establish a consistent wake-up time seven days a week.
- Ensure your bedroom is a designated place of sleep by keeping it dark, cool and quiet. And turn around your clock so you can’t see the time if you’re tossing and turning in the middle of the night.
- Pursue support if you are experiencing chronic insomnia, defined as difficulty sleeping three or more times per week for at least three months. “We know that the longer insomnia lasts, the more difficult it is to treat,” says Dr. Ramar.
Support can include:
- Cognitive behavioral therapy for insomnia (CBTI), a form of talk therapy focused on learning how to create an optimal sleep environment with positive bedtime routines and avoidance of factors that trigger anxiety and negative thinking. Requiring up to 12 weeks to see results, the key is shifting from “trying hard to sleep” to “allowing sleep to happen,” according to Stanford Health.
- Prescription sleep hypnotics, such as Ambien or Lunesta. Hypnotics can be considered in conjunction with CBTI, but patients must be closely monitored for adverse effects and a buildup of tolerance to the medication’s effects. Low doses of Trazodone, an antidepressant, are sometimes used, as it causes drowsiness.
- Light therapy, which is especially helpful for those who need to reset their circadian rhythms; e.g., a night owl who wants to function better with an early morning rising time.
If you are experiencing too many wakeful nights, please let your healthcare provider know. It may be helpful to keep a sleep diary for several weeks to help pinpoint the habits affecting your ability to fall and stay asleep. In some cases, we may recommend a polysomnography (sleep study), where you’ll be monitored for blood oxygen levels, body position, breathing, electrical activity in the brain, eye and leg movements, heart rates and rhythms, sleep stages and snoring during an overnight stay in a sleep lab.
Finally, keep in mind that the amount of sleep needed per night – typically 7 or 8 hours on average – varies by individual. “If you function well and are fully alert during the day, you can be confident your sleep needs are being met,” says Dr. Ramar.
Jan 11, 2022 | Medical Conditions, Patient News, Wellness
Coping With Sad This Winter
As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD, is once again on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Similar to last winter, the emotional stress and ongoing uncertainty that come with a global pandemic is unfortunately creating an ideal climate for SAD. Not surprisingly, mental health experts are expecting to diagnose and treat an increased number of people with SAD in 2022.
First discovered in the 1840s, SAD was not officially recognized as a disorder until the early 1980s, when Dr. Norman Rosenthal coined the term and categorized it as a form of clinical depression. We now know that SAD affects at least 5% of Americans; is more likely to affect women than men, those with other forms of depression or family members with the condition; and is far more common in northern regions, due to reduced natural sunlight. New research has advanced several theories as to why some people develop SAD, including: sluggish transmission of serotonin (which helps regulate mood and the body’s circadian rhythms; reduced sensitivity of the eyes to environmental light; a combination of these factors; or other reasons yet to be uncovered).
A deeper understanding of what triggers SAD and its impact on mental health has inspired a growing number of clinical treatments that can effectively neutralize its effects.
Chief among them:
Healing light.
Sitting in front of a bright light box for 30 to 45 minutes daily has been a treatment of choice for more than three decades, helping SAD patients with either 10,000 lux of white fluorescent or full spectrum light that shines 20 times brighter than ordinary indoor illumination. Dawn simulation, another form of light therapy, begins in early morning before patients awake by emitting a low level of light that gradually increases over 30 to 90 minutes to recommended room light level (approximately 250 lux). Enhancing indoor lighting with regular lamps and fixtures is also recommended).
Talk therapy.
Newer studies from the University of Vermont suggest that cognitive behavioral therapy (CBT), a psychological treatment aimed at providing patients with tools to change negative thoughts and behaviors, may be as effective as light therapy for treating SAD. According to the National Institute for Mental Health (NIMH), CBT adapted for SAD focuses on behavioral activation, helping SAD sufferers identify and engage in enjoyable seasonal activities to combat the ennui and fatigue they typically experience in winter.
Sleep hygiene.
Creating a consistent light-dark, sleep-wake cycle is important for SAD patients, who often experience hypersomnia (excessive daytime sleepiness) and insomnia (trouble falling or staying asleep).
Antidepressant medications. Because SAD is associated with disturbances in serotonin activity, antidepressant medications have been effectively used to treat symptoms.
Active days. Keep moving with daily walks outside, even on cloudy days, and aerobic exercise. Both can help alleviate symptoms of SAD.
Winterize your mental health
Be proactive in safeguarding your mental wellness over the coming months. Most importantly, know the symptoms of SAD and call our office for help if you’re experiencing:
- Diminished interest in things that were once enjoyable
- Low energy or overwhelming fatigue
- Difficulty with concentration or focus
- Worthless or helpless feeling
- Sleep issues: too much sleep, or not enough
- Changes in appetite or weight; increases in carbohydrate and sugar cravings
- Agitation
Experts advise those who’ve previously experienced episodes of seasonal depression to try to get in front of it this year. Call our office for guidance regarding medications or CBT sessions. For many, reprogramming their mindset can help restore proper circadian rhythms and eliminate the psychological dread of winter. Try enrolling in an online class, taking up a new hobby or creating a new routine to optimize daylight exposure. Or keep it even simpler. As Dr. Rosenthal told the New York Times, “A 20-minute early morning walk in the sun can be as good as commercial light therapy.”
