Ask the Doctors December, 2006 Issue

ASK THE DOCTORS 12/06

I have rheumatoid arthritis in my hands, wrists, and elbows, as well as chronic pain in my neck. Is there any danger in getting chiropractic treatment for my neck while RA is present?

According to chiropractic literature, patients who have pain caused by acute inflammation, as in rheumatoid arthritis or spondylitis, rarely benefit from neck manipulation.

Chiropractic adjustment in a rheumatoid arthritis patient can actually irritate the synovial joints and cause a flare-up of the condition. Rheumatoid arthritis can weaken the connective tissues in the upper spine, and forceful manipulation could be dangerous.

Iím 65 years old and have been active in sports my entire life. In 2004, I had a total replacement of my left hip. However, my hip has yet to return to pre-op flexibility. Iíve started gradually to perform three exercises: flexing the left foot across the right knee, pulling the left knee to my chest, and inching close to a full squat. My goal is 90 percent of "completeness" after a full year of healing. Am I flirting dangerously with a left hip dis-location?

Without knowing more about your hip-replacement surgery, it is difficult to give you an accurate answer. Dislocation is more likely after some approaches to hip surgery than it is after others. The size of the implant also may be a factor; larger femoral head replacements have been found to be less likely to dislocate than smaller replacements.

Research has shown that most total hip dislocations occur within a month or two after surgery. One recent study found that the dislocation rate was about 2 percent for the first year, then an additional 1 percent for each subsequent five-year period.

Extreme twisting and bending from the hip are the most frequent causes of dislocation. I donít know what you consider "90 percent completeness" or why such extreme hip flexion is necessary when any number of physical activities (swimming, cycling, cross-country skiing) would benefit your cardiovascular and muscular fitness, including strength and flexibility. My advice would be to discontinue these exercises to eliminate the risk of hip dislocation.

After being diagnosed with osteoporosis six years ago, my doctor put me on Fosamax. The results of a recent bone scan were so good that Iíve now been told that I donít have to continue taking Fosamax. But if I do stop taking it, wonít my osteoporosis reoccur?

In general, you are correct: Fosamax helps to prevent osteoporosis as long as it is taken regularly, and once you stop taking it, bone loss will restart. However, there are some current studies on postmenopausal women with osteoporosis who discontinued Fosamax after five years. Bone-density studies in these patients demonstrated that there was no loss of bone mass over a two-year period in the spine, but a loss of bone mass in the hip began soon after Fosamax was discontinued.

These data suggest that patients can possibly discontinue Fosamax for 12 to 24 months and maintain the bone mineral density benefit. However, there is no data on whether fracture risk would be reduced.

Studies also have shown that, after menopause, there is a five- to seven-year period of accelerated bone loss; then the rate slows and returns to an age-related rate. Your physician is the best judge of when or if you should resume Fosamax, possibly based on regular bone-scan information. In the meantime, you should continue with a good nutrition and exercise regimen to minimize bone loss.