Ask the Doctors October 2017 Issue

Ask the Doctors: October 2017

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

Q: My wife takes a drug for osteoporosis. She’s encouraging me to get a bone density test. I’m a 72-year-old man. Should I be concerned about osteoporosis?

A: The short answer is yes. The bone-thinning disease osteoporosis often is thought of as a concern only for postmenopausal women. According to the National Osteoporosis Foundation, about one-half of postmenopausal women break a bone due to osteoporosis in their lifetimes. But this is true of up to one-fourth of men over age 50 as well. Twenty percent of all hip fractures occur in men.

Bone density screening is recommended for all women age 65 and older and for all men age 70 and older. Men with specific risk factors, such as family history of osteoporosis, breaking a bone after age 50, or taking corticosteroid drugs, should be screened earlier. Bone density is measured with a noninvasive test called a dual energy X-ray absorptiometry (DXA).

Screening is important because until a bone fracture occurs osteoporosis does not cause symptoms. And having an osteoporotic fracture can have serious consequences. Up to 50 percent of people who suffer a hip fracture require long-term nursing care, and about 40 percent of men die within one year.

A person with osteoporosis can fracture a bone from a relatively minor trauma or fall or even spontaneously. By detecting low bone mass early, measures can be taken to significantly decrease the chances for a bone fracture. These include making sure you have adequate intake of calcium and vitamin D, engaging in weight-bearing and muscle-strengthening exercises and possibly taking an osteoporosis medication. After age 70, men need 1,200 mg of calcium a day and 800 IU of vitamin D. If the DXA test shows you have low bone density, your doctor will use an assessment tool called FRAX® to determine your risk for a bone fracture and whether you should take an osteoporosis medication.

Q: Can hyaluronic acid injections be used for joints other than the knee?

A: The pain of osteoarthritis can be frustrating. There’s not one single treatment. Instead, it requires a multipronged approach, including weight loss (if overweight), physical therapy, pain medications and other measures. It’s no wonder people look for anything else they might try to relieve pain and improve function.

Injections of hyaluronic acid (also called viscosupplementation) are one option. They are used only after all other nonsurgical methods have been tried. Hyaluronic acid is a natural gel-like fluid in joints that helps to cushion, lubricate and protect the joint. A synthetic form of hyaluronic acid can be injected into joints.

Hyaluronic acid injections have been approved by the FDA only for knee joints. This is because there has been enough convincing evidence only in knees to justify the approval. Even so, the benefits are variable and some people don’t respond at all. For people who do have a positive result, it can take four to six weeks to feel the effects, and pain relief usually lasts about six months.

Hyaluronic acid continues to be studied in other joints, such as hips, ankles and shoulders. So far, these studies have not demonstrated a significant enough improvement to warrant FDA approval. Even though hyaluronic acid injections are approved only for knees, doctors can still use them for other joints. It’s considered an “off-label” use. Because hyaluronic acid injections are relatively safe, some doctors may be willing to try it. Common side effects are local and temporary.

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