Ask the Doctors May 2007 Issue

Ask The Doctors: 05/07

I’m 83, have low bone mineral density, and have been diagnosed with osteopenia. I have dairy/lactose intolerance and drink soy milk. With my lactose intolerance, can you recommend a calcium I can take daily? Do you recommend sun exposure for natural vitamin D?

Lactose-reduced milk, which contains all of the nutrients found in regular milk, is available at most supermarkets. Many foods are rich sources of calcium, such as salmon and sardines, kidney beans, black beans, turnip greens, broccoli, and kale. Most calcium supplements are also safe for lactose-intolerant individuals.

Several recent studies have confirmed the beneficial effects of sunlight. Direct sunlight absorbed through the skin boosts the body’s production of vitamin D, which helps the body absorb calcium. Some studies have also found that sunlight may help protect against a number of other diseases, including heart disease, rheumatoid arthritis, and some cancers. So sitting in the sun for 20 to 30 minutes is a good "prescription." As an added bonus, sunshine stimulates production of serotonin, one of the body’s "feel good" chemicals, which can make you feel better and more alert. Use caution, however, when in the sun. Too much sun exposure can increase the risk of skin cancer.

Some people with arthritis seem to be going strong after being diagnosed with the disease 20 or more years ago, while others are disabled quickly. Why does arthritis progress so rapidly in some and not in others?

First, the term arthritis applies to many different diseases; in fact, there are more than 100 types of arthritis. To focus on osteoarthritis—erosion of cartilage in the joints and the most common form of the disease—progression in patients with osteoarthritis of the knee, for example, may depend on a number of factors, including body weight and overuse of the knee. Patients who are overweight put more stress on their knee joints. It is estimated that for every pound of your weight, the knee experiences three to four pounds of additional force. And if you suffer from knee osteoarthritis, high-impact activities—such as running—can accelerate the progression of cartilage damage.

I have chronic bursitis in both hips. Is there anything I can do to relieve pain besides having to go through injections every three months? Can exercise or diet help?

A bursa is a fluid-filled sac that allows smooth motion between two uneven surfaces. In the hip, there is a bursa between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passes over this bone. When the bursa becomes inflamed (bursitis), pain results each time the tendon has to move over the bone. Treatment usually begins with rest until the inflammation subsides, anti-inflammatory medications, and application of ice. Most patients find some relief with stretching exercises. Patients with hip bursitis also can often benefit by weight reduction and the use of proper footwear for exercise activities. Generally, you should avoid hills and stairs and direct pressure on the affected hip (sleep on the other side) while symptoms are present. Most patients who follow these guidelines improve within six weeks or so.

I have arthritis, and I fall frequently. Is there any relationship between my arthritis and falling?

A person can fall for a variety of reasons. Some people experience a drop in blood pressure, become light-headed, and fall. Arthritis can also cause falls, especially if it affects joints in the legs, hips, knees, and feet. In this case, a patient could have pain, favor a knee or hip, and lose balance. Patients with lower-extremity arthritis often develop weak muscles because they use their lower extremities less, largely due to the pain of use.