Ask the Doctors December 2009 Issue

Ask The Doctors: 11/09

Thyroidism and Osteoporosis. . .Hip Arthritis. . .Steroid Therapy for RA

Q. My sister, who suffers from osteoporosis, broke her hip recentlyóand I have an overactive thyroid. Iím told that both are risk factors for hip fracture. Is there anything I can do to prevent it?

A. Family history of osteoporosis nearly doubles your risk of hip fracture, and hyperthyroidism (overactive thyroid) also is a risk factor. There are, however, several steps you can take to reduce your risk of hip fracture. The simplest are lifestyle changes, including smoking cessation and limiting alcohol intake, exercising regularly, and following a balanced diet that gives you adequate calcium and vitamin D. Unfortunately, most women donít get anywhere near the recommended amounts of calcium and vitamin D. Additional calcium can be obtained by consuming more dairy products or calcium-fortified foods, such as orange juice. In addition to adding foods such as fish, eggs, and vitamin-D- fortified foods to your diet, vitamin D production can be increased by limited sun exposure; even 15 minutes twice a day in the early morning and early evening can boost vitamin D production. The first step is to consult your physician to determine your current bone density and identify any vitamin or calcium deficiency. Depending on your family history and current medical condition, your doctor can help determine what you can do to reduce your risk of hip fracture.

Iíve been experiencing some pain for several weeks in my groin and inner thigh. Could I have arthritis in my hip?

The most common symptom of hip arthritis is pain, often in the groin and thigh. Other symptoms include increased pain with activity, limited range of motion, stiffness of the hip, and walking with a limp. Pain and stiffness generally are worse in the morning or after sitting for a long period. Arthritis symptoms tend to progress as the condition worsens, but often do not progress steadily. Patients often report having "good" days and "bad" days or symptom changes with weather changes. Hip arthritis usually is "wear and tear" arthritis or osteoarthritis, and it typically affects individuals over age 50. It is more common in patients who are overweight, and there is some genetic predisposition for this condition, meaning it can run in families. There are, however, a number of other conditions that can cause groin and hip pain, such as bursitis, tendonitis, muscle strains, stress fractures, and referred pain from the lower back. To determine the cause of your pain, your physician will obtain x-rays to check the condition of your hip joint and look for signs of osteoarthritis as well as rule out other causes.

I have rheumatoid arthritis and was told that steroid injections can control my inflammation. Steroids also can be taken orally. Which is most effective?

There are several types of steroid injections, and although they all can be effective, their use is normally tailored to the specific situation. When a joint is inflamed, fluid is usually removed and the steroid is injected directly into the joint. These injections are effective but often need to be repeated. The same joint should not be injected more than four times in a year. If a joint requires repeated injections, it is often a sign that the arthritis is not well controlled and that the medications you take may need to be adjusted. When there is a generalized flare with so many joints that local joint injections are not practical, systemic steroids in the form of an intramuscular injection or oral steroids can be used. Both forms are effective but are used in different situations. If one joint is inflamed it is better to give a local injection. Systemic steroids have significant side effects. They may cause weight gain, bruising, elevated blood sugar, osteoporosis, or muscle weakness. If steroids are prescribed, most physicians will administer them in as low a dose as possible.