Johns Hopkins Health Alerts - Back Pain and Osteoporosis

Soy and Osteoporosis Prevention: What's the Connection?

Fri, 05 Feb 2010 06:00:00 CST

The risk of developing osteoporosis increases as we grow older. Exercise, proper nutrition, and – when appropriate – medication can all help to prevent osteoporosis. But what about isoflavones? A reader asks: My sister-in-law has been eating isoflavone-enriched cereal bars to reduce her risk of osteoporosis. Do they really work? Here’s what the science suggests.

Many women use natural alternatives to hormone replacement therapy, such as soy supplements, in an attempt to reduce their risk of osteoporosis with fewer side effects. And some evidence suggests that isoflavones, which are estrogen-like plant chemicals found in soybeans, may protect against postmenopausal bone loss. But based on currently available data, it does not appear that isoflavone-enriched foods can help reduce the risk of osteoporosis.

In fact, European researchers used the most rigorous type of evaluation -- a double-blind placebo- controlled trial -- to test the potential effect of isoflavones on women's bones. They randomly assigned 300 healthy, white, early-postmenopausal women (average age 53) to eat cereal bars and biscuits enriched with 110 mg of isoflavones daily for one year or to eat the same food without isoflavones.

The results of the study, which were reported in the American Journal of Clinical Nutrition, were thumbs down for the isoflavone-enhanced foods. Eating them did not improve bone mineral density of the lumbar spine or total body and did not affect the natural turnover of bone.

The bottom line: There's no harm in eating those soy-enriched cereal bars, but there's no solid evidence they will reduce the risk of osteoporosis.

Another Reason to Practice Yoga

Fri, 25 Dec 2009 06:00:00 CST

If you have chronic lower back pain and are looking for relief, you may want to try yoga. According to a new study from India, published in the Journal of Alternative and Complementary Medicine (Volume 14, page 637), one week of intensive yoga practice may reduce chronic low back pain and improve spinal flexibility better than a simple physical exercise program.

In the study eighty adults with low back pain for more than three months attended a residential healthcare center for one week. Researchers randomly assigned them to eight hours a day of yoga or general physical exercises like hamstring stretches.

The yoga group practiced meditation, breathing and chanting, deep-relaxation and stress-reduction techniques, and yoga postures designed to relax muscles in the spine and strengthen back and abdominal muscles. The physical exercise group also did breathing exercises (non-yoga based), received information about causes of back pain, the benefits of exercise and stress reduction, and they performed standard stretching and strengthening exercises.

At week's end, the yoga group had a 49% reduction in disability and a significant increase in spinal flexibility. The physical exercise group also had a reduction in disability and better spinal flexibility, but improvements were not as great as those in the yoga group.

Bottom line: If you want to try yoga, check with your doctor first. If you get the okay, be sure the yoga teacher is knowledgeable about low back pain.

Common GERD Drug Increases Risk of Osteoporosis

Fri, 15 Jan 2010 06:00:00 CST

Proton pump inhibitors (PPIs) treat GERD and ulcers by limiting the production of caustic gastric acids. The problem: Gastric acids are a vital component of digestion. Blocking them may interfere with the absorption of calcium, which is essential for maintaining strong bones. By limiting calcium absorption, PPIs may put you at greater risk for developing osteoporosis. If you have osteoporosis, taking a PPI may increase your fracture risk. Here’s what you need to know …

A recent study published in the Canadian Medical Association Journal compared 15,792 people with osteoporosis who fractured a wrist, vertebra, or hip with 47,289 people who didn't have osteoporosis or a previous fracture. The researchers found that taking a PPI at least every other day turned out to be substantially more common in the osteoporosis/fracture group. In particular, people who reported using PPIs for seven years or more were four times as likely to fracture a bone. Taking PPIs for less than five years was safe, but after that, risk increased.

What does this mean for you? While doctors are taking this information seriously, it is important to note that the data come from an observational trial that followed participants over a number of years, recording and comparing their medical information. Placebo-controlled clinical trials -- the gold standard of medical proof -- have yet to test the link between PPIs and osteoporosis.

H. Franklin Herlong, M.D., Associate Professor of Medicine, Division of Gastroenterology, Johns Hopkins Bayview Medical Center, and Health After 50 Board Member, remarks, "The new information should encourage doctors to review the need for long-term PPI use and ensure the benefits continue to outweigh the potential risk.

"I'm concerned about the long-term use of PPIs, particularly for patients who have or are at increased risk for osteoporosis and people with conditions such as liver disease that interfere with their ability to utilize vitamin D and calcium. "These patients should have bone density tests and, if the tests show evidence of osteoporosis, take calcium and vitamin D supplements while continuing their PPI."

Proton Pump Inhibitors

Omeprazole (Losec, Prilosec, Zegerid, Ocid)

Lansaprazole (Prevacid, Zoton, Inhibitol)

Esomeprazole (Nexium)

Pantoprazole (Protonix, Somac, Pantoloc, Pantozol, Zurcal, PAN)

Rabeprazole (Rabecid, Aciphex, Pariet, Rabeloc)

Prilosec OTC (available without a prescription)

Can Massage Help Back Pain?

Fri, 04 Dec 2009 06:00:00 CST

In addition to relaxing muscles and easing tension in the back, massage is believed to temporarily overpower pain signals going to the brain. In this article from our popular newsletter, Health After 50, Johns Hopkins explores the therapeutic potential of massage to relieve back pain.

Nonspecific back pain (pain that isn't from a condition or injury) can be frustratingly difficult to treat, but there are potential benefits to massage therapy. Massage can relax tight muscles and may improve blood circulation to the body's tissues, which can help reduce pain and inflammation. Massage also stimulates the release of hormones called endorphins, which act like natural analgesics; endorphins may be why people often experience a heightened sense of well-being following a massage.

Sustained pain relief may require commitment: Studies on massage typically involve a course of therapy, not just one massage. For instance, in a study from the Archives of Internal Medicine, among 262 people with chronic back pain, patients who received one massage per week for 10 weeks reported less back pain up to one year after the study ended.

Combining different approaches may also improve your chances of success. A recent Cochrane review of 13 clinical trials that included over 1,500 participants with chronic back pain found that massage therapy was more effective at reducing pain and improving function when participants also incorporated stretching exercises and basic education about behaviors (like poor posture) that contribute to back pain.

Massage is safe, except for people with phlebitis (inflammation of a vein), deep vein thrombosis, advanced osteoporosis, bone fractures, skin infections, burns, or eczema. Find a licensed massage therapist who is nationally certified through the National Certification Board for Therapeutic Massage & Bodywork (www.ncbtmb.org) or the American Massage Therapy Association (www.amtamassage.org). Medicare and most private insurance do not cover massage.

6 Simple Stretches for Pain-Free Travel

Fri, 23 Oct 2009 06:00:00 CDT

Don't let back or neck pain cramp your travel fun. Experts who treat back pain recommend that you stretch regularly while you’re in flight or when you take a driving break. Stretching can help relax tense muscles and overly tight ligaments in the back and neck.

Traveling by car or plane can be a pain in the neck, literally, as well as a pain in the back. Sitting for prolonged periods adds strain to the structures of the lower back and neck, and poor posture while sitting puts even more stress on your spine. Regular travel with back or neck pain can be a challenge, but you can take measures to reduce or avoid pain and discomfort while on the road or in the air.

Here are six simple, yet effective stretches to help you can do anywhere, without a lot of fancy equipment:

Neck and shoulder stretches :

To loosen your neck, rotate your head to the left and maintain this position for about five seconds. Turn your head forward again; then turn to the right and hold for five seconds. Repeat five times.

To loosen your shoulders and neck, shrug your shoulders up while holding your arms at your sides. Stay in this position for about five seconds, then return to a resting position. Repeat five times.

Back stretches:

Begin in an upright, seated position and gradually lower your torso toward your knees. Let your arms drop down and then wrap them around your thighs. Hold this position for about 20 seconds while breathing deeply, then return to your normal, seated position. Repeat five times.

While standing, put your hands on your lower back and slowly stretch backward from the waist. Hold for 10 seconds, then relax and straighten up. Repeat five times.

Place your hands on your hips and bend to the left. Maintain this position for five seconds. Return to an upright position, then bend to the right and hold for five seconds. Repeat five times.

Leg stretch:

While sitting, keep the balls of your feet on the floor and raise your heels. Hold for 10 seconds. Lower your heels back down, and repeat 10 times. Although this is really a calf stretch exercise, you’ll feel the stretch all the way up into your lower back.

Is Surgery Your Best Option for a Herniated Disk?

Fri, 21 Aug 2009 06:00:00 CDT

About 10% of people experience symptoms from a herniated disk at some point in their lives. Symptoms usually occur when the protruding disk presses on one or more of the spinal nerves emerging from the spinal column. In some people, the disk presses on the spinal cord itself or on the cauda equina (the bundle of nerve roots at the bottom of the spinal cord). This causes pain not only in the back, but also in the part of the body served by the compressed and inflamed nerve. What should you do for relief?

If you have a herniated disk and experience back and leg pain from sciatica for more than six weeks, surgery may be the right treatment for you, according to a new study published in the journal SPINE (Volume 33, page 428).

In this study from the Spine Patient Outcomes Research Trial (SPORT), researchers randomly assigned 1,244 people with disk herniation and back pain for at least six weeks to undergo a diskectomy or usual nonoperative care including pain medication and exercise. Ultimately, 775 people had surgery within two years, while 416 received only conservative treatments such as nonsteroidal anti-inflammatory drugs, physical therapy, and education and counseling.

The findings are based on results from those 1,191 patients. Leg pain improved more than back pain in both groups. Both groups had improvements in back pain, but the surgical group fared significantly better: 28% of the surgical group had no pain three months after surgery, whereas only 12% of those who received conservative care had relief. At two years, 25.5%in the surgery group and 18% in the conservative-care group reported no pain.

If you have pain from sciatica that has been radiographically demonstrated to be caused by a herniated disk, then surgery is more likely than conservative care to provide you with partial or even complete pain relief.

Supervised Exercise for Fast Back Pain Relief

Fri, 11 Sep 2009 06:00:00 CDT

Exercises for back pain focus on strengthening the muscles in the back and abdomen and stretching the muscles in the back. Flexibility exercises for your hips and even your shoulders may also be needed, because improving your flexibility in these areas will decrease the demands on your back.

A study published in the Archives of Physical Medicine and Rehabilitation (Volume 89, page 1305) suggests that supervised exercises can lead to faster improvement in disability caused by chronic low back pain than nonsupervised exercise.

Researchers asked 60 adults who had low back pain for at least three months to decide whether they wanted to undergo manipulation therapy by a chiropractor or physical therapist or to participate in back and abdominal training from a physical therapist for four weeks.

At the end of the treatment, participants were randomly assigned to receive 12 weeks of supervised exercises using an exercise ball or to receive basic advice explaining how to perform commonly recommended exercises for low back pain at home. At 16 weeks, significantly more people in the supervised exercise group reported improvements in disability than those in the basic exercise group -- and they improved more rapidly. Nine months later, however, there were no differences between the two groups. And both groups reported significantly less disability than at the start of the study.

Bottom line: If you want faster relief from chronic low back pain, a supervised program may fit the bill. Whatever program you choose, you will likely need to continue doing back exercises for long-term relief.

6 Exercises to Build Bone Strength

Fri, 19 Jun 2009 06:00:00 CDT

When you put demands on bone, it responds by becoming stronger and denser. Any activity that works against gravity, including walking and climbing stairs, stimulates the growth of new bone tissue. Here are six bone-building exercises from Johns Hopkins.

Exercise and adequate calcium are two of the three essentials for preventing osteoporosis. Vitamin D is the third. Regular exercise can help limit bone loss, improve your balance and coordination, and strengthen the leg and torso muscles that help you stand upright. Calcium within bones makes them strong, and taking daily calcium supplements can ensure that your bones will remain strong.

Here are six weight-bearing and resistance exercises you can try to help prevent bone loss. You would achieve the best bone-building results by doing this regimen with exercise machines. However, you can do a similar workout at home using dumbbells and resistance bands (such as Theraband or Dynaband).

For starters, do one set of six to eight repetitions of each exercise and build up to doing two sets. Once you can easily do two sets of six to eight repetitions, increase the weight by a few pounds or move up to a higher-resistance band.

Exercise 1 -- Wall Squat. Stand with your feet shoulder-width apart, back against a wall. Hold a dumbbell in each hand, with your arms at your sides, palms facing inward. Slowly bend your knees and lower your buttocks 8 inches or more (but do not allow your hips to sink below knee level). Pause, then slowly return to the starting position.

Exercise 2 -- Back Extension. Lie face down on the floor with your legs straight, arms extended flat on the floor above your head, palms down. Keep your nose pointed downward and slowly raise your right leg and left arm off the floor (reach out as well as up). Keep your head and neck in line with your arm. Pause, then slowly return to the starting position. Now slowly raise your left leg and right arm together. Change sides and repeat.

Exercise 3 -- One-arm Military Press. Lie with your back on a bed or bench with your feet flat on the floor, holding a dumbbell in each hand on top of your chest. Press the weight straight up with one hand. Pause, then return it back down. Barely touch your chest, then repeat with the other hand. Alternate sides and repeat.

Exercise 4-- Seated Row. Sit on the floor with your legs fully extended. Hook a resistance band on the balls of your feet. Wrap each end of the band around your hands. Keeping your back straight, pull the band toward you with both arms. Pause, then slowly release your arms straight in front of you again.

Exercise 5 -- Leg Press. Lie on the floor, flat on your back, with your knees hugged into your chest. Place the center of a resistance band on the balls of your feet. Wrap each end of the band around your hands. Keep your elbows close to your sides and squeeze your inner thighs together as you press your legs up toward the ceiling. Pause, then draw your legs back down.

Exercise 6 -- Lat Pull-down. Stand with your feet shoulder-width apart, knees unlocked, and abdominals tight. Grasp a resistance band with your hands slightly wider than shoulder-width apart. Lift your arms just above your head, palms facing forward as you look straight ahead. Extend your arms out to the sides at shoulder height, with your wrists firm and your elbows slightly bent. Pull your shoulder blades back and together and expand your chest. Return to starting position. Repeat.

How Osteoporosis Develops

Fri, 02 Oct 2009 06:00:00 CDT

Are you at risk for osteoporosis? Although many of us think of our bones as stable, solid structures that do not change with time, the truth is that bone is living tissue that undergoes a constant process of rebuilding.

The word osteoporosis means porous bone. A person with osteoporosis typically has low bone mass, poor bone quality, and fragile bones. This combination, together with the increased risk of falling among older people, leads to painful fractures and other health problems. About 10 million Americans -- eight million women and two million men -- already have osteoporosis, and 34 million more are at increased risk because of low bone mass (osteopenia). Osteoporosis-related fractures are estimated to account for $13.8 billion in hospital and nursing home costs each year, and these costs are increasing. As our population continues to age, osteoporosis is expected to become an even greater health problem.

The hallmark of osteoporosis is weakened bones that fracture easily. Osteoporosis results from an abnormality in a natural process known as bone remodeling. As part of its normal cycle, old bone is broken down (resorbed) by cells called osteoclasts, and new bone is formed by cells called osteoblasts to replace the bone removed by resorption.

The body maintains bone mass as long as bone replacement keeps pace with bone resorption. Osteoporosis develops when resorption occurs faster than replacement. The spine, in particular, is susceptible to this imbalance.

Osteoporosis often leads to thinning of the bone and disruption of the struts called trabeculae that make up the bone architecture. In the vertebrae, this can cause vertebral compression fractures. Part of the hip joint, the femoral neck, also is highly vulnerable to fractures from osteoporosis.

Osteoporosis arises largely as a result of increasing age and a decline in the level of sex hormones. Normally, estrogen in women and men, as well as testosterone in men, maintain bone mass. Peak bone mass is reached around age 30. Estrogen production rapidly declines after menopause, placing women at particularly high risk for osteoporosis. Women may lose 20–30% of their bone mass in the 10 years following their menopause.

Don't Forget Your Pillow

Fri, 10 Jul 2009 06:00:00 CDT

Good sleeping posture allows the body to follow the natural S-shape curve of the spine. Here's advice on protecting your neck and back while you sleep.

Lying in certain positions while you sleep can throw the spine out of alignment; for example, sleeping on your stomach puts stress on your neck and exaggerates the curve of the lower back. A better choice that helps maintain the natural curves of your spine is to sleep on your side with your knees bent and a pillow placed between.

Another option is to sleep on your back, but keep your knees slightly raised by placing a pillow underneath them. This prevents your lower back from overarching by supporting the weight of your extended legs. If you can't break the habit of sleeping on your stomach, place a pillow underneath your abdomen to keep your spine aligned. If you have neck pain, consider using a neck support pillow.

A recent study in the Journal of Rheumatology found that individuals with chronic neck pain who slept with a neck support pillow and performed simple isometric neck exercises (see below) five to 10 minutes a day reported significant improvement in their symptoms. However, use of heat or cold packs with gentle massage, exercise alone, or the neck pillow alone was not as effective.

Another benefit from combination treatment: Those who used both the neck pillow and the exercises continued to feel better up to one year later. If you're interested in such a regimen, ask your doctor to refer you to a physical therapist who can teach you the exercises and the appropriate way to use a neck pillow during sleep.

Isometric Neck Exercise:
Here's an example of an isometric exercise for the neck: Tilt your head to the right while applying resistance with your right hand. Hold for 20 seconds. Repeat on the left side, then do the same exercise, tilting your head first forward and then backward.

What Is Passive Physical Therapy?

Mon, 20 Jul 2009 06:00:00 CDT

In most cases, back pain resolves quickly, regardless of the type of treatment. But if you experience severe back pain that doesn't improve after a couple of days of bed rest, you may want to consider physical therapy. A reader asks: What are passive and active physical therapy modalities, and how do they work?

A. Passive physical therapy is called passive because the modalities are done to you, whereas with active physical therapy you take an active role in the modalities.

Passive modalities typically are heat packs and/or ice massage and ultrasound. Heat and/or ice, the most commonly used type of modality, help reduce muscle spasm and inflammation. This usually works best over the first few days of back pain. You may find one or the other works better for you, or you can alternate them to reduce pain. Generally, you apply heat and/or ice for up to 20 minutes every two hours. Ultrasound uses sound waves applied to the skin to penetrate into and deeply heat soft tissues to enhance tissue healing. It is particularly useful to relieve acute pain.

Active physical therapy usually includes exercises to stretch and strengthen back muscles. Often, these exercises include a simple daily routine that may include knee pulls, hurdler stretches, modified toe-touches with and without rotation, abdominal curls, pelvic tilts, and back and hip extensions. Your physical therapist may also ask you to perform a spinal stabilization program consisting of progressive exercises that emphasize muscle strengthening to support the spine.

Should You Treat Osteopenia?

Fri, 29 May 2009 06:00:00 CDT

If your bone mineral density test indicates osteopenia – a warning sign for osteoporosis – should you begin treatment? In this article, Johns Hopkins researchers offer advice … and it may surprise you.

If you’ve ever had your bone mineral density tested, you may have been given your score -- more precisely, your T score. The T score is drawn from the world of statistics; it reflects the number of standard deviations a person’s bone mineral density (BMD) is above or below the norm. In this instance, the “norm” is the BMD of an average, healthy young woman.

If your T score is –1 or higher, your BMD is considered normal; if it’s –2.5 or less, you have osteoporosis. But if you fall in between, you have osteopenia. The World Health Organization developed these parameters.

Osteopenia sounds serious -- but is it? Technically, osteopenia is not in and of itself a disease, as osteoporosis is. Instead, osteopenia is an indication that your BMD is below the statistical norm and that you could eventually develop osteoporosis or be at risk of a future fracture. If you have osteopenia, the real difficulty comes in determining whether you need treatment with any bone-building medications.

On one hand, treating osteopenia sounds logical. Osteoporosis doesn’t develop overnight, out of the blue; surely, a person with the disease was osteopenic at some point along the line. However, just because you have osteopenia doesn’t mean that you’re absolutely guaranteed to develop osteoporosis, nor are you fated to have a serious fracture. Thus, taking bisphosphonates or other bone-building medications for your osteopenia means that you might be treated for a condition you never would have developed even if left untreated.

As a result, many experts argue that most people with osteopenia don’t need treatment, that blanket prescribing of bone-building drugs for osteopenia is more about alleviating anxiety than actually preventing fractures -- and that such a strategy makes no sense when drug costs and potential side effects are taken into account. Instead, the general consensus is in favor of selective, targeted treatment for osteopenia -- that is, treatment that considers the whole person rather than just the T score.

You and your neighbor might have the exact same osteopenic T-score, but that doesn’t mean that you have the exact same risk profile for developing osteoporosis or breaking a bone in the future. BMD is only one of many factors in your individual risk profile. Other factors include: your age, history of personal fractures, family history of osteoporosis, whether or not you’re underweight or smoke, whether you’re starting treatment with certain drugs, particularly glucocorticoids, or you have another illness that could compromise your BMD.

Whether or not you are prescribed medication for your osteopenia, it’s worth regarding osteopenia as a “wake-up call” and taking steps to be sure you’re doing all you can to be as healthy as possible. If you smoke, stop. And be sure to get plenty of weight-bearing exercise, enough calcium and vitamin D, and to limit alcohol and caffeine intake.

Steroid Injections for Back Pain

Fri, 08 May 2009 06:00:00 CDT

For older people, chronic conditions such as degenerative changes of the spinal bones and disks, vertebral compression fractures, spinal stenosis (narrowing of the spinal column), and spinal deformities are the most common sources of back pain. Recently many of us are turning to steroid injections to ease our back pain, according to a recent study in the journal SPINE.

In most cases, back pain resolves quickly, regardless of the type of treatment. In fact, about 90% of cases improve on their own. Fewer than 5% of people with back pain have a major medical problem that requires either intensive care or surgery. But if you experience severe back pain that doesn't improve after a couple of days of bed rest, or if your back pain is recurring or is accompanied by pain, numbness, or tingling that radiates into the buttocks or legs, it is important to see a doctor.

Now data reported in the journal SPINE (Volume 32, page 1754) suggests that older people with back pain are receiving steroid injections for a growing number of conditions, despite limited evidence about how well the steroid injections actually work and limited agreement on when they should be used.

A look at Medicare claims for steroid injections from 1994 through 2001 showed a 271% increase in steroid injections into the lower back (epidural) and a 231% increase in injections into facet joints (small stabilizing joints located between and behind adjacent vertebrae). The majority of the steroid injections were given to treat conditions for which there is little documented evidence of benefit. Women were 1.5 times more likely than men to receive an epidural steroid injection.

Expenditures associated with these steroid injections have risen as well. The total inflation-adjusted reimbursed costs (professional fees only) for lumbosacral steroid injections rose from $24 million to more than $175 million, and costs per injection doubled, rising from $115 to $227 per injection. According to the researchers, at least part of the reason for the rise may be profit related. They note a 32% increase per year in steroid injections at ambulatory surgery centers, which are reimbursed at a higher rate than injections administered in a hospital or doctor's office.

Yoga Therapy

Fri, 06 Mar 2009 06:00:00 CST

Mounting evidence suggests that yoga can relieve chronic back pain. There are many schools or types of yoga. They feature precise alignment and props such as mats, blocks, and straps. The props help in achieving correct yoga poses. The poses, combined with breathing techniques, help relax muscles and calm the mind.

There’s nothing new in the world of exercises for back pain, correct? Not exactly. In fact, there’s more evidence that yoga -- specifically, Iyengar yoga -- can help alleviate chronic back pain.

There are many schools or types of yoga. Iyengar yoga (named for its developer, B.K.S. Iyengar) features precise alignment and props such as blankets, bolsters, and chairs. The props help people who are less flexible and/or are injured achieve the correct yoga poses. The attention to alignment helps prevent further injury.

Iyengar yoga teachers are trained with a premium on knowledge and a stepladder of increasing levels of accreditation. Even at the entry level, certified teachers undergo a rigorous education program that includes in-depth knowledge of anatomy and physiology, and demonstrated expertise in teaching.

In the first randomized trial of Iyengar yoga and back pain, 60 participants were placed in either a yoga group or an educational group. Both programs lasted 16 weeks. Participants had experienced low back pain for an average of 11.2 years, and 48% used pain medication. At the end of the study and at a three-month follow-up, those in the yoga group had significant reductions in pain intensity, functional disability (including spinal range of motion), and use of pain medication. The results compare favorably with results obtained with physical therapy.

With yoga’s increasing popularity, finding a teacher today is easier than ever. If your local Yellow Pages aren’t helpful, try Yoga Journal (www.yogajournal.com) or the National Association of Iyengar Teachers (www.iynaus.com). Be sure to ask about the teacher’s training and certification, and be honest about your concerns and any limitations or injuries.

Remember, too, that yoga is not a competitive sport: You have nothing to prove, and there is no gain to be found in pain. Honor your body, with all of its idiosyncrasies. If you come up empty-handed, don’t despair. Many of the back exercises taught by physical therapists closely resemble those taught in a yoga studio.

Simple Steps to Prevent Falls

Fri, 27 Mar 2009 06:00:00 CST

A hip fracture usually occurs when a person falls from a standing position, with the hip taking the impact of the fall, although less traumatic falls also can cause hip fractures. Ninety percent of the 350,000 hip fractures that occur each year in the United States are the result of a fall. What can you do to prevent hip fracture? Here's advice from Johns Hopkins.

Many older people fear hip fractures -- and with good reason. Of all types of fractures, hip fractures have the most significant impact on the quality of life. An alarming 20–25% of people over age 50 who break a hip will die within a year.

In addition, 40% are unable to walk independently a year after they've broken a hip, and 60% are unable to perform basic activities of daily living, such as dressing themselves. Because of these devastating consequences, preserving and boosting bone mass and preventing falls and fractures are crucial.

The rate of hip fracture begins to increase at age 50, doubling every five to six years. Nearly half of the women who reach the age of 90 have suffered a hip fracture. Men account for nearly 30% of hip fractures.

What you can do to prevent hip fractures. Along with bone-strengthening medications, preventing falls is a crucial component of fracture prevention. Here are some simple steps you can take to reduce the likelihood of falling.

First, make sure that your floors are clear of any obstacles such as area rugs or extension cords.

Hallways, stairwells, and bathrooms should be well lit (especially at night).

Grab bars in showers and bathtubs are highly recommended.

Be sure that your eyeglasses or contact lens prescriptions are up to date.

Review your medications with your doctor; some medications can increase the risk of falls by impairing balance and alertness.

In some cases, lightly padded hip protectors may be recommended; these can reduce the risk of a hip fracture in the case of a fall.

Another way to reduce the risk of falls is to improve your muscle strength through resistance training and your balance through yoga or tai chi exercises. Check with a physical therapist or certified trainer to get recommendations that are appropriate and safe for you.

What's Your Back Pain History?

Fri, 13 Feb 2009 06:00:00 CST

Why does your back hurt? Some of the best clues to the cause of your back pain will come from your description of the pain. Here are eight important questions your doctor will ask to help diagnose the cause of your back pain.

Only about 2% of back pain episodes require immediate medical treatment. However, to rule out the possibility of a dangerous condition, doctors still need to ask certain questions routinely -- for example, whether you can relieve the pain by changing your position and whether you feel pain when you're not moving. Questions your doctor will ask include:

Where is the pain located? Is it confined to the lower back or does it radiate to the buttocks or legs? These questions check for sciatica.

How severe is the pain? For example, is the pain so excruciating that any movement is difficult or impossible? Can you go about your normal daily activities, even though the pain prevents vigorous exercise or activities associated with a lot of bending and twisting, such as gardening or golf? A good description of pain intensity can help the doctor determine its cause.

When did the pain begin? Was it related to an activity or an injury? If the pain follows an injury, it is less likely to be due to a slowly progressing condition, such as spinal stenosis.

What makes your back feel better or worse? For example, does lying down make it feel better? Does bending for ward to tie a shoe increase the pain? The pattern of pain may indicate whether a nerve is involved, possibly because of a disk herniation.

Have you had a prior episode of back pain? If so, how was it treated and how effective was the treatment? The condition may have recurred.

Do you have any other health problems? Weight loss and poor appetite, for example, raise the concern that cancer has spread to the vertebrae. In addition, some disorders, such as hyperthyroidism, can cause osteoporosis.

What medications do you take? Certain drugs, such as corticosteroids or anticonvulsants, can affect spinal bone mass.

What do you do for a living, and what kinds of exercise or other activities do you do? In what ways is the pain disabling? Muscle injury is frequently related to a particular activity.

Should Men Be Screened For Osteoporosis?

Fri, 12 Dec 2008 06:00:00 CST

The National Osteoporosis Foundation recommends that all women age 65 and older get screened for osteoporosis. In addition, post-menopausal women who are under age 65 but have additional risk factors for osteoporosis (such as use of corticosteroids or a family history of osteoporosis) or who have recently had a fracture should be screened. There are no official guidelines on when to screen men for osteoporosis, but some experts have suggested routine osteoporosis screening in some older men.

Routine testing and treatment for osteoporosis may indeed make sense for certain older men, according to a new study reported in the Journal of the American Medical Association (Volume 298, page 629).

Researchers used a computer program to estimate the risk of hip fracture for white males over age 65 -- the group of men with the highest risk of osteoporosis. They also estimated the direct medical costs and indirect costs, such as lost productivity, associated with an osteoporotic fracture in these men.

They found that it might be cost-effective to perform routine bone mineral density testing in men older than 65 years if they had had an earlier fracture and to test men over 80 regardless of their fracture history. Treatment with bisphosphonates, if needed, also would be cost-effective if the price of therapy were less than $500 per year.

Routine screening for osteoporosis is currently not recommended for older men in the United States. But if you have risk factors for osteoporosis (long-term steroid use; chronic disease that affects the kidneys, lungs, stomach or intestines and alters hormone levels; low testosterone level; smoking; drinking excessive amounts of alcohol, consuming too little calcium or getting insufficient physical exercise) talk to your doctor about whether you might be a candidate for bone mineral density testing and medication for osteoporosis prevention or treatment.

How Disks Herniate

Fri, 21 Nov 2008 06:00:00 CST

Pain due to a herniated, or slipped disk usually strikes suddenly and can be excruciating. In this Health Alert, Johns Hopkins explains what happens when disks herniate.

At some point in their lives, 10% of all Americans experience painful symptoms from a herniated disk – commonly known as a slipped disk. Over the years, the demand of supporting the body's weight causes the outer layer of the disk to weaken, become thinner, and develop microscopic tears. At the same time, the center of the disk slowly loses its water content and becomes progressively drier. These changes make the disk susceptible to herniation (protrusion), in which mild trauma, such as lifting an object or even sneezing, can cause the center of the disk to bulge through the weakened outer layer.

Painful symptoms usually result from pressure by the protruding disk on one or more of the spinal nerves emerging from the spinal column. In some cases, the disk presses on the spinal cord itself or on the cauda equina. This pressure causes pain not only in the back, but also pain in the part of the body served by the compressed and inflamed nerve. Although herniation can involve any disk, 90% to 95% of cases occur in the two lowest disks because they carry the greatest weight.

What happens? Each intervertebral disk is composed of two distinct regions: a tough, fibrous outer ring made up of many overlapping layers of collagen fibers (called the annulus fibrosus), and a soft, gel-like core (the nucleus pulposus).

In a normal, healthy disk, these tissues contribute to the remarkable flexibility of the spine: As the body moves, the annular fibers expand and contract, while the gel-like nucleus changes shape. Although each individual disk can only bend to a limited degree, their combined flexibility throughout the spine provides a great range of motion.

As we age, however, the disks gradually lose their resiliency. The annulus weakens, while the nucleus loses its water content, becoming progressively drier and more brittle. These changes make the disk more vulnerable to herniation -- commonly known as a slipped disk.

Herniation may produce only local back pain, or pain may radiate down the path of a spinal nerve if the nerve is compressed by the protruding disk.

Illustration of a Herniated Disk

How Bones Form and Repair

Fri, 23 Jan 2009 06:00:00 CST

About 10 million Americans -- eight million women and two million men -- already have osteoporosis, and 34 million more are at increased risk because of low bone mass (osteopenia). Osteoporosis-related fractures are estimated to account for $13.8 billion in hospital and nursing home costs each year, and these costs are increasing. As our population continues to age (more than 35% of Americans will be age 50 or older by 2011), osteoporosis is expected to become an even greater health problem.

Many people think of their bones as stable structures that do not change with time. But bone is a living tissue that undergoes a constant process of renewal. In this process, called bone remodeling, old bone is resorbed (broken down) and new bone is formed.

The framework of each bone is a matrix, or scaffold, that is mostly made up of collagen. Although collagen is soft, it hardens with the deposition of calcium and phosphorus, which enter the bone from the bloodstream. A regular supply of these minerals is required to keep bones strong.

In the resorption stage of bone remodeling, special cells called osteoclasts invade the surface of the bone and remove both the matrix and minerals, leaving small cavities in the bone surface. Resorption is followed by the bone formation stage, which is carried out by another set of special cells, called osteoblasts, which fill in the cavities with new bone.

When bone loss outpaces bone formation, the result is low bone mass. When there is less bone, bones become more fragile and are more prone to fracture. Osteoporosis is a disease of severely low bone mass.

What's the Best Exercise for Chronic Back Pain?

Fri, 10 Oct 2008 06:00:00 CDT

Weight loss, if necessary, and exercise – stretching, flexibility, and muscle-strengthening exercises – are particularly helpful in treating chronic back pain. A recent study provides insights on the most effective exercise regimens to relieve chronic back pain.

Doctors commonly prescribe exercise for lower back pain. Now a new study reported in the journal Pain (Volume 131, page 31) sheds light on which type provides the greatest pain relief -- at least for the short term. The researchers randomly assigned 240 adults with low back pain for at least three months to one of three groups: general exercise, motor control exercise, or spinal manipulative therapy.

The general-exercise group performed strengthening and stretching exercises as well as exercises to improve cardiovascular fitness. The motor control-exercise group performed exercises aimed at improving the function of specific trunk muscles thought to be involved in movement of the spine. These included the diaphragm, the transversus abdominis, and the pelvic floor muscles. People in the spinal manipulative therapy group were treated with joint mobilization or manipulation techniques applied to the spine or pelvis.

At eight weeks, people in the motor-control group and the spinal manipulative therapy group improved slightly more than those in the general-exercise group, with a better ability to function and a greater perception of benefit from treatment. However, at six and 12 months, there were no differences between any of the groups.

The bottom line: A variety of exercises can provide relief for chronic low back pain. Whichever you choose, you'll likely need to continue it for long-term pain relief.

Pain-Free Driving Advice

Fri, 31 Oct 2008 06:00:00 CST

Traveling by car can be a pain in the neck, literally, as well as a pain in the back. In this Health Alert, Johns Hopkins provides advice to help you avoid pain and discomfort while on the road.

If you drive for extended periods you may be at risk for back and neck pain, sciatica, and herniated disks. However, you can make adjustments in the way you sit to limit spine, back, and neck problems.

What's the optimal way to sit while driving? That question was answered in a study in the Journal of Manipulative and Physiological Therapeutics. After an exhaustive review of scientific journals and automotive engineering reports, here's what the authors recommend.

The seat back should be almost straight up at a 100-degree angle from the floor. Your knees should be only slightly higher than your buttocks. Your head should tilt back very slightly (only 10%). Current guidelines recommend that the elbows rest on the armrests as you grip the wheel with your hands in the 9 o'clock and the 3 o' clock positions (instead of at 10 o'clock and 2 o'clock positions) to avoid injuring the hands if the airbag deploys.

Here are some additional tips:

Make sure that your back is aligned against the back of your seat in an upright position and that your headrest is supporting the middle of your head.

Use a lumbar support pillow to make your seat more comfortable and to support your lower back.

Adjust the seat and steering wheel to a comfortable position to avoid reaching for the wheel.

Consider using cruise control for long drives. Resting both feet on the floor provides more support for your lower back than if one foot is on the gas.

Get out of the car and stretch every 20–30 minutes, if possible.

If back pain flares up while you're driving, apply a cold pack to the painful area. Wrap a small bag of ice in a towel and place it between your lower back and the seatback. Or if it feels better, alternate ice and heat from a disposable, portable heat pack every 15–20 minutes.

Should You Have Surgery For Sciatica?

Fri, 29 Aug 2008 06:00:00 CDT

If you have sciatica and find that rest and pain medication are not working to relieve your pain, should you consider surgery? Recent research provides the answer.

Sciatica refers to leg pain caused by a herniated disk in the spine that presses on the sciatic nerve. People with sciatica often experience intense pain that radiates into the buttocks, down the thighs, into the calves, and often into the feet.

Surgery can provide fast pain relief for sciatica, but you might do just as well without an operation, a study finds.

In this study, researchers randomly assigned 281 people with sciatica for at least six weeks to have surgery to decompress the nerve or to receive conservative treatments such as pain medication and exercise. On average, people who had sciatica surgery felt their leg pain was better after four weeks while it took about 12 weeks for those who did not have surgery to note improvement. But within one year, 95% of the study participants said they felt significantly better, no matter what sciatica treatment they had.

Bottom line advice: If you are experiencing searing pain or numbness in your leg from sciatica and conservative treatment is not working, then surgery may be right for you. On the other hand, if you feel you can handle the leg pain and are willing to postpone sciatica surgery, you just might find that you don’t need it.

[This study was reported in The New England Journal of Medicine (Volume 356, page 2245).]

Is It Safe To Exercise With Osteoporosis?

Fri, 08 Aug 2008 06:00:00 CDT

Taking steps to prevent osteoporosis can help you avoid bone fractures and back problems later in life. Osteoporosis prevention relies on a three-pronged approach of exercise, proper nutrition, and – when appropriate – medication. But what if you already have osteoporosis? Is it safe to exercise or should you limit your activity? Johns Hopkins provides advice.

Contrary to what you might believe, most people with osteoporosis should actually do more physical activity, not less.

Physical activity places an increased "load" or force, on bones. Bones respond by increasing in density. It’s important to maintain a load on your bones to build up your bone density if you have osteoporosis. That usually requires you to exercise at a moderate intensity for at least six months. Any gains in bone density will be lost if you stop working out.

Your workout should consist of weight-bearing exercises, such as walking, stair climbing, jogging, dancing, plus strength training using lightweight dumbbells, resistance bands, or exercise machines. Before you start any exercise program, however, particularly if you are frail or have had a fracture, ask your osteoporosis doctor or physical therapist about the correct way to perform the exercises, and don’t overdo it.

Also, the National Osteoporosis Foundation sells an exercise video titled “Be BoneWise -- Exercise,” which demonstrates routines designed specifically for people with osteoporosis. The exercises avoid movements that could be unsafe, such as twisting the spine or bending forward from the waist. Go to www.nofstore.org for more information.

Six Stretches for Pain-Free Travel

Fri, 18 Jul 2008 06:00:00 CDT

Don't let back or neck pain cramp your summer travel fun. Experts who treat back pain recommend that you stretch regularly while you’re in flight or when you take a driving break. Stretching can help relax tense muscles and overly tight ligaments in the back and neck.

Traveling by car or plane can be a pain in the neck, literally, as well as a pain in the back. Sitting for prolonged periods adds strain to the structures of the lower back and neck, and poor posture while sitting puts even more stress on your spine. Regular travel with back or neck pain can be a challenge, but you can take measures to reduce or avoid pain and discomfort while on the road or in the air.

Here are six simple, yet effective stretches to help you can do anywhere, without a lot of fancy equipment:

Neck and shoulder stretches --

To loosen your neck, rotate your head to the left and maintain this position for about five seconds. Turn your head forward again; then turn to the right and hold for five seconds. Repeat five times.

To loosen your shoulders and neck, shrug your shoulders up while holding your arms at your sides. Stay in this position for about five seconds, then return to a resting position. Repeat five times.

Back stretches --

Begin in an upright, seated position and gradually lower your torso toward your knees. Let your arms drop down and then wrap them around your thighs. Hold this position for about 20 seconds while breathing deeply, then return to your normal, seated position. Repeat five times.

While standing, put your hands on your lower back and slowly stretch backward from the waist. Hold for 10 seconds, then relax and straighten up. Repeat five times.

Place your hands on your hips and bend to the left. Maintain this position for five seconds. Return to an upright position, then bend to the right and hold for five seconds. Repeat five times.

Leg stretch --

While sitting, keep the balls of your feet on the floor and raise your heels. Hold for 10 seconds. Lower your heels back down, and repeat 10 times. Although this is really a calf stretch exercise, you’ll feel the stretch all the way up into your lower back.

Once-a-Year Reclast for Osteoporosis

Fri, 27 Jun 2008 06:00:00 CDT

Michele Bellantoni, M.D., Associate Professor of Medicine and Medical Director, Johns Hopkins Bayview Care Center, answers questions on Reclast (zoledronic acid) – the new once-a-year-osteoporosis drug.

What is zoledronic acid?
Zoledronic acid belongs to a class of drugs called bisphosphonates. A form of zoledronic acid called Zometa has been used for many years to treat certain cancers, and Reclast is approved to treat Paget’s disease, which causes enlarged or misshapen bones. Oral bisphosphonates, such as Fosamax (alendronate) and Actonel (risedronate), have been used to treat osteoporosis for over 10 years.

Data on how well this new treatment works for osteoporosis were published in The New England Journal of Medicine (NEJM). What did the NEJM study find?
Researchers assigned 3,889 osteoporosis patients to receive an I.V. infusion of either zoledronic acid or a placebo. The infusions were repeated once a year for three years. Women who received zoledronic acid had a 70% decrease in the risk of vertebral fractures and a 41% decrease in hip and other fractures. But the women also had an increased incidence of atrial fibrillation.

Do you have concerns about the safety of Reclast?
Yes. Although reports of irregular heartbeats, or atrial fibrillation, were uncommon in the NEJM study, when a serious adverse effect like this is seen in a clinical trial, the concern is that the complication will be seen in even more patients after the drug is approved and used more widely.

How does Reclast compare with the oral forms of osteoporosis treatment?
The oral bisphosphonates have been used for a long time for osteoporosis, and we know a lot more about their safety profiles and efficacy. When a new drug becomes available, you always have to ask what this new treatment offers over the old treatments. Clearly the once-a-year administration of Reclast for osteoporosis is an advantage, but there is the potential for side effects like atrial fibrillation that we don’t see with oral osteoporosis therapy. I wouldn’t try Reclast instead of other osteoporosis medications. Until more safety data are available, I will reserve Reclast for osteoporosis patients who cannot tolerate oral therapy.

Who will benefit from Reclast?
What Reclast offers is an alternate way of getting bisphosphonates to the small minority of people who have unique gastrointestinal conditions that prevent them from taking the oral osteoporosis medications. If wider use shows that the atrial fibrillation is not a significant issue, then more patients may be able to try Reclast for its convenience over other options, and this is important.

What else should people know when considering osteoporosis treatment?
I think it’s important to mention the profound importance of calcium and vitamin D. None of these bisphosphonates will work -- in fact, they could even harm bone -- if the osteoporosis patient does not take adequate calcium and vitamin D. These medications keep protein in the bone. But the bone is not strong until calcium is deposited on the protein. And vitamin D helps our body absorb the calcium. So we need both these building blocks.

I recommend 400 International Units (IU) of vitamin D per day for men and women age 51–70 and 800 IU for those over 70. And you need between 1,200 and 1,500 mg of calcium daily as well, either through food or supplements.

A Pain in the Neck

Fri, 16 May 2008 06:00:00 CDT

Chronic neck and shoulder pain are common complaints. But the good news is that with good posture and exercise it's possible to undo the effects of years of slumping and neck tension.

For many of us, "a pain in the neck" is more than just a casual cliché. In the Health, Aging and Body Composition study, 11.9% of the more than 3,000 participants reported neck pain lasting one month or longer and 18.9% reported shoulder pain. White women had the highest prevalence of neck pain (15.4%), while black women had the highest prevalence of shoulder pain (24.3%).

Because neck pain can spring from a wide variety of conditions, some of which are serious, chronic neck pain warrants medical evaluation and treatment. In many instances, however, neck pain is not caused by illness. Instead, it’s the result of years of poor posture and chronic muscle tension.

Consider how most of us spend our free time: driving, reading, watching television, and talking on the phone. At work, we may be at the computer. Unless we have perfect posture, we can often be found slouching or hunched over. Years of slumping leads to rounded shoulders and kyphosis (an exaggerated curve in the thoracic spine).

Another culprit is what’s known as forward head position. The average head weighs 12-15 lbs. When that weight is carried forward of the central line of the spine, the muscles of your upper back and neck have to do extra duty, and they tighten in the attempt to hold your head up. Eventually, these muscles become overstretched and tired. And once again, your thoracic curve becomes exaggerated.

The combination of forward head position and kyphosis has consequences throughout the entire body. Tension headaches are common, as are bursitis in your shoulders and rotator cuff problems. You may also experience lower back problems, as the rounding of your thoracic spine sets off a cascade of actions -- as your chest collapses inward, your lungs press against your diaphragm, moving it downward against the abdominal wall. This weakens the abdominal muscles, causing problems in your lumbar spine.

The Solution: Exercise -- There is good news: It is possible to undo the effects of years of slumping and neck tension. However, it takes time and patience.

If you just have garden-variety neck pain and mild kyphosis, you will need to address a series of muscle imbalances. A physical therapist or a yoga teacher who is experienced in therapeutic yoga can provide you with safe exercises. Be sure to practice slowly and gently -- years of misalignment can’t be cured overnight.

Water Workouts

Fri, 25 Apr 2008 06:00:00 CDT

For many people with back pain, hydrotherapy -- exercising in water -- offers a way to build muscle strength and flexibility with minimal stress on joints and muscles. This article is written by Kelly Daley, senior physical therapist at Johns Hopkins' Department of Physical Medicine and Rehabilitation.

Strengthening the muscles that support the back helps both to prevent low back pain and injury and to treat existing back problems. But many exercise programs are too strenuous for people who are recovering from a back injury -- such as a herniated disk or vertebral compression fracture -- and for those whose spine is susceptible to injury due to conditions like osteoporosis. For these people, hydrotherapy -- exercising in water -- is an excellent alternative.

Like other forms of exercise, water workouts help to increase flexibility, muscle strength, and cardiovascular fitness. But exercising in water has many additional benefits for people with back problems. Because water is buoyant and helps to support weight, water exercise places minimal stress on joints and muscles, including those in the back. Thus, water may allow a more vigorous exercise program than would be possible on land.

In addition, exercising in warm water can relieve pain, reduce spasm and swelling, and relax back muscles. Water also offers a safe environment for muscle strengthening, which is important for people who are vulnerable to spinal injury.

Because water offers natural resistance to movement, pulling or pushing your body through water can strengthen your muscles. For example, walking while immersed in chest-high water is a gentle and effective way to tone the abdominal muscles, which help support the back. For people with osteoporosis, improved muscle tone can help preserve bone density, and water exercise has the added advantage of reducing the risk of falls while working out.

People who are recovering from a back injury -- such as a herniated disk -- may need to start with personal instruction from a physical therapist, who can devise a safe water program that focuses on warm water stretches to relieve pain and improve range of motion and teach people how to keep the spine properly aligned in the water.

Most water workouts should be done while submerged in chest- to waist-depth water. The deeper you are, the greater the water’s buoyancy and cushioning. People with severe back injury may need to begin exercising while submerged to the neck. This position can reduce pressure on spinal nerves and soft tissues and decrease pain. As the spine grows stronger and is able to tolerate partial weight-bearing exercise, a gradual transition is made to more shallow water.

When Osteoporosis Plus Other Disorders Equals Catch 22

Fri, 04 Apr 2008 06:00:00 CST

What should you do if your doctor’s advice for treating your osteoporosis conflicts with treatment for your diabetes, or other medical condition? Johns Hopkins researchers analyze this common problem and offer bottom line advice.

Half of people over age 65 have three or more chronic diseases, and they juggle advice from different doctors about how to deal with them. Researchers who recently set out to look at this problem have demonstrated how challenging it can be to follow guidelines for several chronic diseases at the same time.

Johns Hopkins researchers found that some of these clinical practice guidelines consider a specific pair of diseases. But the guidelines rarely give recommendations for treating people who have three or more chronic diseases at the same time.

For their study, the Johns Hopkins researchers determined the most prevalent diseases in older Americans by reviewing data from the National Health Interview Survey and a sample of national Medicare claims. They then evaluated clinical practice guidelines for nine of the 15 most common chronic diseases: high blood pressure, chronic heart failure, stable angina (chest pain from coronary disease), atrial fibrillation (an arrhythmia with an erratic heartbeat), high cholesterol, diabetes, arthritis, chronic obstructive pulmonary disease (emphysema), and osteoporosis.

As an example, the researchers specifically evaluated what would happen if they used clinical practice guidelines to treat a hypothetical 79-year-old woman who had moderately severe osteoporosis as well as type 2 diabetes, arthritis, high blood pressure, and chronic obstructive pulmonary disease.

Using explicit instructions from the published guidelines for each individual disease, they assembled a comprehensive treatment plan for her. If she were to abide by all of the guidelines’ recommendations, this imaginary woman would be taking 12 medications in 19 doses, five times a day. The medications would cost her more than $400 a month. What’s more, adhering to all five guidelines at once could lead to interactions among medications for different diseases or between her medications and her food. Also, taking so many medications would increase her risk of receiving the wrong medication, of having an adverse drug reaction or of needing to be hospitalized.

Bottom Line Advice: For the best care, you need to discuss all of your medications and treatment requirements with each of your doctors. If advice from different doctors conflicts, talk with them about it. No two people are the same, and your care plan should be as unique as you are. Ideally, you should have one primary doctor who has the responsibility to keep tabs on all of the medications you are taking, including all of your over-the-counter drugs and any nutritional supplements you use.

How Osteoporosis Weakens the Bones

Fri, 14 Mar 2008 06:00:00 CST

Are you at risk for osteoporosis? Although many of us think of our bones as stable, solid structures that do not change with time, the truth is that bone is living tissue that undergoes a constant process of rebuilding.

The word osteoporosis means porous bone. A person with osteoporosis typically has low bone mass, poor bone quality, and fragile bones. This combination, together with the increased risk of falling among older people, leads to painful fractures and other health problems. About 10 million Americans -- eight million women and two million men -- already have osteoporosis, and 34 million more are at increased risk because of low bone mass (osteopenia). Osteoporosis-related fractures are estimated to account for $13.8 billion in hospital and nursing home costs each year, and these costs are increasing. As our population continues to age, osteoporosis is expected to become an even greater health problem.

The hallmark of osteoporosis is weakened bones that fracture easily. Osteoporosis results from an abnormality in a natural process known as bone remodeling. As part of its normal cycle, old bone is broken down (resorbed) by cells called osteoclasts, and new bone is formed by cells called osteoblasts to replace the bone removed by resorption.

The body maintains bone mass as long as bone replacement keeps pace with bone resorption. Osteoporosis develops when resorption occurs faster than replacement. The spine, in particular, is susceptible to this imbalance.

Osteoporosis often leads to thinning of the bone and disruption of the struts called trabeculae that make up the bone architecture. In the vertebrae, this can cause vertebral compression fractures. Part of the hip joint, the femoral neck, also is highly vulnerable to fractures from osteoporosis.

Osteoporosis arises largely as a result of increasing age and a decline in the level of sex hormones. Normally, estrogen in women and men, as well as testosterone in men, maintain bone mass. Peak bone mass is reached around age 30. Estrogen production rapidly declines after menopause, placing women at particularly high risk for osteoporosis. Women may lose 20–30% of their bone mass in the 10 years following their menopause.

Managing Chronic Back Pain

Fri, 01 Feb 2008 06:00:00 CST

Research on the use of opioid medication to relieve chronic back pain yields surprising results.

Most cases of back pain resolve in a matter of weeks to months, but for some people the pain becomes a constant problem that interferes with their daily lives. If ignored, chronic back pain -- generally defined as unremitting pain that lasts at least six months and is not relieved by standard treatments -- can lead to depression, disturbed sleep, poor balance, withdrawal from physical and social activities, inability to work, and a reduced quality of life.

Contrary to what you might expect, taking opioids to ease long-term, chronic pain unrelated to cancer does not in fact relieve pain. Nor does it improve quality of life or every-day functioning.

Opioids are strong narcotics often prescribed for severe pain when other medications don’t work. In a study reported in the journal Pain (Volume 125, page 172), Danish researchers interviewed more than 10,000 adults with chronic pain (but not cancer) that had lasted at least six months, asking how satisfied they were with their treatments. The researchers analyzed responses separately for opiate users and others. They also took into consideration the subjects’ age, gender, pain intensity, and use of anxiety and depression medications.

Surprisingly, those who used opioids were much more likely to report moderate to severe or very severe pain, poor health, unemployment, more use of health care services, and a poorer quality of life. While pain can have many causes and may be difficult to pin down, the researchers described their results as “remarkable,” because opioids did not seem to achieve any of the key goals of pain treatment.

Research on Osteoporosis Screening

Fri, 11 Jan 2008 06:00:00 CST

A recent report indicates that women who are at the highest risk for osteoporosis are the least likely to get bone density tests.

The National Osteoporosis Foundation recommends that all women age 65 and older get screened for osteoporosis. In addition, postmenopausal women who are under age 65 but who have additional risk factors for osteoporosis (such as use of corticosteroids or a family history of osteoporosis) or who have recently had a fracture should be screened for osteoporosis. Although widespread screening of premenopausal and perimenopausal women is not generally recommended, it might be appropriate depending on your individual health profile.

Now an article in the Journal of the American Geriatrics Society (Volume 54, page 485) reports that those women who most need bone density testing to determine whether they have osteoporosis are the least likely to be tested.

Researchers analyzed Medicare records to see whether older women are more or less likely to have bone density testing. Among nearly 44,000 women ages 65-90, they found, 27% of those in the youngest age group (66-70) had the test. Only 25.6% of women age 71-75 and less than 10% of those older than age 75 had bone density tests for osteoporosis. Since the women were not interviewed, the researchers could not determine exactly why older women failed to get the test.

Some possible reasons include doctors not realizing the importance of bone density testing or not being aware that at age 80 most women can expect to live another nine years and that osteoporosis treatment can reduce the risk of having a fracture even in adults of advanced age. Perhaps some women did not realize that they are at increasing risk or mistakenly believed that osteoporosis is an inevitable part of aging.

Should You Try Traction?

Fri, 21 Dec 2007 06:00:00 CST

Although traction has been used to treat low back pain since ancient times, there’s little evidence to show that it actually helps.

For most back pain sufferers, the back pain resolves quickly, regardless of the type of treatment. Fewer than 5% of people with back pain have a major medical problem that requires either intensive care or surgery. But if you experience severe back pain that doesn’t improve after a couple of days of bed rest, or if your back pain is recurring or is accompanied by pain, numbness, or tingling that radiates into the buttocks or legs, it is important to see a doctor.

If you have back pain, should you try traction? Little evidence supports the use of traction or corsets, although temporary use of a corset with built-in supports may be helpful during the recovery period following surgery or during activities that have to be performed even when you are still experiencing pain. Whether back braces help in treating back pain is unclear, and seemingly contradictory findings continue to be published.

Supporting data from the journal Spine (Volume 31, page 1591): The ancient Greeks used traction to treat low back pain. It’s still used, but there’s no hard evidence that traction helps reduce pain. So concludes a review of 24 studies that included 2,177 people with low back pain.

All varieties of traction use a harness, which is often weighted, worn either all the time or off-and- on. The harness is intended to improve alignment by gradually stretching the skeleton. The level of force and duration of treatment vary. The participants in these studies, both with and without sciatica, used various types of traction (with or without other treatments) or a placebo, for as little as two weeks or as long as a year. Their back pain ranged from acute (lasting less than four weeks) to chronic (more than 12 weeks).

The studies were of poor quality, analysts said, so the consensus may yet change. But for now, traction alone seems not to improve pain, disability, or ability to return to work, although traction using body weight (autotraction) was moderately better than the other types. Six studies even found that traction actually caused increases in pain and aggravated neurological signs.

Try Yoga

Fri, 30 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Try Yoga

Yoga practitioners have long touted this ancient exercise as a back pain treatment. Now there’s scientific evidence to support this claim.

A major study on the use of alternative therapies found that almost 60% of people who consulted a medical doctor for back pain had tried some sort of alternative therapy. There is mounting evidence that yoga can relieve chronic back pain. The yoga poses, combined with breathing techniques, help relax muscles and calm the mind.

Now a study reported in the Annals of Internal Medicine (Volume 143, page 849 ) provides scientific evidence that gentle yoga seems to work just as well as traditional exercise to relieve chronic lower back pain.

Researchers studied 101 adults who had experienced mild to moderate lower back pain for at least three months. For 12 weeks, one group (chosen at random) attended a weekly 75- minute gentle yoga class. Another group exercised weekly for 75- minute sessions of aerobics, strength training, and stretching. A third group received a book recommending fitness, lifestyle changes, and tips for managing back pain.

By the last treatment, those in the yoga group reported significantly more pain relief than those who got the book and slightly more pain relief than the exercise group. The benefits persisted; 14 weeks later, the yoga group continued to say that their pain was still getting better. Why did they do so well? The researchers believe that yoga instills a sense of relaxation and increases awareness of how you sit, stand, and walk.

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Try Yoga

Rest, Ice, Heat, or Exercise?

Fri, 17 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Rest, Ice, Heat, or Exercise

Fewer than 5% of people with back pain have a major medical problem that requires intensive care or therapy. Many back-pain sufferers self treat with rest, ice, heat, or another therapy.

In most cases, back pain resolves quickly, regardless of the type of treatment. However, you can take the following steps on your own to help ease your back pain:

Exercise for low back pain -- Back relaxation exercises, which involve gentle stretching to relax back muscles, lengthen the spine, and relieve compression of the vertebrae, are effective for alleviating stress and strain on the back. Ask your doctor for a referral to a physical therapist or for printed instructions on how to safely perform the exercises.

Rest for low back pain -- Lying down takes pressure off the spine and usually lessens back pain. The best postures in bed are lying in the fetal position with a pillow between the knees, or on your back with knees flexed, using a pillow to support the legs. Most experts advise limiting bed rest to one or two days, however. The inactivity associated with longer periods of bed rest may do more harm than good by weakening muscles. It is better to get out of bed and move around as soon as you can.

Ice for low back pain -- After a sudden back injury immediately applying ice can be therapeutic. In addition to relieving back pain, ice reduces internal bleeding and swelling by decreasing blood flow. An ice bag, commercial cold pack, or even a package of frozen vegetables should be used for 10–20 minutes every two hours for the first 48 hours after injury (while you’re awake). The 20-minute limit is important to avoid the risk of frostbite. Another approach to relieving back pain is to massage the painful area with an ice cube.

Heat for low back pain-– It’s best to wait for 48 hours after an acute back injury before you apply heat. However, chronic back pain or a more widespread backache that starts some time after a back injury may be eased by relaxing muscles with a hot bath or shower, a heating pad, a heat lamp, or hot, moist compresses.

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Rest, Ice, Heat, or Exercise

Diagnosing Nonspecific Back Pain

Fri, 19 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Diagnosing Nonspecific Back Pain

A research team from St. Louis designs a classification system to diagnose and treat nonspecific back pain.

At some point in their lives, four out of five people experience back pain. Yet the vast majority of them will never know exactly what caused their back pain.

Your back pain may be very specific -- you can literally put your finger on it -- but usually a physical exam does not reveal any identifiable cause such as a herniated disk or a neurological problem. X-rays and magnetic resonance scans are notoriously unhelpful.

Most often doctors end up diagnosing low back pain as mechanical or "nonspecific,” which means pain in the lower back due to an unknown cause. Although guidelines exist to help doctors decide how to manage nonspecific low back pain, the evidence about which treatments are effective has been conflicting.

Most often, nonspecific back pain is caused by muscle strain that responds to a few days of rest and pain medications, followed by a gradual return to normal activities. You may also need medications to reduce muscle spasms and perhaps physical therapy to improve strength and flexibility in your spine, abdomen, and legs. In most cases the back pain will eventually go away by itself. So does it matter at all what your doctor prescribes?

Yes, indeed it does, according to a recent study. A team based in Salt Lake City has spent years creating a classification system to rationalize the diagnosis of low back pain, based on factors such as duration and location of the back pain and range of motion. Recently, they proceeded to test whether their criteria really offered a solid rationale for treatment choice.

Their latest study involved 123 patients referred for physical therapy because of nonspecific low back pain that had persisted for less than 90 days. Based on the symptom classifications, 50 people received one of three treatments: spinal manipulation, repeated range-of-motion exercises to flex or extend their backs, or exercises designed to strengthen and stabilize their trunks. The remaining 73 people had one of these treatments chosen at random. Everyone got treatments twice a week for four weeks.

At the end of the four weeks and then a year later, the research team examined the study subjects again. Those who got a treatment chosen at random had about 20% more remaining disability than people whose treatments corresponded to the classification of their symptoms, the researchers reported in the journal Spine. Because failure to recover quickly from nonspecific low back pain carries a greater risk of permanent disability, choosing the best back pain treatment immediately may have long-term benefits.

So what to do if your own back goes out? You or your doctor can look up the classification system; it is described in two separate places on the Internet for free (Annals of Internal Medicine 2004;141:920–928 and BMC Musculoskeletal Disorders 2006; Feb 10;7:11).

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Diagnosing Nonspecific Back Pain

How to Cope With Stress - Induced Back Pain

Fri, 28 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | How to Cope With Stress - Induced Back Pain

Two studies point to the connection between poor emotional coping skills and back problems.

If you have pain in your back, the source may be inside your head. One of the main causes of back pain is emotional stress, and back pain may be a signal that you are not coping well with stress, according to two new studies.

A recent study of more than 48,000 men in the Swedish Army clearly shows the link between back problems and the ability to cope with stress. These military recruits took a battery of medical examinations, intellectual tests, and a test of their ability to cope with stress. Coping was defined as efforts to manage or modify the negative impact of stress.

The researchers found that more than 5,000 men had a back problem severe enough to interfere with military service. The vast majority of these problems were nonspecific back pain and disease. Those who had poor coping skills were more likely to have back pain. Interestingly, good coping ability and intelligence were strongly associated, which may mean that the smarter you are, the easier it is to learn how to handle stress.

In a similar study, a group of 368 U.S. Army soldiers filled out questionnaires about their health and work habits at their first visit to a clinic for acute low back pain. Job stress was related to emotional distress, and this distress was directly related to clinic visits for back pain. The more emotional distress a soldier had, the more return visits to the clinic it took to solve the back pain.

This study confirms other research that shows the combination of psychological distress and the physiological demands of work relate to increased risk of back symptoms. The Army researchers believe that job stress plays an important role in persistent low back pain, and that reducing emotional distress can reduce that pain.

What’s the Connection? It’s common knowledge that people under stress are tense, and that tension can easily settle in your back. If you experience constant stress, even at a low level, your muscles may be tightening up so often that you don't notice anything out of the ordinary. But those taut muscles can send a strong signal of pain to your brain. The pain may lead you to become leery of doing normal activities. Limiting your movement and activity only leads muscles to become deconditioned and weaker, which in turn leads to more back pain. This sets up a vicious cycle that may end up in chronic back pain.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | How to Cope With Stress - Induced Back Pain

When Should You Treat Osteopenia?

Fri, 15 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | When Should You Treat Osteopenia

If osteopenia is a warning sign that osteoporosis may develop, how much should you worry? Johns Hopkins researchers offer advice.

If you’ve ever had your bone mineral density tested, you may have been given your score -- more precisely, your T score. The T score is drawn from the world of statistics; it reflects the number of standard deviations a person’s bone mineral density (BMD) is above or below the norm. In this instance, the “norm” is the BMD of an average, healthy young woman.

If your T score is –1 or higher, your BMD is considered normal; if it’s –2.5 or less, you have osteoporosis. But if you fall in between, you have osteopenia. The World Health Organization developed these parameters.

Osteopenia sounds serious -- but is it? Technically, osteopenia is not in and of itself a disease, as osteoporosis is. Instead, osteopenia is an indication that your BMD is below the statistical norm and that you could eventually develop osteoporosis or be at risk of a future fracture. If you have osteopenia, the real difficulty comes in determining whether you need treatment with any bone-building medications.

On one hand, treating osteopenia sounds logical. Osteoporosis doesn’t develop overnight, out of the blue; surely, a person with the disease was osteopenic at some point along the line. However, just because you have osteopenia doesn’t mean that you’re absolutely guaranteed to develop osteoporosis, nor are you fated to have a serious fracture. Thus, taking bisphosphonates or other bone-building medications for your osteopenia means that you might be treated for a condition you never would have developed even if left untreated. As a result, many experts argue that most people with osteopenia don’t need treatment, that blanket prescribing of bone-building drugs for osteopenia is more about alleviating anxiety than actually preventing fractures -- and that such a strategy makes no sense when drug costs and potential side effects are taken into account. Instead, the general consensus is in favor of selective, targeted treatment for osteopenia -- that is, treatment that considers the whole person rather than just the T score.

You and your neighbor might have the exact same osteopenic T-score, but that doesn’t mean that you have the exact same risk profile for developing osteoporosis or breaking a bone in the future. BMD is only one of many factors in your individual risk profile. Other factors include: your age, history of personal fractures, family history of osteoporosis, whether or not you’re underweight or smoke, whether you’re starting treatment with certain drugs, particularly glucocorticoids, or you have another illness that could compromise your BMD.

Whether or not you are prescribed medication for your osteopenia, it’s worth regarding osteopenia as a “wake-up call” and taking steps to be sure you’re doing all you can to be as healthy as possible. If you smoke, stop. And be sure to get plenty of weight-bearing exercise, enough calcium and vitamin D, and to limit alcohol and caffeine intake.

For more Alerts and Special Reports, please visit the Back Pain and Osteoporosis Topic page.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | When Should You Treat Osteopenia

Meet the Charite Disk

Fri, 07 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Meet the Charite Disk

For patients with back pain, the Charite artificial disk offers some clear advantages – but also some unanswered questions.

Each year, some 200,000 people undergo spinal fusion surgery for chronic and disabling low back pain. Some back pain sufferers may be candidates for a new device, the Charité artificial disk.

The FDA approved the Charité disk for back pain in late 2004. The disk is made of a plastic core sandwiched between two metal endplates and replaces an actual disk that is removed due to disease or injury, helping to restore the natural distance between two vertebrae. There’s no question that development of the disk opens a new era in surgery for back pain. And artificial disk surgery has a clear advantage over spinal fusion with regard to preserving spinal mobility. However, the disk has its critics -- and some of their observations are sobering.

Not everyone with back pain is a potential candidate for the Charité. The FDA formally approved the disk for people who have degenerative disk disease at one level in the lumbar spine (from L4––S1) and who have experienced no back pain relief after at least six months of non-surgical treatment for low back pain. It is not recommended for people with scoliosis, spondylolisthesis, or degenerative disk disease at more than one level. Overall, of people with back pain who are potential candidates for spinal surgery, 90% would still undergo spinal fusion surgery according to current practice. This may change in the future as surgeons accumulate experience with larger numbers of back pain patients and develop a fuller understanding of the outcomes people have with the Charité disk.

One of the most contentious issues surrounding the Charité disk is the variety of results seen after surgery. The disk was first approved in Europe, and a study conducted there of 53 back pain patients came to the conclusion that, "Proof that long-term results with the disk are at least as good as fusion results is still missing.” This study, published last year, offers the longest perspective of any to date, with a follow-up of 17 years.

In contrast, a second European study of 107 back pain patients with minimum follow-up of 10 years, concluded that the outcomes seen with the disk compared favorably with those typically seen with spinal fusion surgery. In this country, the FDA based its approval on results from a study that found that back pain patients who received the disk did no worse than those who underwent spinal fusion. Follow-up in that study lasted for only 2 years.

If you believe that you’re a candidate for the artificial disk at this time, be sure to ask your surgeon plenty of questions about what your expectations, data on outcomes, and the potential for disk failure. If you want to take a wait-and-see stance, more studies on the Charité disk will be forthcoming. In addition, other artificial disks are being developed for people with back pain and tested in clinical trials, some in head-to-head comparison studies with the Charité disk.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Meet the Charite Disk

Back Pain Relief with Acupuncture

Fri, 06 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Back Pain Relief with Acupuncture

Patients with chronic back pain are finding that acupuncture – sometimes combined with massage and heat therapy – may provide long-term relief.

We’ve come a long way since 1971. That was the year when New York Times reporter James Reston, accompanying Secretary of State Henry Kissinger on a trip to China, described how Chinese doctors used acupuncture to ease his pain after an emergency appendectomy.

Once thought of as esoteric and somewhat mysterious, acupuncture has become increasingly accepted in the United States. The majority of visits to acupuncturists are for pain and musculoskeletal problems, with back pain leading the list. And the research indicates that acupuncture is effective for musculoskeletal conditions -- in a recent meta-analysis of 33 studies, acupuncture proved effective for chronic low back pain.

If you decide to pursue acupuncture, what can you expect? There are an estimated 10,000 acupuncturists in this country, and a third of them are physicians. Many non-physician acupuncturists hold licenses in other health professions, notably nursing. Currently, 51 acupuncture schools are accredited in this country, and 42 states allow the practice of acupuncture by non-physicians, who usually have the initials L.Ac. after their names.

An acupuncture visit usually begins with an extensive interview, with questions about your specific symptoms as well as your lifestyle in general. The acupuncturist usually will examine your tongue and take your pulse as well. The hair-thin, stainless steel acupuncture needles vary in length. The FDA requires that sterile, nontoxic needles be used and that qualified practitioners label them for single use. The acupuncturist should swab the treatment sites with alcohol or another disinfectant before the needles are inserted. On average, from 3–15 needles will be used during an acupuncture session. As the acupuncture needles are inserted, you might feel pressure, a slight pinch, or even a tingling sensation -- or nothing at all. Once the needles are in place, you usually will be asked to remain still. During that time, some people feel pleasantly relaxed; others report experiencing sensations at different sites in the body. Because the acupuncture needles are so fine, they often leave no trace; if they do leave a mark, it may look as though your skin was lightly touched with a red ink pen. Side effects from the needling treatment are uncommon, although contact dermatitis (a skin reaction to the stainless steel needles) has been reported.

Acupuncturists also treat pain by combining needling with massage or heat therapy. Like the needles themselves, these therapies also stimulate the acupuncture points in the body. Physician acupuncturists also may combine the needle treatments with standard medical therapy.

For more information about acupuncture, go to our article Choosing an Acupuncturist

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Back Pain Relief with Acupuncture

Spotlight on Osteoporosis

Fri, 04 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Spotlight on Osteoporosis

What We Think We Know About Osteoporosis

Most American adults don’t know as much as they should -- or think they do -- about osteoporosis. In a small but in-depth study reported in the Journal of Rheumatology (Volume 32, page 673), researchers conducted one-on-one interviews with 15 older adults, asking a series of questions designed to illuminate the depth of their understanding about osteoporosis. Of the 15 participants, 11 were women; the mean age was 75.5 years.

While most of the participants identified osteoporosis as a serious condition and could describe it as a thinning, weakness or loss of bone, most didn’t have a clear understanding of the clinical consequences of osteoporosis. Moreover, many did not perceive themselves to be at personal risk of developing osteoporosis, even though some had already experienced fractures.

In addition, some of the participants mistakenly believed that osteoporosis has clear warning symptoms. As for prevention and treatment, self-reported calcium and vitamin D intake was low, and many of the participants expressed reservations about taking prescription medications because of concerns over cost, side effects and interactions with their current medications. The researchers are using the results to develop a patient-education program that will be evaluated in a future study.

Encouraging News for Women With Osteoporosis -- More Evidence Strontium Ranelate Prevents Fractures

Strontium ranelate, a new drug for osteoporosis, significantly reduces the risk of hip and non-vertebral fractures in postmenopausal women with osteoporosis. In the Treatment of Peripheral Osteoporosis (TROPOS) study, a double-blind, randomized study, more than 5,000 postmenopausal women at several European study sites received either two grams of strontium ranelate or a placebo every day for three years.

At the end of the study period, the risk of incurring a non-vertebral fracture was 16% lower in the strontium ranelate group. The risk of a major fracture was 19% lower for all other sites, including hip, pelvis, ribs and wrists. And the drug reduced the hip fracture risk by 36% in a high-risk subgroup -- women most likely to develop a hip fracture because of their age and low bone density T scores at the femoral neck.

Strontium ranelate is not yet approved in the United States, but is sold abroad under the name Protelos. It has a unique action in that it appears to decrease bone resorption and stimulate bone formation at the same time. This action rebalances bone turnover in favor of the formation of new and strong bone. The study was reported in the Journal of Clinical Endocrinology and Metabolism (Volume 90, page 2816).

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Spotlight on Osteoporosis

Research Update on Back Pain Relief

Fri, 25 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Research Update on Back Pain Relief

Depression as a Risk Factor for Back Pain

There’s no question that low back pain can lead to depression, but can depression lead to low back pain? The answer appears to be yes.

In a three-year prospective study of 148 people aged 35 - 70 years, depression proved to be a stronger predictor of low back pain than the results of magnetic resonance imaging (MRI). The three-year incidence of back pain was 67%; those who reported depression when the study began were 2.3 times as likely to have back pain as those who didn’t report depression.

In contrast, any progression of anatomic abnormalities, as seen on MRI, was infrequently and only occasionally associated with new onset of back pain. Most of the participants were men; none had any back pain when the study began. Those who reported depression were either being treated for depression or had their activities limited by depression. While MRIs were taken only at the beginning and end of the study, all of the participants were interviewed every four months regarding back pain and functional status. This intriguing study was reported in the journal Spine (Volume 30, page 1541).

Acupuncture for Low Back Pain

Acupuncture has a role in treating chronic back pain, a new review of the topic concludes. The review, reported in Annals of Internal Medicine (Volume 142, page 651), is a meta-analysis of 22 previously published randomized studies. It found that acupuncture is "significantly more effective” than fake acupuncture or no treatment in people who have chronic back pain. However, the researchers stated that there is no evidence to suggest that acupuncture is more effective than other active therapies for chronic back pain, such as massage, medication, or chiropractic adjustment.

For acute back pain, the researchers noted that acupuncture’s role remains uncertain because the studies available for review are, in their opinion, limited in quantity and quality. On a positive note, the researchers add that several large, well-designed studies add to the growing support for acupuncture as a modality for treating back pain. At the time that this meta-analysis was published, these studies had not yet been published, but their results had been presented at conferences.

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Research Update on Back Pain Relief

Are You a Good Candidate for Spinal Fusion?

Fri, 23 Mar 2007 06:00:00 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Are You a Good Candidate for Spinal Fusion? is no longer current, and has therefore been removed.

If you would like to read related articles about Back Pain and Osteoporosis, please go to the Back Pain and Osteoporosis topic page. Thank you.

Trauma to the Tailbone

Fri, 02 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Trauma to the Tailbone

In older adults, falling is the most common cause of tailbone injury.

The technical name for your tailbone (which is actually made up of several bony segments at the base of your spine) is the coccyx, and pain in that area is called coccydynia. Tailbone pain is usually caused by falling and landing on the coccyx. Older adults, who often have balance problems, are particularly at risk for this type of fall, especially when walking on ice or a wet floor. Women are at higher risk than men because a woman’s coccyx is rotated and faces backward, leaving it more exposed. Other risk factors for coccyx injury include arthritis, osteoporosis, and medications (such as corticosteroids, which can cause osteoporosis). Also, activities that involve repetitive straining against the tailbone and friction (such as cycling or rowing) can cause injury to the coccyx.

An actual coccyx fracture is rare; instead, the injury usually bruises the bone or stretches ligaments in the area. The main symptom of coccyx injury is severe pain and tenderness in the tailbone area, particularly when sitting. Bowel movements can be painful, as can sexual intercourse for women. Most cases of coccyx injury are treated with self-care techniques, but these symptoms require a visit to the doctor to rule out other possible causes.

Treating coccyx pain -- In most cases, injuries to the coccyx heal on their own, although pain can linger for several weeks or months. The following measures can be helpful in reducing pain after a coccyx injury:

Apply ice to the coccyx for 15 to 20 minutes at a time, four times a day, during the first few days after the injury.

Use a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as needed.

Sit on a donut-shaped pillow, which keeps the injured area away from the hard surface of a chair. These pillows can be purchased at a medical-supply store.

Avoid sitting for long periods of time, if possible.

Constipation can make bowel movements painful, so prevent it by eating a diet high in fiber and drinking plenty of fluids. Your doctor may also prescribe a stool softener to achieve the same result.

Spend some time in a hot tub or whirlpool, if possible, which will reduce pain and swelling. For severe pain, your doctor may prescribe a stronger pain reliever, administer anesthetic and steroid injections, or refer you to a physical therapist. Surgical treatment usually is not required.

Click here to download illustrations and a handy tip sheet on treating Tailbone Trauma

For more Alerts and Special Reports, please visit the Back Pain and Osteoporosis Topic page.

Johns Hopkins Health Alerts |

Back Pain - Osteoporosis | Trauma to the Tailbone

A Pain in the Back ... A Drain on the Pocketbook

Fri, 09 Feb 2007 06:00:00 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article A Pain in the Back ... A Drain on the Pocketbook is no longer current, and has therefore been removed.

If you would like to read related articles about Back Pain and Osteoporosis, please go to the Back Pain and Osteoporosis topic page. Thank you.

Osteoporosis and Men

Fri, 19 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Osteoporosis and Men

Osteoporosis is not just a woman’s disease. Johns Hopkins provides a review of risk factors, screening tests, and drugs that are FDA-approved for use in men with osteoporosis.

For many of us, the face of osteoporosis belongs exclusively to older women. As we’re finally coming to understand, men can get osteoporosis, too. Osteoporosis is estimated to affect approximately two million men in the United States, and that number is expected to grow as more men survive into their 80s and 90s. Overall, one in four men is likely to have an osteoporosis-related fracture in his lifetime (compared with one in two women). While osteoporosis typically begins later in life in men than it does in women, it can be equally dangerous. Of those men who have hip fractures, for instance, one-third will die within a year.

Risk factors for osteoporosis in men

There are two risk factors—male hypogonadism and prostate cancer— that affect only men. Male hypogonadism refers to low testosterone levels, which may occur naturally with aging or as a result of a disease. When it comes to other risk factors, however, osteoporosis knows no gender difference. Several diseases -- notably, rheumatoid arthritis and asthma -- raise the risk of developing osteoporosis because of the drugs used to treat them, especially glucocorticoids. Anticonvulsants and immunosuppressive drugs can also raise the risk of developing osteoporosis.

In addition, people with hypercalciuria, or gastrointestinal disorders that interfere with absorption of nutrients important for bone health are at risk of developing osteoporosis. Several glandular disorders such as hypothyroidism, hyperthyroidism, or Cushing’s syndrome put people at risk for osteoporosis as well.

Finally, behavioral or lifestyle factors -- drinking too much alcohol, smoking cigarettes, not getting enough weight-bearing exercise, and low calcium and vitamin D intake -- put men at risk for osteoporosis, just as they do for women.

Osteoporosis screening advice

Many women begin to think about getting a bone density test around the time of menopause, when estrogen levels drop. But men have no similar timeline, other than general aging or fractures that occur in the absence of obvious trauma.

Certainly, if you experience a suspicious fracture, your bone mineral density (BMD) should be checked. Currently, there are no age-specific guidelines for men, but it might be worth discussing your risk with your doctor if you’re 65 or older. By age 65, men and women lose bone at the same rate.

Be aware, however, that BMD testing in men has its own challenges: There is an ongoing debate over whether the same reference values used in women should be applied to men. One organization, the International Society for Clinical Densitometry, has recommended using a T score of –2.5 or less to diagnose osteoporosis in men who are 65 or older. However, not all osteoporosis experts agree with this recommendation.

Basic osteoporosis treatment for men includes adequate calcium and vitamin D intake, regular weight-bearing exercise, stopping smoking, and cutting back on alcohol. As for drugs that are FDA-approved for osteoporosis, the following are approved for use in men:

The bisphosphonates Fosamax (alendronate) and Actonel (risedronate)

Teriparatide, a parathyroid hormone, which is approved for men who are at high risk of fractures. It also may be used in those men who don’t respond to bisphosphonate therapy

Testosterone therapy for men with low testosterone levels

For more Alerts and Special Reports, please visit the Back Pain and Osteoporosis Topic page.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Osteoporosis and Men

New Findings on Osteopenia and Osteoporosis

Thu, 23 Nov 2006 10:56:26 CST

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

New Findings on Osteopenia and Osteoporosis

The Connection Between Celiac Disease and Osteoporosis

People who have osteoporosis may need to be screened for celiac disease -- an intestinal disorder that is proving to be more common than previously thought. In a study reported in the Archives of Internal Medicine, researchers evaluated 840 people, 266 of whom had osteoporosis; 12 of them tested positive for celiac disease, vs. six of 574 people who didn’t have osteoporosis. Further study via endoscopic intestinal biopsies confirmed the presence of celiac disease in nine of the participants with osteoporosis and in one person who didn’t have osteoporosis.

Celiac disease is an intestinal disorder caused by intolerance to wheat gluten. Celiac disease was believed to be a rare disease in the United States. However, current estimates of its overall prevalence range from 5–15%, with prevalence rates higher in some selected populations. Celiac disease can contribute to gastrointestinal problems such as diarrhea. Celiac disease can also lead to malnutrition, because it interferes with absorption of essential nutrients, including iron and calcium. Treatment for celiac disease involves a gluten-free diet, which allows the intestine to heal. In this study, the researchers placed the 10 patients with celiac disease on a gluten-free diet; this led to an improvement in both their gastrointestinal symptoms and bone density levels.

Should You Begin Drug Treatment for Osteopenia?

Is it a good idea to take the osteoporosis drug Fosamax (alendronate) if you have osteopenia but no other risk factors for fractures? The answer is no, according to the results of a cost-effectiveness study, reported in the Annals of Internal Medicine.

The question of when to begin osteoporosis treatment is a tricky one for women who have osteopenia (low bone mass) but don’t have osteoporosis or a history of fractures. Osteoporosis treatment is standard in women who have bone mineral density T-scores of –2.5 or greater, but not in women with T-scores higher than –2.5. Some organizations and researchers have recommended beginning osteoporosis treatment at T-scores of –2.0 or even –1.8, even without additional risk factors for fractures.

This study notes that the cost and risk of earlier osteoporosis treatment is warranted only if there is a reduction in the ultimate cost and disability that can be attributed to fractures. Overall, Fosamax is not cost-effective in osteopenic postmenopausal women who have not had any previous fractures, the study shows say, unless the woman is at risk independent of her bone mineral density readings. The results likely apply to Actonel (residronate) and Evista (raloxifene), according to the study, but can’t be applied to estrogen replacement therapy.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

New Findings on Osteopenia and Osteoporosis

Evidence That Iyengar Yoga Can Ease Your Chronic Back Pain

Tue, 24 Oct 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Evidence That Yoga Can Ease Chronic Back Pain

Ready to try something new for your back pain? Iyengar yoga may be the way to go.

There’s nothing new in the world of exercises for back pain, correct? Not exactly. In fact, there’s more evidence that yoga—specifically, Iyengar yoga—can help alleviate chronic back pain.

There are many schools or types of yoga. Iyengar yoga (named for its developer, B.K.S. Iyengar) features precise alignment and props such as blankets, bolsters, and chairs. The props help people who are less flexible and/or are injured achieve the correct yoga poses. The attention to alignment helps prevent further injury.

Iyengar yoga teachers are trained with a premium on knowledge and a stepladder of increasing levels of accreditation. Even at the entry level, certified teachers undergo a rigorous education program that includes in-depth knowledge of anatomy and physiology, and demonstrated expertise in teaching.

In the first randomized trial of Iyengar yoga and back pain, 60 participants were placed in either a yoga group or an educational group. Both programs lasted 16 weeks. Participants had experienced low back pain for an average of 11.2 years, and 48% used pain medication. At the end of the study and at a three-month follow-up, those in the yoga group had significant reductions in pain intensity, functional disability (including spinal range of motion), and use of pain medication. The results compare favorably with results obtained with physical therapy.

With yoga’s increasing popularity, finding a teacher today is easier than ever. If your local Yellow Pages aren’t helpful, try Yoga Journal (www.yogajournal.com) or the National Association of Iyengar Teachers (www.iynaus.org). Be sure to ask about the teacher’s training and certification, and be honest about your concerns and any limitations or injuries.

Remember, too, that yoga is not a competitive sport: You have nothing to prove, and there is no gain to be found in pain. Honor your body, with all of its idiosyncrasies. If you come up empty-handed, don’t despair. Many of the back exercises taught by physical therapists closely resemble those taught in a yoga studio. And as it happens, a growing number of physical therapists are yoga practitioners themselves.

In addition, a number of certified Iyengar instructors have written books, among them Suza Francina, Mary Pullig Schatz, M.D., and Patricia Walden. (Dr. Schatz’s book focuses exclusively on back care.) Mr. Iyengar also has written several books. However, be careful about relying solely on books. Many of the subtleties of alignment are easy to miss—and of course, you can’t see your body the way a yoga teacher or physical therapist can.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Evidence That Yoga Can Ease Chronic Back Pain

Research Update on Back Pain Relief

Fri, 22 Sep 2006 10:27:05 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Research Update on Back Pain Relief is no longer current, and has therefore been removed.

If you would like to read related articles about back pain relief, please go to What's the Best Exercise for Chronic Back Pain? and Water Workouts. Thank you.

Exercise Tips To Relieve Neck Pain

Fri, 22 Dec 2006 13:12:05 CST

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Exercise Tips To Relieve Neck Pain

A new study from Finland shows that endurance and resistance exercises can help soothe chronic neck pain.

Treatments for chronic neck pain include medication, spinal manipulation, improvements in posture and ergonomics, and relaxation techniques. Now a study from Finland shows that neck endurance and resistance exercises are also effective options for neck pain.

In the study, researchers randomly assigned 180 women with chronic neck pain (25 to 53 years old) to endurance training, resistance training, or a control group. Participants in the endurance- and resistance-training groups were assigned to five 45-minute sessions a week. Endurance training consisted of neck exercises such as repeatedly lifting the head while lying face up and then face down. Resistance training involved wrapping a specialized elastic band (such as the Thera-Band, available from a physical therapist or a sporting goods store) around the head while bending the neck forward, backward, to the left, and to the right. Both groups also used free weights to strengthen the shoulders and arms and regularly engaged in aerobic exercise. The control group performed aerobic exercises only.

After one year, all groups had less neck pain and disability, but the greatest improvements in neck pain were seen in the endurance- and resistance-training groups. These two groups were also taking less pain medication than the control group. Benefits in the endurance- and resistance-training groups were seen even in those who attended only two sessions per week. Whether these results would also apply to men is uncertain, the study’s authors note.

If you have chronic neck pain and are interested in endurance and resistance training, you may want make an appointment with a physical therapist who can design and teach you an individualized exercise program. Once you are able to perform the neck exercises independently, you can continue on your own without a physical therapist.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Exercise Tips To Relieve Neck Pain

Relieving Back Pain and Neck Pain

Wed, 20 Sep 2006 14:49:34 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Relieving Back Pain and Neck Pain

Is your mattress too hard? Does your neck hurt? Here’s some advice to help soothe your pain.

For those vulnerable to low back pain, minimizing back stress while you sleep can be an important preventive measure. Choosing the right mattress can help. Although conventional wisdom has long held that firm mattresses are best for the back, evidence supporting this idea was lacking. Now a study has shown that a mattress of medium firmness may be the most helpful. When 313 people with chronic back pain had their mattress replaced, those who received a mattress of medium firmness were twice as likely to experience reductions in back pain and the need for pain medication as those who received a firm mattress.

Sleeping position is also important. Adopting certain positions while sleeping can throw the spine out of alignment; for example, lying on one's stomach puts stress on the neck and exaggerates the curve of the lower back. This can trigger a bout of back pain or prolong recovery time. The best sleeping positions allow the back to relax by keeping it aligned.

Ideal:The best way to sleep if you have back pain is on your side with your knees bent and a pillow between your knees. This position helps to maintain the natural curves of your spine.

Good: When sleeping on your back, keep your knees slightly raised by placing a pillow underneath them. This prevents your lower back from overarching by supporting the weight of your extended legs.

Acceptable: If you can't break the habit of sleeping on your stomach, place a pillow underneath your abdomen to keep your spine aligned.

Relieving Neck Pain

Treatments for chronic neck pain include medication, spinal manipulation, improvements in posture and ergonomics, and relaxation techniques. Now a study from Finland shows that neck endurance and resistance exercises are also effective options.

In the study, researchers randomly assigned 180 women (25 to 53 years old) to endurance training, resistance training, or a control group. Participants in the endurance- and resistance-training groups were assigned to five 45-minute sessions a week. Endurance training consisted of neck exercises such as repeatedly lifting the head while lying face up and then face down. Resistance training involved wrapping a specialized elastic band (such as the Thera-Band, available from a physical therapist or a sporting goods store) around the head while bending the neck forward, backward, to the left, and to the right. Both groups also used free weights to strengthen the shoulders and arms and regularly engaged in aerobic exercise. The control group performed aerobic exercises only.

After one year, all groups had less neck pain and disability, but the greatest improvements were seen in the endurance- and resistance-training groups. These two groups were also taking less pain medication than the control group. Benefits in the endurance- and resistance-training groups were seen even in those who attended only two sessions per week. Whether these results would also apply to men is uncertain, the study’s authors note. If you have chronic neck pain and are interested in endurance and resistance training, you may want to make an appointment with a physical therapist who can design and teach you an individualized exercise program. Once you are able to perform the neck exercises independently, you can continue on your own.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis | Relieving Back Pain and Neck Pain

No Whey -- Getting Enough Calcium If You Don't Eat Dairy

Thu, 24 Aug 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Osteoporosis on Calcium Deficiency

People who are lactose intolerant or who eat a vegan diet often don’t consume enough calcium. So how do you get enough calcium in your diet if dairy is not on your plate?

Dietary calcium is essential for maintaining normal bone metabolism, and dairy products are by far the largest source of calcium in the Western diet. But two groups of people --those with lactose intolerance and vegans -- often don’t get enough calcium because of a lack of dairy in their diet.

What Is Lactose Intolerance?

Lactose intolerance is an inability to digest lactose, the major sugar in milk and products derived from milk. Its symptoms include gas, bloating, crampy abdominal pain, and diarrhea, which occur because the small intestine lacks adequate lactase, the enzyme that breaks down lactose into simple sugars.

Studies show that lactose-intolerant people have low levels of calcium in their diet. A report in the Journal of the American College of Nutrition found that people with lactose intolerance consume only 693 mg of calcium daily, on average, primarily because they eat less dairy than the average person. This level is much less than the 1,000 mg recommended for adults age 50 and under and the 1,200 mg recommended for those over 50. The lactose-intolerant subjects also had elevated markers of bone turnover and lower-than-normal bone mass, two factors that are also common in people with osteoporosis.

What Do Vegans Eat?

A vegan is a strict type of vegetarian who chooses to eliminate all animal products from the diet, usually for ethical reasons. Other types of vegetarians typically do not eat meat, but they still may eat animal-derived products like eggs and milk.

Because vegans do not consume any milk or any foods that contain milk, they often have lower-than recommended levels of calcium in their diets. A German study of about 150 vegans published in the European Journal of Clinical Nutrition found that they consumed only 810 mg of calcium daily, on average.

Nondairy Sources of Calcium

For these groups who consume little or no dairy, nondairy foods that are high in calcium are a good option. Foods with naturally occurring, high calcium levels include collard greens, turnip greens, kale, bok choy, soybeans, okra, and broccoli. Other nondairy sources include fish with soft, edible bones – canned sardines or salmon -- cultured soy yogurt, tofu, and almonds, as well as calcium-fortified orange juices, soy milks, and cereals.

Supplements are another excellent nondairy source of calcium. In fact, many people with lactose intolerance or vegans may need a combination of foods high in calcium along with calcium supplements to reach their recommended intake of calcium. Also, be aware that the body cannot absorb more than 600 mg of calcium at one time, so calcium intake will need to be spread throughout the day.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Osteoporosis on Calcium Deficiency

Easing Back Pain with Good Posture

Tue, 25 Jul 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Easing Back Pain with Good Posture

In a perpetual slouch? Poor posture can lead to back pain, or worse! Follow these simple posture tips for back pain relief!

Contrary to popular belief, standing at attention -- with head and shoulders rigidly pulled back and lower back excessively arched -- is not correct posture and can be hard on the back. Good posture allows the body to follow the natural S-shaped curve of the spine. As simple as that sounds, however, poor habits, injury, and even ill-fitting shoes can contribute to improper spinal alignment. Poor posture can strain muscles and ligaments and increase the risk of compressed nerves – all leading to back pain!

The easiest way to evaluate your posture is to stand sideways in front of a mirror when you are not wearing any bulky clothing. Ideally, it should be possible to visualize a straight line running through the front of your earlobe, the front of your shoulder, the center of your hip, just behind your kneecap, and just in front of your ankle bone. Your chin should be parallel to the floor, not thrust outward. To check your posture while sitting, sit in an armless chair with your side to a mirror. You should be able to visualize a line running through the same points of your upper body down to the center of your hip.

Perpetual slouching with shoulders rolled forward causes kyphosis (commonly called dowager’s hump, humpback, or hunchback). Mild kyphosis and lordosis (swayback) usually can be corrected through a program of exercise, along with weight loss for overweight people with lordosis. More severe cases may require surgical correction.

Posture varies with age. As people get older and lose height because of disk changes, the curve in the lumbar region of the back tends to straighten, leading to a slight stoop, which is normal. In addition, the curve in the thoracic region tends to become accentuated with age.

Follow these 6 simple tips to improve your posture and soothe your back pain:

Back pain tip #1: At the desk, choose a straight-backed chair, and sit with your shoulders against the chair back, your chest lifted, your arms in the armrests, and your upper back straight.

Back pain tip #2: When sitting, your feet should comfortably touch the floor, with your knees slightly above your hips. You may need to place a footstool or thick book underneath your feet.

Back pain tip #3: An ideal chair should include armrests to support the weight of your arms and reduce the pressure on your back.

Back pain tip #4: When sitting, it is important to get up and move around every half hour or so.

Back pain tip #5: When driving, adjust your seat position so that you can comfortably reach the steering wheel, brakes, and accelerator. Frequently shifting your hand position on the steering wheel will minimize stress on the muscles in the upper back and neck.

Back pain tip #6: When in bed, lying on one side with knees bent and a pillow between them helps to maintain the natural curves of the spine. Place a pillow behind your knees when sleeping on your back and under your abdomen if sleeping on your stomach.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Easing Back Pain with Good Posture

The Right Tests and Timetable for Checking on Osteoporosis

Thu, 22 Jun 2006 16:19:10 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Osteoporosis on Bone Density Tests

A test called dual-energy x-ray absorptiometry (DEXA or DXA) is the most accurate way to tell how solid your bones are – and it requires less radiation than a regular x-ray.

Osteoporosis has no symptoms, and many people do not know they have osteoporosis until they break a bone. Tests that measure bone density can diagnose osteoporosis and detect osteopenia before fractures occur.

A test called dual-energy x-ray absorptiometry (DEXA or DXA) is the most accurate way to tell how solid your bones are. DEXA scans use two x-ray beams powerful enough to measure bone density at the hip and spine—the areas where people with osteoporosis are most likely to suffer a fracture—and yet require less radiation than a regular x-ray.

Other types of bone density tests are also available. All are associated with minimal discomfort and risk. The type of test your doctor performs may reflect a balance between your needs and the availability of testing equipment in your area.

Currently, widespread osteoporosis screening for premenopausal and perimenopausal (around the age of menopause) women is not recommended. However, certain individuals should seek screening.

According to the National Osteoporosis Foundation (NOF), all women age 65 and older should be screened for osteoporosis, as well as all perimenopausal women who are considering osteoporosis treatment, have additional risk factors for osteoporosis (such as use of corticosteroids or a family history of osteoporosis), or have sustained a fracture.

The NOF recommends bone mineral density testing for all men older than age 70. Younger men between the ages of 50 adnd 70 only need such testing if they are at high risk for osteoporosisis.

The U.S. Preventive Services Task Force also recommends routine screening for all women age 65 and older; routine screening should begin at age 60 for those women identified as high risk for osteoporosis. The USPS does not have an osteoporosis screening recommendation for men.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Osteoporosis on Bone Density Tests

How To Minimize Back Pain Around The House

Mon, 17 Apr 2006 09:50:30 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Minimize Back Pain Around The House

If you are prone to acute back pain flare-ups, you may worsen your condition while going about your daily chores. These tips can help!

Washing dishes, dusting the furniture, picking up socks from the floor, doing laundry, raking the lawn—all of these routine household tasks can present unique challenges for people with back pain. If you suffer from chronic back pain—or are prone to acute back pain flare-ups—you may worsen your condition while going about your daily chores. Fortunately, you can take some steps to minimize the stress on your back and accomplish your household chores more effectively.

In general, avoid sitting or standing for extended periods during chores if you have chronic back pain. Change positions frequently, walk around between tasks, or take a break to do a few back stretches. If you suffer from occasional flare-ups of back pain, it’s a good idea to cut back on unnecessary household chores when you are in pain. When your back pain symptoms are under control again, you can increase your activity level and resume normal household routines.

Also follow these three tips to protect against back pain:

While performing tasks that require prolonged standing—such as cooking, ironing, or dishwashing—rest one foot on a footstool, book, or inside shelf of a cabinet, and occasionally alternate feet. If possible, your countertops, ironing board, and sink should be at waist height.

When lifting, observe the age-old mantra of bending at the knees, not at the waist. Hold items close to your body as you lift, and if you have to turn, step in the direction of the turn rather than twisting your torso. Never try to lift or carry more than you can handle. For example, transfer wet clothes from the washer to the dryer a few at a time—wet clothes can be unexpectedly heavy—and dispose of your garbage in several small bags rather than one large trash bag.

When you have to bend over, don’t bend from the waist—instead, squat, kneel on one or both knees, or bend your knees and stoop slightly while performing such tasks as making the bed, reaching for an object under the sink, or loading the dishwasher.

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Minimize Back Pain Around The House

Choosing Acupuncture For Back Pain Relief

Mon, 01 May 2006 21:18:09 CDT

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Acupuncture For Back Pain Relief

National Institutes of Health stated that for back pain, acupuncture “may be useful as an adjunct treatment …”

Acupuncture comes from the traditional Chinese medical theory that pain or disease occurs when the body’s natural energies (chi) are out of balance. The Chinese believe that chi is conducted through the body along pathways called meridians, which intersect at specific points in the body. Stimulating these points through acupuncture needles is meant to correct the improper flow of chi—and relieve the disorder.

The needles used in acupuncture are as thin as a hair. In general, 10 to 15 of these needles are inserted into the back to treat pain. Sometimes the needles are stimulated with electricity or heat, or turned after insertion. Acupuncture may relieve pain by triggering nerves to send out natural, pain-blocking chemicals (endorphins) within the body. Pain relief, while common, is usually temporary.

Although a panel convened by the National Institutes of Health found few well-designed studies of acupuncture, they concluded that there was enough evidence of its value for further research. They also stated that for certain situations, such as back pain, acupuncture “may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.”

To find a reputable acupuncture practitioner, contact the National Certification Commission for Acupuncture and Oriental Medicine ( www.nccaom.org), the American Academy of Medical Acupuncture (www.medicalacupuncture.org), the American Association of Oriental Medicine (www.aaom.org), or the Acupuncture and Oriental Medicine Alliance (www.aomalliance.org).

Johns Hopkins Health Alerts | Back Pain - Osteoporosis |

Acupuncture For Back Pain Relief