Experts recommend that older women have regular bone density tests to screen for osteoporosis. But it’s been unclear how often to repeat the tests.

A study of nearly 5,000 women now reports that patients with healthy bone density on their first test might safely wait 15 years before getting rescreened.

Osteoporosis is a disorder marked by weakened bones and an increased risk of fractures. More than 40 million people nationwide either have osteoporosis or are at increased risk for broken bones because of low bone mineral density (osteopenia).

Osteoporosis is often called a “silent disease” because it usually progresses slowly and without symptoms until a fracture occurs.

When low bone density is identified early through screening, lifestyle changes and therapies can help protect bone health and reduce the risk of fractures.

That’s why the U.S. Preventive Services Task Force recommends routine screening of bone mineral density for women ages 65 and older.

To help doctors decide how often to repeat bone density tests in women who don’t have osteoporosis at their initial screening, a research team led by Dr. Margaret Gourlay of the University of North Carolina at Chapel Hill analyzed data on nearly 5,000 women, age 67 or older.

The women were participants in the Study of Osteoporotic Fractures, a long-term nationwide study supported by NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA) and National Center for Research Resources (NCRR).

Researchers divided the women divided into 4 groups based on initial bone density tests that were either normal or showed mild, moderate or advanced osteopenia. They were given 2 to 5 bone density tests at varying intervals during the 15-year study period.

As reported in the January 19, 2012, issue of the New England Journal of Medicine, the scientists found that less than 1% of women who initially had normal bone mineral density went on to develop osteoporosis during the study.

Only 5% of those with mildly low bone density at the start made the transition to osteoporosis. Overall, the data suggest that women in these 2 categories might safely wait about 15 years before being rescreened for osteoporosis.

The scientists also found that about 1 in 10 women with moderate osteopenia at baseline developed osteoporosis within 5 years. For those with advanced osteopenia at the start, about 10% had developed osteoporosis within a year, suggesting that 1-year screening intervals might be advisable for this group.

“If a woman’s bone density at age 67 is very good, then she doesn’t need to be rescreened in 2 years or 3 years, because we’re not likely to see much change,” Gourlay says. “Our study found it would take about 15 years for 10% of women in the highest bone density ranges to develop osteoporosis. That was longer than we expected, and it’s great news for this group of women.”

These findings can help guide doctors in their bone screening recommendations. Other risk factors, such age, medications or specific diseases, would also influence screening frequency.

This article first appeared in NIH Research Matters.

To learn more about osteoporosis:

• Health Info: Osteoporosis

• Osteoporosis: The Bone Thief

• Bone Mass Measurement: What the Numbers Mean

• Article: Keeping Bones Strong and Healthy

Credit: Wikipedia - Creative Commons License

By Carolyn M. Clancy, M.D.

January 3, 2012

Whether it’s music, lifestyles, or a refuse-to-age outlook, Baby Boomers think of themselves as trailblazers.

Now, that generation born between 1946 and 1964 can claim credit for another “first”—a dramatic increase in knee replacement surgeries.

Women and men between the ages of 45 and 64 were more than twice as likely to have had knee replacement surgery in 2009 than in 1997, recent data from the Agency for Healthcare Research and Quality (AHRQ) show. The rates among women were even higher.

Knee replacement surgery is most common in people whose knees have been damaged by osteoarthritis (OA), rheumatoid arthritis, or injury.

Due to their age and fondness for sports, Baby Boomers fit neatly into each category.

The percentage of people who have osteoarthritis, the most common type of arthritis, grows with age. About 27 million Americans have this condition, and, after age 45, it is more common in women. Osteoarthritis occurs when the cartilage that coats the end of each bone breaks down. This can cause the bones to rub against each other, causing pain and stiffness.

Knee pain may also be caused by rheumatoid arthritis, a less common form of arthritis that occurs when the membrane surrounding the joint becomes inflamed. Over time, inflammation damages cartilage, resulting in pain and stiffness. Rheumatoid arthritis affects about 1.3 million people—more women than men. It often begins in middle age, but can occur in children and young adults.

Arthritis after a serious knee injury or repeated stress is another reason for knee replacement surgery. Pain caused by ligament tears or bone fractures caused by sports injuries, for example, may be managed non-surgically for years. Over time, however, pain and limited knee function causes some patients to consider knee replacement surgery.

If you have knee pain from one of these causes, you’ve probably heard about treatments that are intended to relieve pain and even postpone the need for surgery. Some, but not all, of these options work, a review of 86 research reports funded by AHRQ has found.

What has been shown to work?

• Exercise. Becoming more active—whether through walking, swimming, or water aerobics—can reduce pain and make movement easier. Physical therapy may also help, so ask your doctor if you would benefit.

• Maintain a healthy weight. A 10 percent weight loss combined with a moderate exercise program reduced knee pain in patients with knee osteoarthritis by 50 percent, a recent study  by Wake Forest University researchers has found.

• Pain medicines. Medicines can relieve osteoarthritis pain, AHRQ’s research review concluded. Your doctor or nurse may prescribe an over-the-counter or prescription medicine. Learn more about choosing pain medications for osteoarthritis in this guide developed by AHRQ.

What has been shown not to work?

• Glucosamine and chondroitin. Some people take nutritional supplements to help build new cartilage. Studies have found that people who take these supplements report less pain, but people who don’t take the supplements report the same result.

• Joint lubrication shots. This treatment is a gel-like substance given by a shot into the knee. Studies have found that most people who get the shots do not improve very much.

• Arthroscopic knee surgery. In this procedure, a flexible tool is inserted into the knee, which is used to rinse the joint. It can be helpful for other types of knee problems, but not for knee osteoarthritis.

If conservative treatments don’t provide relief from pain, it may be time to consider knee replacement surgery. The good news is that this procedure has been shown to give a better quality of life that makes it worth the cost, a Government-funded study has found.

The benefits of this procedure are even better if the surgery is done at a hospital that does a large number of knee replacement procedures.

Before you have surgery, prepare yourself for the best possible outcome by asking questions of your surgeon. You will feel more in control of your health if you have a good idea of what to expect before, during, and after surgery.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project

Statistics on Hospital-Based Care in the U.S., 2009
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Effective Health Care Program

Osteoarthritis of the Knee: A Guide for Adults
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=132

Choosing Pain Medicine for Osteoarthritis
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=4

Having Surgery? What You Need to Know
http://www.ahrq.gov/consumer/surgery/surgery.htm

National Institute of Arthritis and Musculoskeletal and Skin Disease

Handout on Health: Osteoarthritis
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

Handout on Health: Rheumatoid Arthritis
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

Total Knee Replacement Found Cost-Effective for End-Stage Knee OA
http://www.niams.nih.gov/News_and_Events/Spotlight_on_Research/2009/knee_OA_replacement.asp

American College of Rheumatology

Weight Loss Best Medicine for People with Knee Osteoarthritis
http://www.rheumatology.org/about/newsroom/2011/2011_ASM_21_weightloss.asp

Current as of January 2012

Internet Citation:

Baby Boomers Trigger Major Increase in Knee Replacement Surgeries. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 3, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010312.htm

In a smaller, earlier trial, lead author Dr. Karen Sherman, Ph.D. and colleagues found that yoga was slightly more effective than a program of aerobic, strengthening, and stretching exercises, so they decided to do a larger trial in which patients with back pain were randomly assigned to participate in a yoga program, a stretching program or to self-care.

The yoga and stretching programs consisted of 12 weekly, 75 minute classes at Group Health facilities. In addition, participants were asked to practice for 20 minutes a day on non-class days.

To supplement class instruction, the participants received handouts and instructional yoga CDs or stretching DVDs.

The yoga program included seven simple postures adopted from a style of yoga called viniyoga. Each class included breathing exercises, 45-50 minutes of yoga, and ended with a session of “guided deep relaxation,” the researchers write.

The self-care group received The Back Pain Helpbook, which provides information about the causes of back pain, advice on exercising, lifestyle modifications and the management of flare ups.

At the end of 12 weeks, back-related symptoms and function had improved in all three groups, but those in the stretching and yoga programs saw significantly more improvement than those in the self-care group.

“We expected back pain to ease more with yoga than with stretching, so our findings surprised us,” said Dr. Sherman.

“The most straightforward interpretation of our findings would be that yoga’s benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles,” Dr. Sherman said.

Dr. Sherman speculated that because the stretching classes included more stretching than many programs and because the stretches were held for a relatively long time, the stretching classes may have “been a bit more like yoga than a more typical exercise program would be.”

“Our results suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain,” Dr. Sherman said. “But it’s important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants’ individual physical limitations.”

Learn about care and recovery from complicated spinal cord injuries, with case studies and in-depth research. From vertebroplasty to disc replacement, this series delivers the most recent developments in spine treatment from national experts as well as doctors at with UW Medicine.

To view:

• Go to: UWTV

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Got a bum leg?

Well if you do, maybe you should call ahead to the emergency room instead of immediately driving over.

A new study by doctors from Massachusetts General Hospital in Boston suggests that hospitals could save time and money if patients with ankle sprains and other lower extremity injuries talk to a health provider first, then schedule an appointments rather than come to the emergency department during regular business hours.

Seems simple enough, but research shows that in 2009, lower leg strains and sprains accounted for more than 30 percent of ER visits.

In an effort to combat overcrowded emergency rooms, Dr. David Ring, one of the authors of the study, said that using triage procedures such as special phone lines might help.

“What the data show are that there are alternative methods to provide health care for leg injury because so many of them are relatively minor,” Ring told KHN in an e-mail.

Ring and his colleagues reviewed data on leg injuries from the federal National Electronic Injury Surveillance System — which monitors injuries in emergency rooms  in about 100 hospitals — and conducted follow-up clinical research.

They found that most patients with leg injuries evaluated in the ER had relatively minor problems that don’t require an ER visit.  ”A sore injured leg certainly feels like it needs immediate attention.  But we know enough about leg injuries that a simple phone triage might allow some patients to avoid the long waits and inconveniences of the ED without any adverse health effects,” Ring said.

Scotland’s national health care system, for example, is looking into conducting a telephone follow up for patients with leg injuries, Ring noted. “These types of things merit additional study—we should explore these opportunities,” he said.

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.  Read more in the Daily Health Policy Report.

PHOTO by Typo-queen.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.