Doctor - If I Have Arthritis How Do I Keep my Bones Strong?
Patients with arthritis who take medications such as corticosteroids for their arthritis are at increased risk for fractures.
The most devastating are hip fractures.
Most hip fractures occur as a result of low-energy falls in elderly patients.
Falls are uncommon in young adults due to better balance and strength and when they do occur, they usually do not cause the "hip fracture" pattern of injury that is commonly seen in the elderly.
The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight.
On exam, the affected extremity is often shortened and externally rotated.
Calcium is the most important mineral for building strong bones.
Generally accepted guidelines indicate that women should receive at least 1,000 milligrams (mgs) per day if younger than 50 and 1200-1500 mgs per day if older than 50.
Dietary calcium is available through eating green leafy vegetables, low fat milk, cheese, yogurt, calcium containing fruit juices, bread, cereal, and salmon.
When taking additional calcium as a supplement, a person should check the amount of elemental calcium available because that is what will be absorbed.
Calcium should be taken in small doses throughout the day rather than all at once.
Only about 500 mgs of calcium can be absorbed at one time.
Since vitamin D is required for the calcium to work, a patient should like for a calcium preparation that contains vitamin D.
Calcium citrate is absorbed the easiest.
It doesn't contain as much elemental calcium as some preparations and is also the most expensive.
Calcium carbonate is the least expensive and has more elemental calcium.
It should be taken with meals or with orange juice.
I t tends to cause gas and constipation.
Calcium phosphate is more expensive than calcium carbonate.
It is easily absorbed and does not cause gas or constipation.
Calcium gluconate and calcium lactate have very little elemental calcium and are probably not as good as the others for that reason.
Coral calcium and oyster shell calcium may contain lead.
Another note of caution: Proton pump inhibitor (PPI) therapy is linked to an increased risk for hip fractures, with the highest risk in those receiving high-dose PPI therapy, according to the results of a case-control study reported in the December 27, 2006 issue of the Journal of the American Medical Association.
The authors state, "At this point, physicians should be aware of this potential association when considering proton pump inhibitor therapy and should use the lowest effective dose for patients with appropriate indications.
" "For elderly patients who require long-term and particularly high-dose proton pump inhibitor therapy," they added, "it may be prudent to reemphasize increased calcium intake, preferably from a dairy source, and coingestion of a meal when taking insoluble calcium supplements.
"
The most devastating are hip fractures.
Most hip fractures occur as a result of low-energy falls in elderly patients.
Falls are uncommon in young adults due to better balance and strength and when they do occur, they usually do not cause the "hip fracture" pattern of injury that is commonly seen in the elderly.
The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has pain and is unable to bear weight.
On exam, the affected extremity is often shortened and externally rotated.
Calcium is the most important mineral for building strong bones.
Generally accepted guidelines indicate that women should receive at least 1,000 milligrams (mgs) per day if younger than 50 and 1200-1500 mgs per day if older than 50.
Dietary calcium is available through eating green leafy vegetables, low fat milk, cheese, yogurt, calcium containing fruit juices, bread, cereal, and salmon.
When taking additional calcium as a supplement, a person should check the amount of elemental calcium available because that is what will be absorbed.
Calcium should be taken in small doses throughout the day rather than all at once.
Only about 500 mgs of calcium can be absorbed at one time.
Since vitamin D is required for the calcium to work, a patient should like for a calcium preparation that contains vitamin D.
Calcium citrate is absorbed the easiest.
It doesn't contain as much elemental calcium as some preparations and is also the most expensive.
Calcium carbonate is the least expensive and has more elemental calcium.
It should be taken with meals or with orange juice.
I t tends to cause gas and constipation.
Calcium phosphate is more expensive than calcium carbonate.
It is easily absorbed and does not cause gas or constipation.
Calcium gluconate and calcium lactate have very little elemental calcium and are probably not as good as the others for that reason.
Coral calcium and oyster shell calcium may contain lead.
Another note of caution: Proton pump inhibitor (PPI) therapy is linked to an increased risk for hip fractures, with the highest risk in those receiving high-dose PPI therapy, according to the results of a case-control study reported in the December 27, 2006 issue of the Journal of the American Medical Association.
The authors state, "At this point, physicians should be aware of this potential association when considering proton pump inhibitor therapy and should use the lowest effective dose for patients with appropriate indications.
" "For elderly patients who require long-term and particularly high-dose proton pump inhibitor therapy," they added, "it may be prudent to reemphasize increased calcium intake, preferably from a dairy source, and coingestion of a meal when taking insoluble calcium supplements.
"
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