What is osteoporosis?

Osteoporosis is a disease that causes weak, thinning bones. This leaves the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.

What causes osteoporosis?

The exact cause for osteoporosis is unknown. But, a number of factors contribute to the disease including:

  • Aging.  Bones become less dense and weaker with age.
  • Race. White and Asian women are most at risk. But, all races may get the disease.
  • Body weight. People who weigh less and have less muscle are more at risk for this condition.
  • Lifestyle factors. These  lifestyle factors may increase the risk of osteoporosis:
    • Lack of  physical activity
    • Caffeine use
    • Excessive alcohol use
    • Smoking
    • Dietary calcium and vitamin D deficiency
  • Certain medications
  • Family history of bone disease

Who is at risk for osteoporosis?

Osteoporosis affects over 10 million Americans over the age of 50. Women are 4 times more likely to get osteoporosis than men.

Another 34 million Americans over the age of 50 have low bone mass (osteopenia). This group is at a greater risk for osteoporosis.

Low estrogen is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20% of their bone mass in the 5 to 7 years after menopause.

What are the symptoms of osteoporosis?

People with osteoporosis may not get any symptoms. Some may have pain in their bones and muscles, particularly in their back. Sometimes, a collapsed vertebra may cause severe pain, decrease in height, or spinal deformity.

The symptoms of osteoporosis may look like other bone disorders or medical problems. Always consult your doctor for a diagnosis.

How is osteoporosis diagnosed?

Your doctor will review of your personal and family medical history and do a physical exam. Other tests include:

  • X-rays. This test uses electromagnetic energy beams to make images of tissues, bones, and organs onto film.
  • Bone density test (also called bone densitometry). Measurement of the mass of bone in relation to its volume to find the risk of getting osteoporosis.
  • Blood tests. These tests are done to measure calcium and potassium levels.
  • FRAX score. A score given to estimate the risk of a fracture within 10 years. The score uses the results of a bone density test as well as other factors.

Guidelines from the North American Menopause Society (NAMS) urge the following:

  • Women should review lifestyle practices with their doctors regularly.
  • A woman’s risk for falls should be assessed at least once a year after menopause.
  • A woman’s height and weight should be checked yearly.
  • Women should be checked for kyphoses. This is the development of a rounded humped spines — and back pain.

How is osteoporosis treated?

Your health care provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medications, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goals of managing osteoporosis are to:

  • Decrease pain
  • Prevent fractures
  • Minimize further bone loss

Some of the ways to treat osteoporosis are also ways to prevent it.

  • Maintain a proper body weight.
  • Increase walking and other weight-bearing exercises.
  • Cut down on caffeine and alcohol.
  • Stop smoking.
  • Get enough calcium through diet and supplements. Vitamin D is also needed because it helps the body absorb calcium.
  • Prevent falls in the elderly to prevent fractures. This may include installing hand railings, or assistive devices in the bathroom or shower.
  • Ask your doctor about medication.

The FDA has approved these medications to maintain bone health in women with osteoporosis at menopause:

  • Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT). ERT reduces bone loss, increases bone density, and reduces the risk of hip and spinal fractures in postmenopausal women. However, a woman considering ERT should consult her doctor first. Research found several important health risks associated with this therapy. For many women, the risks of ERT outweigh the benefits.
  • Bisphosphonates. These medications reduce bone loss, increase bone density, and reduce the risk of fractures.
  • Selective estrogen receptor modulators (SERMS). This medication helps prevent bone loss.
  • Parathyroid hormone. This medication is a form of parathyroid hormone. It is approved to treat postmenopausal women and men who are at high risk for fractures. It helps form bone.
  • Monoclonal antibody. This medication is given by injection under the skin. It’s approved for women with osteoporosis at high risk for fractures. It’s also used for women who are being treated with cancer medications that can weaken bones.

Living with osteoporosis

Living with osteoporosis includes rehabilitation to return to the best possible bone health and daily living. An osteoporosis rehab program can be vital to a full recovery. The focus of rehab is to decrease pain, help prevent fractures, and minimize further bone loss.

To help reach these goals, osteoporosis rehab programs may include the following:

  • Exercise programs and conditioning to increase weight bearing and physical fitness
  • Pain management techniques
  • Nutritional counseling to improve calcium and vitamin D intake and decrease caffeine and alcohol intake
  • Use of assistive devices to improve safety at home
  • Education, especially prevention of falls

Osteoporosis rehab programs can be done on an inpatient or outpatient basis. Many skilled professionals are part of the team, including:

  • Orthopedist/orthopedic surgeon
  • Physiatrist
  • Internist
  • Rehabilitation nurse
  • Dietitian
  • Physical therapist
  • Occupational therapist
  • Social worker
  • Psychologist/psychiatrist
  • Recreational therapist
  • Chaplain
  • Vocational therapist

Key points about osteoporosis

  • Osteoporosis is a disease that causes weak, thinning bones. This leaves the bones at greater risk of breaking. The bones most often affected are the hips, spine, and wrists.
  • Women are 4 times more likely to get osteoporosis than men due to a decrease in estrogen.
  • Risk factors for osteoporosis include aging, race, body weight, and taking certain medicines.
    The goals of managing osteoporosis are to decrease pain, prevent fractures, and minimize further bone loss.
  • For postmenopausal osteoporosis in women, the FDA has approved medications to maintain bone health.
  • Rehab programs can help regain bone health.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Is It Time for a New Joint?

Millions of us struggle with pain and loss of motion because of joint damage caused by arthritis. If other treatments don’t offer relief, you may wonder about turning in your worn-out joints for new ones.

Surgery may not be your first choice. But if you are a candidate for total joint replacement, know that more than 90% of people have good to excellent results, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. They get relief from pain and can return to normal daily activities.

Should you have surgery?

Joint replacement should be a final step in treatment. More conservative treatments are generally recommended before joint replacement.

Those other treatments include using pain medicine, losing weight to ease stress on the joint, and reducing physical activities that cause pain. Healthcare providers also may suggest exercises to keep muscles and joints flexible, promote fitness, and make muscles stronger that support damaged joints.

While most people undergoing joint replacement surgery are in their 60s or older, younger people may undergo joint replacement when their condition supports this. However, younger people may have other choices available to them like changing to a less physically demanding job, or having a different type of procedure that realigns or only replaces part of a joint.

The younger you are when you get a new joint, the more likely you are to need surgery to revise the joint replacement in the future. Surgery to fix or replace artificial joints has a risk of infection and other complications about 4 times greater than the first surgery. Because healthcare providers shape and remove bone to accept the new joint, repeated surgery also leaves less bone to attach to each new joint.

When do you need surgery?

X-ray evidence of joint damage is 1 of the factors used to decide who should have this surgery. Your pain and other symptoms are the most important things to keep in mind when deciding. This is mostly a quality of life decision.

People who are considered for joint replacement surgery should have 1 of the following: severe pain during activity, such as walking or getting up from a chair; pain that prevents them from doing activities; or pain at night that prevents them from sleeping.

What can you expect?

To get ready, you should work with your healthcare provider to be sure you can tolerate anesthesia. Have dental problems fixed before surgery to reduce the risk for infection. Any medical problems should be made stable before surgery.

Total joint replacement involves a 2-day or 3-day hospital stay. Typical hip and knee patients can walk the next day using a walker. You’ll probably be released from the hospital on the third or fourth day, but you’ll need time to recover.

At first, you may need items like crutches or a walker after hip replacement. Within a few months, you should be able to return to most of your normal daily activities without help. You may still need physical therapy.

After shoulder replacement surgery, you can start shoulder exercises with someone else moving the joint for you. Three to 6 weeks after surgery, you’ll do exercises a therapist gives you. In time, you’ll begin to stretch and strengthen your shoulder so you can get back to normal use with far less pain than you had before the surgery.

Recovery from joint replacement surgery generally involves some pain for 2 to 3 months. However, it’s usually a different type of pain and will go away as you recover.

Will a new joint last?

Experts warn against unrealistic expectations for a new joint. You shouldn’t expect it to bear activities that involve jumping or the kind of stress that would be hard on a natural joint. Your healthcare provider will advise you to avoid certain activities after surgery. Your healthcare provider may even recommend that you should avoid certain joint positions in order to prevent dislocation of the joint. The limitations given will depend on the joint that is replaced, as well as your situation.

An artificial joint will eventually develop changes from wear and tear, even under normal use and activity conditions. It may need to be replaced at some point. Artificial joints generally last 10 to 15 years. A person who is younger at the time of the joint replacement surgery may eventually need to have the new joint replaced. The good news is that new materials being developed for joint replacement are giving artificial joints a longer life span.

Sprains, Strains, Breaks: What’s the Difference?

If you’ve sprained your ankle, you know what severe pain is.

But maybe that “sprain” was a “strain” or possibly even a “break.”

The amount of pain in each case can be virtually equal. So, oftentimes the only way to find out what you have is to see a healthcare provider.

Just the facts

Here are some facts on musculoskeletal injuries:

  • Sprains are a stretch and/or tear of a ligament, the tissue connecting 2 bones. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the upper leg with the lower leg. This lets you walk and run.
  • Strains are a twist, pull and/or tear of a muscle and/or tendon. Tendons are cords of tissue that connect muscles to bones.
  • Breaks are a fracture, splinter or complete break in bone, often caused by accidents, sports injuries or bone weakness.


A sprain is caused by an injury that stresses a joint and overstretches or even ruptures supporting ligaments. This can happen from a fall, twist, or blow to the body,

In a mild sprain, a ligament is stretched, but the joint remains stable and is not loosened. A moderate sprain partially tears the ligament, causing the joint to be unstable. With a severe sprain, ligaments tear completely or separate from the bone. This loosening interferes with how the joint functions. You may feel a tear or pop in the joint. Although the intensity varies, all sprains commonly cause pain, swelling, bruising, and inflammation.

The ankle is the most commonly sprained joint. And a sprained ankle is more likely if you’ve had a previous sprain there. Repeated sprains can lead to ankle arthritis, a loose ankle or tendon injury.


Acute strains are caused by stretching or pulling a muscle or tendon. Chronic strains are the result of overuse of muscles and tendons, through prolonged, repetitive movement. Not getting enough rest during intense training can cause a strain.

Typical symptoms of strain include:

  • Pain
  • Muscle spasm
  • Muscle weakness
  • Swelling
  • Inflammation
  • Cramping

In severe strains, the muscle and/or tendon is partially or completely ruptured, resulting in serious injury. Some muscle function will be lost with a moderate strain, in which the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle or tendon is stretched or pulled, slightly.

These are some common strains:

  • Back strain. This happens when the muscles that support the spine are twisted, pulled, or torn. Athletes who engage in excessive jumping—during basketball or volleyball, for example—are at risk for this injury.
  • Hamstring muscle strain. This is when a major muscle in the back of the thigh tears or stretches. The injury can sideline a person for up to 6 months. The likely cause is muscle strength imbalance between the hamstrings and the quadriceps, the muscles in the front of the thigh. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to happen again.


Bone breaks, unlike sprains and strains, should always be looked at by a healthcare provider to ensure proper healing. Call your healthcare provider if the pain does not lessen or if the bone appears to be deformed. Seek urgent medical care if you have numbness, weakness, or poor circulation in the injured limb.

Athletes are most susceptible

All sports and exercises, even walking, carry a risk of sprains. The areas of the body most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer, and other jumping sports share a risk for foot, leg and ankle sprains.

Soccer, football, hockey, boxing, wrestling, and other contact sports put athletes at risk for strains. So do sports that feature quick starts, like hurdling, long jump, and running races. Gymnastics, tennis, rowing, golf, and other sports that require extensive gripping put participants at higher risk for hand strains. Elbow strains often happen in racquet, throwing, and contact sports.

Treating injuries

A severe sprain or strain may need surgery or immobilization, followed by physical therapy. Mild sprains and strains may need rehab exercises and a change in activity during recovery.

In all but mild cases, your healthcare provider should evaluate the injury and establish a treatment and rehab plan.

Meanwhile, rest, ice, compression and elevation (called RICE) usually will help minimize damage caused by sprains and strains. Start RICE right away after the injury.

RICE relieves pain, limits swelling, and speeds healing. It’s often the best treatment for soft-tissue injuries, like sprains and strains. Here’s what to do:

  • Rest buy generic propranolol. Move the injured area as little as possible to allow healing to begin.
  • Ice. Apply ice right away to reduce inflammation, which causes more pain and slows healing. Cover the injured area with an ice pack wrapped in a thin towel for about 15 to 20 minutes, 3 to 4 times a day.
  • Compression. Using a pressure bandage helps prevent or reduce swelling. Use an elastic bandage. Wrap the injured area without making it so tight that it will cut off the blood supply.
  • Elevation. Raise the injured area above the level of the heart. Prop up a leg or arm while resting it. You may need to lie down to get your leg above your heart level.

Do all 4 parts of the RICE treatment at the same time. If you think you have a more serious injury, like a broken bone, call your healthcare provider right away.


No one is immune to sprains and strains. But here are some tips to help reduce your risk for injury:

  • Take part in a conditioning program to build muscle strength.
  • Do stretching exercises every day.
  • Always wear shoes that fit properly.
  • Nourish your muscles by eating a well-balanced diet.
  • Warm up before any sports activity, including practice, and use or wear protective equipment that’s right for that sport.

Help Your Back Work for You

Your back is important to almost every move you make, but you probably won’t realize that until you hurt it. Then you may wish you could return to the days when you took your back for granted and didn’t have any pain. Even though you can’t turn back time, you can recover from most back injuries. You can also learn how to protect your back so you’ll keep moving and stay comfortable in the future.

For people younger than 45, back pain is the most common cause of disability. A variety of factors can bring on this pain, says the National Institute of Neurological Disorders and Stroke (NINDS). Poor muscle tone and being overweight strain your back. Improper twisting or lifting can send your back into spasms. Aging can make your back more at risk for injury. And sometimes, back pain happens for no known obvious reason.

Man leans against wall and presses lower back with expression of pain on his face.
Strong abdominal and back muscles can reduce your risk for injury. You can strengthen your back muscles by getting regular exercise.

At home

Simple home remedies can relieve most back pain. It will take some patience, but if you care for your back correctly, you should feel better within 6 weeks after the injury.

Rest in bed as little as possible—a few days at most, says the NINDS. Too much bed rest weakens your muscles and could slow your recovery. Get up and move around as soon as you can.

For the first 2 days, use ice or cold compresses. It may help to ease your back pain. Wrap a towel around a bag of ice and place it against the painful area for up to 20 minutes. You can also use a bag of frozen vegetables. This will change to fit the shape of your body. If you still have pain after 2 days, soothe your muscles with heat. Try a heating pad on its lowest setting, take a warm shower, or soak in a warm bath.

Over-the-counter pain relievers and anti-inflammatory medicines may also help. Either of these can reduce muscle and joint inflammation and relieve pain. Talk with your healthcare provider about the right medicine for you.

When to call your healthcare provider

Your back pain may require medical attention. Call your healthcare provider if any of these statements apply:

  • Your back pain started after you fell or were struck.
  • Your leg feels weak or numb.
  • You have bladder or bowel problems.
  • Your pain doesn’t go away after a few weeks of home care.

Your healthcare provider will probably ask you when the pain started. It will help if you can tell your healthcare provider what makes the pain worse and what makes it better, like a specific activity or treatment.

Make it strong

Even if you’ve had back trouble, you can have a strong back. If you take care of your back, it’s more likely to carry you through the day with few complaints. Here are some guidelines for strengthening this important part of your body:

  • Maintain good posture.
  • Sit in a chair that supports your lower back. If you don’t have a supportive chair, place a small pillow or rolled-up towel against the curve in your lower back.
  • Exercise. Strong back muscles can reduce your risk for injury. Strong arms, legs, and belly muscles can reduce the work your back has to do. Aerobic exercise, like walking or biking, increases the flow of blood and oxygen to your back muscles. Choose your exercises carefully. For example, running may not be good for a weak back. Swimming and water aerobics support your back while you exercise. Walking is also a good choice. If you’ve had a serious back injury, you should talk with your healthcare provider before you start exercising regularly.
  • Maintain a healthy weight. This will lessen the strain on your back. Your healthcare provider can tell you if you need to lose weight.
  • Learn how to lift properly. When you bend to pick something up—even a child—bend at your knees and keep your back straight. You may have to squat or kneel. This puts the stress on your legs. They are stronger than your back. When you pick up an object and carry it, hold it close to your body. The farther it is from the middle of your body, the more it strains your back.
  • Pay attention to pain or twinges. If you feel back pain during an activity, stop and rest. Your body may be trying to prevent you from harming your back.

Hand Pain and Problems

Anatomy of the hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

Anatomy of the hand
Click Image to Enlarge
  • Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2.
  • Metacarpal bones. The 5 bones that compose the middle part of the hand.
  • Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm, the ulnar bone and the radius bone.

Numerous muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are some common hand problems?

There are many common hand problems that can interfere with activities of daily living (ADLs), including the following:


Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful.


Osteoarthritis is one of the most common forms of arthritis in the hands and may be caused by normal use of the hand or it may develop after an injury. Osteoarthritis usually develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Signs and symptoms of osteoarthritis include:

  • Stiffness
  • Swelling and pain
  • Bony nodules at the middle or end joints of the finger
  • Pain and possibly swelling at the base of the thumb
  • Loss of strength in the fingers and the grip of the hand

Treatment for osteoarthritis includes:

  • Nonsteroidal anti-inflammatory drugs
  • Resting  the affected hand
  • Wearing splints at night
  • Using heat to soothe the pain
  • Using ice to reduce swelling
  • Possible cortisone injections
  • Possible surgery when no other treatments work

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

  • Trouble gripping objects with the hand(s)
  • Pain or numbness in the hand(s)
  • “Pins and needles” feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. Always see your healthcare provider for a diagnosis.

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
  • Oral or injected (into the carpal tunnel space) anti-inflammatory medicines (to reduce the swelling)
  • Surgery (to relieve compression on the nerves in the carpal tunnel)
  • Changing position of a computer keyboard, or other ergonomic changes

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts the most common, benign (noncancerous), soft-tissue tumor of the hand and wrist.

The following are the most common symptoms for ganglion cysts include:

  • Wrist pain that is aggravated with repeated use or irritation
  • A slow growing, localized swelling, with mild aching and weakness in the wrist
  • An apparent cyst that is smooth, firm, rounded, or tender

The symptoms of ganglion cysts may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

Initially, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and interferes with the functionality of the hand is treatment usually necessary. Treatment may include:

  • Rest
  • Splinting
  • Nonsteroidal anti-inflammatory medicines
  • Aspiration
  • Cortisone injections
  • Surgery

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (such as, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

  • Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.
  • Medial epicondylitis (commonly known as golfer’s or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.
  • Rotator cuff tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.
  • DeQuervain’s tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.
  • Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or “trigger” suddenly.

Treatment for most tendon problems may include:

  • Activity modification
  • Ice
  • Splinting or immobilization
  • Steroid injections
  • Nonsteroidal anti-inflammatory medicines
  • Surgery