Anxious Women May Want to Keep an Eye on Their Bone Health

Anxious Women May Want to Keep an Eye on Their Bone Health

As if older women didn’t already worry enough about their bone health, new research suggests that anxiety may up their risk for fractures.

Based on an analysis involving almost 200 postmenopausal Italian women, the finding builds upon previous research linking anxiety to a higher risk for heart disease and gastrointestinal problems.

“Our findings are quite surprising because an association between anxiety levels and bone health was not reported before,” said study author Dr. Antonino Catalano, though the study did not prove that anxiety caused fracture risk to rise.

Catalano is an expert in internal medicine, bone metabolism and osteoporosis with the department of clinical and experimental medicine at the University Hospital of Messina in Italy.

As to what might explain the association, Catalano pointed to a number of factors.

“Our opinion is that anxious women are more likely to engage in poor health behaviors, such as smoking or a poor diet,” he said. “Moreover, the negative effects of stress hormones on bone status may be considered as also enhancing fracture risk.”

Catalano added that women who struggle with higher levels of anxiety were also found to have lower levels of vitamin D. “Poor vitamin D status has been previously associated with increased fracture risk,” he said.

The researchers noted that osteoporosis is the most common metabolic bone disease in the world. An estimated 33 percent of women and 20 percent of men will suffer from an osteoporosis-related fracture at some point in their lives.

The research team also noted that 7 percent of the world’s population suffers from anxiety disorders.

To see how the two issues might intersect, the researchers focused on patients attending one Italian osteoporosis clinic in 2017.

On average, participants were nearly 68 years old. All underwent in-depth health screenings to assess, among other things, prior fracture history, arthritis diagnoses, heart and lung health, and smoking and alcohol habits. Bone mineral density exams were also done.

A wide range of mental health concerns were also explored, including depression, tension, insomnia, memory and anxiety levels ranging from moderate to severe.

The investigators determined that women who had the most anxiety faced a noticeably higher fracture risk, compared with women with the lowest degree of anxiety.

Higher anxiety was linked to a 4 percent greater risk for a major fracture over a 10-year period, and a 3 percent greater risk for a hip fracture in the same time frame, said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.

The study was published online May 9 in the society’s journal Menopause.

Higher anxiety was also linked to lower bone mineral density scores in both the lower back area (known as the lumbar spine) and in the femoral neck area (just below the ball of the hip joint).

The findings should encourage physicians to explore anxiety levels among older women when assessing fracture risk, the researchers said.

Pinkerton highlighted a number of steps women can take to minimize fracture risk as they age.

“Women reach peak bone mass around age 35,” Pinkerton noted. “So it becomes important for perimenopausal women and menopausal women to get adequate amounts of calcium.” Experts recommend 1,200 milligrams a day, between diet and supplements, she said.

Getting sufficient magnesium and vitamin D — from either sun exposure or supplements — is also critical, she added, alongside routine strength and resistance training. That, she said, can include walking, lifting weights or using elliptical machines.

Women should also avoid smoking, drinking too much, being sedentary, taking excessive thyroid replacement medications, and/or medications such as steroids or proton pump inhibitors, Pinkerton said.

For women particularly concerned about anxiety, she suggested turning to “mindfulness, cognitive therapy, self-calming strategies, yoga, or seeking help through counseling or, if needed, medications,” she said.

As for hormone therapy, Pinkerton stressed that while it’s not a treatment for depression or anxiety, “it can sometimes be helpful in women, and is sometimes used alone or in combination, depending on whether women have menopausal symptoms or respond favorably to a trial of hormone therapy.”

More information

There’s more on bone health at the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SOURCES: Antonino Catalano, M.D., Ph.D., expert in internal medicine, bone metabolism, and osteroporosis, department of clinical and experimental medicine, University Hospital of Messina, Italy; JoAnn Pinkerton, M.D., executive director, North American Menopause Society, and professor, obstetrics and gynecology, University of Virginia Health System, Charlottesville; May 9, 2018, Menopause, online

Why Does My Foot Hurt?

Why Does My Foot Hurt?

Plantar fasciitis, bunions, or achilles tendonitis got you down? If you’re experiencing pain in your feet, we can help you pinpoint the source of your discomfort and recommend the best course of treatment for your condition.

While joint pain of any kind can put a serious damper on your ability to participate in sports or exercise regularly, pain in the feet can be especially debilitating. If you’re having difficulty simply staying on your feet throughout the day, a number of conditions could be to blame.

From Morton’s neuroma in the ball of your foot to Achilles tendonitis in the ankle, the first step to seeking relief from your pain is identifying its source. We’ve identified the most common conditions that affect the feet, and what you can do to address your symptoms.

1. BACK OF THE FOOT

If you’re experiencing burning, swelling, or stiffness in the back of your foot, you could be suffering from Achilles tendonitis. Most common in athletes whose sports are centered around running, jumping, or lunging, Achilles tendonitis occurs when the Achilles tendon (which controls flexing of the foot or ankle) becomes inflamed due to injury or overuse. The pain may worsen with intense exercise, particularly if you wear tight shoes when working out.

Most cases of Achilles tendonitis can be effectively treated by regularly resting and icing the tendon and wearing soft, loose shoes with special orthotic inserts. If the pain persists, taking anti-inflammatory medication or cortisone shots can help. If necessary, you can also opt for a physical therapy program designed to restore the tendon’s range of motion and redevelop the surrounding muscles.

2. BOTTOM OF THE FOOT

Pain in the bottom of the foot could result from several sources — but if it’s concentrated in the heel, the arch, or both, it’s most likely the product of plantar fasciitis, which is an inflammation of the tissue that runs from the heel to the base of the toes. Pain in this area of the foot may also be caused by a heel spur, which is an abnormal bone growth that usually forms in response to poorly fitting shoes, improper posture, or frequent running. Some patients suffer from heel spurs and plantar fasciitis at the same time.

In the case of heel spurs, relief can generally be found through the use of orthotic inserts. Meanwhile, the treatments we recommend for plantar fasciitis are similar to treatments for Achilles tendonitis: rest, icing, orthotic shoe inserts, and physical therapy. Anti-inflammatories and corticosteroid shots can provide additional relief. If your symptoms don’t improve in a year, you’ll likely need to undergo a short procedure to remove the damaged tissue.

3. SIDE OF THE FOOT

Pain or discomfort on the side of the foot is a common sign of a bunion: a bony protrusion on the side of the big toe that forces it to slant against the remaining toes. In addition to pain and swelling, bunions can alter the shape of your foot, making it more difficult to wear certain shoes.

Bunions are permanent, so if they’re causing you particular distress, you should discuss bunion removal surgery with a qualified orthopedic specialist. Otherwise, wearing wider, more comfortable shoes or custom-made inserts can help.

4. BALL OF THE FOOT

High heels and ill-fitting shoes are the most common source of pain in the ball of the foot, which can be a sign of metatarsalgia or Morton’s Neuroma. Metatarsalgia is a more general inflammation, while Morton’s neuroma is a compression or thickening of a nerve in the ball of the foot. For athletes, this pain can be a consequence of repeated stress or overuse.

Metatarsalgia usually responds well to rest and physical therapy, but more advanced cases of Morton’s neuroma may require further treatment. If you still feel pain after trying different shoes and custom shoe inserts, anti-inflammatories, and corticosteroid injections, your podiatrist may suggest surgery to remove the damaged portions of the nerve.

5 Easy Adjustments to Avoid Back Injuries During Weightlifting

5 Easy Adjustments to Avoid Back Injuries During Weightlifting

Back injuries often plague those who lift weights on a regular basis — but with some proactive adjustments to your routine, you can significantly decrease your risk.

From rows to squats, the back plays a critical role in many weightlifting exercises — and developing strong back muscles can help you push yourself farther at the gym for a wide variety of lifts.

As with any part of your body, it’s impossible to keep your back completely safe from injury while you’re working out, but there are some simple steps you can take to significantly decrease your risk. When the price of a setback is not only losing hard-won progress, but potentially developing more serious health issues, prevention is well worth the effort.

With all of that in mind, here are five tips to prevent common back injuries while you lift.

1. TRAIN YOUR POSTURE

As you probably know, poor form greatly increases your risk of injury in any exercise. If you’re working on your back, you’ll want to keep your vertebrae neatly aligned to avoid placing too much pressure on a particular bone or muscle.

If you’re new to lifting, don’t simply mimic what you see others doing at the gym. Instead, ask a trainer or do some research online in order to better understand how you should position your body. If you’re a more experienced gym-goer, it’s still a good idea to check up on your form every now and then. Protect your body by regularly recalibrating your form and squelching any bad habits before they lead to injury.

2. RECOGNIZE THE RISKS

Any weightlifting exercise that involves flexion (forward bending) or extension (backward bending) of the joints in your back puts those areas at risk. These movements often result in sprains (a tear or rupture of a ligament), but they can lead to more serious injuries as well. Extreme extension, for example, can lead to spondylolysis, or cracks in the vertebrae. Similarly, extreme flexion can lead to a herniated disc.

These risks aren’t limited to exercises that specifically target the back. The most common weightlifting-related cause of herniated discs is the deadlift, which — when done properly — doesn’t depend on back flexion or extension for power, but when done incorrectly, puts a dangerous amount of pressure on the vertebrae. Deadlifts can also exacerbate degenerative disc disease, lumbar spinal stenosis, and other chronic conditions affecting the lower back.

3. KNOW WHEN IT’S TIME TO STOP

That twinge you felt while working out might be gone by tomorrow with a bit of stretching and rest. If you push the compromised area through additional stress, however, it can turn into something worse.  Don’t ignore what your body is telling you. The burn of a fatigued muscle feels very different from a pull in your back, and “no pain, no gain” only works when you don’t sabotage the body you’re trying to strengthen. If you’re feeling pain when lifting, it’s time to call it a day — plain and simple.

4. MODIFY YOUR ROUTINE

First off, I recommend that you always wear a weightlifting belt when working out, as it can do wonders to stabilize and protect your back during most exercises. However, if a particular movement causes you problems even with the belt on, consider finding an alternative. For most lifts, there are one or more corresponding exercises that can target similar muscles without causing the same pain.

5. STRETCH

To learn proper posture is one thing, but to fully put it into practice requires some extra work. As any knowledgeable trainer will tell you, a dedicated stretching routine is the key to sustainable lifting. In order to build a strong and resilient back, consult a fitness trainer or orthopedic specialist you trust and create a stretching regimen to maintain the integrity of your back for future challenges. For maximum benefit, stretch both before and after each lifting session.

Bone Drug ‘Holiday’ May Raise Fracture Risk

Bone Drug ‘Holiday’ May Raise Fracture Risk

Osteoporosis patients who take “holidays” from bisphosphonate drugs are at increased risk for fractures, a new study finds.

A six-year follow-up of patients who took a break from the bone-building drugs found 15 percent of them suffered fractures, according to researchers at Loyola University in Maywood, Ill.

“Fracture risk needs to be regularly assessed during the drug holiday and treatment resumed accordingly,” said Dr. Pauline Camacho and her colleagues.

Bisphosphonates, such as alendronate (Fosamax) and risedronate (Actonel), are the most widely prescribed osteoporosis drugs. They are designed to slow or prevent bone loss.

But patients who take these drugs for long periods are typically told to take temporary breaks to prevent rare but serious side effects to the jaw and thighs.

However, there is little data on how long these breaks should last, the researchers explained.

To shed light on the issue, they examined the medical records of patients (371 women, 30 men) with osteoporosis or osteopenia (weak bones but not osteoporosis). Patients took bisphosphonates for an average of 6.3 years before beginning breaks from the drugs.

Over six years, 15.4 percent of the patients suffered fractures after going on their drug holiday. The most common fracture sites were the wrist, foot, ribs and spine. However, foot fractures are not currently considered osteoporosis-related fractures, the researchers noted.

The patients most likely to suffer fractures were older and had lower bone mineral density at the beginning of the study. Patients who suffered fractures were put back on bisphosphonates.

The yearly incidence of fractures ranged from about 4 percent to almost 10 percent, with most occurring during the fourth and fifth years.

“Patients who begin drug holidays at high risk for fracture based on bone mineral density, age or other clinical risk factors warrant close follow-up during the holiday, especially as its duration lengthens,” the researchers said in a university news release.

The study was published recently in Endocrine Practice.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on osteoporosis.

SOURCE: Loyola University Health System, news release, May 4, 2018

Non-Opioids Often Underused After Back Surgery

Non-Opioids Often Underused After Back Surgery

Spine and joint surgery patients aren’t taking advantage of common pain relievers like Tylenol or Motrin during their recovery, researchers say.

Instead, many are given opioids, such as oxycodone (OxyContin) or hydrocodone (Vicodin). These highly addictive narcotics are potentially deadly when abused. The United States is currently grappling with an ongoing opioid epidemic.

The new study also found that post-surgical patients improperly store and dispose of their unused opioid painkillers.

“It’s clear we need to empower patients to ask their physicians about non-opioid pain management options, as well as call on prescribers to be more thoughtful of their prescribing practices,” said study first author Dr. Mark Bicket. He’s an assistant professor of anesthesiology and critical care medicine at Johns Hopkins University in Baltimore.

Greater use of non-opioid painkillers means fewer opioids would need to be prescribed, making it less likely that they’d be lost, sold, taken by error or discovered by a child, Bicket said in a university news release.

The researchers found that six months after surgery, more than one-third of patients still had unused opioids at home. And more than 90 percent admitted that they weren’t stored safely.

Three-quarters or more said they had not received instructions on how to store or dispose of the opioids, the study authors noted.

The study included 140 patients, average age 56, who were surveyed two days, two weeks, one month and six months after surgery about their use of non-opioid painkillers. These drugs include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin and Advil, and acetaminophen (Tylenol).

Two days after surgery, 82 percent of patients were not using NSAIDs. Forty-four percent reported not using acetaminophen. Only 5 percent used both NSAIDs and acetaminophen.

One month after surgery, only 6 percent of patients reported use of multiple non-opioid medications.

Also one month after their operation, nearly three-quarters of patients said they had unused opioids. Almost half of these said they had 20 or more unused pills, and 37 percent said they had more than 200 morphine milligram equivalents of opioids. Some experts say that, at this dosage, a patient who has never had narcotic painkillers would overdose.

The vast majority of the study patients reported unsafe storage of opioids a month after surgery and said they had not disposed of unused pills.

The study was published recently in the journal Anesthesia & Analgesia.

More information

The American Academy of Family Physicians has more on pain control after surgery.

SOURCE: Johns Hopkins University, news release, April 30, 2018

Health Tip: When To Call Your Doctor If You Have Lower Back Pain

Health Tip: When To Call Your Doctor If You Have Lower Back Pain

Few people go through life without having episodes of lower back pain.

For some people, though, it’s a daily struggle.

The American Academy of Family Physicians says back pain may be controlled by maintaining proper posture and sitting, lifting, standing and exercising properly.

Others have to seek medical attention for relief. The academy mentions these warning signs that you should see a doctor about your aching lower back:

  • If pain radiates down your leg below your knee.
  • If your leg, foot or groin feel numb.
  • If you have fever, chills, nausea, vomiting, stomach pain or weakness.
  • If you have difficulty going to the bathroom.
  • If the pain was caused by an injury.
  • If pain is so intense that you can’t move.
  • If your pain doesn’t improve or gets worse after two weeks.
  • If you notice any muscle atrophy.