A Geriatric Physician Discusses Osteoporosis
F. Katz, MD, is director of The Center for Healthy Living
in Teaneck, New Jersey. An internist specializing in the care of the
elderly, Dr. Katz is associated with PMR, the Physical Medicine and
Rehabilitation Center, P.A., of Englewood, New Jersey. PMR is devoted to
the diagnosis and treatment of medical problems related to pain and
disability, and its multidisciplinary treatment teams provide
comprehensive care for sports, spine, orthopedic, and neuromuscular
conditions. For more information,
please click here.
Today we are pleased to present short articles by Dr. Katz on two topics
of great importance to many older adults: osteoporosis and nutritional
Osteoporosis is often called the "silent disease" but affects over 10
million people in the United States. Osteoporosis is a skeletal disorder
characterized by compromised bone strength predisposing one to an
increased risk of fracture. Early on, there are no symptoms. Losing
height or breaking a bone may be the first sign. One in three women and
one in nine men older than 80 years of age will have a hip fracture as a
result of osteoporosis, and 15 percent to 30 percent of these
individuals will die of complications related to the fracture.
The dual energy X-ray absorptiometry (DEXA) test is the best way to
diagnose osteoporosis. This is a painless and safe test that is covered
by Medicare and readily available in the community.
It is never too late to initiate treatment, as many of the drugs have
beneficial effects after only six months of treatment. Fosamax or
Actonel are taken by mouth once a week, and Boniva, a drug that works by
a similar mechanism, is taken by mouth once a month. Evista, an estrogen
receptor modulator, is taken once a day. These drugs decrease bone
resorption and all have similar effectiveness. Miacalcin is less
effective at treating osteoporosis but does have an analgesic effect and
is taken as a nasal spray. The most exciting new drug now available is
Forteo, which works by laying down new bone. It is given as an injection
on a daily basis.
The simplest and safest treatment, which should be initiated even as a
preventive measure, is calcium (1200-1500 mg) and vitamin D (400-800 IU)
supplements every day.
People who perform regular exercises involving weight bearing have a
greater chance of maintaining their bone density and reducing risk of
fracture than those performing only non-weight bearing exercises such as
As in my practice, medical personnel can identify osteoporosis, and
physical and occupational therapists can help plan appropriate exercise
programs. Don't wait for the first fracture to seek treatment -- ask
your doctor whether you need evaluation for osteoporosis.
Nutritional Supplements for Older Adults
Older persons are often concerned with their diets
and whether they are receiving adequate nutrition. Age-related changes
in physiology, metabolism, and function alter the nutritional
requirements of older adults. Aging is associated with an increase in
total body fat, especially in the abdomen, and a decrease in muscle and
Older adults have different vitamin and mineral requirements than
younger people. When deciding the types of food to eat, older adults can
follow the traditional U.S. Department of Agriculture Food Guide
Pyramid, with a few changes for the special nutritional needs of adults
70 years old and older. Most healthy older adults have lower caloric
needs than when they were younger. Taking in enough fiber also becomes
more important as we age, to avoid problems with constipation.
A true vitamin deficiency is defined as a low vitamin level
accompanied by physiological or biochemical abnormalities. Without
documentation of definite deficiency, the benefit of vitamin and herbal
supplementation may be debatable, but certainly most supplementation
should not cause harm. This does not mean that there is absolutely no
risk associated with vitamins.
Vitamin A takes months to become depleted, and there is little data to
indicate that its deficiency is a problem in older adults in the United
Deficiencies in Vitamin B Complex (including vitamins B1, B2, B3, and
B12) have been linked to cognitive problems. Particularly vitamin B12 is
measured and supplemented when there are memory problems, as well as
certain types of anemia. Folate deficiency is also associated with
anemia. The theory that folate and B12 can provide cardiovascular
protection has not been borne out in studies.
Recognition of the importance of vitamin D in both immunological and
bone disorders, along with the increased prevalence of deficient states
in the elderly, has led to its becoming one of the most important
vitamin supplements today. Because vitamin D deficiency is so common and
the risk associated with supplementation is so low, vitamin D should be
given either alone or in combination with calcium in most older
Books for Brainiacs
more ways than one!
First of all, the books described below address the subject of cognitive
fitness. Secondly, they are written at an advanced academic level. The
publisher recommends them for, among others, cognitive gerontologists,
researchers, graduate students, and university faculty members who study
or teach related topics. Since many Experience! readers fall into those
categories, we want to let you know about these excellent resources.
These texts are the first two volumes of a planned three-part series on
aging, exercise, and cognition published by Human Kinetics. They can be
ordered through any bookstore.
Active Living, Cognitive Functioning, and Aging (2006) presents
scientific findings regarding the effect of regular physical activity on
cognitive functioning and general health during the aging process.
Internationally recognized experts discuss pertinent issues in
measurement and physiological mechanisms. Major topics include:
- The status of
- Future directions of
- Advances in
- Key issues relating
to aging, physical activity, cognition, and putative mechanisms;
- The potential of
intervention programs that positively influence cognition; and
- Implications for
public policy making.
Exercise and Its
Mediating Effects on Cognition (2008) examines how physical activity
can indirectly affect cognitive function by influencing mediators --
such as sleep quality, nutrition, disease states, anxiety, and
depression -- that impact physical and mental resources for cognition.
Seventeen international authorities on exercise, cognition,
neurobiology, and aging review the current state of knowledge and
Both books were edited by Leonard Poon, PhD, and Wojtek Chodzko-Zajko,
PhD. Joining them to edit the first volume was Phillip Tomporowski, PhD.
Waneen Spirduso, EdD, joined in editing the second volume.
Ancient Notable on Brain Fitness
That physical activity and cognition are linked
is not a new concept. Marcus Tullius Cicero was a Roman statesman,
orator, and philosopher who lived from 106 BC to 43 BC. Cicero had this
to say on the subject:
"It is exercise alone that supports the spirits, and keeps the mind in
Experience! readers: Thank
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