Progressive Health Blog

Cerebral Palsy Changes Bone Mineral Density of Adolescents

2010-08-21T17:00:00Z

Individuals with cerebral palsy (CP) are in a population group at increased risk for developing osteopenia and osteoporosis before old age. The relative causes for the development of osteopenia and osteoporosis are different than that for elderly individuals. Multiple factors play a causal role including poor nutritional status and decreased mobility. The development of osteoporosis and osteopenia in adolescents with CP is almost fully attributed to poor bone mineral density growth, versus loss of bone mineral density in the elderly population.

The Journal of Pediatrics published a study in June that examined the factors involved in bone mineral density status in adolescents with CP in cases with no known interventions in place. The study enrolled 69 children and adolescents age 2 thru 17 with moderate to severe spastic CP. The prospective, longitudinal study followed 55 subjects for 2 years and 40 of the original subjects for more than 3 years to observe changes.

The assessment included several measurements of growth. Bone mineral density in the distal femur and spine were assessed throughout the study. General health, nutritional status, growth, Tanner staging, and clinical features of CP were also assessed throughout the study.

The researchers found that more severe forms of CP were associated with a lower bone mineral density at initial evaluation. Severity of CP was scaled based on poor feeding, gross motor function, and poorer growth. Bone mineral density did increase in the study, but the range was wide, from +42% to -31%. Overall, bone mineral density in the distal femur decreased with age according to statistical analysis.

The authors conclude that children with moderate to severe CP are at risk for developing osteopenia and osteoporosis. This is due to a multitude of factors that cause poor bone mineral density growth. This is in contrast to the elderly population that has bone mineral density loss. Children with CP do not have proper growth and development of bone due to poor nutrition associated with poor feeding ability and decreased motor skills which decrease stimulation to the bone to lay down minerals in the bony matrix. The study provides an understanding of the processes at play in the development of osteopenia and can now give greater information in terms of which interventions may best help decrease the rate of osteopenia and improve bone mineral density.

Can Pumping Iron Help Rheumatoid Arthritis?

2010-08-16T19:21:06Z

Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation. It leads to disability due to chronic pain and decreased muscle mass and strength. Now research reports that regular weight training may help treat arthritis. RA patients who pumped iron had improvements in daily physical function.

The study, published in Arthritis Care and Research, examined the effects of progressive resistance training (PRT) on patients with RA. Researchers at Bangor University, UK administered either regular weight training or less strenuous standard home exercise (control) to 28 patients with controlled RA for 24 weeks. Body composition tests and muscle insulin-like growth factor (IGF-1) levels were obtained from the participants pre- and post-study. IGF-1 is required for muscle, bone and cartilage growth.

The researchers found that the weight training group had a 20 to 30 percent improvement in physical function including walking. They also had a 119 percent increase in strength. Findings also revealed that IGF-1 levels were increased. There were no changes in the control group.

"In an RCT [randomized controlled trial], 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA," the study authors write. "Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels, revealing a possible contributory mechanism for rheumatoid cachexia. PRT should feature in disease management."

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Rose Hip Powder Decreases Arthritis Symptoms

2010-08-14T17:00:00Z

Rosa canina or rose hips are well known for their high vitamin C content. The seeds from rose hips can also be used as a diuretic to flush excess water from the body. Rose hips have been used for centuries to fight off infections and to provide the body with much needed nutrients. A recent study out of Denmark investigated the effects that daily consumption of rose hips in powder form may have on the symptoms of osteoarthritis and use of medications such as NSAIDs.

A total of 94 patients, both men and women, with a prior history of osteoarthritis enrolled in the study. They were randomized to receive either 5 grams of rose hip powder or placebo daily for three months, then in crossover design each group received the opposite(treatment or placebo). Measures of pain, stiffness, disability, and disease severity were scored using the WOMAC questionnaire, a typical battery for osteoarthritis. Patients were all assessed at baseline, 3 weeks and 3 months.

After 3 weeks the only variable to differ significantly between the two groups was the pain score. Patients consuming 5 grams per day of rose hip powder reported significantly less painful days. Because of the decrease in pain symptoms, medication use was also reported to decline in the treatment group compared to placebo. After 3 months WOMAC scores for disability, stiffness, and disease severity also decreased significantly. These scores did not differ at 3 weeks.

Based on the outcome of this study, it was concluded that rose hip powder, when consumed daily, can reduce the symptoms of osteoarthritis. Rose hips caused a significant decrease in all measures including pain, stiffness, disability, and disease severity. Participants in the rose hip group also reported significantly less medication use as a result of decrease symptoms. The study does not examine the mechanism of action, but perhaps it is due to the high antioxidant content and diuretic action of the rose hips leading to decreased inflammation in the affected joints.

Nutritional Status and Bone Density

2010-08-11T17:00:00Z

Bone mineral density naturally declines with age. However specific populations are at greater risk for developing osteoporosis, a severe loss of bone mineral density. Osteoporosis increases the risk of fracture and hospitalization, both of which decrease the quality of life and contribute to morbidity.

Natural decline in bone mineral density is thought to be affected by oxidative stress. Antioxidant minerals and vitamins such as selenium, vitamin A, vitamin E, and vitamin C can reduce the amount of oxidative stress in the body. Researchers investigated a possible association between bone mineral density and antioxidant and mineral status in the Women's Health Initiative Study.

The results were published this September in the American Journal of Clinical Nutrition. A total of 11, 068 women participated in the study that measured bone mineral density, dietary intake of antioxidants (A, C, E, selenium, and beta carotene), antioxidant supplement use. A smaller subset of women had serum concentrations of carotenoids, retinoids, and tocopherols measured and used in analysis.

They found that antioxidant intake was not independently related to bone mineral density. Increased or decreased intake of Vitamins A, C, E, beta-carotene, or selenium was not associated with any changes in bone mineral density. One interaction, statistically significant, was found in women who used hormone replacement. The analysis showed that Vitamin C intake and hormone therapy was associated with a greater bone mineral density in the femoral neck, total body, and spine.

The authors conclude that antioxidant vitamin and mineral intake is not an independent therapeutic marker for bone mineral density. However, a significant relationship was found between Vitamin C and bone mineral density in a subset of women who were taking hormone replacement therapy (HRT). The authors state that this relationship needs to be explored further in order to offer therapeutic recommendations.

Preventing Bone Loss with Vitamin D3

2010-08-03T17:00:00Z

Bone loss and development of osteoporosis in women after menopause is a common concern. Estrogen is involved in bone metabolism in women, and as levels decline during menopause, bone mineral density declines. Bone mineral density decreases due to calcium being absorbed from the bone into the blood. This process can be exacerbated with low calcium intake and low Vitamin D status.

Previous research has shown that calcium supplementation alone, and with Vitamin D, can improve bone mineral density in postmenopausal women. A new study published in the Archives of Internal Medicine in July investigated the effect, if any, of Vitamin D3 supplementation in African American postmenopausal women who are receiving adequate calcium.

The study enrolled 208 healthy postmenopausal women of African American background. They were between the ages of 50 and 75 years old. They were ensured a total calcium intake between 1200 and 1500mg/day. The women were randomized to two groups; the treatment group received 20mcg/day (800 IU) of Vitamin D3, versus placebo. After 2 years the amount of D3 was increased to 50mcg/day. Bone mineral density was measured at 6 month intervals. Other outcome measures included concentration of Vitamin d metabolites, parathyroid hormone, and markers of bone mineral turnover in the blood.

At completion of the study (3 years later) bone mineral density was compared between the two groups. There were no statistical differences throughout the study. The researcher also found no relationship between the rate of bone turnover and the levels of Vitamin D. There was no difference in bone turnover markers, parathyroid hormone between the groups as well. NO adverse effects were observed due to Vitamin D supplementation.

In conclusion, the addition of Vitamin D to the treatment regimen of postmenopausal African American women receiving adequate nutrition provided no additional health benefit. No effect was observed on bone mineral density or markers of bone turnover. Further studies are needed to determine if these results can be applied to women of other ethic backgrounds. As a race, African American women tend to be less at risk for osteoporosis. Caucasian and Asian women are at greater risk for developing the disease.

Is Meauring Urinary Calcium Excretion Useful?

2010-07-18T17:00:00Z

Osteoporosis is a growing problem for women. Biphosphate drugs such as Alendronate have proven effective at increasing bone mineral density by decreasing bone breakdown. In certain clinical situations a 24-hour urinary calcium excretion measurement is recommended to determine the level of calcium supplementation needed by women on drug therapy with alendronate or similar.

A study published this January in the Gynecology and Endocrinology journal investigated the usefulness of a 24-hour urinary calcium. The study attempted to find a correlation between urinary calcium excretion and increase in bone mineral density following one year of treatment with alendronate.

A total of 64 women were enrolled in the study. The women were postmenopausal, had a previous diagnosis of osteoporosis, using HRT (hormone replacement therapy), and were prescribed alendronate for osteoporosis. Bone mineral density was measured at baseline. Women were also taking calcium supplements, but these amounts were not recorded. After one year 24 hour urinary calcium excretion was measured as well as repeat bone mineral density.

The results found no correlation between urinary calcium excretion and change in bone mineral density. Bone mineral density did increase in both the spine and femur after one year of treatment with alendronate. The authors suggest that urinary calcium excretion may be more related to calcium supplementation and dietary intake.

In conclusion, there appears to be no clinical relevance to a 24-hour urinary calcium excretion to determine the level of calcium supplementation for women on biphosphate therapy for osteoporosis.

Diet Cola Depletes Calcium

2010-07-08T17:52:50Z

Previous studies suggest that cola sodas may be linked to decreased bone density and increased fracture risk. Now research reports that diet cola drinks may deplete calcium and phosphorus in women. A negative calcium balance can increase the risk for decreased bone density and fracture.

The small study, presented at the annual meeting of the Endocrine Society in June 2010, investigated the effect of diet cola consumption on calcium, creatinine and phosphorus levels. Researchers at the Walter Reed Army Medical Center in Washington administered 24 ounces of diet cola or water (control group) to 20 healthy women ages 18 to 40, for 2 days. Urine samples were obtained from the participants for three hours after drinking the beverage. The urine was analyzed for calcium, phosphorous and creatinine levels.

The researchers found that the mean calcium excretion was 6.85 mg higher in the cola group than the control group. Furthermore, mean phosphorus excretion was 41 mg higher in the cola group.

"Certainly my personal practice among adolescent girls who tend to be concerned about their weight -- and who drink diet beverages while they are in that critical period of bone formation -- is to just try and counsel them to set habits of drinking calcium-containing beverages and maintaining adequate vitamin D," says researcher Noelle Larson, MD, of the Walter Reed Army Medical Center, in a news release.

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Omega 3 DHA Improves Bone Health

2010-06-11T18:22:10Z

Omega 3 essential fatty acids found in fish consist of biologically active EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Studies suggest that omega-3 fatty acids can lower the risk of heart disease, inflammation, obesity and other chronic diseases. Now research reports that omega 3 DHA may improve bone health.

The study, published in the British Journal of Nutrition, examined omega 3's bone effects in lab rats. Researchers at various institutions including Purdue University and the US National Institutes of Health (NIH) administered a diet containing LA (linoleic acid) enriched milk, or LA plus 1% DHA milk, 1% omega-6 DPA (docosapentaenoic acid) or DHA plus DPA, to omega-3 deficient young rats. When the rats reached adulthood the researchers measured omega 3 levels and bone mineral density by dual-energyX-ray absorptiometry.

The researchers found that DHA group had a higher bone mineral content than the DPA group. Furthermore, DHA was an important constituent of the bone marrow. Findings also revealed that the DPA group had the lowest bone mineral content and bone mineral density. DPA was not found in bone marrow.

"In conclusion, DHA accumulates in the osteoblast-rich and nerve-abundant periosteum of femur; DHA but not EPA appears to be a vital constituent of marrow and periosteum of healthy modelling bone; and both DHA and total n-3 PUFA strongly correlate to BMC [bone mineral content]," the study authors write.

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FDA Issues Warning of Fracture with Heartburn Drugs

2010-05-26T17:07:13Z

The U.S. Food and Drug Administration (FDA) has issued a warning that proton pump inhibitor (PPI) drugs have a high risk of bone fractures. PPI drugs, including over-the-counter (OTC) medications Prilosec, Nexium and Prevacid, are commonly taken for the treatment of heartburn. PPI prescription and OTC medications will now be required to carry a warning about increased risk of bone fractures.

Gastroesophageal reflux disease (GERD) is a condition in which stomach acids back up into the esophagus, causing irritation and inflammation. GERD, also known as heartburn, is the third most common gastrointestinal disorder in the U.S.. PPI drugs effectively reduce stomach acid. They are taken for treatment of GERD, ulcers and other gastrointestinal problems.

The FDA warning followed the FDA's review of epidemiological studies showing an increased risk of bone fractures in patients who take PPI drugs. One major study found a five times greater risk of hip fracture in patients taking PPI drugs for seven or more years.

The FDA recommends taking PPI drugs for no more than 14 days. PPI drug use should be limited to three 14-day courses yearly. They also recommend that patients at risk for osteoporosis taking PPI drugs should supplement with bone building nutrients like vitamin D and calcium.

"Healthcare professionals and users of proton pump inhibitors should be aware of the possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors, and weigh the known benefits against the potential risks when deciding to use them," states the FDA in their news release.

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Are you taking heartburn drugs? Do you have any comments? Please add below!

Discovered Genes Linked with Rheumatoid Arthritis

2010-05-11T16:23:16Z

Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation in the joints, leading to chronic pain, deformities and disability. RA affects nearly 1% of Americans (about 2.1 million people in the United States). Now a meta-analysis reports that seven genetic variants are linked with an increased risk of RA. This discovery may help develop genetic tests for determining RA risk. A meta-analysis examines similar studies to reveal trends that may not be evident from just one study.

The meta-analysis, published in Nature Genetics, conducted a genome-wide association repeating six previous studies of RA patients. Researchers at Brigham and Women's Hospital in Boston and various other U.S. Institutes investigated 34 suspected genetic variants in the genomes of 5,549 patients with RA and 20,169 control participants of European ancestry. They also investigated the genetic variants of 6,768 RA patients and 8,806 control participants in Canada, Britain and other countries.

The researchers found that 7 new RA genetic variants were discovered. The variants were found near immune function genes. The study authors suggest that more RA genetic variants need to be identified.

"The findings leverage us to better understand the basic biology of rheumatoid arthritis (RA), with the goals of developing new targets for therapy and new biomarkers for diagnosis and prognosis," the study authors write.

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Your Thoughts

Are you using alternative therapies to help manage rheumatoid arthritis symptoms? Please share with us below.

Low Vitamin D Linked to Higher Rheumatoid Arthritis Risk

2010-04-13T17:44:08Z

Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation in the joints, leading to chronic pain, deformities and disability. Rheumatoid arthritis affects women more frequently than men. Now research reports that low sun exposure and vitamin D deficiency may increase the risk of rheumatoid arthritis. Vitamin D is made by the skin on exposure to sunlight. More than half of Americans are vitamin D deficient.

The study, published in Environmental Health Perspectives, investigated the relationship between geographical location and rheumatoid arthritis risk. Researchers at Boston University School of Public Health, analyzed the data of 461 female nurses diagnosed with rheumatoid arthritis and 9,220 control subjects enrolled in the ongoing Nurses' Health Study between 1988 and 2002.

The researchers found that participants living in the northeastern U.S. had a higher risk of rheumatoid arthritis. This suggests that less sunlight exposure and vitamin D deficiency may be linked to increased incidence of rheumatoid arthritis. Vitamin D is known to play an important role in activating immunity.

"Spatial analyses suggest women living in higher latitudes may be at greater risk for RA," the study authors conclude. "Further, RA risk may be greater for locations occurring earlier in residential histories."

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Your Thoughts

Are you using alternative therapies to help manage rheumatoid arthritis symptoms? Please share with us below.

Prebiotics Enhance Absorption of Calcium

2010-04-08T17:00:00Z

One of the most commonly taken supplements is calcium due to the widespread knowledge by the general public that calcium is important for bone health, particularly the prevention of osteoarthritis. Many other nutrients are also important for optimal bone density and new research shows that a prebiotic can improve bone structure in young teenagers. A study published in the American Journal of Clinical Nutrition (2005;82(2):471-476) demonstrates that supplementing the diet with a combination of long and short chain inulin-like fructans (prebiotics) during puberty resulted in improved calcium absorption and increased bone mineral density of the whole body.

Prebiotics are compounds that are used as a fuel source by "friendly" bacteria in the gastrointestinal tract. Recent evidence has suggested that short term supplementation with inulin type fructans (ITFs) has improved calcium and magnesium absorption in animals and adolescents. Researchers wanted to assess these findings over a longer course and examine the effect on bone mineral density, a measure of the strength of bone.

Ninety-two pubertal boys and girls completed this randomized, double-blind, placebo-controlled trial. They were divided in to groups given either 8g per day of the fructan (prebiotic) supplement or a maltodextrin placebo for 12 months. Both groups were advised to mix the powder with a standard amount of calcium fortified orange juice. Assessments of calcium absorption, dietary intakes and bone mineral density and bone mineral content were completed. The results showed that calcium absorption was enhanced in the fructan group at 8 weeks and 1 year after the start of the trial, which was not a surprise based on prior results. However, this is the first time improved bone mineral density and content has been demonstrated with long-term consumption of a fructan supplement.

The effect observed was between 15-20% greater than the placebo group. The authors suggest this effect may be due to "increased absorption of calcium in the colon by scavenging unabsorbed calcium." By-products produced by "friendly" bacteria in the colon may increase the solubility of minerals, thereby enhancing absorption. The amount of fructan consumed in the study was modest and only one subject complained of gastointestinal upset which resolved upon discontinuation of the supplement. This study offers a safe additional product to improve bone health.

Spa Therapy for Ankylosing Spondyolitis

2010-04-05T17:00:00Z

Ankylosing spondyolitis is a chronic progressive disease that affects the spine. Over time the spine loses its natural flexibility and becomes rigid like a bamboo pole. The vertebra begins to fuse together causing in ability to function and decreased range of motion. Not only is range of motion affected, but also the disease results in severe pain both from the growth and fusion of bone, compression of nerves, and the loss of function.

Traditionally spa therapies such as balneotherapy and climatotherapy have been used to decrease pain and improve musculoskeletal function. Balneotherapy involves the use of water, heat, and organic materials such as mud or peat packs or baths, and mineral waters such as those found in natural springs. Climatotherapy involves the use of temperature and water to produce favorable effects.

A study published in the Israel Medical Association Journal investigated the effects of balneotherapy and climatotherapy on Ankylosing spondyolitis (AS). The study enrolled 28 individuals who had been diagnosed with AS. They were given daily spa treatments for 2 weeks then followed for 3 months post treatment. The investigators measured the pain index, AS disease Index, quality of life, and range of motion.

They found that treatment with both the balneotherapy and climatotherapy resulted in positive changes. There was significant improvement in the AS disease index as well as pain perception and range of motion. Although there was no difference in the changes observed between the two treatment types, there was a time dependent difference. Research showed that the longer duration treatments resulted in a greater therapeutic benefit.

The only significant difference between the two therapies was a greater improvement in quality of life reported by participants in the balneotherapy group.

This is a promising early study on the effects of spa therapy for Ankylosing spondyolitis. It supports previous evidence that spa treatments can be used effectively for musculoskeletal conditions, acute and chronic. Larger and more long-term studies are needed to show sustained benefit for those with AS.

Can Free Radicals Cause Fibromyalgia?

2010-02-28T17:00:00Z

The study, published in the Journal of Rheumatology International (2005, vol. 25, no. 3), evaluated the oxidant/antioxidant balance in fibromyalgia patients. Researchers from Mersin University Medical School in Turkey, analyzed data from 85 female fibromyalgia patients, matched with 80 healthy women. The scientists recorded the participants' malondialdehyde (a free radical marker) and superoxide dismutase (an antioxidant marker) levels, pain assessment, age, smoking, and duration of disease.

Researchers found that malondialdehyde levels were significantly higher and superoxide dismutase levels were significantly lower in fibromyalgia patients, compared with the control subjects. Age, BMI, smoking, and duration of disease did not modify the results. "Increased free radical levels may be responsible for the development of fibromyalgia," the study authors conclude. "These findings may support the hypothesis of fibromyalgia as an oxidative disorder."

]]> REFERENCES:
1. Bagis S et al. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatol Int. 2005 Apr;25(3):188-90.

Carotenoids and Inflammatory Arthritis Risk

2010-02-13T17:00:00Z

Inflammatory polyarthritis (IP) often progresses to rheumatoid arthritis (RA), a debilitating condition affecting a relatively large segment of the population. Preventative steps to combat this condition are likely dietary in nature, such as a high intake of vitamin C or fruits. This can be explained by the theory that the pathogenesis of RA and many inflammatory disorders is linked to oxidative damage. Therefore, higher intakes of antioxidants like vitamin C should decrease the risk of developing such conditions. A study published in the American Journal of Clinical Nutrition (2005;82(2):451-455) shows that higher dietary intakes of B-cryptoxanthin is associated with decreased risk of developing inflammatory polyarthritis. B-cryptoxanthin is a carotenoid that has also shown a protective effect against developing RA in the large Iowa Women's Health Study. Researchers wanted to examine this association in the development of IP.

A case-controlled study was undertaken as part of the Norfolk arm of the European Prospective Investigation of Cancer Incidence study (EPIC-Norfolk), an ongoing study involving more than 25000 subjects. These subjects were under ongoing surveillance for detection of new cases of IP, and for this study 88 subjects with newly diagnosed IP were identified and matched with controls. Participants completed a detailed diet diary for 7 days to assess the dietary intakes of various carotenoids. The results showed that the median B-cryptoxanthin intake was almost 40% lower and zeaxanthin 20% lower in subjects with IP than in controls. However, there were no significant differences in the intakes of B-carotene, lutein, and lycopene (other carotenoids). Vitamin C intake was corrected for, demonstrating that the association is independent of this potent antioxidant.

B-cryptoxanthin is found in significant quantities in oranges, bell peppers, and some tropical fruit. There are also carotenoid supplements containing B-cryptoxanthin and zeaxanthin, and some multi-vitamin/mineral supplements also contain these compounds.