How COVID Has Impacted Bone Health and What You Can Do About It Right Now

From YouAreUNLTD by Feel It In Your Bones

Osteoporosis is often described as “a silent disease.” During COVID, this has never been more true. Bone health took a back seat. Health assessments, bone density testing and sometimes treatment itself were upended by the pandemic. This disruption in care may have serious, long-term consequences for patients.“The impact is going to be seen both immediately and down the line, as we see people not getting diagnosed, not getting treated,” says Dr. Vivien Brown, a family physician, assistant professor with the department of family and community medicine, University of Toronto. “And ultimately, we may see an increase in fracture risk and fracture rate. And now, six months into COVID when we’re referring patients for bone density tests, there is a backlog.”

Screening for osteoporosis is critical, according to Dr. Brown, especially for women over the age of 50. More than breast cancer, more than heart attacks or stroke, women are most likely to experience a fracture due to weakened bones. Medical intervention to prevent or treat osteoporosis, as well as the adoption of healthy lifestyle behaviours, may be needed. Failing to diagnose the disease can lead to serious outcomes.

“Until they’ve had a fracture, until they’ve had an event, people don’t really have osteoporosis on their radar as a concern,” explains Dr. Brown, who just updated her book, A Woman’s Guide to Healthy Aging (to be published in January 2021). When COVID hit, the focus for healthcare was on providing essential services only. Bone density testing was not considered essential.”

Long-term consequences of the care gap

These interruptions have caused a care gap, making incidents like hip fractures an even greater concern. The research is alarming – 28 per cent of women and more than 37 percent of men over the age of 80 die in the first year after a hip fracture. “It can be a life-altering event, if not a life-ending event,” she says. “We really need to still maintain our level of vigilance around osteoporosis. And I don’t think that’s happening day to day in the medical community.”

Furthermore, she points out that hip fractures can become family tragedies, according to Dr. Brown. “Some patients can’t return home to live independently. They may not be able to walk without assistance. They may not ever be able to drive again. It really alters their quality of life, which impacts the entire family…. The way I think about osteoporosis is that it is not just a bone disease. Osteoporosis is your independence on the line.”

As the impact of COVID has rippled across the country, continuity of care for osteoporosis patients has suffered. For those who were prescribed injectable medications, missed shots were an issue. “The consequences are really significant because the benefits of an injectable medication are completely reversible,” points out Dr. Brown. “That means when you get past that six-month window where you’re supposed to get your next injection, if you go more than a month or so, you start to reverse the benefits you’ve had because the drug is out of your system. That reversal actually increases your risk of fracture. It’s really important to stay on schedule with this medication. It means being creative – either seeing your doctor for the injections, getting it from a pharmacist, or learning how to self-inject. Just delaying an injection is not acceptable.”

During COVID, the focus on osteoporosis decreased. Good lifestyle habits also waned as people stayed home. Sedentary behaviour and poor dietary habits increased, while the ability to exercise in a gym and access to healthy food was negatively impacted. “A number of my older patients who live at home alone and don’t want to go to the grocery store are not eating healthy diets,” she says. “And if they’re not checking in with their doctor and not being reminded of what they need to do – something gets forgotten or left by the wayside.”

“The Way I Think About Osteoporosis Is That It Is Not Just A Bone Disease. Osteoporosis Is Your Independence On The Line.”

Issues with fracture follow-up

The pandemic has had a profound impact on our social support systems, too, especially when someone goes into the hospital with a fracture. Due to safety protocols, they cannot have their partners or someone else with them to be present to listen to a doctor’s instructions post-discharge. It’s concerning to Dr. Brown who fears that something will be overlooked. “If you’re in the hospital by yourself, it may be scary and you may be in pain,” she says. “You may not hear what the doctor is saying clearly. You get your cast or have the fracture treated, then get sent home. I don’t know that people are getting good follow up care.”

That lack of follow-up has a direct impact on continuity of care – a key component in successful osteoporosis management. “In some ways, osteoporosis is like hypertension. Patients often don’t feel it,” she notes. “Maybe they take their drugs for a couple of months, but then stop taking them if the meds are not easily accessible, if they don’t understand them, or not feeling the impact of the disease… It’s important to adhere to whatever has been prescribed.”

Now, it’s time to get back on track and to make bone health a priority again. How do we do that? Here are a few pointers from Dr. Brown:

6 ways to get back on track with your bone health during COVID

  1. Contact your doctor for a health review, which should include a discussion of osteoporosis prevention and ensuring you’re up-to-date with any medications to treat the disease.
  2. Let your doctor know whether you’ve had a recent fracture. A fracture may need to be investigated further to rule out osteoporosis as an underlying cause.
  3. Take an easy online test to determine your risk of a fracture. The FRAX fracture assessment tool can be done in just a few minutes and will look at key factors to calculate how likely you are to experience a fracture in the next 10 years.
  4. Have your risk for osteoporosis assessed by a healthcare provider. Factors that heighten your risk include: low body weight, family history of osteoporosis or broken bones from a minor injury, lifestyle behaviours (smoking, having three or more alcoholic drinks a day, and being sedentary), certain medical conditions (like rheumatoid arthritis), being a woman over the age of 50, and certain medications.
  5. Ask your doctor or pharmacist whether it’s time to schedule a bone density test. It is recommended that all women and men over age 65 have routine bone density tests. Men and women from the age of 50 to 64 with risk factors for fractures should also be tested.
  6. Resume good habits, like eating a diet with adequate vitamin D and calcium, exercising and sitting less.

 

 


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Did You Know That Inactivity is Actually HARD On Your Knees?

Between working from home and being glued to the television watching the latest election updates, many of us are guilty of increased “couch potato” behavior lately.  And we’ve all heard of the dangers of sedentary lifestyles contributing to obesity, etc.,  but did you know that *not* moving can actually weaken your knees and increase your chances of osteoporosis?

Continue reading for more from Noyes Knee Institute and the Journal of Public Health.

Do you spend a lot of time sitting? Maybe you work at an office where most of your time is at your desk, or maybe when you’re at home, you prefer to rest on the couch instead of being on your feet. Many people live a mostly inactive lifestyle, but they might not realize that inactivity can be the reason why they experience increased joint pain.

Learn the reasons why inactivity can hurt your knees and what you can do to change it.

Weakens Your Knees

If you live a life or limited activity, your body adapts to that lack of motion. Essentially, when you aren’t using your legs muscles, ligaments, and joints for moderate levels of activity, you are losing them. Your knees become weaker as you require less of them.

One runner found that as she took time off running to rehabilitate an injury, she could not run after completing her recovery because of knee pain. She had to complete additional physical therapy because the rest had caused her to develop a condition called chondromalacia of the patella.

Essentially, her kneecap would not follow the proper range of motion because she had developed some weakness in the joint. It’s a common condition for people who are not active. Even something as simple as going up or down the stairs can make your knees ache.

If you spend your day sitting, you also experience pain in other areas that can also aggravate the knee. Your quadriceps become tight, which exert a pulling sensation on your knees.

You can help your knees feel better by focusing on flexibility. Stretch daily, and participate in joint-stabilizing exercises like yoga. Try to be more active during the day. Stand at your desk, or take time to walk around the office a few times. Use the stairs instead of the elevator.

Increases Your Risk of Arthritis Pain

If you start to experience joint pain as a result of arthritis, your first instinct is to rest more, because walking, running, biking, or other activities cause pain. However, resting when you have knee pain is often the worst solution.

Resting will cause the muscles that give the knee support to weaken. As a result, they become less able to bear your weight, which results in greater joint pain. Reduced strength in the knee joint also translates to reduced stability, which can increase your risk for accidents and make exercising even more difficult to do safely.

If you have arthritis or if you have a history of arthritis in your family, staying active is one way you can help to prevent it from getting worse. Ask a knee specialist for exercises that are safe and helpful for strengthening your knees without causing you too much pain during workouts.

Promotes Weight Gain

A sedentary lifestyle is often why people struggle to manage their weight. Gaining weight with age is common, and spending your days seated can make that problem worse. With every extra pound, the pressure on your knees increases by about four pounds. So, just 10 pounds of extra weight means 40 pounds of pressure on your knees.

All that stress naturally means that your knees start to hurt, and they can hurt even more when you try to be active again. Make sure you intentionally choose low impact exercise as first. Try a stationary bike or a brisk walk in supportive shoes to begin. Focus on losing weight through diet control.

After you lose some weight, you can increase your physical workouts if your doctor believes they will be safe. You might try incorporating some resistance training to really give your lower body some increased strength and stability, as long as you also spend time stretching and increasing your flexibility.

Increases Risk for Osteoporosis 

From the Daily Mail

Being a couch potato weakens your bones: Adults in their 60s face greater risk of fractures if they spend hours sitting down each day – but walking 10,000 steps each day helps

  • The study of 214 adults was published today in the Journal of Public Health
  • It is the first to show a link between a sedentary lifestyle and osteoporosis
  • Participants’ hips and spines were scanned to measure their bone density

A couch potato lifestyle leads to weaker bones in later life, particularly for men, researchers have found.

Experts discovered that men spent more time on average sitting still than women and therefore had weaker bones, particularly in their lower back.

But the new findings, conducted by academics from Durham and Newcastle universities, show that even just completing 10,000 steps a day can help to keep bones strong.

The study showed that people in their sixties who spent a lot of time sitting down had weaker bones which increased their risk of developing ‘fragility’ fractures.

It is well known that weight-bearing and muscle strengthening exercises are important for building bone strength and preventing osteoporosis.

The study, published in the Journal of Public Health, is the first to show that a sedentary lifestyle in men is associated with weaker bones and osteoporosis.

More than half a million fragility fractures – where a fracture occurs from a fall at standing height or less – happen each year in the UK. It is estimated that by 2025, that number will have gone up by 27 per cent.

Dr Karen Hind, of the Department of Sport and Exercise Sciences at Durham University, said: ‘We know that excessive sedentary time can lower someone’s metabolism which can lead to being overweight and Type 2 diabetes.

‘What we now know is that being inactive is also associated with lower bone strength and an increased risk of osteoporosis.

‘Osteoporosis is a disease that affects older people but by encouraging this age group to keep active, it will help improve their bone health.’

The research team followed 214 men and women, aged 62, from Newcastle University’s Thousand Families Study.

Each participant wore a monitor for seven consecutive days which measured their physical activity and sedentary time. The number of daily steps was also recorded, and then compared with public health recommendations.

The participants’ hips and spines were scanned to measure their bone density.

Participants involved in 150 minutes of light physical activity a week had better bone strength than the more sedentary participants, according to the findings.

The men who spent more than 84 minutes per day sitting still, compared to the average of 52 minutes, had 22 per cent lower bone density in their spine.

The researchers say the impact on their bone density is similar to that of smoking, which is also a risk factor for osteoporosis.

The economic and personal costs of osteoporosis are substantial – in the UK the direct costs of fragility fractures are estimated to be £4.4billion which includes £1.1billion for social care.

The participants all lived in Newcastle-upon-Tyne, and Public Health England statistics indicate that the North East has the greatest proportion of physically inactive adults and the highest incidence of hip fractures compared to the rest of the UK.

The researchers said that the message from their findings is: stay active and reduce sedentary time.

They emphasised that the study shows that hitting the daily target of 10,000 steps and avoiding long periods of sedentary time will increase bone strength.

They say that even making daily lifestyle ‘hacks’ can make a difference – such as parking the car further away from the shopping centre or taking the stairs instead of the lift.

Dr Hind added: ‘Currently there are no specific guidelines for this age group to encourage light physical activity or to reduce sedentary time.

‘Yet, as people retire they are more likely to increase the time they spend watching television and reduce their daily step count.

‘It would be great to see initiatives that specifically target this group to increase their awareness of the importance of staying active and reducing the amount of time spent sitting still.’

Learn more about bone health


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Exercise for Bone Health

Featured on National Osteoporosis Foundation.

May is National Osteoporosis month so we’re sharing some great exercises from the National Osteoporosis Foundation. The following exercises promote good posture, strength, movement, flexibility and balance in healthy people as well as those with osteoporosis. If you’ve recently broken a bone or if you have very low bone density, discuss these exercises with your physical therapist or healthcare provider before trying them and remember to avoid all activities that require bending forward from the waist or too much twisting of the spine.

Read more

Tips for Exercising When You Have Osteoarthritis

By K. Aleisha Fetters | Featured on US News

IF YOU HAVE osteoarthritis, your relationship with exercise is bound to be a tricky one. After all, increasing physical activity is one of the fundamental must-dos for managing the degenerative wear-and-tear joint disease and slowing its progression. But if you have osteoarthritis, certain exercises can be incredibly painful and contribute to further joint damage.

That’s why it’s critical to take a smart, measured approach to exercise if you’re one of the more than 30 million Americans that has osteoarthritis, according to the Centers for Disease Control and Prevention.

Here are seven pro pointers for reaping all of the joint-protecting benefits of exercising with osteoporosis and reducing the risk of exercise aches and pains:

  • Consult with a specialist.
  • Warm up.
  • Focus on low-impact workouts.
  • Use your full range of motion, as long as it’s pain-free.
  • Learn isometric exercises.
  • Keep things short and frequent.
  • Tune into your body and adjust as necessary.

Consult With a Specialist

Discussing your individual joint health, symptoms and exercise history with an expert is the perfect starting point when increasing physical activity with osteoarthritis, says Katrina Pilkington, a Nevada-based National Academy of Sports Medicine certified personal trainer and corrective exercise specialist. She recommends reaching out to your rheumatologist and getting set up with a personal trainer or physical therapist.

Working with a trainer or physical therapist is especially important if you have never worked with one in the past. Both can teach you the fundamentals of exercise form to ensure you perform all activity in the safest, healthiest manner for you.

Warm Up

When you’re short on time, it can be tempting to dive straight into your workout, but don’t give in. It’s critical to take a few minutes at the beginning of any exercise routine to increase blood flow to the muscles and joints you’re about to work, according to the Arthritis Foundation. Some gentle warmup drills include arm circles, side-to-side marches, partial bodyweight squats and light cardio, such as walking and cycling.

Focus on Low-Impact Workouts

High-impact exercises involving running and jumping can help strengthen your bones, joints and their supporting musculature, but this isn’t the best starting place for anyone with joint disease. “I would recommend starting with lower-impact exercises and gradually progress based on how you feel,” says physical therapist William Behrns, a board-certified Orthopedic Clinical Specialist at the Hospital for Special Surgery in New York City.

Great low- and no-impact forms of exercise include cycling, swimming and strength training, in which both feet stay planted on the floor at all times. For example, instead of stepping back and forth during lunges, performing them with a stationary split stance eliminates any potential jolting of your ankles, knees and hips. Similarly, swap out jump squats for goblet squats (where you hold a single weight in front of your chest) to work your muscles just as hard while reducing potentially irksome stress to your joints.

Use Your Full Range of Motion as Long as It’s Pain-Free

Your joints’ ability to freely move is contingent on regular movement, Pilkington says. It’s a use-it-or-lose-it scenario. However, it’s important that you don’t force your body into painful positions.

For example, maybe you can get into a very low squat, but it hurts your knees and/or hips. Stick to a shorter range of motion, bending at the hips and knees only as far as you can do so without pain, Behrns says.

Learn Isometric Exercises

In some joints, just about any motion can be painful – and that’s where isometric exercises come in handy. In them, rather than moving up and down or side to side, you hold a position.

With isometric exercises, it’s important to remember that you’ll only challenge and strengthen your muscles in the positions that you’re holding. So, if possible, hold each exercise in multiple positions. For instance, if you’re performing isometric lunges, try holding the exercise for 30 seconds near the bottom of your available range of motion and again for 30 seconds near the top.

Other isometric exercises to try include squats, glute bridges and shoulder raises. These are particularly helpful since osteoarthritis most commonly affects the knees, hips and shoulders.

Keep Things Short and Frequent

Sprinkling short activity sessions throughout the day is a great way for anyone to fit exercise into their daily routine and break up time spent sitting. But for anyone with osteoarthritis, short activity sessions can also be useful in ensuring that, when you do exercise, you don’t overstress your joints, Pilkington says.

Any movement, no matter how brief, counts toward your daily activity goals. Behrns recommends getting 150 cumulative minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week. A combination of the two also works.

Tune Into Your Body and Adjust as Necessary

Exercising with osteoarthritis can be frustrating, especially if exercise mistakes contributed to your condition or you’re a longtime exerciser who’s suddenly limited in what your body can and can’t do.

However, if you move forward based on how your body feels – rather than what you’re used to or what you expect your body to do now – you’ll be far better off, Behrns says. He recommends listening to your symptoms and if you experience any pain, to immediately think through what aggravated your body and do something about it. That could mean switching up exercise variations, scheduling more recovery work into your routine or adjusting the time during the day that you work out.

 


Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Osteoporosis and Spinal Fractures

Article Featured on AAOS

As we get older, our bones thin and our bone strength decreases. Osteoporosis is a disease in which bones become very weak and more likely to break. It often develops unnoticed over many years, with no symptoms or discomfort until a bone breaks.

Fractures caused by osteoporosis most often occur in the spine. These spinal fractures — called vertebral compression fractures — occur in nearly 700,000 patients each year. They are almost twice as common as other fractures typically linked to osteoporosis, such as broken hips and wrists.

Read more