Tag Archives: bone health

B12 In The Body

Vitamin B12, or cobalamin, is an important nutrient. It is an essential nutrient, meaning in this case not that it is necessary for good health—though it is—but it is not produced in the body, and must be consumed in food or supplements. Vitamin B12 is needed to produce red blood cells and effects the functioning of the brain and nervous system. It is also used to treat cyanide poisoning, to essentially suck the cyanide out of the bloodstream so it can be passed harmlessly.

It is also, unsurprisingly, used to treat B12 deficiency. B12 deficiency is rare, because most people consume more than they need and the body stores the excess—as much as five years’ worth—primarily in the liver. Certain medical conditions or treatments can diminish the body’s ability to absorb or use B12, however, and this can lead to symptoms such as fatigue, depression, and impaired memory. More severe deficiency can result in irreversible damage to the brain and nervous system, leading to dementia.

Dietary sources of vitamin B12 include in fish and shellfish, meat, eggs, and dairy products. Vitamin B12 is often added to livestock feed in the United States, so farmed meat generally has particularly high levels. Vegans, who don’t eat eggs or dairy, often need to take supplements, which are typically made from a synthetic form called cyanocobalamin. This molecule does not occur in natural sources but is easily converted by the body into the natural forms of the vitamin. Vegetarians who do eat eggs and dairy products may still need supplements, because vegetarian diets often feature a lot of soy, which can impair B12 absorption.

Scientists have recently found signs of a previously unknown role for vitamin B12. In conjunction with the compound taurine—known from energy drinks, but actually an important nutrient in its own right, with important roles in the functioning of the cardiovascular and central nervous systems—B12 helps regulate the creation of new bone tissue.

This means doctors may be able to add osteoporosis to cyanide poisoning and vitamin B12 deficiency on the list of conditions treated with B12. While it can stop or even reverse cognitive decline resulting from B12 deficiency, there is no indication B12 can improve cognitive function in healthy people.

Osteoporosis Prevention Starts Early

Osteoporosis, a condition in which the bones become porous and weak, is common in older people. As people age—and exacerbated, in women, by menopause—the cycle of bone restoration becomes disrupted. Ordinarily, the skeleton in a constant state of renovation and restoration, like a suspension bridge; some part is always adding new material and replacing worn-out material. However, for many people, the removal speeds up over time, or the replacement slows down, or both. This has no noticeable symptoms on its own, but it does contribute to the loss of height and posture seen as people age, as well as leaving the bones fragile and more prone to fracture.

This bone loss is more common in women than in men. In addition to osteoporosis related to menopause, that related to aging, which happens to people over 75, is twice as common in women than in men. Changes in the sex hormones that result from aging play a large role in the development of osteoporosis, and anything else that reduces the level of those hormones—breast cancer treatments that reduce estrogen levels, or prostate cancer treatments that have a similar effect on testosterone—can contribute to osteoporosis. Overactive thyroid, or thyroid medication to treat underactive thyroid, also increase the risk. People who take corticosteroid drugs for chronic inflammation often experience bone loss as well.

Preventing osteoporosis, for people at risk, means consulting a medical professional, particularly for people who take corticosteroids, have been treated for breast or prostate cancer, have experienced hormonal problems, or who have thyroid illness. There are some lifestyle changes that can also help ward off bone loss. A sedentary lifestyle is a risk factor for osteoporosis, and so getting exercise can help reduce the risk. Calcium and vitamin D, either in the diet or from supplements, can also prevent the condition from developing.

However, experts now say the foundation for osteoporosis in old age is laid in childhood, and so the foundation for bone health needs to be as well. While calcium and vitamin D later in life can help, they are particularly important in childhood. Many other risk factors, such as exercise and body weight, are likewise rooted in habits best developed while young.

Avoiding Falls

Every year, one in three people over age 65 suffers a fall. "Falling" doesn’t sound serious, but falls are the number one reason for emergency-room visits among elderly people, and the leading cause of injury, fatal and nonfatal alike. Falling often means breaking bones, particularly the hip bone. Falling is also the most common cause of traumatic brain injury, which is responsible for almost half of fatal adult falls. Even without physical injury, falling can be detrimental to quality of life. People who have fallen often fear falling again. In fact, it’s a vicious cycle—people who have fallen curtail activities, which lowers mobility and fitness, which makes another fall more likely.

This effect is compounded by the fact that many people, as they get older, resign themselves to falling, or to fear of falling. It’s thought of as an inevitable part of aging, one of many grim equations: getting older equals falling down. In fact, falling isn’t simply something that happens to people when they get old; falls can be prevented. One often-overlooked preventative measure is getting new glasses. Eyesight really does diminish with age, and people over about 30 should get their eyes examined regularly. Regular checkups also make it possible to avoid drastic changes in prescription, which can make things worse. Even people who didn’t need glasses or contact lenses growing up should see an optometrist in their later years.

Exercise is good for staying fit, allowing for easier recovery from near-falls, and maintaining balance. T’ai chi, a martial art introduced to the United States in 1939, has proven benefits in helping balance and preventing falls. In a study of stroke survivors, who are particularly prone to falling, t’ai chi cut the risk in half. The destressing effect can also lessen fear of falling.

It is also helpful to make a person’s space as fall-proof as possible. That means tucking away tripping hazards such as shoes, cords, plants, and boxes. All rooms in the house should be well-lit, and stairway railings should be secure. Stairs are especially dangerous, and carrying bulky items like laundry a particular hazard. Throw rugs and the like should be secured so thy don’t bunch up and so the edges don’t curl, such as with non-skid mats or double-sided tape.

Battling Arthritis

The most common and most familiar form of arthritis affects 27 million people in America. People tend to think of arthritis as something that just happens with age. Indeed, it’s sometimes referred to as wear-and-tear arthritis, and results in part from the protective layer of cartilage covering the ends of the joints getting ground down by use over time. However, it isn’t an inevitable part of aging. Not everyone gets arthritis when they get older, and there are even things that can be done to prevent it.

Obesity is a significant risk factor for arthritis, particularly in the knees. Some people think that exercise can be a contributing factor to arthritis, but there is no evidence of a connection, and no reason to believe that the benefits of exercise in terms of preventing obesity and easing the stress on the bones don’t outweigh any risk there may be. Repetitive stress to the joints, however, can increase the risk of arthritis.

Other risk factors can’t be controlled. While arthritis isn’t inevitable with age, the risk of developing it does increase over time as the cartilage degrades. People with bone deformities are more likely to get arthritis; the unusual shapes of the bone cause unusual wear patterns, weakening the layer of cartilage. Joint injuries, too, can lead to arthritis, though there is no sign of any link with cracking knuckles.

Research has also suggested a possible genetic link, not to arthritis itself but to being vulnerable to the disease. Arthritis does tend to run in families, and in particular siblings of arthritis sufferers tend to get it themselves as well. That may not be entirely down to heredity, however. In a study published earlier this year, researchers fund that while drug use does not lead to arthritis, parental drug abuse might.

The researchers discovered that people whose parents had used drugs or drank excessively while the patients were under 18 and living at home were almost 60 percent more likely to get arthritis. The patients’ own substance use appeared to have no significant effect on the likelihood of getting arthritis. The researchers warn that what they have discovered is only a statistical construct, and what, if any, causal relationship exists is unknown.

Healthy Bones

In developing countries, one of the most common childhood ailments is a bone disease called rickets. Children with rickets generally are deficient in vitamin D or the minerals calcium or phosphorus. Rickets leads to an increased tendency to suffer fractures, dental problems, muscle weakness, bow legs, skeletal deformities, poor growth, a misshapen skull, or other problems.

Another bone disease, one more common among adults and in the developed world, is osteoporosis. The name of the disease provides a description—bone weakness. People with osteoporosis, too, are prone to bone fractures. One-third of all women over age 50 will have a fracture as a result of osteoporosis, and that fracture is likely to be her first indication that she’s losing bone mass.

Here are some tips on keeping bone fragility at bay:

  • Get enough calcium. Calcium is in milk, and grocery-store shelves are replete with calcium-enriched food products. Vitamin D, which is found in some foods and in sunlight, is also helpful.
  • Quit smoking and cut back on alcohol. Both of these things can hasten the loss of bone mass.
  • Talk to a doctor about the effects on bone density of important medications, such as corticosteroids.
  • Get exercise. Exercise helps strengthen bones and protect against diminishment

A bone density test should be a part of regular checkups for both women and men over about 50, or who are on corticosteroid medications. Early intervention can be important, as osteoporosis often has no symptoms at first.

Reliveing Arthritis Pain

Predicting the weather from joint pain is an old wives’ tale, but now researchers have found solid science behind it. More than 60 percent of people suffering from osteoarthritis report an effect from rain, barometric pressure, temperature, and other weather conditions on their symptoms. Scientists confirmed this by comparing reported pain levels with weather records. Because they used pain reports from a previous study, the influence of expectation—patients already primed to pay attention to the weather subconsciously perceiving their pain as worse when they expect it to be worse—was minimized.

The effect of weather, particularly barometric pressure, was small, but no less real to the patients. It’s not clear why weather should make a difference. Arthritis happens when the cartilage protecting the joints wears away, whether because of infection, injury, or simply with use over the years. The bones grinding together, without the cartilage to cushion them, is what causes arthritis pain. Because cartilage degrades over time, arthritis is common in older people.

The pain and stiffness is usually worse in the morning, and a little light exercise at night can help make mornings more bearable. Sitting in one position for a long time can exacerbate joint pain, while shifting helps avoid it. Physical activity is good, but certain types of exercise can do more harm than good: running, high-impact aerobics, and anything involving repetitive motion such as tennis can make the joint pain worse. Low-impact aerobics, on the other hand, can help alleviate the pain, as can stretching exercises and strength training. Pilates can also be good exercise for people with arthritis, and may help with the stiffness.

Medical treatment uses non-steroidal anti-inflammatory drugs and other painkillers, combined with physical therapy. Although some doctors have recommended medical marijuana for patients with arthritis, new studies show no sign that it does any good. The active ingredient in cannabis can relieve pain in some conditions, but arthritis pain works in a way that is not affected by it. In severe cases, surgery can be performed to treat arthritis pain. There is currently nothing that can be done to restore the cartilage, but joint replacement surgeries, which remove the damaged joints entirely and put artificial joints made from synthetic materials in their place, are common.

Arthritis And Sulfur

About 27 million Americans suffer degenerative arthritis, or osteoarthritis, making it the most common form of arthritis. It is one of many conditions that were once considered an inevitable part of aging, but that we are learning more and more about how to predict, prevent, and control. Osteoarthritis results from the gradual wearing down of the protective cartilage on the ends of bones where the joints are. The likelihood does increase with age, and it is also more common in women, obese people, people with bone deformities, and people who have suffered repetitive stress injuries or other joint problems.

Now researchers have found that sulfur compounds play an important role in maintaining this protective layer and preventing arthritis. One is hydrogen sulfide. This is ordinarily a malodorous poison, but enzymes produce it, safely, in the body, and research suggests that it can be harnessed to reduce swelling and inflammation in arthritic joints. It appears that releasing it in the body slowly—as happens in the natural process—may have some therapeutic effect. Another compound, sulforaphane, is released by eating broccoli, and to a lesser extent other cruciferous vegetables. Sulforaphane has anti-inflammatory properties and it impedes the enzymes that are responsible for destroying the protective cartilage. That means the compound may play a role in halting or reversing the degeneration that leads to arthritis.

Scientists are also looking into possible treatments. Currently, arthritis is generally treated with a combination of medication and physical therapy, however the medication consists only of painkillers—including non-steroidal anti-inflammatory drugs and narcotics—to address the symptoms, and there is currently nothing that can be done about the cartilage degeneration that is causing the condition in the first place. Similarly, therapy and medical devices such as braces can help patients avoid pain but do nothing to end it. The sulfur compounds are one line of research in that direction, and scientists also have a new tool to help in the fight. New imaging techniques are helping doctors get a better look at what is going on in a patient’s joints, so as to have a better model of what arthritis looks like. This can help them see where the problems lie and what might be done to arrest the degeneration so it doesn’t get worse.

Early Osteoporosis Detection

Many people, as they get older, find their bones losing mass and density, a condition called osteoporosis. It’s a natural consequence of aging: bone naturally loses mass with use, and after about age 25, new bone is created slower than old bone breaks down. If you didn’t develop a large surplus before that, your bones will eventually be delicate and fragile, and highly prone to fractures. Another common symptom is back pain and poor posture, due to a weakened spine.

As with many conditions, early detection is key. A test recently developed in England, based on ideas from researchers at the University of California at Santa Barbara, measures bone density and fragility directly, rather than through imaging. Risk of fracture goes up before loss of mass may be visible, and a severe fracture is often the first indicator of osteoporosis, by which time a significant amount of damage has already occurred.

Experts think one-third of women over 50 will have a fracture due to osteoporosis; this test will help doctors better predict which patients are likely to suffer these fractures. Called microindentation, it’s not only more accurate and thorough than imaging, it requires only a small handheld device rather than complicated equipment, and can be done in the office as opposed to a separate dedicated facility. In addition, imaging can determine density but not quality, which is also relevant to fracture risk.

This early detection allows treatment—to slow or stop the loss of bone mass—to be given before fractures become a serious likelihood. The best-known treatments are drugs called bisphosphonates that halt bone loss. In severe cases, or if the bisphosphonates are not well tolerated, drugs that stimulate bone growth may be used to restore the lost mass, though this is not normally necessary.

Vitamin D and calcium, due to their roles in bone development, are often suggested as ways to treat osteoporosis. Studies have shown, however, that vitamin D on its own has almost no effect; it needs to interact with calcium in order to preserve and rebuild bone in earnest. Preventing osteoporosis also means quitting smoking and drinking in moderation if at all; nicotine and alcohol both accelerate the degradation of bone tissue. Also exercise can strengthen bones as well as muscle.

Calcium And The Parathyroid

Around 1.8 million Americans have a condition called hypercalcemia, meaning they have calcium levels that are too high. This is not simply a matter of too much calcium in the diet, since it’s normally metabolized; hypocalcemia is a medical condition. About half of all cases have no symptoms. Other patients will experience kidney stones, abdominal pain bone pain, nausea, and in some cases anxiety and depression. Excess calcium leads to increased stomach acid production, meaning people with the condition can get ulcers or even pancreatitis.

People are especially prone to hypercalcemia who take lithium or who have cancers such as squamous-cell carcinoma, lung cancer, or breast cancer. Excessive vitamin A or vitamin D can also lead to calcium levels that are too high. Another cause of hypercalcemia is inactivity. When bones are underused, they release calcium into the bloodstream. This weakens the bones by lowering bone mass, and it also overwhelms the body’s ability to process calcium.

Now researchers at the University of California at Los Angeles have found another possible risk factor for hypercalcemia: parathyroid disease, specifically a kind called hyperparathyroidism in which the parathyroid glands, found next to the thyroid in the neck, are overactive. The study was one of the first to look at hyperparathyroidism in subjects from a variety of racial backgrounds, as opposed to primarily white people. This is important because the condition is typically found in African-American women. The parathyroid gland is responsible for regulating calcium, and problems with the gland cause this regulation to go awry.

The parathyroid condition is associated with several factors, including radiation treatment involving the neck and certain rare hereditary conditions. It is also frequently found in women who have been through menopause. In addition to excess calcium, symptoms include pain in the abdomen, forgetfulness, needing to urinate a lot, osteoporosis, and fatigue. People with the condition often feel generally sick and run-down with, if hyperparathyroidism has not been diagnosed and is not otherwise apparent, no clear reason.

Make No Bones About Weight Loss Surgery

Bariatric surgery is widely touted as a drastic but effective method of weight loss. The surgery, which restructures the stomach to limit the amount of food a person can eat, has been successfully performed on thousands of obese patients in the last few decades. However, there are some side effects that are concerning doctors. One of the more worrying is a number of cases in which bariatric surgery seems to have resulted in bone loss.

Weight-loss surgery was first performed in 1954, and the first gastric bypass, the best-known type of bariatric surgery for weight loss, took place in 1966. Gastric bypass—initially using a technique called vertical banded gastroplasty to create a stomach pouch—was a safer procedure than the intestinal bypass that had been performed in the 1950s, which caused patients to become dangerously dehydrated. The modern procedure, called Roux-en-Y anastomosis, was developed more recently. It is one of the most common types of weight-loss surgery, and probably the one most people think of when they think of surgical weight loss.

In this procedure, the intestine, which is normally the output for the whole stomach, is rerouted in a Y shape around most of the stomach and attached to a small pouch. Other surgeries involve a band, sometimes adjustable, around the stomach to limit its capacity. The adjustable band procedure is done laparoscopically, using miniaturized instruments through a small incision, and is one of the safest forms of bariatric surgery available.

Surgical techniques are usually reserved for significantly obese people—meaning a body mass index above 40—or people with a BMI higher than 35 and an obesity-related condition such as type 2 diabetes. In recent years procedures have started to be performed more often on teenagers as well as adults. Unfortunately, teenagers who have had the procedures, particularly Roux-en-Y, performed have shown reduced bone density. A similar though smaller effect has been seen with patients who had the surgery as adults.