Preventive Treatment Options
Calcium
The most fundamental suggestion is to increase your calcium intake, either through dietary changes or supplemental pills. It is best for people to begin adequate calcium intake at an early age, as bone mass begins to decrease around the age of 30. After age 30, calcium helps decrease bone loss, strengthen bones, and decrease the risk of fractures.
The recommended daily intake for women age 25 to 50-and women over 50 who take hormone replacements-is 1,000 mg (milligrams) per day. Women over 50 who do not take hormone replacements should have 1,500 mg per day. Men ages 25 to 65 years old should have 1,500 mg per day. And men and women over 65 should have 1,500 mg per day.
If you take calcium supplements, make sure they contain Vitamin D, as this helps with absorption. Calcium citrate is absorbed better than calcium carbonate. If you take the carbonate form, make sure to take it with food.
Vitamin D
A vitamin D deficiency may contribute to bone loss and fracture. At least 800 mg per day is recommended for all adults. Many calcium supplements contain vitamin D. You can also get vitamin D through foods such as egg yolks, fish, and fortified milk and cereals. Fish sources include halibut, mackerel, sardines, shrimp, pink salmon, and cod liver oil.
Exercise
Exercising five days a week for at least 30 minutes helps reduce bone loss. The best exercises for maintaining bone mass are weight-bearing exercises like walking, low-impact aerobics, and safe forms of dancing.
Medications
Currently, four medications have approval from the Food and Drug Administration (FDA).
Hormone Replacement Therapy (HRT)
Hormone (estrogen) replacement therapy (HRT) is used for both prevention and treatment of osteoporosis. HRT can reduce bone loss, increase bone density in the spine and hips, and reduce the risk of hip and spinal fractures in postmenopausal women.
HRT is usually given as a pill or skin patch. It is effective even when started after age 70. Estrogen taken alone can increase the risk of developing endometrial cancer (cancer of the uterine lining). For this reason another hormone called progestin is usually prescribed in combination with estrogen for women whose uterus is intact.
Side effects of HRT can include nausea, bloating, breast tenderness, and high blood pressure. Some studies indicate a relationship between estrogen use and breast cancer, while other studies do not. Make sure to discuss the pros and cons of estrogen replacement therapy with your doctor.
Bisphosphonates
These compounds inhibit breakdown of bone and slow down bone resorption. They've been shown to increase bone density and decrease the risk of hip and spine fractures. Alendronate is the bisphosphonate that has been approved by the FDA for preventing and treating osteoporosis in postmenopausal women. The strongest side effect of alendronate is gastrointestinal problems. To avoid these problems it should be taken on an empty stomach. Also take it with a full glass of water and remain in an upright position for at least thirty minutes afterward.
Calcitonin
Calcitonin is used for women who cannot or choose not to take estrogen. For women who are at least five years past menopause, calcitonin can increase spinal bone density and slow bone loss. Calcitonin is a protein, so it cannot be taken orally because it would digest before it goes to work. It is available as an injection or nasal spray.
Selective Estrogen Receptor Modulators (SERMs)
SERMs are compounds that have effects similar to estrogen in some parts of the body, such as the spine and hip. SERMs seem to prevent bone loss of the spine, hip, and total body. Raloxifene is the SERM drug currently approved by the FDA for prevention of osteoporosis. Its impact on the spine does not appear to be as powerful as either estrogen replacement therapy or alendronate. There are no common side effects with raloxifene. Some women have experienced hot flashes and deep vein thrombosis (DVT).
Blood Clots
Deep venous thrombosis (DVT) (or thrombophlebitis) is the medical name to describe blood clots formed in the veins of the legs. This is a common problem following many types of surgical procedures. These blood clots form in the large veins of the calf. They may continue to grow and extend up into the veins of the thigh, and in some cases into the veins of the pelvis.
It is true that some people develop DVT even though they have not undergone any recent surgery. But the risk is much higher following surgery-especially surgery involving the pelvis or the lower extremities. There are logical reasons why the risk is increased. The body is trying to stop bleeding associated with surgery, so the body's clotting mechanism becomes very active during this period. Also injury to blood vessels around the surgical site from normal tugging and pulling during surgery can set off the clotting process. Blood that does not move well sits in the veins and becomes stagnant. If it sits too long in one spot it may begin to clot.
The prevention of DVT is a serious matter. Blood clots that fill the deep veins of the legs stop the normal flow of venous blood from the legs back to the heart. This causes swelling and pain in the affected leg. If the blood clot inside the vein does not dissolve, the swelling may become chronic and can cause permanent discomfort. While the discomfort is unpleasant, the blot clot actually poses much more serious danger. If a portion of the forming blood clot breaks free inside the veins of the leg, it may travel through the veins to the lung. There it can lodge itself in the tiny vessels of the lung, cutting off the blood supply to the blocked portion of the lung. This blocked portion cannot survive and may collapse. This is called a pulmonary embolism. If a pulmonary embolism is large enough, and the portion of the lung that collapses is large enough, it can cause death.
Reducing the risk of developing DVT is a high priority following any type of surgery. Preventative measures fall into two categories, mechanical involves getting the blood moving better, and medical involves using drugs to slow the clotting process.
Mechanical
Blood that is moving is less likely to clot. Getting you moving so that your blood is circulating is perhaps the most effective treatment against developing DVT. Once you begin walking, your leg muscles will contract and keep the blood in the veins of the legs moving. But you can still do things while you are in bed to increase the circulation of blood from the legs back to the heart. Simply pumping your feet up and down (like pushing on the gas pedal) contracts the muscles of the calf, squeezes the veins in the calf, and pushes the blood back to the heart. You should do these exercises as often as you can.
Pulsatile stockings are very effective. They are special stockings that wrap around each calf and thigh. A pump inflates them every few minutes, squeezing the veins in the legs and pushing blood back to the heart. Support hose, sometimes called TED hose, are still commonly used following surgery. The hose work by squeezing the veins of the leg shut. This reduces the amount of stagnant blood that is pooling in the veins of the leg and lowers the risk of blood clotting.
Medical
Medications that slow down the body's clotting mechanism can reduce the risk of DVT. They are widely used following surgery of the hip and knee. Aspirin can be used in very low risk situations. Heparin shots may be given twice a day in moderately risky situations. When there is a high risk for developing DVT, several potent drugs are available that can slow the clotting mechanism very effectively. Heparin can be given by intravenous injection, a new drug called Lovenox can be given in shots administered twice a day, and Coumadin can be given by mouth. Coumadin is the drug of choice when the clotting mechanism must be slowed for more than a few days because it can be taken orally.
In most cases of spinal surgery, both mechanical and medical measures are used simultaneously. It has become normal practice to use pulsatile stockings and place patients on some type of medication to slow the blood clotting mechanism. You are encouraged to get out of bed as soon as possible and begin exercises immediately after surgery.
