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Medical Edge Newspaper Column from Mayo Clinic
DRUGS, MEDICAL CONDITIONS CAN CONTRIBUTE TO BONE LOSS
DEAR MAYO CLINIC: My mother has very bad bone degeneration due to osteoporosis, arthritis and scoliosis. She is shrinking and her head is falling to the front. She’s being managed for pain, but her condition is getting worse and I fear she is giving up. Is there anything that can be done? — Tucson, Ariz.
ANSWER: Your mother’s advanced bone loss is challenging to manage, but it’s possible that more can be done to improve her condition.
First, make sure that the osteoporosis — not just the pain — is being treated. Treatment can slow or stop further bone loss and physical decline.
Her doctor needs to determine the cause of the bone loss. While osteoporosis is related to aging and menopause, secondary causes are a factor in 20 to 30 percent of postmenopausal women. Secondary causes can include medications and other medical conditions.
Medications: Long-term use of corticosteriods to treat asthma, rheumatoid arthritis and other inflammatory conditions can contribute to lower bone mass. Anticonvulsants, thyroid medications, immunosuppressants given after organ transplant, diuretics and blood thinners such as heparin can contribute to bone loss.
Medical conditions: Endocrine disorders including Type 1 diabetes and thyroid conditions; disorders of the stomach, intestine and liver; and rheumatoid arthritis are among medical conditions that could cause bone loss.
Once the causes are determined, the doctor can develop a treatment plan that includes adequate calcium and Vitamin D, medications, bracing and exercise. In addition, cigarette smoking and excess alcohol consumption can promote bone loss and should be avoided.
There are five classes of medication that can be considered for the prevention and treatment of osteoporosis. The International Osteoporosis Foundation Web site (www.osteofound.org) has more information about these medications.
Bracing would support your mother’s neck and back, and help prevent additional abnormal curving of her back. You may want to consult with a physical medicine and rehabilitation physician for recommendations.
Your mother should stay active, with stretching and weight-bearing exercise if possible. Consult with a physical therapist to develop a program that your mother can do safely.
Even though your mother’s osteoporosis is advanced, steps can be taken to make her comfortable, slow or stop additional bone loss, and avoid further complications.
— Randy Shelerud, M.D., Spine Center, Mayo Clinic, Rochester, Minn.
Additional Resources:
Osteoporosis
Appointment Information
READERS: Mayo Clinic researchers have found that frequent headaches in children appear to be associated with sleep problems. More than two-thirds of children studied who suffer from chronic daily headache also experience sleep disturbance, especially delay in sleep onset. For children with episodic headaches, one-fifth had sleep problems.
“What’s novel in our study is the finding that a high percentage of patients with headache have sleep disturbance,” says Kenneth Mack, M.D., Ph.D., pediatric neurologist specializing in headache and the senior study investigator. “The number of patients who have headaches and also sleep disturbance surprised us. They also have the same sleep disturbance: a delay in sleep onset.”
The researchers undertook this study to scientifically study their observation in the clinic that many children suffer from both headaches and sleep problems.
“We’ve continually seen that children with headaches are poor sleepers and that they’re fatigued because they have poor sleep,” says Dr. Mack. “We’ve known that when people don’t get enough sleep they get more headaches, but we’d not appreciated the frequency of sleep disturbance with chronic daily headache.”
The study involved a retrospective chart review of 100 children ages 6 to 17 with chronic daily headache (headache present 15 or more days a month for three months or more) and 100 children in the same age category with episodic headache (headache that occurs with less frequency than chronic daily headache). In addition to sleep onset delay, sleep problems found in children studied included awakening during the night or too early in the morning, or not feeling refreshed after sleep.
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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