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Welcome to avoidboneloss.com A website created to help you prevent osteoporosis and select competent, education-oriented medical professionals. This web page gives preventative tips. Other avoidboneloss.com pages provide the following types of information: ■ Short answers to basic questions about osteoporosis ■ How to get maximum benefit from your bone density tests This website also gives some background information about me under Author Interview. If you’re interested in buying supplements, drugs, herbs, or "miracle" cures for osteoporosis, you’d better go elsewhere. There are no shopping carts on this website. However, there is a strong emphasis on getting the right type and amount of exercise and on going to test centers that will give you complete copies of your test results and discuss them with you. Ten Tips for Preventing Osteoporosis 1. Keep active and exercise your entire body. Walking is not sufficient; it targets the feet, ankles and legs, not your hips, spine, shoulders and wrists. According to the U.S. Surgeon General "The evidence suggests that the most beneficial activity regimens for bone health include strength-training or resistance-training activities. These activities place levels of loading on bone that are beyond those seen in everyday activities." (Page 171 of Bone Health and Osteoporosis: A Report of the Surgeon General) For optimal results, you should have a well-rounded exercise program that targets the weak areas of your skeleton. For example, if you have low bone mass in your hips, it helps to add hip exercises such as squats, lunges, and single leg lifts (side, front and back) with and without weights, and to use the hip adduction and abduction machines at a gym. Consult your doctor before beginning an exercise regime, start gradually, and have professionals verify that you’re doing exercises correctly. If you have osteoporosis, have a physical therapist show you which exercises are safest and best for you. For more detailed exercise advice, go to the webpage How to Get Maximum Bone Benefit from Exercise. One way to get well rounded exercise and have fun at the same time is to join the YMCA or another fitness center that offers group classes. For around $30 to $40 per month, you can take as many classes as you wish and have access to their equipment and pool. If you are 65 or older, you may be able to have your gym fees paid for by your supplemental insurance. For more information contact your insurance agent and http://www.silversneakers.com. Bodyworks classes are especially helpful for preventing bone loss. Avoid high impact exercise such as jumping because it can cause joint problems. There are better ways to build bone. People with arthritis and other physical problems can usually benefit from water aerobics classes. I have found that exercise is the most important factor in building and maintaining bone. 2. Get good nutrition. For example, in place of soda pop, drink fruit juice, vegetable juice, milk, and/or calcium- fortified soy milk. Instead of doughnuts and packaged cookies, eat frozen yogurt, fruit desserts, low-fat ice cream, muffins made at home or at a bakery, etc. Instead of snacking on potato or corn chips, have some unsalted almonds and walnuts, which offer a variety of beneficial nutrients for your heart and your bones. A well-balanced diet high in fruits and vegetables and low in saturated or trans fat is ideal. 3. Take vitamin and mineral supplements if you're not getting enough calcium, vitamin D, magnesium and other bone nutrients from your diet. Chapters 8 and 9 in my book Osteoporosis Prevention will help you determine if you’re getting enough of the most important bone nutrients. Lately there's been a lot of emphasis on getting enough vitamin D3 in order to promote calcium absorption. Many doctors are now recommending at least 800–1000 IU per day. Roughly 50% or more Americans are Vitamin D deficient. A blood test can determine if you have a Vitamin D deficiency or not. 4. Avoid smoking and excessive drinking. They impair calcium absorption and inhibit the growth of bone-building cells. 5. Consider adding soy foods to your diet. They contain plant estrogens, which may help reduce bone loss. If you eat too much soy food or take a lot of soy supplements, this could suppress your thyroid function and result in thyroid disease. As with most substances including calcium, too much of anything can have undesirable consequences. It's better to drink soy milk or eat soy foods than to take soy supplements. 6. If the preceding measures aren’t sufficient for preventing osteoporosis, consider taking preventive medication. Chapter 11 in Osteoporosis Prevention discusses the advantages and disadvantages of various osteoporosis drugs. Discuss these with your physician. A key consideration should be the drug's effectiveness at preventing both vertebral and non-vertebral fractures. Some doctors have stopped prescribing bisphosphonate drugs (e.g. Fosamax, Actonel, Boniva and Reclast) for more than five years because studies have not shown a fracture benefit past five years and because they want to avoid over-suppressing their patients' bone turnover (the natural process of breaking down and building up of bone), which in turn may lead to spontaneous bone fractures. In order to avoid potential negative effects from long-term use, some patients prefer to take reduced dosages of bisphosphonates and then take a drug holiday for a year or two while monitoring their bone density before restarting the drug. The most serious side effects occur in people who take a once-a-month or once-a-year osteoporosis drug, particularly when it is given intravenously. For first-hand accounts of drug reactions to a once-a-year drug, go to If you need to take an osteoporosis drug but would like to avoid possible flu-like symptoms, extreme bone and joint pain, and even a possible trip to the hospital, take a once-a-week drug such as Fosamax or Actonel, rather than a once-a-month or once-a-year drug. It's common sense that the higher the dosage of a drug, the greater the chance of a negative side effect, which accounts for the strong reactions patients are having to high dosage infusions of bisphosphonates. The most cost-effective osteoporosis drug is alendronate, which is generic Fosamax. Keep in mind that none of the osteoporosis drugs prevent loss of muscle. With proper exercise, you can maintain bone and avoid the muscle atrophy associated with aging. 7. If your bone density is low, find out about low magnitude vibration therapy when it becomes available in your area. This involves standing for 10–20 minutes a day on a medical device that delivers low amplitude vibrations designed to stimulate bone formation. In 2006, it was approved and introduced as an osteoporosis therapy in Europe, Canada, Australia, and a number of other countries in Asia and South America by the Juvent company after more than twenty years of research. I had an opportunity to see the Juvent platform device and talk to company officials in Ireland just after it was launched on the market there. The low magnitude vibration platform is registered with the FDA as a Class 1 device and has been sold in the US for muscle strength and restoration because it stimulates key muscles such as the calf (soleus) muscle, which controls postural stance and balance. As a result, it can help prevent falls, fractures and muscle loss as well as stimulating blood flow. In 2009, the Juvent Company was sold, but its Juvent platform is currently unavailable. Because of demand for the product, two new companies have been formed, one by the original founder called Micro G and the second company called Marodyne, by Clinton Rubin, the primary developer and principal scientist of the technology. Marodyne's device is named the LIV (Low Intensity Vibration) Therapy platform. Hopefully by the middle of 2012, a low magnitude vibration device will be available for sale. NASA has co-funded many of the research studies behind low magnitude vibration technology. Scientists hope that the technology can be used on the space station to help prevent the bone loss in astronauts that occurs in zero-gravity conditions. A few people have started to market ordinary vibrating exercise machines as osteoporosis products. Some of these machines are unsafe and can cause permanent nerve damage. Before buying and using vibrational devices for osteoporosis prevention or muscle restoration, find out if they have been medically approved and shown to be safe and effective in clinical trials. Currently no medically approved devices are available in the U.S. for the treatment of osteoporosis. For more information, see Chapter 12 in Osteoporosis Prevention. 8. Learn about bone density tests before being tested. You’ll profit more from the results. Bone density tests don’t just tell you whether or not you have osteoporosis. They can give information that will help you design an exercise program to strengthen areas of low bone density; moreover, the images can reveal a variety of other medical problems you may not be aware of. It's helpful to deal with a testing center or specialist that will provide this information. For more details click on density tests, sample reports, and see Chapters 13, 14, 15 and 17 in Osteoporosis Prevention. 9. If possible, select an information-oriented test center that provides detailed reports of the spine and hip and that will discuss the results with you. Besides serving as a diagnostic tool, the results on bone density reports can help you select exercises that are right for your needs. See Chapter 15 in Osteoporosis Prevention. Unfortunately, Medicare cuts in bone density test reimbursements have been decreasing from $140 since 2007 down to $55 in 2010. This has resulted in the closure of many private bone density test (DXA) centers, making it more and more difficult to get tested. See the example comments from doctors at the bottom of this page. The March 2010 healthcare reform bill that was signed by President Obama contained a provision requiring Medicare to reimburse DXA bone density tests at no less than $98 for the following two years. But the future of bone density testing in the US is uncertain after 2011. If you've been affected by the cuts or have had difficulty getting a bone density test, contact Donna Fiorentino at the ISCD (International Society of Clinical Densitometry). Her e-mail is dfiorentino@iscd.org. You should also contact your congressional representatives. 10. Ask for copies of your bone density reports and chart your progress. People who are involved in their health care and who discuss the results with their doctors are more motivated to take preventative measures to maintain their bone health. It’s never too late to take steps to avoid bone loss. However, the sooner you start, the easier it is to prevent osteoporosis. In so doing, you’ll also improve your overall health. Here are a few of many comments coming from doctors and bone density test centers as a result of the cuts in bone density test reimbursements.
We are a corporation of 50 OB/GYN's offering
high risk pregnancy services AND DXA scanning with counseling. It was our
vision to be certain women were not only tested but would understand exactly
what to do to maintain or improve bone density. It is a wonderful program
and the feedback from the patients is enthusiastic. However, considering the
cut back in reimbursement, we cannot justify leasing equipment and paying FT
technologist in the future...so for the ladies in our area they will have to
go back to getting tested and being told to 'take Calcium' by their
physician, if told anything at all.
Because of the cuts in Medicare reimbursement,
we shut down our most rural office and returned our equipment. Sadly the
patients who live in this area, must travel 30+ miles to the nearest
locations, and they usually don't or won't. We also had to reduce our office
staff, and if the cuts continue as planned, we will shut down our second
location, reduce our staff again, and work at a loss. Note that we only use
"Certified" Radiologic technologists and all scans are read by a
"Certified" MD - the final reimbursement proposed won't cover
their costs, not including the actual cost of operations. I
am the director of the Osteoporosis Center of Southeastern Massachusetts at Livingston,
New Jersey
The Saint Barnabas Osteoporosis and Because of CMS mandated cuts in reimbursement for bone densitometry, the Saint Barnabas Osteoporosis Center will no longer be able to support our nurse educators or these excellent educational and outreach services as of June 1, 2007. These cuts will also reduce patient access to expert physician consultations re osteoporosis and will remove very valuable resources from the community. We
had plans to perform central DXA at every one of our 16 retirement
communities nationwide to curb the high prevalence of osteoporosis related
fracture that results in profound disability and morbidity among our
residents. The drastic cuts in reimbursement have brought our implementation
to a halt as we can no longer cover the expenses of the Program. I am part of a multispecialty
group medical practice located in I
was certified by ISCD to do DXA scans, but with the cuts, I had to dismantle
my machine and no longer provide the service to my patients. To sit for the
test and take time away from my practice in order to recertify my skills,
while maintaining a solo practice would cost in the area of $20,000. Because
of the declining reimbursement, I cannot offset the expense of ongoing
personnel, license fees, taxes, additional space and maintenance. As the
only civilian DXA in the area, my patients are no longer able to access this
important test. My elderly patients are unable to travel and I am now unable
to provide appropriate care because I have no way to screen or follow them.
Many are very upset. Because
of the service I once provided, I believe I have saved these patients from
future fractures-and in some instances death from their complications, not
to mention the expense associated with their care. Where we once had prompt
diagnosis, treatment and continuity of care we will now have increased
medical costs directly related to this issue. Copyright © 2006 and 2012 by Renée Newman |
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