How to walk away from joint, bone and vascular disease
By Mary Ellen Kuhn

Don’t go out on a limb when it comes to keeping your legs fit and healthy. Diseases of the joints, bones or circulatory system, including osteoarthritis, osteoporosis, and peripheral arterial disease (PAD), tend to strike later in life, so adopting a healthy lifestyle early on will reduce your risk. Here’s what you need to know.

ALL ABOUT OSTEOARTHRITIS
Osteoarthritis, the most common form of arthritis, occurs when joint cartilage breaks down. Any joint can be affected, although those that bear most of your weight—hips, knees and feet—are more susceptible. The exact cause of osteoarthritis isn’t known, but the risk increases if you are over age 45, overweight or have had prior joint injuries, among other conditions.

So never ignore joint pain, counsels Dr. Steven Sides, an orthopedic surgeon with North Colorado Medical Center in Greeley, Colo. “If you can get it cured early on, a lot of times you won’t have longer-term problems with joints,” he stresses.

If osteoarthritis does strike, over-the-counter painkillers like Tylenol or nonsteroidal anti-inflammatory drugs such as Advil and Aleve may provide relief. In many cases, Dr. Sides says, he also recommends the supplements glucosamine and chondroitin.

Something relatively simple like a knee brace or physical therapy to stabilize the knee joint may also do the trick. Other options include steroid injections or a newer treatment called viscosupplementation therapy, which involves injecting hyaluronan, a substance found in joint fluid, into the knee. Even if surgery is indicated, a total joint replacement may not be necessary. In the case of osteoarthritis in the knee, for example, a less-invasive “compartmental replacement, where we just replace the part that ails you,” may be all that’s needed, says Dr. Sides.

BONING UP ON OSTEOPOROSIS
Many of us first think about osteoporosis, a disease of low bone mass, at mid-life.

If you do join the ranks of the 10 million Americans who have been diagnosed with osteoporosis, it’s never too late to improve bone health, according to Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation in Washington, D.C.

“At all stages of the disease, we can help prevent deterioration, we can re-grow some bone that’s been lost,” says Dr. Cosman. In addition to prescription drugs, physical therapy and lifestyle changes can help as well. 

There is also a great deal of emerging news about osteoporosis prevention and treatment:

• The National Osteoporosis Foundation recently increased its recommended daily intake of vitamin D for those over age 50 to 800–1,000 International Units daily.

• A new fracture-prevention drug called Reclast (zoledronic acid) that is administered only once a year holds great promise. “The medication binds to the bone and stays in the bone for a long time,” says Dr. Cosgrove.

• Later this year, the World Health Organization is expected to approve a new computer program to assess a patient’s risk of breaking a bone because of osteoporosis, called the Absolute Fracture Risk index.

DON’T LET PAD CRAMP YOUR STYLE
PAD is still relatively unknown, but it’s common among older adults, says Dr. William Flinn, a vascular surgeon affiliated with Baltimore Washington Medical Center, Glen Burnie, Md. PAD occurs when fatty deposits (plaque) narrow the arteries and reduce blood flow to the limbs. The result is that your extremities—usually your legs—don’t get an adequate blood supply, which can make walking painful.

Testing for PAD is quick and easy: The Ankle-Brachial Index (ABI) involves measuring the blood pressure at the ankle and comparing it with the blood pressure in the arm. “If your ABI is reduced, we know that there’s a blockage of the circulation in the leg,” says Dr. Flinn.

PAD treatment typically starts with lifestyle changes,such as stopping smoking and exercising the legs.

If pain from PAD makes walking difficult, drugs such as cilostazol or pentoxifylline can improve blood flow and lessen discomfort.

Non-surgical artery-opening therapies for PAD are becoming more common, Dr. Flinn reports, including angioplasty, in which a thin tube called a catheter is used to dilate narrowed or blocked arteries. A stent— a cylindrical wire mesh tube—can also be placed in the narrowed artery to keep it open. Bypass surgery may be required if the narrowing involves a long portion of the artery.

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