Bone Problems

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#808080" TEXT="#080000" background="044b8573.jpg"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>MEDI-MAIL</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="MEDIMAIL"><B>home</B></A></div> <div>                                                   </div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#808080" TEXT="#080000" background="045d2083.jpg"> <div> <IMG SRC="0925e370.png" border=0 width="94" height="55" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </td> <td valign="top" height=390 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000" background="04605053.jpg"> <div> <I>Bone Problems</I></div> <div> From your head growing bigger</div> <div> to limbs that mysteriously warm</div> <div> up, the bone problems that strike</div> <div> millions — yet too often go ignored</div> <bR> <div> ASK your GP for a check-up and he'll happily take your blood pressure, look in your ears, measure your wobbly bits and so on — but chances are, he won't talk to you about your bones.</div> <div> For despite the fact that millions of us are affected by some sort of a bone problem — often without realising it — bone health is a low prior¬ity, say some experts.</div> <div> `GPs have prompts on their computer telling them to check patients for signs of cardiovascular disease when they come to the surgery,' says Professor Philip Conaghan, professor of muscu¬loskeletal medicine at the University of Leeds, and a spokesperson for the Arthritis Research Campaign.</div> <div> `However, there is no such prompt for bone disorders, despite the millions who suffer from them. Some conditions can, for example, make bones so weak that they can snap without cause, or can lead to joints unexpectedly collapsing even in the young. And, the earlier they are diagnosed the easier it it is to treat them.</div> <div> `The other problem is that if someone goes to an Accident and Emergency department with a broken wrist they get treated for the broken wrist, but no one follows up to see if an under-lying condition, such as osteoporosis, might have caused it. This means thousands of people are walking around with bone conditions and don't even know it.'</div> <div> Meanwhile, a recent study by the University of Derby has hignlighted shortfalls in treatment for those with osteoporosis, finding that as few as one in eight people at risk of a bone fracture was treated according to national guidelines.</div> <div> Worringly, bone cancer is detected later than any other cancer in young people, sometimes remaining undiagnosed for as long as three years. On average, it is diagnosed 23 weeks from the onset of symptoms, compared with an average five weeks to diagnose leukaemia, and just over six weeks to diagnose a brain tumour.</div> <div> FOR MOST people, bone problems are a result of the ageing process. An adult has 206 bones, more than half of them in the hands and feet, with new bone constantly</div> <div> growing to replace old.</div> <div> `Old bone is broken down — the remains of which are released into the blood — and new bone cells are made in a cycle lasting three months,' explains Professor Cyrus Cooper, an expert in rheumatology and director of the Med¬ical Research Council Muscular Skeletal. Unit. `When we are young, bone is made faster than it is destroyed. Between the ages of 25 and 35 the destroy and renew process is balanced, but as we get older, the bone-making cells become less active and we start to lose bone density.'</div> <div> This can lead to problems such as osteoporo-sis, while Paget's disease causes the cells that make new bone to work too quickly, throwing down new cells even where they are not needed, causing the bones — even those in the skull — to visibly enlarge.</div> <div> Here, we look at some of the more common dis¬orders that can affect bones and their treatment.</div> <bR> <bR> <div> OSTEOPOROSIS</div> <bR> <div> SYMPTOMS: Bone fractures under minimal impact — even a sneeze may be enough to fracture a rib; some sufferers develop a stoop caused by minor fractures in the spine.</div> <div> CAUSE: As we age, old bone is destroyed faster than new bone is made, so our bones become thin-ner and weaker. In someone with osteoporosis this process happens earlier and faster than normal.</div> <bR> <div> Osteoporosis is especially com-mon in women after the menopause as levels of the hormone oestrogen, which is needed for getting calcium from the bloodstream to the bone, and progesterone, which is needed to stimulate the action of the cells which make new bone, drop dramatically.</div> <div> Smoking or taking steroids increase the risk. Osteoporosis affects around three million peo¬ple in the UK, and leads to around 230,000 fractures a year.</div> <div> TREATMENT: Drugs — bisphospho-nates — can slow down the destruction of bone, stopping the condition progressing. Calcitonin, a hormone, has a similar effect. Other treatments include Ralox-ifene which mimics the action of oestrogen, helping maintain bone strength.</div> <div> In balloon kyphoplasty, a small balloon is inserted between frac-tured vertebrae, inflated and then surgical cement is injected in to fill the space. This will help those who become stooped as a result of the disease.</div> <bR> <div> IT HAPPENED TO ME: Retired university administrator Terry Pearce, 58, says:</div> <div> ONE morning four years ago I was putting on my shoe when the muscles in my back cramped. I was in masses of pain, but the doctor told me I'd simply pulled a muscle.</div> <div> Six months later I was still in agony and had an MRI and bone density scan — these showed I had five cracked vertebrae and was suffering from severe osteo-porosis. The back spasms were my muscles trying to protect the weakened bones. It was put down to my early menopause (at the age of 42).</div> <div> I was given morphine and diazepam to reduce the muscle spasms and calcitonin to slow down my bone loss. I was also told I had to stay active to help build new bone.</div> <div> But my recovery was very slow. I had to take eight months off work and later took early retirement. I now have a dog which I walk twice a day — I find I'm okay as long as I keep moving.</div> <bR> <div> NATIONAL Osteoporosis Society helpline: 0845 450 0230 www.nos.org.uk</div> <bR> <div> AVASCULAR NECROSIS</div> <div> SYMPTOMS: Aching in the groin and buttocks; symptoms will gradually worsen over weeks or in some cases days and may lead to a limp; the pain may become persistent and this together with a loss of mobility from the joint can make it impossi¬ble to walk.</div> <div> hips, this is caused by a temporary or permanent interruption to the blood flow to the bone. Without suf¬ficient blood flow the bone cannot repair itself and so breaks down and dies, within weeks, even days.</div> <div> The condition can occur as a result of an injury or dislocation or from conditions which reduce blood flow around the body, such as dia¬betes and alcoholism.</div> <div> Around 35 per cent of cases are caused by prolonged high dose steroid treatments given for asthma, for example. It may also</div> <div> lead to osteoarthritis becauseof the damage to the joint and bone. Avascular necrosis most commonly strikes between the ages of 30 and 50. There are around 4,000 cases each year in the UK.</div> <div> TREATMENT: Prostacyclin a drug which encoruages the blood vessels to dilate can be given intravenously to help promote blood flow to the affected area.</div> <div> Another treatment is surgery to remove the damaged bone; this allows blood to flow to the area,</div> <div> encouraging the production of new bone. Damaged joints often need replacing.</div> <bR> <bR> <div> THE charity Contact a Family has a website for people to find others who have the same condi¬tion www.makingcontact.org</div> <bR> <bR> <div> PAGETS DISEASE</div> <div> SYMPTOMS: Bones can visibly thicken and become deformed. Persistent aching or shooting pains; bowing of the legs or spine; fractures occur from very minor injuries. The affected area can be unusually warm as the condition causes bones to have more blood vessels than normal. If the skull is affected it may visibly enlarge and can cause deafness or tinnitus. Many people have no symptoms.</div> <div> CAUSE: New bone is replaced much quicker — 40 times faster — than normal, so bones become bigger. However they're not as strong and so are liable to bow or break. Typically the spine, pelvis, legs or skull are affected. Around one million Britons have</div> <div> this condition, which is thought to have a genetic or viral link. Men are more at risk, as are those over 40, although it's not clear why.</div> <div> TREATMENTS: Bisphosphonates (also used for osteoporosis) can slow down the natural destruction of the bone, in turn, slowing down the bone turnover and replacement process, stopping the condition progressing. In extreme cases surgery may be necessary to shave off and realign bone. A new drug, Denosumab, now under development works by interrupting the signals that accelerate the destruction and renewal process.</div> <div> NATIONAL Association for the Relief of Paget's Disease, 0161 799 4646 www.paget.org.uk</div> <bR> <div> OSTEOSARCOMA</div> <div> SYMPTOMS: Affected bone will feel swollen and warm to the touch. It may also hurt to put weight on it. Unexplained weight loss in late stages.</div> <div> CAUSE: A tumour inside the bone. The most common form is osteosarcoma which tends to affect young people aged between ten and 20. It occurs most often in the thigh bone.</div> <div> The cause isn't clear although genes may play a part; it might also form as a result of an injury. Around 500 new cases are diagnosed in the UK each year.</div> <div> TREATMENT: Chemotherapy to shrink the tumour makes it easier to remove it surgically. Radiotherapy may be used</div> <div> if the tumour is in the spine for example and therefore inoperable.</div> <div> Sometimes amputation is the only option if the disease is found in the later stages.</div> <div> A new drug, Mifamurtide, improves patients' survival rates. The treatment is already available in America and should soon be assessed in the UK. Mifamurtide works by stimulating the body's immune cells to control the spread of osteosarcoma.</div> <div> MACMILLAN Cancer Support www.macmillan.org.uk Helpline: 0808 808 2020.</div> <bR> <div> OSTEOMYELITIS </div> <div> SYMPTOMS: Intense pain in one</div> <div> area; redness and inflammation</div> <div> around the neighbouring joints, a</div> <div> high temperature, nausea and</div> <div> feeling generally unwell.</div> <div> A wound in the area may produce pus.</div> <div> CAUSE: An infection of the bone usually caused by bacteria, some¬times a fungus. It is diagnosed by swabbing the wound to check for bacteria or through a blood test. In children it often occurs for no apparent reason; in adults it's normally after an injury or cut (bacteria gets into the blood¬stream and attacks the bone). It's common among diabetics —they are prone wounds in their feet due to bad circulation. If it is left untreated, osteomyelitis can lead to blood poisoning which can be fatal. There are around 2,000 new cases in the UK every year.</div> <div> TREATMENT: Antibiotics to kill the infection. Sometimes surgery is necessary to remove dead bone and if the infection has caused an abscess, this might need draining. The gaps left in the bone will be filled with a bone graft.</div> <div> In extreme cases if the infection eats a lot of the bone, amputation might necessary.</div> <div> DIABETES UK www.diabetes.org.uk, 0845 120 2960.</div> <bR> </td> </tr></table></body>