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December 2008

Your guide to orthopedic health

Bones &Joints

Sally Field, Advocate for Bone Health

Page 3 Exercising for Life

Page 4 Supplements

Page 6 Healing at Home

BONES & JOINTS

An Advertising Supplement to USA Today2

Look after yourselfKeeping your bones healthy to prevent osteo-porosis may not be at the top of your wellnesslist. But it should be. As an osteoporosis special-ist and clinical scientist I have seen first-handthe tremendous physical, emotional and eco-nomic toll this disease can take on individualsand our nation as a whole.Osteoporosis is a disease in whichan individual’s bones become weakand are more likely to break. Break-ing a bone from osteoporosis cancause severe pain that may not goaway, disability, deformity and adiminished quality of life. Certainbone breaks, such as those of thehip, will increase a person’s risk ofdying and are common reasonswhy people need long-term nursinghome care. Today, 10 million Amer-icans age 50 and over have osteo-porosis and nearly 34 million morehave low bone mass, placing themat increased risk for the disease.

In 2004, the U.S. Surgeon Gen-eral’s Report on Osteoporosis andBone Health reported that osteo-porosis is a serious threat to ournation’s public health and thatthere is a major the economic bur-

den caused by this disease. In2005, osteoporosis was responsiblefor an estimated two million frac-tures and $19 billion in healthcarecosts. By 2025, experts predict thatosteoporosis will be responsible forthree million fractures and $25.3billion in costs.

Osteoporosis is largely preventa-ble and treatable. The NationalOsteoporosis Foundation recom-mends steps that all individualsshould take to care for their bones:eat a balanced diet rich in calciumand vitamin D, do regular weight-bearing exercise and avoid smok-ing and excessive alcohol con-sumption.

It is also important to talk to yourhealthcare professional about bonehealth to help you better understandyour own risk for osteoporosis.

Depending on your age and risk fac-tors, you may need to have a bonedensity test or take medication tohelp prevent or treat osteoporosis.

For more information on bonehealth and osteoporosis preven-tion, diagnosis and treatment,please visit www.nof.org or call 1(800) 231-4222.

Felicia Cosman, MD, is clinicaldirector for the National Osteo-

porosis Foundation, MedicalDirector of the Clinical Research

Center at Helen Hayes Hospital inWest Haverstraw, NY and Profes-sor of Clinical Medicine at Colum-

bia University.

CONTENTSForward from the National

Osteoporosis Foundation 2

Spotlight on: Sally Fields

– Advocate for Bone Health 2

Benefits of Exercise for

Bone & Joint Health 3

Supplements for Strong

Bones & Joints 4

Nintendo Wii transforms

the way Exercise is done 5

Healing while Relaxing &

Working at Home 6

Complementary Alternative

Medicine 7

Osteoporosis: Symptoms,

Diagnosis & Treatment 8

Joint Replacement 8

Understanding Enzymes for Bone &

Joint Health 11

BONES & JOINTS A TITLE FROM MEDIAPLANETPublisher: Anthony Chiaravallo, +1 646 922 1403, [email protected]: Marlene Pitturo, PhDPrint: Vertis Design: Jez MacBeanPhotos: istockphoto.com

Advertising Policy StatementThe acceptance of advertising in thispublication does not constitute orimply endorsement by Mediaplanet.People with Bone & Joint problemsshould consult their physiciansbefore using any medication ortherapy. Mediaplanet accepts noresponsibility for claims made in theadvertising component of thispublication.

Mediaplanet is the leading publisherof high-quality and in-depth analysison topical industry and marketissues, in print, online and broadcast.For more information aboutsupplements within the daily press,contact Kayvan Salmanpour on +1646 922 1400

www.mediaplanet.com

Sally Field – OsteoporosisBecause Sally Field was at risk for osteoporosis, her physician was mon-itoring her bone health regularly. Even knowing she was at risk, Fieldwas shocked when one of her bone mineral density (BMD) tests showedshe had osteopenia (or low bone mass) because she has always led ahealthy, active lifestyle.

Her physician decided to contin-ue her calcium supplementationand increased her vitamin Dintake, and she continued to eathealthy and exercise regularly.However, calcium and vitamin D

alone were not enough to preventthe progression to osteoporosis.Field and her doctor then dis-cussed treatment options and shewas prescribed a medication totreat her osteoporosis.

After a year on a prescriptiontherapy, Field received a follow-up BMD test, and her resultsshowed that her bone health hadimproved. Through the RallyWith Sally For Bone Health cam-

paign, sponsored by Roche andGlaxoSmithKline, Field helps edu-cate women over 50 years oldabout the importance of bonehealth and the increased risk ofosteoporosis. As part of her cam-paign, Field travels across thecountry encouraging women tonot let osteoporosis slow themdown.

To learn more about bonehealth, log on to www.bone-health.com.

Editorial content provided byRoche and GlaxoSmithKline.

BONES & JOINTS

An Advertising Supplement to USA Today 3

Exercise for a healthy lifeExercise is a magical elixir for maintaining strong bones and helpingkeep osteoporosis and other bone thinning conditions at bay. However,aging athletes need extra time and care for ligaments, muscles, andjoints to work properly, says Marlene Piturro, PhD.

The National Osteoporosis Foun-dation recommends weight-bear-ing exercise such as running,walking, tennis, stair climbing,and aerobics to reduce bone lossand help prevent osteoporosis.Swimming and biking are goodcardiovascular workouts but don’tput enough stress on bones to pre-vent bone thinning.

Before undertaking any exer-cise program, follow these tipsfrom the American Academy ofOrthopedic Surgeons:• Check with your doctor beforestarting any exercise program.

Your individual medical condi-tions and a history of injuries willhelp you and your doctor decidewhat exercise regime is right foryou.• Take lessons or work with a per-sonal trainer to help you to doyour chosen exercise or sport,thereby avoiding injuries such aspulled muscles or tendonitis• Warm up and stretch for at least3-5 minutes before exercising toavoid injury• Plan 20-30 minutes of moderateexercise daily rather than being a‘week-end warrior.’• Take daily calcium and VitaminD supplements for bone strength• After vigorous or long workoutsrest your body the following day• For seniors, choose a balancedfitness program such as Health-ways’ Silver Sneakers.

Strong on Bone Health,Easy on the StomachKeeping bones strong involves combining ahealthy diet, regular exercise, and gettingenough daily calcium. The Arthritis Foundation(www.arthritis.org) recommendsfor post-menopausal women andmen over 50 years of age 1,200mg per day of calcium and 1,000mg for folks under 50. The Foun-dation notes that eating greenleafy vegetables, drinking low-fatmilk, yogurt and cheese, andchoosing calcium-fortified juice,bread, and cereal provide a calci-um-rich diet, but that most peoplerequire a daily calcium supple-ment to achieve the 1200 mg or1000 mg suggested daily intake ofthe bone-building mineral.

The Arthritis Foundation alsosays that all calcium supplementsare not equally potent. It advisesconsumers to check the amount ofelemental calcium present in asupplement. Studies suggest thatabsorption of calcium from solu-ble calcium source is as good asmilk if not better when deliveredunder 200 mg each time. Thatmeans:• Taking several smaller dosesbecause the body can only absorbsmall amount of calcium at a time• Adding a vitamin D supplementto use calcium most efficiently

TOTALLY CALCIUM, a 100%water soluble and absorbablechelated calcium supplement pow-der available from Naples Market-ing System of Burlington, MA,enhances the bio-available calciumcontent of foods and beveragesbecause the intestine absorbs it effi-ciently without constipation orbloating. Available in powder formin convenient ‘stick’ packets con-taining 120 mg of calcium, it meetsthe Arthritis Foundation’s recom-mendations for taking calcium insmall doses. The powder is easilymixed in hot or cold beverages,cereals, soups, salads and bakingmixes. It could be a very good alter-native source of calcium for lactoseintolerants without the cholesteroland calories of milk. TOTALLY

CALCIUM doesn’t require stomachacid to be dissolved prior to absorp-tion as do calcium carbonate andcalcium phosphate. The supplementis an efficient way to maintain

healthy bones for life. For limitedtime only to receive free sample bymail use promo code: MYCALCIUMfor ordering item code: 001 atwww.totallycalcium.com.

Silver SneakersSilver Sneakers group exerciseclasses were developed for bothactive older adults and couchpotatoes. Its group classes incor-porate these exercise modalities:• Muscular strength and rangeof motion using free weights,elastic tubing with handles, anda ball for resistance • The Cardio Circuit class helpsbuild fitness and endurancethrough upper body strengthen-ing, non-impact aerobic chore-ography • Silver Splash involves non-swimming exercise in the waterto improve agility, flexibility andcardiovascular endurance.• YogaStretch provides a seriesof seated and standing yoga pos-tures designed to increase flexi-bility, balance and range ofmotion. Breathing exercises andfinal relaxation promote stressreduction.

BONES & JOINTS


Benefits of supplements forjoint relief and preventionThe National Institute of Health (NIH) esti-mates that over 27 million American adultslive with pain and impaired mobility fromosteoarthritis (OA), a degenerative joint diseasecaused by cartilage breakdown, writes Mar-lene Piturro, PhD.

Nearly one-third of them rely ondietary supplements, mostly glu-cosamine and chondroitin sulfate(GCS) to reduce pain and slow thedisease’s progression. Althoughsome research suggests that glu-cosamine and/or chondroitin posi-tively impact OA other supplementspromoted for treating OA; devil’sclaw, turmeric, and ginger; have notproduced measurable results.

Glucosamine chondroitin sulfatesupplements are hugely popularwith osteoarthritis sufferers, whospent $1.7 billion on them in 2005,according to Nutrition BusinessJournal. Both Glucosamine are nat-ural substances found in andaround cartilage. Glucosamine isusually obtained from shrimp, lob-ster and crab shells; chondroitinfrom shark and cattle cartilage. Glu-cosamine is an amino sugar pro-

duced by the body and distributedin cartilage and other connectivetissue, while chondroitin sulfate is acomplex carbohydrate that helpscartilage retain water. GCS supple-ments augment the body’s naturalproduction of these substances,essential as cartilage deteriorateswith age.

The Science behind GSCIn 2007 World Health Organization(WHO) researchers performed ameta-analysis of major studies onGCS’s efficacy for pain relief andstructural management of hip andknee OA. Conclusive results provedelusive because of two major fac-tors: the supplements’ form andpatients’ use of pain medication. Toalleviate pain OA sufferers oftenrely on pain medications: prescrip-tion Celebrex, and over-the-counter

analgesic and anti-pyretic aceta-minophen (Tylenol); non-steroidalanti-inflammatory drugs (NSAIDS)including Aleve and Naprosyn, andibuprofen (Advil, Motrin). When OApatients combine prescription orover-the-counter pain relieverswith GCS, determining what causespain relief is difficult. A 2007 studyin Arthritis Rheum. reported thatpatients taking a daily dose of 1500mg of chondroitin sulfate for sixmonths experienced more effectivepain relief than those taking either aplacebo or acetamphetamine(Tylenol). However, WHO releasedthese findings:• There is compelling evidence thatGCS may interfere with OA’s pro-gression• GCS was most effective inpatients with moderate-to-severeknee pain but did not reduce pain inthe overall group of all OA patients • Some evidence suggests that GCSpositively restructures joint andcartilage

In the U.S., the largest study ofGCS’s impact on osteoarthritis isNIH’s 2005 study of 1500 patientsin GAIT (Glucosamine/chondroitinArthritis Intervention Trial). It com-pared a placebo, glucosamine

hydrochloride, chondroitin sulfate,a combination of glucosamine andchondroitin, and Celebrex. GAIT’simportant findings were that glu-cosamine and chondroitin, aloneand in combination, did not pro-vide significant relief from the painof knee OA. However, a subset ofthe study participants with moder-ate to severe pain experienced sig-nificant relief from GCS. StephenStraus, MD, Director of NIH’sNational Centers of Complementa-ry and Alternative Medicine(NCCAM), sums up GAIT’s results:“We now know that this supple-ment combination [GCS] may offeran option to some patients,although much more remains to belearned about glucosamine andchondroitin sulfate.”

Because the GAIT study showedsome improvement with GCS NIHsponsored a two-year follow-upstudy called GAIT II. Just releasedresults from GAIT II indicate thatafter two years, glucosamine andchondroitin in various dosages andcombinations did not slow cartilageloss in OA of the knee.

Luke Bucci, PhD, CCN, CNS andVice President, Research of SchiffNutrition International, contendsthat GAIT researchers used chon-droitin capsules that didn’t dissolveproperly, yielding no chondroitin inthe bloodstream. “In Europe chon-droitin is prescribed as a slow-act-ing drug for the treatment ofosteoarthritis (SYSADOA) and is

widely recommended as a thera-peutic agent,” he says. Results bearhim out. A 2008 study onOsteoarthritis and Cartilage byDaniel Uebelhart of Zurich,Switzerland, found that chondroitinsulfate proved effective in sympto-matic knee OA by building newcartilage. Additionally, “the tolera-bility and safety of chondroitin sul-fate was very favorable.” An earlierstudy by Dr. Uebelhart showed thatchondroitin sulfate retarded theprogression of OA in the knee butdidn’t affect pain.

Although science has yet toprove or disprove GCS’s useful-ness conclusively, there is sub-stantial evidence that glucosaminechondroitin supplements buildnew cartilage and reduce pain forsome people. Maintaining jointhealth for each individual involvesfinding the right combination ofsupplements, pain relieving med-ications, exercise, calcium-richfoods, and optimum weight.Patients should talk to their doc-tors about the best path to jointhealth for them.

FYI• National Institute of Complemen-tary and Alternative MedicineClearinghouse www.nccam.nih.gov• National Institute of Arthritis andMusculoskeletal and Skin Diseaseswww.niams.nih.gov• Office of Dietary Supplements,NIH www.ods.od.nih.gov

BONES & JOINTS


Healing while relaxingand working at homeFor 43 million Americans with arthritis and another 65 mil-lion living with back pain, home can be made a haven ofsoothing relief from unyielding outdoor and indoor envi-ronments. The comfort and buoyancy of warm waterwhirlpool baths eases sore muscles andimproves blood flow while specially-designed anti-fatigue floor mats can protectthose with compromised joints and backpain from hard, unforgiving floor surfaces.An assortment of pillows, wedges, footrests, and lifter-seat cushions placed strate-gically on chairs and couches can enhancerelaxation and reduce pain. And an array ofproducts that increase mobility, promotejoint preservation and conserve energy canhelp people with arthritis better cope with

everyday tasks. Just about every area of thehouse can benefit from products and tech-nologies that help people with pain andimpaired flexibility function better. Here aresome ideas.

Bedroom/Living roomLong flexible shoehorns, easy grip nail clip-pers, grip button hooks, dressing sticks,door handle grips, magnetic jewelry clasps,and easy pull sock aids all help arthritis suf-ferers manage everyday tasks more easilyand maintain their independence.

For sports-minded adults who want to mini-mize weight-bearing exercise, Nintendo’s Wii, asuite of video games in virtual reality, keeps themind and body moving and the competitivejuices flowing. Residents of Sedgebrook, anErickson Retirement Community (ERC) in Lin-colnshire, Illinois discovered the Wii in Decem-ber 2006 as they tested ‘hot’ toys for theirgrandkids. They parked the Wii outside a diningroom, then started Wii bowling after dinner.They were hooked and bowled until midnight.Resident Flora Dierbach, an early Wii adaptor,asked Ian Brown, the campus director, to buy aWii console for the campus. After watching theresidents play, he enthusiastically agreed.

Soon, all of Erickson’s 23 campuses had Wiis,with Nintendo donating 20 consoles after itsaw the Erickson mass mania for Wii. In 2007ERC residents from campuses in Texas, Illinois,Virginia and Maryland competed in a hotlycontested virtual Wii Bowling Tournament(www.erickson.com/ericksonvideogallery).

In addition to Wii bowling, Wii Fit, a set ofvirtual reality applications that tests users forbalance, body mass index, body control andthen offers yoga, balance, strength trainingand aerobics modules, has also proven popular.Dr. John Parrish, Executive Director of theErickson Foundation, ERC’s charitable arm,evaluates Wii’s impact: “As is true throughoutone’s entire life span, engagement in low-impact activities such as Wii games is protec-tive of limbs and joints, typically promotesfriendships, and encourages periodic stand-out performances of individual competitors. Itenables the game player to experience thedirect core benefits of safe physical movementand helps eye-hand coordination. “ He expectsmore systematic investigation into the defin-ing characteristics and underlying mecha-nisms of Wii’s benefits and adds: “Our observa-tions suggest that Wii is among many sourcesof fascination with capacity-extending, life-expanding technologies for people of any age.”

NINTENDO’S Wii EXPANDS EXERCISE OPTIONS

Ergonomic pillows, wedge pillows to relievepain, knee/hip pillows and foot and leg restsall allow people with aching bones andjoints to position themselves comfortably inbed, chair or sofa. A moist heat muff helpssoothe aching fingers while the user relaxesor watches television, while a lap desk pro-vides a convenient portable writing area inany room.

KitchenLong hours in the kitchen standing on hardfloors is tough on arthritic joints, and flimsyfloor mats that can slip and lead to falls cancause injury. In contrast, high-quality floormats put a cushion between non-givingfloors and aching hips, knees and ankles.Such floor mats should be durable, anti-slip, stain-resistant and provide substantialcushion between the floor and your feet.Easy open kitchen scissors, automatic jaropeners, pain relief gloves, and assortedgrippers help keep hands moving freely. TheArthritis Foundation recommends gentlestretching and frequent breaks from foodpreparation and cooking

FYI• www.gelpro.com Anti-fatigue floor mats• www.aidsforarthritis.com Products forpeople with arthritis and other health issues• www.watertechtn.com WaterTechWhirlpool Baths• www.arthritis.org The Arthritis Foundation

Aching backs, knees, shoulders, hips, elbowsand wrists send millions of Americans toalternative health practitioners for pain relief.Complementary and Alternative Medicine(CAM) remedies span a wide spectrum: dietarysupplements, chiropractic, acupuncture andacupressure, aromatherapy, yoga, biofeed-back, magnets and local electrical stimulation,to name a few. Here’s a glimpse at two popularCAM approaches to pain relief.

Brian Berman, MD, director of the Uni-versity of Maryland’s Center for IntegrativeMedicine, led a NCCAM-sponsored study(www.nccam.nih.gov) on 570 patients withknee osteoarthritis, showing that acupunc-ture, a technique that penetrates the skinwith thin, solid metallic needles manipulat-ed by the practitioner, relieved pain betterthan ‘sham’ acupuncture and no treatment.Recent surveys indicate that 2.1 millionAmericans use acupuncture annually,accounting for around 5 million visits topractitioners for pain relief.

In Dr. Berman’s study all participantswere allowed to use conventional care forarthritis such as anti-inflammatory medi-cines, if they chose. By the study’s eighthweek, patients receiving acupuncture func-tioned better than either of the other twogroups and by the 14th week, the acupunc-

ture group also reported significantly lesspain. “While there’s no cure for osteoarthri-tis, acupuncture helped improve functional-ity and reduce pain. It’s an important part ofa multidisciplinary approach to this dis-ease,” Dr Berman concluded.

According to NCCAM, each year nearlyone-quarter of U.S. adults experience lowback pain and up to 20 percent of themhave sought relief through chiropracticadjustment. Today’s chiropractors haveadded a new arrow to their quiver—spinaldecompression. Marco Caruso, D.C. of SpineCare in Eastchester, NY explains that he seespatients with neck pain, herniated discs,sciatica, stenosis and other painful muscu-loskeletal conditions. “We use MRIs, CT

scans and physical examination to deter-mine the nature of the problem and feedthat information into our computerizeddecompression table, which gently pullsand relaxes the spine,” he says.

Because a computer directs the angle,strength and duration of the 30-45 minutetreatments, practitioners feel that spinaldecompression is more effective than tradi-tional traction. Dr. David Lans of NewRochelle offered this testimonial about spinaldecompression: “I had herniated disk surgeryin 1990, was fine for 14 years but then start-ed to have severe sciatic pain three years ago.I didn’t want any more surgery so I hadspinal decompression treatment and the painhas been completely gone for one year.”

Spinal decompression is FDA approvedbut does not yet have a sufficient body ofscientific research supporting its efficacy tobe covered by many insurers.

BONES & JOINTS


Alternative therapies

Benefits of Hydro-Therapy for Joint ReliefHydrotherapy, or water therapy, is the use of water to relieve discomfort and promote physical well-being. NIH’sOffice of Complementary and Alternative Medicine notes that hydrotherapy is used for a number of therapeu-tic purposes. Hydrotherapy modalities include bathing in heated water as from hot springs or the sea, mineralbaths, and water-jet massage, or whirlpool. Hydrotherapy dates back to ancient Greek and Roman times andhas long been popular in Europe and the United States.

Whirlpool baths are a popular standard treatment for athletic injuries and sprains, often alternating with iceor cold packs. As a CAM remedy for osteoarthritis, rheumatoid arthritis and more routine muscle and joint pain,hydrotherapy is often combined with other treatments. Stretching, mild exercise, massage, diet, aromatherapy,adding essential oils to the water, herbal wraps and mud packs are often used to enhance hydrotherapy’s bene-ficial impact on aching muscles and joints. Hydrotherapy is considered a safe and low-risk treatment modality,although prolonged exposure to too much heat or cold is not advised.

A whirlpool bath uses heat, buoyancy and massage to relieve stress, increase blood flow to muscles and jointsand relieve pain. Warm water massage stimulates the body to release endorphins that reduce stress and promotea good night’s sleep. The Arthritis Foundation calls hydrotherapy tubs a safe, ideal environment for relievingsymptomatic arthritis pain, adding that using a whirlpool bath adds another component to therapy-massage.

With almost 20 million Americans suffering from arthritis most seek medical attention for their chronic, andsometimes acute, condition. Presently, there is no cure for arthritis, and conventional medical treatment some-times is not enough for preventing or stopping the pain and disability that results. A variety of methods, allopath-ic and alternative, exist to manage the symptoms of arthritis. Exercise therapy has been proven effective in reliev-ing pain and improving mobility -- however, for people with arthritis, normal exercise can be painful. Hydrothera-py offers relief for joint pain and muscle aches without putting too much stress on your painful joints.

Today's whirlpools have gone far beyond their humble origins of hydro-massage therapy. High-end unitsnow feature the most advanced design and technology available offering users a safe and effective way to healthemselves within the privacy and comfort of their own home.

BONES & JOINTS


Osteoporosis: symptoms,diagnosis and treatmentsAccording to the National Osteoporosis Foun-dation (NOF) 10 million Americans over 50years of age have osteoporosis and nearly 24million have osteopenia (low bone mass), leav-ing them with thinning bones.In 2005, osteoporosis caused nearlytwo million bone fractures, cost thehealth care system $19 billion, andinflicted severe pain, disability anddiminished quality of life on thosewith the disease. Osteoporosis caus-es bones to thin and become proneto fracture. In contrast to osteo-porosis’ brittle bones, normal bonescontinually change, with somebone cells dissolving and new cellsreplacing them through a processknown as ‘remodeling’. In osteo-porosis and osteopenia, too muchbone breaks down, with too littleremodeled bone replacing it. Brittle,fracture-prone bones result.

What causes osteoporosis?Many factors contribute to boneloss in both men and women. • In women, estrogen deficiencysubsequent to menopause• Hormone deficiencies in youngwomen who stop menstruatingfrom anorexia or intense exercise • Removal of both ovaries • In men, low levels of testosterone• Parathyroid and growth hormoneimbalances• Medications including high levelsof synthetic thyroid, and corticos-teroids for treating asthma andrheumatoid arthritis• Inadequate dietary calcium andVitamin D• Lifestyle factors-smoking, lack ofexercise, and excess alcohol

Ask these Questions to deter-mine your risk for Osteoporosis• I am small and thin, and Cau-casian or Asian• I or an immediate family memberbroke a bone as an adult

• I am postmenopausal• I have had early or surgically-induced menopause• I have taken immunosuppressivemedication or chemotherapy forcancer• My diet is low in dairy productsand other sources of calcium• I am physically inactive• I smoke cigarettes or drink alcoholin excess• I have taken high doses of thyroidmedication or glucocorticoids for 3months or more

The more ‘yes’ answers thegreater your risk of osteoporosis

Source: National OsteoporosisFoundation,2008

Diagnosing osteoporosisDoctors diagnose osteoporosisusing a fast and painless bone den-sity test called dual energy X-rayabsorptiometry (DEXA). DEXAmeasures how many grams of calci-um and other bone minerals arepacked into the scanned bone seg-ment. The higher the mineral con-tent, the denser the bones, and theless likely they are to break. DEXAmeasures bone density on bones atrisk of osteoporotic fractures—thelumbar vertebrae, femur, wrist andforearm. DEXA scanners are eitherlarge machines on which thepatient lies down (central devices)or smaller machines that scan fin-gers, wrists and heels.

While DEXA is the standard bonedensity test, quantitative computertomography (QCT) and ultrasoundare also used. To increase access toosteoporosis detection globally, theWorld Health Organization hasdeployed FRAX, a web-based tool

that predicts the ten-year risk ofosteoporosis fracture in men andwomen. FRAX will be of consider-able value to health care profes-sionals and policy makers in coun-tries with few DEXA scanners.

The U.S. preventive Services TaskForces recommends routine bonedensity screening for women age 65or older, those 60 years old withincreased osteoporosis risk, andwomen 50 and older who have hada fragility fracture.

Preventing osteoporosisThe good news is that bone thin-ning can be prevented and/orslowed through several classes ofmedications. The treatments workin different ways and may be delin-eated as follows:• Bisphonphonates-Boniva, Fos-amax, and Reclast slow the rate ofbone thinning and may be pre-scribed for both men and women• Raloxifene-Evista, is a selective

estrogen receptor modulator(SERM) prescribed only for women;it slows bone thinning• Hormone Replacement Therapy-replacing estrogen in women with-out uteruses and estrogen/progrestinfor those with uteruses decreases riskof hip fracture but slightly increasesrisks associated with breast cancer,heart attack, and stroke. For menwith low testosterone levels, testos-terone injections, gels and patcheshelp prevent osteoporosis • Calcitonin-a naturally occurringhormone that helps regulate calciumlevels and build bones. It is adminis-

tered via injection or nasal spray• Parathyroid hormone-injected inmen and postmenopausal womenwith severe osteoporosis at high riskfor bone fracture

No matter what medication yourdoctor prescribes to prevent or treatosteoporosis, add high-quality cal-cium and Vitamin D supplementsand calcium-rich foods to your diet;do regular weight-bearing exerciseto maintain bone health. Avoidsmoking and excess alcohol. Withdiligence and cooperation betweendoctor and patient, osteoporosis ishighly preventable and treatable.

Medications Don’t Work If PatientsDon’t Take ThemCompelling research shows that bisphosphonates effectively prevent andtreat osteoporosis, yet fewer than 50 percent of patients stay on their med-ications for more than a year. Canadian scientists led focus groups to find outwhy. The results: belief in the importance of taking medication for osteoporo-sis, medication-specific factors, belief regarding medication and health, rela-tionship with their doctors, and getting updated information about theirdrugs impacted compliance. In another study, Israeli researchers surveyed4448 women taking biphosphonates, finding that 20% stopped after the firstmonth, with most taking their medications for six months, then stopping. Theresearchers found that rotating medications, offering pharmacy discounts,and physician follow-up in the first three months promoted compliance. -MP

National Osteoporosis Foundation www.nof.org, or call 800 231-422

JOINT REPLACEMENTAn athlete’s passion for running, racquetball, aerobics, orskiing may outlast his aging hips and knees. But forBoomers and others with damaged joints, a new genera-tion of replacement parts and cutting-edge surgical tech-niques minimizes recovery time and gets them back on thecourt, track or slopes in record time.

From the surgical suite, less invasive techniques andmicro-targeting cut recovery time and improve outcomes.Hip resurfacing reshapes and caps the femur, preservingmost of the patient’s own bone as opposed to convention-al total hip replacement, in which surgeons remove thehead of the femur, replace it with a metal stem insertedinto the thigh bone, then fit the joint socket with a metalshell in a plastic liner. Hip resurfacing works best for menunder age 50 because of their large bones. Laparascopichip surgery (LHS) is minimally invasive compared to con-ventional total hip replacement described above. LHSinvolves a small incision in the front of the hip and followsthe natural plane down to the joint, as opposed to cuttingthrough muscles and tendons. Smaller knees for womennow account for approximately 10% of knee replace-ments, although some orthopedic surgeons such as Dr.

Thomas Barber, an American Academy of Orthopedic Sur-geons board member, argue that there is little evidence ofbetter outcomes with gender-specific knees lesseningpain. On the horizon are spine and tissue replacement forBoomers who just won’t quit.

Fast Facts• Presenters at the 2008 annual meeting of the AmericanAcademy of Orthopedic Surgeons, predicted that thenumber of first time total knee replacements will jump673% by 2030• Total first time hip replacements will climb 175% by2030• Medical Marketing Diligence 2008 predicts that sales oftitanium, polymers, and other new biomaterials for long-lasting replacement joints will soar to $10 billion by 2011• On 7/18/08 the Boston Globe noted that _ to 2/3 of allpatients receiving hip or knee replacements were over-weight • ChangeWave 2008 forecast demand for joint replace-ment experiencing the largest surge among medical treat-ments in the next two years

For years, I hoped calcium, vitamin D, and exercise would keep my bones healthy. But I got osteoporosis anyway, so my doctor started me on once-monthly BONIVA. In most women, BONIVA works with the body to help stop and reverse bone loss. My test results proved I was able to stop and reverse my bone loss with BONIVA. And studies show, after one year on BONIVA, 9 out of 10 women did, too.†

BONIVA is a prescription medication for the management of postmenopausal osteoporosis.Important Safety Information: You should not take BONIVA if you have low blood calcium, cannot sit or stand for at least 60 minutes, have severe kidney disease, or are allergic to BONIVA. Stop taking BONIVA and tell your doctor right away if you experience difficult or painful swallowing, chest pain, or severe or continuing heartburn, as these may be signs of serious upper digestive problems. Follow the dosing instructions for once-monthly BONIVA carefully to lower the chance of these events occurring. Side effects may include diarrhea, pain in the arms or legs, or upset stomach. Tell your doctor and dentist about all the medicines you take. Tell them if you develop jaw problems (especially following a dental procedure) or severe bone, joint, and/or muscle pain. Your doctor may also recommend a calcium and vitamin D supplement.You are encouraged to report negative side effects of prescription drugs to the FDA.Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Bone density measured at the lumbar spine after 1 year of treatment. Individual results may vary.

Bone density measured at the lumbar spine, total hip, or trochanter; 3 out of 4 at the femoral neck.

Please read Patient Information on the next page.

*

†

BONIVA and symbol are trademarks of Roche Therapeutics Inc. © 2008 Roche Laboratories Inc. All rights reserved. BO2352R0

Ask your doctor if BONIVA is right for you. And for a free trial offer, call 1-866-571-6891 or visit tryBONIVA.com

BONIVA did more for me than stop my bone loss. It reversed it!*

Patient InformationBONIVA® [bon-EE-va] (ibandronate sodium)TABLETS

Rx only

Read this patient information carefully before you start taking BONIVA. Read this patient information each time you get a refi ll for BONIVA. There may be new information. This information is not everything you need to know about BONIVA. It does not take the place of talking with your health care provider about your condition or your treatment. Talk about BONIVA with your health care provider before you start taking it, and at your regular check-ups.

What is the most important information

I should know about BONIVA?

BONIVA may cause serious problems in the stomach and the esophagus (the tube that connects your mouth and stomach) such as trouble swallowing, heartburn, and ulcers (see “What are the possible

side effects of BONIVA?”).

You must take BONIVA exactly as prescribed for

BONIVA to work for you and to lower the chance

of serious side effects (see “How should I take

BONIVA?”).

What is BONIVA?

BONIVA is a prescription medicine used to treat or prevent osteoporosis in women after menopause (see “What is osteoporosis?”). BONIVA may reverse bone loss by stopping more loss of bone and increasing bone mass in most women who take it, even though they won’t be able to see or feel a difference. BONIVA may help lower the chances of breaking bones (fractures). For BONIVA to treat or prevent osteoporosis, you have to take it as prescribed. BONIVA will not work if you stop taking it.

Who should not take BONIVA?

Do not take BONIVA if you:• have low blood calcium (hypocalcemia)• cannot sit or stand up for at least 1 hour (60 minutes)• have kidneys that work very poorly • are allergic to ibandronate sodium or any of the other ingredients of BONIVA (see the end of this Patient Information for a list of all the ingredients in BONIVA)

Tell your health care provider before using BONIVA:

• if you are pregnant or planning to become pregnant. It is not known if BONIVA can harm your unborn baby

• if you are breast-feeding. It is not known if BONIVA passes into your milk and if it can harm your baby

• if you have swallowing problems or other problems with your esophagus (the tube that connects your mouth and stomach)

• if you have kidney problems • if you are planning a dental procedure such as tooth extraction

Tell your health care provider (including your

dentist) about all the medicines you take including prescription and non-prescription medicines, vitamins, and supplements. Some medicines, especially certain vitamins, supplements, and antacids can stop BONIVA from getting to your bones. This can happen if you take other medicines too close to the time that you take BONIVA (see “How should I take BONIVA?”).

How should I take BONIVA?

• Take BONIVA exactly as instructed by your health care provider.

• Take BONIVA fi rst thing in the morning at least 1 hour (60 minutes) before you eat, drink anything other than plain water, or take any other oral medicine.

• Take BONIVA with 6 to 8 ounces (about 1 full cup) of plain water. Do not take it with any other drink besides plain water. Do not take it with other drinks, such as mineral water, sparkling water, coffee, tea, dairy drinks (such as milk), or juice.

• Swallow BONIVA whole. Do not chew or suck the tablet or keep it in your mouth to melt or dissolve.

• After taking BONIVA you must wait at least 1 hour (60 minutes) before:- Lying down. You may sit, stand, or do normal activities like read the newspaper or take a walk.

- Eating or drinking anything except for plain water.- Taking other oral medicines including vitamins, calcium, or antacids. Take your vitamins, calcium, and antacids at a different time of the day from the time when you take BONIVA.

• If you take too much BONIVA, drink a full glass of milk and call your local poison control center or emergency room right away. Do not make yourself vomit. Do not lie down.

• Keep taking BONIVA for as long as your health care provider tells you. BONIVA will not work if you stop taking it.

• Your health care provider may tell you to exercise and take calcium and vitamin supplements to help your osteoporosis.

• Your health care provider may do a test to measure the thickness (density) of your bones or do other tests to check your progress.

What is my BONIVA schedule?

Schedule for taking BONIVA 150 mg once monthly:

• Take one BONIVA 150-mg tablet once a month.• Choose one date of the month (your BONIVA day) that you will remember and that best fi ts your schedule to take your BONIVA 150-mg tablet.

• Take one BONIVA 150-mg tablet in the morning of your chosen day (see “How should I take BONIVA?”).

What to do if I miss a monthly dose:

• If your next scheduled BONIVA day is more than 7 days away, take one BONIVA 150-mg tablet in the morning following the day that you remember (see “How should I take BONIVA?”). Then return to taking one BONIVA 150-mg tablet every month in the morning of your chosen day, according to your original schedule.

• Do not take two 150-mg tablets within the same week. If your next scheduled BONIVA day is only 1 to 7 days away, wait until your next scheduled BONIVA day to take your tablet. Then return to taking one BONIVA 150-mg tablet every month in the morning of your chosen day, according to your original schedule.

• If you are not sure what to do if you miss

a dose, contact your health care provider who

will be able to advise you.

Schedule for taking BONIVA 2.5 mg once daily:

• Take one BONIVA 2.5-mg tablet once a day fi rst thing in the morning at least 1 hour (60 minutes) before you eat, drink anything other than plain water, or take any other oral medicine (see “How should I take BONIVA?”).

What to do if I miss a daily dose:

• If you forget to take your BONIVA 2.5-mg tablet in the morning, do not take it later in the day. Just return to your normal schedule and take 1 tablet the next morning. Do not take two tablets on the same day.

• If you are not sure what to do if you miss

a dose, contact your health care provider who

will be able to advise you.

What should I avoid while taking BONIVA?

• Do not take other medicines, or eat or drink anything but plain water before you take BONIVA and for at least 1 hour (60 minutes) after you take it.

• Do not lie down for at least 1 hour (60 minutes) after you take BONIVA.

What are the possible side effects of BONIVA?

Stop taking BONIVA and call your health care

provider right away if you have:

• pain or trouble with swallowing

• chest pain

• very bad heartburn or heartburn that does not

get better

BONIVA MAY CAUSE:• pain or trouble swallowing (dysphagia)• heartburn (esophagitis)• ulcers in your stomach or esophagus (the tube that connects your mouth and stomach)

Common side effects with BONIVA are: • diarrhea• pain in extremities (arms or legs)• dyspepsia (upset stomach)

Less common side effects with BONIVA are short-lasting, mild fl u-like symptoms (usually improve after the fi rst dose). These are not all the possible side effects of BONIVA. For more information ask your health care provider or pharmacist.

Rarely, patients have reported severe bone, joint, and/or muscle pain starting within one day to several months after beginning to take, by mouth, bisphosphonate drugs to treat osteoporosis (thin bones). This group of drugs includes BONIVA. Most patients experienced relief after stopping the drug. Contact your health care provider if you develop these symptoms after starting BONIVA.

Rarely, patients taking bisphosphonates have reported serious jaw problems associated with delayed healing and infection, often following dental procedures such as tooth extraction. If you experience jaw problems, please contact your health care provider and dentist.

What is osteoporosis?

Osteoporosis is a disease that causes bones to becomethinner. Thin bones can break easily. Most people think of their bones as being solid like a rock. Actually, bone is living tissue, just like other parts of the body, such as your heart, brain, or skin. Bone just happens to be a harder type of tissue. Bone is always changing. Your body keeps your bones strong and healthy by replacing old bone with new bone.

Osteoporosis causes the body to remove more bone than it replaces. This means that bones get weaker. Weak bones are more likely to break. Osteoporosis

is a bone disease that is quite common in women after menopause. At fi rst, osteoporosis has no symp-toms, but people with osteoporosis may develop loss of height and are more likely to break (fracture) their bones, especially the back (spine), wrist, and hip bones.

Osteoporosis can be prevented, and with proper therapy it can be treated.

Who is at risk for osteoporosis?

Talk to your health care provider about your chances for getting osteoporosis.

Many things put people at risk for osteoporosis. The following people have a higher chance of getting osteoporosis:

Women who:• are going through or who are past menopause (“the change”)

• are white (Caucasian) or Asian

People who:• are thin• have a family member with osteoporosis• do not get enough calcium or vitamin D• do not exercise• smoke• drink alcohol often• take bone thinning medicines (like prednisone) for a long time

General information about BONIVA

Medicines are sometimes prescribed for conditions that are not mentioned in patient information. Do not use BONIVA for a condition for which it was not prescribed. Do not give BONIVA to other people, even if they have the same symptoms you have. It may harm them.

Store BONIVA at 77°F (25°C) or at room temperature between 59°F and 86°F (15°C and 30°C).

Keep BONIVA and all medicines out of the reach of children.

This summarizes the most important information about BONIVA. If you would like more information, talk with your health care provider. You can ask your health care provider or pharmacist for information about BONIVA that is written for health professionals.

For more information about BONIVA, call 1-888-MY-BONIVA or visit www.myboniva.com.

What are the ingredients of BONIVA?

BONIVA (active ingredient): ibandronate sodiumBONIVA (inactive ingredients): lactose monohydrate, povidone, microcrystalline cellulose, crospovidone, purifi ed stearic acid, colloidal silicon dioxide, and purifi ed water. The tablet fi lm coating contains hypromellose, titanium dioxide, talc, polyethylene glycol 6000 and purifi ed water.

BONIVA is a registered trademark of Roche Therapeutics Inc.

27899375

Revised: March 2007

Copyright ©2007 by Roche Laboratories Inc.All rights reserved.

BONES & JOINTS


My observation: Bones & jointsneed systemic enzymes supportLike most healthcare professionals, I realizethat bones and joints require significant sup-port to combat wear and tear of everydaydemands. Basic support such as calcium andvitamin D for bones or glu-cosamine and chondroitin forjoints is a good place to start.However, I realize that dynamicinteractions between the immunesystem, circulatory system, vari-ous internal communication sys-tems and other systems supportthe optimal function of bones andjoints – as well as muscles and lig-aments. I know advanced supportmay be required as a person expe-

riences situations in which thebones and joints don’t function aswell as they should. In addition togood nutrition, I, like thousandsof professional nation-wide, havefound that proper enzyme activityis also required by the varioussystems that maintain bone andjoint health.

So, I teach that enzymes main-tain optimal function of the vari-ous systems in the body and sup-port overall good health and opti-

mal quality of life. Enzymes aremolecules that maintain the natu-ral biochemical processes thattake place in the numerous sys-tems responsible for maintainingbone and joint health. Enzymesinteract directly with proteins andother molecules in the humanbody, and support internal regula-tory and communication systemsresponsible for homeostasis (bal-ance) and vitality.

PositiveI have found “Systemic EnzymeSupport” to be a safe and effectiveway to support optimal health ofbones and joints. The ingesting tospecific combinations of certain

enzymes has positive influenceson those complex processes thatwe need for balance and a betterquality of life. I noticed that a sig-nificant amount of the publishedinternational literature is basedon various systemic enzyme sup-port formulations made by a Ger-many company for decades. And,I was pleased to learn that aneffective systemic enzyme supportavailable in America, Wobenzym®N, is still made in Germany, andnow distributed by an Americancompany.

LoyaltyWe healthcare professions use theterm “compliance” to describe ifsomeone loyally follows recom-mendations. The 80 per cent plus,loyalty to this systemic enzymesupport formulation is quite note-worthy, especially since “compli-ance” is so closely tied to “effica-cy”. I realize that the high degreeof compliance to this systemic

enzyme support is primarily dueto its effectiveness.

Based on the published researchand the loyalty and effectivenessseen in people using systemicenzyme support, as well as myexperience with Wobenzym® N, itis clear to me; that in addition tovitamins and minerals and othernutrients, systemic enzyme sup-port is required for optimal healthof joints and bones. The benefitsto bone and joint health, and ulti-mately to society will be signifi-cant when we fully recognize thesuccess of systemic enzyme sup-port, and takes its advantages asour own.

Joseph J Collins, RN, ND.Joseph Collins is a Registered

Nurse, with a Naturopathic Doc-torate. Licensed as a physician in

Washington State, he currentlypromotes health and wellness in

Iowa. He can be reached atjcollins@systemicenzymesup-

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