Frequently asked questions
Topics
Knee Pain
There is joint cartilage degeneration and low-grade inflammation initially. Because of degeneration, cartilage loses its thickness. It is reflected in reduced joint space, on X-rays, particularly on the inner side. The joint fluid may get reduced and joint lubrication suffers. Small bony projections, called osteophytes appear at the margins of the joint surface and the patient’s pain increases. Gradually, joint swelling, lateral subluxation of joints and bowing of the legs appear.
Initially, non-steroidal anti-inflammatory medicines to control pain, cartilage protective medicines, specially designed knee exercises, weight control, and lifestyle changes. Later joint injections and surgery become essential.
What are the different injections, which are given to treat knee osteoarthritis?
- Depo preparation of steroids
- Viscosupplementation (Synthetic joint fluid)
- PRP (platelet-rich plasma)
- Surgery to correct bow legs ( genu /tibia vara)
- Partial joint replacement
- Total joint replacement
Vitamin D
It is very common nowadays, almost 80 percent of the Indian urban population has some degree of vitamin-D deficiency.
It has become so widespread because of the sedentary office lifestyle of normal citizens. large amount of vitamin-D source is sunlight. Due to the working conditions, people do not get enough sunlight. Further, the city pollution does not allow the vitamin-D forming sun rays to reach the earth.
Fish, eggs, mushrooms, milk and milk products, fortified orange juices.
In growing children, it is called rickets. It causes many bony deformities – an apparent deformity is knock knees or genu valgum
In adults, Vitamin D deficiency is called osteomalacia . Common symptoms are diffuse body pains, lethargy, muscle spasm, bony tenderness and in advanced cases, fractures may occur
Osteoporosis
It is a deterioration in the bony architecture of bones. The internal structure of bone becomes weak. As a result, it is not able to tolerate even a small trauma and a fracture may occur
- Age-related or senile osteoporosis: It occurs after the age of 65. As a person becomes senior, there is more bone loss
- .Postmenopausal: In females, after menopause, once the production of female hormones (oestrogen) decreases, the rate of bone loss increases and the incidence of osteoporosis increases sharply
- Medicines: Some medicines like corticosteroids, a few anti epileptic medicines, and anticancer drugs increase osteoporosis
- Chronic diseases: like chronic kidney disease, thyroid disorders, rheumatoid arthritis
- Malignancy (cancer)
- Sedentary life style,
- lack of exercises
- Positive family history
- Low body wight and thin body frame
- Smoking
- Excessive alcohol intake
- Poor nutrition, particularly lack of calcium and Vit D
Bone is a dynamic tissue and there is a continuous process of bone deposition and bone loss. In younger age, the bone deposition is more than bone loss and increase in bone mass. The Peak Bone Mass is attained in mid thirties. Every effort must be made in childhood and early adult life to achieve good peak bone mass .After the mid thirties, there is negative bone balance and gradual bone mass loss. After the age of 65 years, the rate of bone loss increases a lot and consequently the incidence of osteoporosis.
- General body aches
- Diffuse bone pains, particularly spine(backache)
- Weakness and lethargy
- Spine deformities, like upper back hump
- Decrease in body height, because of collapse of multiple vertebrae
Besides blood workup, particularly Vit D levels, blood calcium levels, the investigation which confirms osteoporosis is DEXA scan. It exactly measures the bone content. A value, called T score age matched; if it is less then -1, it is below normal and if it falls beyond -2.5,it is critical and requires expert management.
- An active life style
- Exercise regimen, which include age appropriate aerobic stretching and strengthening exercises
- Maintain optimal Vit D and calcium intake
- Good nutrition
- Avoid smoking, restrict alcohol
Medical treatment, which includes a combination of
- Bisphosphonates
- Teriparatide inj.
- Calcitonin nasal spray
- Denosumab inj
- Vit D and calcium
- Multivitamins and mineral
- Splints and braces, particularly for spine
- Prevention of falls:anti-skid bath mattress, good lighting,
- Urgent treatment of fractures to make the patient mobile at the earliest.