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ASK THE EXPERTS: Osteopenia Choosing a cane Vitamin C for gout.

Q I have been told I have something called osteopenia. Is this the same as osteoporosis, and am I at risk of fractures because of it?

A Osteopenia is the term used to describe lowbone density that is not severe enough to be diagnosed as osteoporosis. Having the condition does not mean that you are at significantly greater risk of a fracture in the near future--however, it does mean, that you should make sure you are doing what you can to maximize your bone health. Strategies for doing this include weight-bearing exercise, ingesting 1,500 milligrams (mg) daily of calcium either in your diet (find it in low-fat dairy and fortified cereals) or through supplementation, taking 700-800 international units (IU) of vitamin D daily, stopping smoking, and avoiding excessive alcohol.

You also should discuss with your doctor the pros and cons of starting an osteoporosis medication like alendronate (Fosamax) or ibandronate (Boniva). This is generally recommendated if you have a major risk factor for developing osteoporosis in the next few years (for example, if you regularly take corticosteroids).

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

Q I am scheduled to have minor surgery on my foot and will need to use a cane afterwards. Can you advise me on how to choose one?

A There is more to purchasing a cane than you might think, and it's very important that you choose one that can be adjusted to fit you and is comfortable to grip. The top of the cane should line up with your wrist when your arm is hanging at your side, so that your elbow bends at an angle of about 30 degrees when you grip the cane (most canes can be adjusted in order to achieve this). The grip should feel comfortable--a rubberized or foam grip is ideal.

As far as materials and style are concerned, a wooden cane will be lightweight and durable but, unlike aluminum, it may not fold. Graphite and fiberglass canes are particularly strong if you need a higher weight limit (a typical cane can support up to 250 pounds), but they typically cost more.

When you walk with your cane, hold it in the hand opposite the side that needs support, so that the cane and your weaker leg make contact with the ground simultaneously. When climbing stairs, lead with your "good" leg, but when descending them, put your cane on the step first and then step down with your weaker leg.

David Thomas, MD, PhD

Medicine and Rehabilitation Medicine

Q Could taking a vitamin C supplement help to relieve my gout?

A Gout is a type of arthritis that can develop due to a build-up of uric acid in the blood. The body produces uric acid as it breaks down substances called purines, which occur naturally in the body as well as in some foods. Normally, uric acid dissolves in the blood and is excreted via the urine, but it's possible for a build-up to occur that causes sharp-edged crystals to form, typically in the large joint of the big toe.

There is some research suggested that boosting vitamin C intake may help prevent gout, with men who had the highest vitamin C intake from supplements and food 45 percent less likely to develop the condition. However, not everyone with high levels of uric acid develops gout, and not everyone who suffers from it has high uric acid levels. If you do have gout, it's likely your doctor will recommend that you also take other measures to reduce the risk of an attack before trying vitamin C. Alcohol is a major trigger, so limit or avoid it.

A caloric restriction diet with increased protein, replacement of refined with complex carbohydrates, and decreased saturated fat can produce a substantial reduction in uric acid. Have the protein come from low-fat dairy products, and limit your intake of animal protein to no more than five or six ounces of lean meat, poultry or fish each day. Particularly limit organ-rich foods (eg, liver, sweetbreads). Drink plenty of water, to keep urine diluted and promote the excretion of uric acid. There also is anecdotal evidence that blueberries and cherries may help lower uric acid levels.

Fran C. Grossman, RD, MS, CDE, CDN

Nutrition

MD, PhD Editor-in-chief Geriatric Medicine

MD, PhD Medicine and Rehabilitaion Medicine

RD, MS, CDE, CDN Nutrition
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Author:Rosanne M. Leipzig; David Thomas; Fran C. Grossman,
Publication:Focus on Healthy Aging
Article Type:Interview
Date:Sep 1, 2014
Words:724
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