Our bones are living, growing tissue that's composed of two kinds of cells: "osteoblasts" that create new bone to fill in holes and "osteoclasts" that break down bone, creating "microscopic pits."  This process of bone formation and absorption, called "bone remodeling," persist throughout our life. But, when bone absorption increases at a higher rate than bone formation, a decrease in bone density may be created-sometimes resulting osteoporosis.

Known as a metabolic bone disease, osteoporosis causes bone loss, making bones weak and brittle and more prone to fractures. The National Osteoporosis Foundation estimates that 25 million Americans, mostly women, have osteoporosis.  Because an osteoporotic bone is very porous, meaning thin and weak, even the simplest daily activity can cause a bone to fracture, particularly in the spine or hips.

A class of drugs called "bisphosphonates" -alendronate  (Fosamax), risedronate (Actonel) and ibandronate (Boniva) -can provide significant increase in bone mass by inhibiting osteoclasts. This reduces the risk of vertebral and hip fractures.  For patients with moderate to severe osteoporosis or a history of hip fracture, bisphosphonates are the drug of choice.

Recently, however, reports have described a dental condition called osteonecrosis of the jaw (ONJ). Bone in the lower jaw-or less commonly the upper jaw-becomes exposed, typically after a dental extraction or some other trauma to the jaw, where the wound that occurs fails to heal within the normal time frame.  Some 95 percent of the ONJ cases to date were in breast cancer and multiple myeloma patients receiving intravenous bisphosphonate, pamifronate, or zoledronate to reduce bone pain and high serum calcium.  About 1 percent of intravenous bisphosphonate users develop ONJ. However, in pill form bisphosphonate users, only about 1 in 100,000 of patients treated with drugs like Fosamax and Actonel have reportedly developed ONJ.

While the actual cause of ONJ is not clear, recent studies have determined important predisposing factors for the risk of this condition. These include the type and total dose of bisphosphonate, as well as history of trauma, dental surgery, or infection.  Keep in mind that doses for cancer patients are often up to 12 times higher than for patients with osteoporosis alone.

The fact is that men have a one-in-three chance of dying within a year of hip fracture, and women, a one-in-four chance. It's obvious the benefits of using oral bisphosphonate medications outweigh the potential risk of developing ONJ.  The National Osteoporosis Foundation recommends that patients taking bisphosphonates continue to get regular dental check-ups and to let their dentists know about all the medications that they are taking.

If you have moderate to severe osteoporosis, you should not be deterred from taking bisphosphonates because of their extremely rare side effects such as ONJ.

Exercise can help prevent obesity

While the causes of obesity are not completely understood, there is a general consensus that obesity results when there is a chronic imbalance between energy intake and energy expenditure.  In other words, you gain weight when the amount of calories consumed exceeds the number of calories burned.

In addition to a healthy diet, weight maintenance is highly dependant on a person's level of physical activity. The goal of weight reduction is to create a caloric deficit through healthy diet and physical activity, while supplying yourself with enough energy consumption to carry out your daily activities.

In the average person, one pound of weight lost is equal to 3,500 calories. To lose a pound a week, which I recommend, you need to burn 500 calories more than you ingest each day. By merely cutting 200 to 300 calories from your daily diet, in conjunction with adequate exercise, it is possible to achieve that goal.

Exercise that is a balance of strength and endurance training with adequate intensity, frequency, and duration ensures that both the musculoskeletal and cardiovascular systems stay healthy.   Weight or strength training likewise is an important element of any weight loss program.  Physical activities such as walking and swimming are especially beneficial, particularly for people with osteoarthritis of the knees or hips. Walking involves the larger muscles of the body, does not require expensive equipment and can be done almost anywhere. Both walking and swimming put minimal stress on the joints.

The formula to calculate your caloric expenditure is rather simple. Say, for example, a person weighing 150 pounds walks for one hour at a speed of 3.5 mph. The caloric factor for walking is 2.4. Multiply your weight by the factor of activity, 2.4, and you will have the amount of calories burned (150 x 2.4).  Swimming a slow crawl for one hour also is a "speed" of 3.5 mph. But different activities have different factors. For example, singles tennis is 2.7 while doubles is lower than 1.8 mph.  Physical activities that are more intense have a higher caloric expenditure. Jogging at 6 mph and bicycling at 10 mph, for one hour, have a factor of 4.2 and 2.7, respectively.

Achieving a healthy weight is best done at a slow and steady pace. The rate at which obese people tend to lose weight will not change dramatically if there is only physical activity without a reduction in caloric intake.  Exercising at a moderate intensity level on a regular basis-combined with a healthy diet- increases a person's chances of winning a battle against obesity. It's a better option than vigorous exercise only done occasionally.

Vaccine can thwart shingles outbreaks

Mary, 78, has a recurrent painful rash on her lower back. The pain can continue for months even after the skin breakout has subsided.  She was diagnosed with herpes zoster (shingles) with complication of post herpetic neuralgia. After so much pain, she was hopeful of any solution to prevent the shingle flare-up.

As we know, the major components of the immune system are B-lymphocytes, T-lymphocytes, Phagocytes and compliment.  The major function of B-lymphocytes is to produce antibodies and protect against bacteria infection. The T-cell does not produce antibody molecules. But the specialized roles of T-lymphocytes are to directly attack organisms such as viruses, fungi, or parasites.

Herpes zoster (HZ), commonly known as shingles occurs only in people who had varicella-zoster (VZV) infection or chicken pox. During the initial infection, VZV rests at the layer of skin where the nerve ending terminates.  After VZV infects nerve endings, the infection travels up to and resides in the dorsal root ganglia-the groups of nerve body-where the virus remains for life.
While the exact nature of latency is still poorly understood, it is well known that VZV.
most of the time, the virus remains latent and patients have no symptoms. However, when VZV-cell immunity is impaired-with aging, after chemotherapy, or even HIV infection-the viral reactivate and a painful rash of shingles breaks out. 

Post herpetic neuralgia (PHN) is chronic neuropathic pain that persists several months, even years after the normal healing of the acute zosters rash. PHN is one of the most common causes of neuropathic pain, and there is an estimated 500,000 cases.  Severe pain associated with PHN has profound impact quality of life in an older adult.  Because VZV specific cellular immunity gradually wanes in the elderly, their immune system responds slowly and ineffectively against reactivation of VZV.  This leads not only to an increased frequency of shingles, but a longer duration of illness and severity of complications.  In those older than 60, the incidence is about 11 in 1,000 people.

Once an individual develops shingles, none of the treatments currently available prevents PHN. While initiation of antiviral therapy can shorten the duration of the rash, it will not prevent the development of PHN in most patients destined to suffer this complication.  In October 2006, the Advisory Committee of Immunization Practice (ACIP) recommended vaccination for individuals 60 years and older. HZ vaccine can boost cell-mediated immunity against VZV and prevent HZ flare-ups.   From studies, HZ vaccine reduced the incidence of PHN by about 66 percent. The effect of vaccine on the incidence of HZ and PHN persists for at least three years.