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Osteoporosis: “The most important factor is prevention”

May is Women’s Health Month, a great time to celebrate and promote stronger health and a perfect time to discuss the latest information about preventing and treating health challenges like osteoporosis.

More than 44 million American women experience the debilitating effects of the bone disease, and many women fear aching joints and brittle bones are an inevitable part of aging. It is important to know the risks, and engage opportunities to maintain optimum bone-health.

Dr. Lawrence R. Housman is an orthopaedic surgeon who specializes in musculoskeletal disease at Tucson Orthopaedic Institute. He sat down with us to discuss the best ways to prevent and treat osteoporosis.

osteoporosis, know your risksWhy are women at greater risk for osteoporosis?  

Women start with a lower bone density than men. They also lose bone mass more quickly as they age. Between ages 20-80, women will lose about 1/3 of her bone density compared to men who lose only 1/4 of their bone density in that time frame. Estrogen levels also affect bone density, and women lose bone mass more quickly in the years immediately following menopause than at any other time of their lives.

What can accentuate this risk?

Alcohol in moderation is not a risk factor, however more than four drinks per day results in a twice the risk of hip fracture. Steroids can also increase this risk. Long term use of steroids will double the risk of fracture in women.

It should be noted that proton pump inhibitors (e.g. Nexium/Protonix used for stomach disorders such as acid reflux) decrease the absorption of calcium from the stomach.

While increasing fiber, phylates (beans, wheat bran), oxalates (spinach, beet greens, rhubarb) and phosphorus (colas) can provide other health benefits they can also interfere with calcium metabolism.

What are the most effective means of preventing osteoporosis?

Regular exercise is one of the most effective means of preventing osteoporosis. Thirty minutes per day – walking is excellent, and Tai Chi reportedly decreases falls by 47 percent and hip fracture by 25 percent.

Nutrition is another import part of maintaining healthy bones. Fruits and vegetables are important. Women ages 19-50 should take in 1000 mg of calcium daily and women older than 50 should get 1200 mg per day.

Vitamin D is another vital nutrient the body needs to prevent osteoporosis. An individual can get their vitamin D through measured exposure to sunlight or through supplements. A diet with dairy, protein or calcium fortified foods (e.g. orange juice), fish (salmon/sardines) and yogurt (6 ounces has 300 mg of calcium) will go a long way in getting vitamin d to the bones.

What are the warning signs of the disease – and when is it time to see a doctor?

There are usually no warning signs before a fracture occurs; therefore, the most important factor is prevention.

A primary care provider (PCP) is the best person to monitor bone health. Most physicians recommend a DEXA (bone density test) after the age of 50.

The DEXA scan is the bone density test done most frequently and is predictive of fracture risk. The scan will also show whether you have normal bone density, osteopenia (bone is becoming weaker) or osteoporosis (bone is at high risk for fracture).

If a fracture occurs, then an orthopaedist would enter the picture to advise on treatment concerning the spine or extremity fracture.

If diagnosed with osteopenia or osteoporosis – what’s next?

With treatment patients can live normal, active and happy lives.

There are many types of medications that are now available – which work to reverse and then rebuild the bone loss. With treatment, the risk of a vertebral fracture drops from between 30-70 percent and the risk of a hip fracture drops by up to 40 percent.

Dr. Housman is an orthopaedic surgeon who practices at the Tucson Orthopaedic Institute. He earned a medical degree from the University of Alberta in Edmonton, Canada and completed an orthopaedic surgery residency at the Montreal General Hospital and McGill University. Dr. Housman is fellowship trained in several orthopaedic pursuits and is a past chief of staff at Tucson Medical Center. He has also served as president of the Western Orthopaedic Association and Arizona Orthopaedic Society.


New Year’s Resolutions – 8 tips for making them stick

7333_134345893574_797101_n (1)I haven’t made a New Year’s Resolution in years. Like many of us, by the second or third week of January I’ve shoved the long list of resolutions denying myself candy, or promising to workout six days a week, and lose that pregnancy weight, deep under the pile of to-do items on my desk which I also vowed to clean up. But I like the idea of New Year’s Resolutions, reflecting on the year that’s gone, putting behind my failures and the clean slate of a whole new year – it’s like the ‘it’s a whole new day’ approach, but on steroids – It’s a whole new year! And despite how many of us feel about New Year’s Resolutions the evidence is that those who seriously make resolutions have a much better chance of succeeding than those who don’t, University of Scranton’s Professor John Norcross shared in a recent NPR Science Friday. After a little informal research about how to make New Year’s Resolutions stick I offer these suggestions for making 2013 the year we give ourselves the Gift of Health. Won’t you join me?

1. Don’t overdo it, pick one or two resolutions

In the past I’ve had a long list of resolutions. Resolutions to do with weight loss, travel, diet, education, community, housecleaning, but it seems that those who have one or two resolutions are more likely to find success. Our focus is on health, but ‘improve my health’ is too general. My specific goals are to increase my cardiovascular health by losing and keeping off 10 pounds through physical activity and dietary changes. What is your focus on?

2. Be specific, realistic, and make it measurable

Increasing your cardiovascular ability and being able to running a half marathon, or losing that extra pregnancy weight or reducing your cholesterol by 50 points are specific, but are they realistic? I’ve been carrying an extra 30 pounds around since pregnancy and have not managed to take AND keep off the weight. I’m not alone. As a country, our widening waistlines are impacting our health – losing weight is not uncommon, or unworthy goal. Now 30 pounds within the next year may not be realistically attainable, but taking 10 pounds off and keeping it off, well that might actually happen. Likewise, if you’re a solid couch potato, with bad knees, the TMC A-Mountain half-marathon next October might not be in the cards, but couch to a 5k program resulting in the TMC Meet Me Downtown 5k June 1, that is more realistic. Check out this 8-week beginners program from Amby Burfoot to get you started .(You can also check out Amby’s connection with TMC & Tucson right here.)

3. Identify why achieving this goal is important to you

This is the time to think about why you want to achieve this goal. If you have a goal you’re passionate about you’re more likely to achieve it. What drives you? If this is a goal you’ve had in the past and not achieved, what stood in the way?

Apparently, getting into that size 8 dress is not enough of an incentive for me, but improving my cardiovascular health so that I can run around with my kids, and grow old gracefully and watch them become adults IS important to me. As is having a healthy body image that I’m not ashamed to share with my daughter. Both Rachel Tineo and Kim Verdugo touched on what they tapped into to finally change the patterns of behavior that were encroaching on their health earlier this year in posts during National Women’s Health Week.

4.What are you passionate about?

What thought can you hold firmly to that will help you surmount those barriers that are getting in the way of achieving what your health goals?

Okay, so now you’ve got a measurable goal, hopefully a deep seated desire to attain it, and you may have identified what’s stopped you attaining the goal in the past. Next, come up with an action plan.

5. Make an action plan

An Action Plan in the making

An Action Plan in the making

Break your goal into small attainable steps and plot out when you’re going to address them. Attempt one change at a time, plan on repeating it often enough that it becomes a habit. The oft-repeated statement that if you repeat something for anywhere between 21 and 30 days then it will become a habit isn’t completely without merit, although it seems though it may take longer. A study published in the European Journal of Social Psychology found that such habit-forming generally took a little longer, on average 66 days. Lally et al (2009). They also found that missing a day here and there wasn’t typically disastrous to the habit-forming.

As you come up with your action plan, think about the challenges you face to achieving it and incorporate solutions into your action steps. For example, I know that part of my battle of the bulge has to do with late night snacking. After the kids are in bed, I’m often tempted to stay up late and munch on left overs or make a few slices of buttered toast and drink a glass of milk. I’m not actually hungry. Perhaps thirsty. My action plan is to substitute the buttered toast and glass of milk for some nice licorice tea or glass of water with lemon, and a piece of fruit if I’m actually hungry after the tea and water and go to bed earlier. I’m going to focus just on this for several weeks before adding any other dietary changes. What are the steps you’re going to take and when are you going to take them? Plan it out. Check out the Action Plan post we shared back in 2012. Particularly important is the section on confidence. As you make your action plan consider the confidence level you have in succeeding. Prime yourself for success, set achievable mini-goals.

6. Be kind to yourself, forgiving and flexible

So you slip up. It’s going to happen. That’s alright, don’t waste time beating yourself up about your folly, get back on track. If part of your action plan isn’t working figure out why and try to come up with a solution.

7. Use the buddy system
Having a few friends or family to support you can make all the difference. Someone you can call, email or connect with when you face a temptation or are looking for a solution, or just a cheering team can make a huge difference. You don’t have to have the same goals, just be there to support one another. Julia shares how she used a private Facebook group to make healthy changes in 2012 in a recent post.

8. Put it in writing and make it public
Declare your resolution to the world. Nothing like everyone knowing to make you more accountable. Track your progress in a written form or perhaps using a smart phone or online app. There are many free ones available. And with that I publicly declare that my New Year’s Resolution is to improve my cardiovascular health by losing 10 pounds through dietary changes and increased physical activity. My action plan will follow! I hope to see you along the way. Happy New Year.

If you’re hoping to address medical concerns with your New Year’s Resolutions share your action plan and resolutions with your physician. Primary care physicians are typically very supportive of patients who seek out their help to make an action plan.

Here are some resources to get you started if you’re looking to start running, biking or face issues with stress eating (me!)

Getting started as a runner for women

Get better on a bike

Stress release and relaxation

Mindful based stress reduction

Healthy eating to avoid stress

Osteoporosis isn’t just for Grandmas – Know your Risk Factors.

osteoporosis isn't just for grandmas, know your riskSo here we are again, with good and bad news about risk factors for osteoporosis. Which do you want first? Bad news? Okay. I like to get that over with too.

The bad news is that many of the risk factors are things that you can’t do a thing about, like, well, being female, for example. Other risk factors are being Caucasian, having a family history of osteoporosis, and having a smaller or thinner frame.

Getting older also increases risk of osteoporosis because bone mass declines after early adulthood. Also, estrogen has a protective effect on bones. So menopause, whether it occurs naturally as a woman gets older, or surgically, through removal of the ovaries because of medical necessity, decreases bone density. Alas, though humans have tried to reverse aging for millennia, the fountain of youth is indeed a myth and like it or not, we get older. But keep in mind that getter older is better than the alternative, as they say.

Other risk factors that aren’t an innate part of every woman’s life, but still aren’t simply lifestyle choices are:

  • Hyperthyroidism
  • Steroid-based medications often used for respiratory illnesses
  • Use of selective serotonin reuptake inhibitors (SSRIs) for depression / anxiety
  • Use of proton pump inhibitors (PPIs) for acid reflux / GERD
  • Antiepileptic medications
  • Intestinal disorder
  • Cancer
  • Rheumatoid arthritis
  • Anorexia

The latter is likely a result of depressed estrogen levels. (Estrogen is stored in fat, so being anorexic and having very little fat means the body has minimal amounts of estrogen.) Incidentally, chronically obese women have a lower incidence of osteoporosis for this exact reason ‑ they have more estrogen stored in their bodies. Also, their day-to-day life involves a greater amount of weight-bearing exercise, because, well, they are indeed bearing more weight. This does NOT mean that one should set out to become obese, as the health risks far outweigh (no pun intended) this particular benefit.

Some other risk factors that one has more control over are:

  • Smoking
  • Excessive alcohol or soda consumption
  • Sedentary lifestyle
  • Long-term use of injectable progestin-only birth control (Depo Provera)*

*If this is your birth control method of choice, discuss with your gynecologist the pros and cons of this particular hormonal contraceptive. You may decide that it’s still a good choice for you, even with the increased change of osteoporosis. There are risks inherent in many forms of contraception, as well as in pregnancy, so these important decisions should be discussed with your provider.

osteoporosis, know your risksHow can you find out if you have osteoporosis? As we said in our previous installment, this is a silent disease. If you are wondering if you should be screened for bone density loss, talk with your health care provider.

Tucson Medical Center offers state-of-the-art bone scanning technology. The facilities are located near TMC’s breast imaging center, so if you are referred for a bone-density screening, you might be able to schedule it to coincide with your next mammogram. The machine, the GE Lunar 1-DXA, known as DEXA, can scan the back, legs, forearms or the entire body. It can accommodate patients up to 400 pounds, a much higher limit than most scanning machines, and can scan children as well. There is minimal radiation exposure in this type of scanning.

To find out more about bone density screening at TMC check out this page which includes how to schedule an appointment.

Have you had a bone density screening yet?

photo credit: chris zerbes via photopin cc

It’s Your Time for Change – Patty’s Commitment to Health

The week of May 13th is National Women’s Health Week and we’d like to address this by highlighting the accomplishments of women within our community who have taken charge of their health through exercise, healthy eating, addressing mental health and through preventative care and screenings. You can check out the stories of other women making a commitment to their health and more information about National Women’s Health Week here.

Patty Ledbetter, 55, Admitting manager at TMC, is a woman who’s taken charge of her health and is proactive in dealing with a high-risk family history.Creating and maintaining a healthy lifestyle is a goal for most women, as it allows us to enjoy ourselves and stay fit. But what about women for whom it may be a matter of life and death?

Patty and Julia Strange (Vice President for Community Benefit) running on campus. Patty is participating in the program First Time 5K with Performance Executive Fitness Trainer Amy Maddox. Patty is training to run her first 5K at Meet Me Downtown on June 2. Julia joined her for one of the training sessions, along with her border collie.

This is the case for Patty. With a family history of heart disease, hypertension and high cholesterol, she knew that being in optimal health was essential. Extra body fat put her at higher risk for developing heart disease and other health problems, and she wanted to make lifestyle changes that stacked the odds in her favor.

Patty met with her doctor and committed to exercising regularly. “I found that focusing on consistency with my exercise, rather than length of time, made the difference. And once I began to see success, I was motivated to continue.” That’s a good reminder to those of us who think that if we’re not training for a marathon or can’t go to a 90-minute spinning class, we might as well sit on the couch. Every bit of exercise counts. A 20-minute lunchtime walk, a few laps in a pool on a summer’s day, walking stairs in your office building—make exercise part of your everyday life and it’ll become second nature.

Eating more healthfully was another change Patty made. She consulted with a nutritionist, and to make sure she’d be able to stick with the changes, she included her family in her new way of eating. “It helps when others are following a similar diet,” she notes.

So did these relatively simple changes—more exercise and a healthful diet—make a difference in Patty’s overall health? You bet! Her total cholesterol dropped over 50 points and her doctor took her off her cholesterol-lowering medication.

Working in a hospital no doubt helps Patty lead a healthful life. “The TMC community supports and encourages the choices I’ve made.” For those of us who aren’t surrounded by medical experts and health-care advocates, Patty has a few words of advice: “Make changes because you want to. Never stop trying, even if you can’t see results. Everything you’re doing is benefitting you. Surround yourself with others who support what you’re doing and who have similar goals.”

So get out there and ask a few co-workers if they want to go on a lunchtime walk a few times a week. If you drive to work, park father away than you need to. If you can bike or walk to your workplace or the bus stop, even better. Patty Ledbetter serves as a great reminder that no matter where we start, we can find our way to a healthier lifestyle.

Thank you, Patty!