Love your bones

AskNurseLindaAskNurseLinda Posts: 74Moderator, Information Specialist Information Specialist
25 Likes 10 Comments Name Dropper 5 Awesomes
edited February 11 in Healthcare Tips
Love your bones

Taking care of your bones is something people do without much thought. The skeletal system (bones) are what gives our bodies structure and support. Without bones, we would not have any framework for our bodies, making us just blobs of tissue.

After a spinal cord injury, protection of our bones and what they do becomes more important. Several of the secondary complications of spinal cord injury have to do with protecting bones from the inside and outside of our bodies.

Bones need to be strong enough to support the body and body weight. Making your bones work keeps them healthy and strong. After a spinal cord injury, you might have difficulty making your bones work to support your body to be upright. When you do not exercise, or use put tension on your bones through movement, bone structure is affected due to loss of minerals.

The strength of bones is measured by bone density. Minerals in the bones make them strong. Bones of normal strength have a normal bone density. If you could look at your bones, you would see a smooth surface. Bones that are affected by mineral loss have tiny little holes where the mineral has been depleted. Bones that have less density are more prone to fracture or breaking.

Some loss of bone minerals results in osteopenia which is a diagnosis or disease of smaller amounts of loss of minerals in the bone. It you could see your bones under a microscope, in osteopenia, they would look like a slightly moth-eaten sweater in appearance with random tiny holes throughout.  When a great deal of minerals has left the bone, a disease is diagnosed called osteoporosis, which is a significant loss of density. Some call the appearance of osteoporosis in the bones as looking like swiss cheese.  Many holes are present and often larger in osteoporosis.

People usually think about osteoporosis when the see older women with misshapen, bent spines. This is due to factors such as age, genetic predisposition and hormonal changes from menopause. Men can have this same issue, but it is typically seen at a later age as male hormonal changes occur more slowly over time than the significant hormonal changes of menopause.

Another group that can have bone density issues are those with spinal cord injury due to the lack of putting tension on the bones, especially through the long bones of the legs and arms. Individuals with higher level injuries have a higher incidence of bone density issues than people with lower level injury but everyone with SCI is at risk for low bone density.

Bone density testing should be performed at least one time per year for individuals with spinal cord injury. This is a relatively easy test as you are required to lay on a special exam table for a short period of time while a wand travels above your body, measuring the density of your bones in the lumbar spine and hip. Sometimes, the wrist is also measured depending on your level of injury and other risk factors.

The bone density test takes about 15 minutes. There is no IV or anything that touches your body. You do need to wear comfortable clothes without metal such as zippers, as the metal will cause the testing measurements to splay as opposed to consolidating at the measurement site.

The results of the test will indicate your bone density in the selected areas, lumbar spine, hip and wrist. These areas are chosen as they are the most vulnerable spots in your body for bone fractures. The results are most commonly reported in ‘T’ scores. A T score is a statistical measurement of how far an assessment is from a collected average. In other words, your bone density T score is how different your bone density is from a random group of people your age and gender. A score of T -1 and above indicates you have normal bone density. If your results are between T -1.1 and T -2.4 you have osteopenia. Results of T -2.5 and below indicates osteoporosis. Sometimes scores are provided by a Z score which is a different calculation and diagnostic parameters.

Treatment for bone density include medication. It can take time to rebuild your bone density through medication. Therefore, it is to your benefit to keep a yearly track of your bone density as this is another example of how early treatment is much easier to correct bone density than attempting to treat a more severe case for a much longer period of time. 

There are also treatments to help you maintain your bone density. Your healthcare provider may assess your vitamin D level through a blood test.  The benefits of Vitamin D have received a lot of press over that last 10-20 years because it has been extensively studied. It provides a variety of functions in the body from regulating metabolism to helping transport calcium and phosphorus into the bones. The body makes its own Vitamin D through sunshine on our skin. In today’s society, most of us work indoors and don’t get much sunshine on our face and hands. If we do have time to enjoy the out of doors, it is necessary to put on sunscreen and wear protective clothing which does not allow the vitamin D exchange.

Be sure you have an assessment of your Vitamin D prior to taking this supplement. Vitamins are divided into two basic groups. Those that are water soluble, in other words, if you take too much of them, any overage will be removed by the kidneys and excreted with your urine. There are four vitamins that are in the group of fat soluble. These are Vitamins A, D, E, and K. These vitamins are stored in your body fat. Taking too much of these vitamins can lead to side effects and overdosing.

Therefore, a blood test will indicate your need for Vitamin D supplementation. Vitamin D can be purchased over the counter or at a higher prescription strength depending on your needs. Be sure to inform your healthcare provider if you take any over the counter vitamins or supplements as these can affect other medications and adversely affect your health.

Another treatment that will help maintain your bone density is activity. If you are able, you can apply pressure to your bones by performing range of motion exercises using therabands (elastic strips) or even a towel for resistance when moving your extremities. Moving parts of your body independently or manually will cause your muscles to move and thereby pull the tendons where they attach to your bones. This provides the tension needed for bones to help maintain their density.

A standing frame can be used to allow your body to be placed in an upright position which might also add tension to the bones. If you have a standing frame that allows your arms to move your legs, further benefits will be gained.  This therapy is done for one hour a day. You will need to start slowly and work up over time. You do not need to move quickly. Just moving will create a benefit.  

Advanced therapy of functional electrical stimulation has demonstrated a positive effect on bone density. Prior to doing any activity, you will want to have an assessment of your bone density as application of weight or resistance with a low bone density can lead to a fracture (breaking) of your bone.

Careful handling of your body is always essential. Rough movement or even moving when distracted can cause injury to anyone. With a SCI or paralysis, your body will react to injury, even if you do not feel it. Moving your body carefully can avoid trauma such as bruising or even fractures (breaking) to bones with or without low bone density.

If you do have a bone fracture, medication might be provided or your might require surgery for a repair. To repair a bone fracture, a plate might be placed along your bone with screws to fasten the plate both above and below the fracture. If your bone density is poor such as with osteoporosis, the screws might not be able to be placed as the bone will not tolerate the stress of the screw. Early treatment of a bone density problem will help this issue.

Ironically, a secondary complication of spinal cord injury can actually help bone density issues. Spasticity is an involuntary contraction of a muscle. Muscles are attached to bone by tendons. Each time the muscle spasms, there is a pull on the bone by the tendon. This action helps strengthen your bones. This is not to say that spasticity should not be treated as it can be painful and disruptive to your everyday activity. Spasticity can lead to a variety of negative side effects. However, if your spasticity is not too severe and not painful, you might want to let it occur to keep your bones healthy. Finding the ‘sweet spot’ between a positive effect of spasticity versus many of the negative effects is often a challenge and might not be to your benefit in the long run.

The key to maintaining your bone density is the annual bone density test. The results might be in the ‘normal’ range for years until suddenly it is low. Catching a lower bone density when it starts is much easier to treat and can avoid long term problems leading to life style changes in the future. Waiting until a bone fracture occurs could indicate problems with your bones throughout your body. Be kind and love your bones by having a yearly bone density assessment. Nurse Linda

Pediatric Consideration: Younger children need bone density assessments as well especially after puberty when the adult bones are established. Be sure to ask your healthcare professional when it would be the right time for your child to start their first assessment. Results for children will typically be reported in the Z score format which matches children for height and weight as opposed to age. Interpretation of the Z score result will be provided to you.

You can begin activity therapies to help protect your child through range of motion with resistance, careful handling of all four extremities, functional electrical simulation and standing. Most insurances will cover a standing frame, but your healthcare professional will have to specifically order one for your child. This will not automatically happen. For extra benefits, ask for a standing frame with gliding action if your child can perform this activity. Your physical therapist can be instrumental in making this assessment for you and your healthcare provider.

Since young bones are still maturing, spasticity can have a negative effect of over pulling on one side and under pulling on the other side of the bone. This can lead to malformation of the bone(s). It is important to have treatment of spasticity to protect the development and formations of young bones.

I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

Leave a comment any time below. Let's get the discussion going!

Nurse Linda

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Comments

  • brigittemcbrigittemc Posts: 11Member
    5 Awesomes 5 Likes First Comment
    What type of a physician performs the wand-based bone density tests??
  • cruiseybabbbycruiseybabbby Posts: 18Moderator Moderator
    25 Likes 10 Comments 5 Awesomes Photogenic
    I was unaware of the importance of diligently knowing and keeping an eye on the levels of my bone density for the first 5 or so years after suffering my spinal cord injury. Unfortunately for me, my levels had dropped EXTREMELY low and for multiple years I have now been getting special injections and taking specific calcium supplements to better my lower back and hip bones osteoporotic state.

    I implore all SCI patients, new and old, to get a bone density scan done at least once a year to prevent your bones from withering away! We already have enough daily issues to worry about so avoid a serious situation like loss of bone density by staying on top of your health, getting regular bone density scans and discussing the fear of this issue with your doctor!
  • garrisonreddgarrisonredd Posts: 129Moderator Moderator
    25 Awesomes 25 Likes 10 Comments First Answer
    I agree with you @cruiseybabbby.
  • AskNurseLindaAskNurseLinda Posts: 74Moderator, Information Specialist Information Specialist
    25 Likes 10 Comments Name Dropper 5 Awesomes
    You will need to be referred for a bone density test by your regular healthcare professional. It is slightly different in many institutions. The test might be performed by a physician or by a technician with the report going to your own healthcare professional.
    Cruiseybabbby provides a cautionary tale. Your bone density can be just fine until-suddenly- one day it isn't. Thank you for your example. Sorry, you have to go through it. But you are on the right track. I would  bet, low bone density will not happen to you again, and you will get it corrected so you will not have the complications it brings. Nurse Linda

    I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

    Leave a comment any time below. Let's get the discussion going!

    Nurse Linda

    Register for my next webchat! Sign up here!

  • SonikaSSonikaS Posts: 1Member
    First Comment
    That was quite a well detailed advice.
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  • ZcollieZcollie Posts: 209Moderator Moderator
    100 Comments 25 Awesomes 25 Likes Name Dropper
    Reading all of this made me realize I need to schedule a bone density test. I cant remember the last time 
    I had one. Any recommendation on vitamins I could take to help with that? I do my best to take a multi-vitamin and calcium pill every morning. 
    Accept what is, let go of what was, and have faith in what will be. -SONIA RICOTTI
  • Mnichols23Mnichols23 Posts: 42Moderator Moderator
    10 Comments 5 Awesomes First Answer Name Dropper
    I don’t remember the last time I had a bone density test.  Reading everything here opened my eyes to it.  I take a multivitamin every day. But is there something else I can take or eat to help my bone density? 
  • AskNurseLindaAskNurseLinda Posts: 74Moderator, Information Specialist Information Specialist
    25 Likes 10 Comments Name Dropper 5 Awesomes
    Hi, Zcollie and Mnichhols 23: Probably it is best to get your bone density test and then see what supplements or medications you will be needing-if any. Calcium can build up in your body if you do not need the supplement leading to kidney stone and electrolyte imbalance. 
    What does help build your bones is tension on the bones by pulling of the tendons. This can be accomplished actively by walking or moving your legs and arms but it is just as effective to do it passively by moving your body parts using range of motion exercises. You can do this several times a day or have someone do it for you. There was a thought at one time that standing would help bone density but this has not borne out in the literature. It is the movement that is needed to improve bone density vs. weight. If you have a standing frame with a glider system, use that to move your extremities. Otherwise, just providing movement helps. 
    The bone density test will let you know if your bones are strong enough for more challenging exercise, like the standing frame. 
    It is a good idea to get a baseline of your bone density. If it is good, then great. But if it changes, you will be able to compare the time of change to help detect medical causes. Nurse Linda 

    I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

    Leave a comment any time below. Let's get the discussion going!

    Nurse Linda

    Register for my next webchat! Sign up here!

  • skosillsskosills Posts: 13Member
    10 Comments
    It was amazing how quickly my husband lost bone density - it was dramatically lower within a year. All these years later, he's broken leg bones on both sides now. He does try to do a stretching routine but I think his uncontrolled spasms probably do most of the work...not enough of course.
    Sandra
    Peer Mentor for able bodied care givers
    Wife of T7 Complete Para
  • AskNurseLindaAskNurseLinda Posts: 74Moderator, Information Specialist Information Specialist
    25 Likes 10 Comments Name Dropper 5 Awesomes
    Bone density is one of those sneaky things. It slips right up on you before you know it. Movement to the extremities will help when the tendon pulls on the bone. Spasticity does help some but finding the balance between helpful and harmful is difficult. You might want to discuss with your husband and healthcare professionals about a standing frame with glider or electrical stimulation. Either of these might not be an option if his bone density is low or due to past fractures. Hopefully, he will be able to do one of these therapies to improve his bone density. They both have other benefits as well including less urinary tract infections, improved bowel program time and less skin problems. I hope this works for you. Nurse Linda

    I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

    Leave a comment any time below. Let's get the discussion going!

    Nurse Linda

    Register for my next webchat! Sign up here!

  • PamelaParkerPamelaParker Posts: 3Member
    First Comment
    Experts recommend that older women have regular bone density tests to screen for osteoporosis as it is common to aged person. We need to care our bones form early age so that our bone can stay healthy. An interesting fact (I think we all mature here) is before puberty, boys and girls acquire bone mass at similar rates. After puberty, however, men tend to acquire greater bone mass than women. We all know Calcium is an essential nutrient for bone health.Calcium deficiencies in young people can account for a significant difference in peak bone mass. Here lifestyle is a big deal. We love to eat junk fruits. We don't like to drink milk rather love to drink soft drinks.
  • selenagomez777selenagomez777 Posts: 1Member
    First Comment
    Hi!!
    I love this post! super fan! 
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