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PAGE 14, OCTOBER 6, 2008, THE ISLANDER
(News to Q-CeCv
The Best is Yet to Be
By Clark Gillespie M.D.,
Professor Emeritus, the University of Arkansas
Making some bones about it
Having used the word “aging” sev
eral thousand times in consecutive
columns, it is about to join “senior”
in our most binding “don’t go there”
list.
But - every possible health prob
lem in our senior midst seems to be
considered due to aging or is aging-
related in some inextricable way. So,
then - what about another word?
After searching dictionaries, vari
ous thesauruses, famous quotations,
and other loquacious sources, the
only regularly-quoted alternative
aging-word was “senescence” - an
even more disagreeable and flawed
moniker. We are, therefore, left with
“aging”- unless we want to be per
fect Anglophiles and spell it “ageing”.
Let’s just get used to it as is.
But - enough for fillers - we now
need to see about the particular
assaults that aging itself actually
makes upon bone strength and the
risk of osteoporosis.
To accomplish this we have to take
a brief dip into bone and body physi
ology as we, ah, move on up in life.
Help was found in this area from the
marvelous new textbook “Osteoporo
sis in Older Persons -Pathophysiology
and Therapeutic Approach” edited by
Gustavo Duque and Douglas P. Kiel.
To begin with, our bone mass
matures and builds to its maximum
in our thirties. None of this bone -
any bone - is truly fixed, its strength
and mass regularly fluctuate, and
is dependant upon our health, diet,
exposure to sunlight, exercise, age,
and our genetic inheritance.
Besides our dependence on our
solid outer bone substance to hold us
upright and together, our inner bone
tissues make most all of our new
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blood cells for us, and do some other
important domestic chores as well.
We understand that our solid bone
is built for us by little cells called
osteoblasts - cells which are balanced
by a group of bone-destructive cells
called osteoclasts. The positive bal
ance between these two divergent
cell groups is what gives us normally
strong bones against watered-down
weaker ones.
It is somewhat like a bank account
- while the principal amount remains
hopefully strong and constant - or
even grows stronger - some money is
regularly leaving on one side whilst
being replaced by deposits on the
other. As with bones, that financial
illustration works fine - as long as
the give and take provides continu
ous strength for the principal - in this
case, our bony frames.
To return to earth, our aging is
accompanied by the loss of a wide
range of physiological processes in
all of our body systems from our
immune, sexual, and memory sys
tems to our body strength and self-
protective reserves. Our bony frame
does not escape this melt-down.
• Bone loss in all of us older
citizens regularly occurs at a rate
approaching 2% annually.
• The life span of our osteoblast
bone-building cells is shortened as
is their ability to reproduce them
selves.
• Genetic factors begin to interfere
with normal bone maintenance.
• Bone loss in women is at least
temporarily accelerated by the meno
pause and the loss of estrogen. This
loss has other systemic metabolic
effects that cannot be overcome by
estrogen replacement.
In the presence of this multitude of
offenders, how can we best preserve
our bony frames as we work towards
some worthwhile senior gold?
Here are a few guidelines:
• Diet: Our Mediterranean-type
diet will provide most of what food
substances we need to support our
bone functions while it continues to
protect our cardiovascular system.
• Weight: Too thin now is just as
bad as too fat. We need adequate fat
in and around our bones or, believe it
not, our osteoblast bone-builders can
actually convert into fat-making cells
- adipocytes! Excess body thinness is
further associated with frailty. Stay
well within your best BMI.
• Exercise: Here involved is mean
ingful and regular physical activity,
guided, when necessary, by a profes
sional - accomplished indoors or out
doors (protecting your skin and your
eyes when outside). But meaningful
and sweaty! And regular!
• Supplements: Both calcium and
vitamin D are necessary additions to
our regular intake. There has been
much controversy recently about the
value of these two bone builders, but
they clearly surmount all that criti
cism.
Larger doses of vitamin D are often
now recommended and the amount of
calcium slightly reduced but when
given to someone who follows the
other tenets of bone health, they do
their stuff. You must ask your doctor
for today’s doses of each. Further in
your bone protective, drive involve
your doctor regularly and get bone
density studies as indicated.
• Medication: Various agents that
stimulate bone production and pro
tection are prescription-marketed
and available when your physician
sees that they are indicated for you.
They are not without important side-
effects which must be well understood
by us takers.
• Safe environments: We have ear
lier written to you about fall-proofing
your home environment. It can be
done with little or even no expense,
and can prevent ages of pain-filled,
broken-hip fall-survival.
Thus - fragile we are - and frail we
might become - so if you don’t do as I
do - at least do as I say. □
Calcium: Do's and Don'ts
By Tom Jeter, RPh., Certified Geriatric Pharmacist,
Magnolia Manor Pharmacy
The top mineral supplement sold
in the U.S. by dollar sales is Cal
cium. Prescribed by doctors and
taken by many to treat and prevent a
wide range of health issues including,
osteoporosis, colon cancer, elevated
cholesterol, elevated blood pressure,
premenstrual syndrome, weight loss
and acid indigestion.
It is the most abundant mineral
in the human body with 99% stored
locally in bones and teeth. It works
also in the body to help muscles
tighten and relax, in the role of nerve
pulse transmission throughout the
body and the activation of blood clot
ting. Calcium has been deemed safe
with even large doses showing no
toxic effects.
Calcium, because of its profound
presence in the body and nearly no
toxic effect, is assumed by the average
consumer not to be in question with
regard to drug interactions, but that
isn’t the case. Please see a partial list
below of some of the more common
calcium — drug interactions. (1)
• Bisphosphonates - (Fosamax®,
Boniva®) - Calcium may interfere
with the absorption of bisphospho
nates, medications used to treat osteo
porosis. Calcium containing products,
therefore, should be taken at least
two hours after any bisphosphonate.
• Blood Pressure Medications -
Taking calcium with a beta-blocker
(such as atenolol), a group of medica
tions used for the treatment of high
blood pressure or heart disorders,
may interfere with blood levels of
both the calcium and the beta-block-
er. Study results are conflicting, how
ever. Until more is known, individu
als taking atenolol, or another beta
blocker, should have their blood pres
sure checked before and after adding
calcium supplements or calcium con
taining antacids to their medication
regimen.
Similarly, it has been reported that
calcium may reverse the therapeutic
effects as well as the side effects of
calcium channel blockers (such as
verapamil) often prescribed for the
treatment of high blood pressure.
These study results are also con
troversial. People taking verapamil
or another calcium channel block
er along with calcium supplements
should likely have their blood pres
sure checked regularly.
• Digoxin - High levels of calcium
may increase the likelihood of a toxic
reaction to digoxin, a medication used
to treat irregular heart rhythms. On
the other hand, low levels of calcium
cause this medication to be ineffec
tive. People who are taking digoxin
should have calcium levels monitored
in the blood closely.
• Diuretics - Two different classes
of diuretics interact with calcium in
opposite ways—thiazide diuretics
such as hydrochlorothiazide can raise
calcium levels in the blood, while loop
diuretics, such as furosemide and
bumetanide, can decrease calcium
levels. In addition, amiloride, a potas
sium-sparing diuretic, may decrease
the amount of calcium excreted in the
urine (and subsequently increase cal
cium levels in the blood), especially in
people with kidney stones.
• Antibiotics, Quinolones and Tet
racyclines - Calcium can interfere
with the body's ability to absorb qui-
nolone antibiotics (such as ciproflox
acin, levofloxacin, norfloxacin, and
ofloxacin) and tetracycline antibiotics
(including doxycycline, minocycline,
and tetracycline), and, therefore,
diminish their effectiveness. If taking
calcium containing supplements or
antacids, therefore, you should take
them two to four hours before or after
taking these antibiotics.
• Levothyroxine - Calcium has
been reported to decrease the absorp
tion of Synthroid® making it difficult
to finding a stabilizing dose. Syn
throid® should be taken first thing in
the morning, on an empty stomach,
at least 4 hours before taking any
Calcium.
Ferrous Sulfate — Given to treat
anemia. Iron absorption may be
decreased when given at the same
time with Calcium. Take Iron supple
ments at least 2 hours before or 4
hours after any Calcium.
To make sure that the medication
you are taking doesn’t react with cal
cium, check with your pharmacist or
check your medication’s on the inter
net by visiting: www.eldercarephar-
macy.org
Reference: (1) www.umm.edu/alt-
med/articles/calcium-000945.htm □