Joint pain and ageing: Tips to maintain bone health as you age

Our bones consist of living tissues that are continuously being dissolved and replaced and for the uninitiated, it is a dynamic organ where new bone is formed and old bone is removed just like our skin.

Our bones help us move around and protect different organs from damage but formation of bones gradually declines with age though removal of bone continues at the same pace leading to weak bones.

Joint pain basically means arthritis and it can be divided into primary and secondary where primary arthritis is caused due to ageing whereas secondary arthritis is due to other factors (inflammatory disease or traumatic cause). Primary arthritis or osteoarthritis is the wear and tear of the cartilage that covers the joint or that protects the joint and due to this wear and tear, the bones start getting exposed and it starts causing pain in the patient.

The most common arthritis in Indian populations is knee arthritis and according to statistics, about 90% of the patients develop arthritis after the age of 45. Caucasians are more prone to hip arthritis and Indian and Asians are more prone to knee arthritis and the reason why arthritis occurs after the age of 40 is due to change in the proportion of protein and water in the cartilage.

After the age of 40, the proportion of protein and water hydration starts altering which leads to the wear and tear. In an interview with HT Lifestyle, Dr Samarth Arya, Consultant Orthopaedics, Joint Replacement and Robotic Surgery at SPARSH Hospital, highlighted the causes and said, “The cause of Arthritis could be genetic i.e pre-existing conditions in the family. Or sometimes the causes can be idiopathic, which means there could be several causes for arthritis.”

He added, “The wear and tear of the cartilage is similar to what happens with a car tyre. Once it is worn out, it is gone forever and it wont grow back. So that is the biggest problem in arthritis. Unlike the case of skin, if damaged or torn, it will heal because it has a bloody supply. In the case of cartilage, it is Avascular, which means there is no blood supply. What we can do is reduce the progression of arthritis but it is very difficult for us to bring back the cartilage. The treatment for arthritis has a wide spectrum that ranges from conservative to surgical.”

According to Dr Nataraj HM, Robotic Joint Replacement and Sports Surgeon, HOD-Orthopaedics at Belenus Champion Hospital in Bengaluru’s Sarjapur Road, certain factors influence the formation and removal of bone and by understanding these factors we can maintain the health of the bone as we age. He suggested the following tips to improve bone health –

1. Increase calcium intake: Calcium is the most abundant mineral in our body that helps to strengthen our bones. Sources of calcium in diet are there in dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu. If it’s difficult to get adequate calcium from diet alone, instead take supplements or take a prescribed calcium tablet suggested by your doctor.

2. Get adequate vitamin D: Body needs vitamin D to absorb calcium and sunlight is the greatest source for vitamin D. Good dietary sources of vitamin D include oily fish, such as salmon, trout, whitefish and tuna. Additionally, mushrooms, eggs and fortified foods, such as milk and cereals, are good sources too. If sunlight exposure and dietary sources are not enough, adding additional supplements helps.

3. Include physical activity in your daily routine: Excess weight will increase your risk of fracturing your arm and wrist. As such, keeping body weight in check is good for bones just as it is for health in general. Weight-bearing exercises, such as walking, jogging and climbing stairs and lifting weight can help you prevent weakening of bones.

4. Avoid substance abuse: Don’t smoke! Reduce alcohol intake especially for women since women are more prone to having weaker bones as they age.

Adding to the list of preventive methods that can decelerate the rate of wear and tear, Dr Samarth Arya recommended:

• One must eat healthy and keeping a good check on calorie intake, especially after over 40 years. Keeping a calorie count, but not per say for the joint, but to maintain the overall body weight. Increased weight will lead to increased wear and tear of the cartilage. Hence, it’s important to keep a check on the calorie intake.
• Maintaining a healthy lifestyle and including green leafy veggies in the diet
• Regular exercises and activities to keep the joint mobile and supple.
• Avoiding impactful and vigorous activities or exercises after the age of 40. Exercise within physiological limits of individuals.

Talking about conservatory management methods for treatment, he advised –

1. Painkillers or injections: In conservative methods, doctors give painkillers or injections to the knee joint. These injections can be Platelet-rich plasma where we take the patient’s own blood, centrifuge it and the part of the plasma that is rich in growth factors will help the cartilage grow back and also decelerate the arthritic progression.

2. Physiotherapy exercises: This helps keep the joints mobile. Even though there is arthritis, we want the joint to keep moving because the flexibility and mobility of the joint is very important. So that way, with physiotherapy, the patient gets to exercise and there are current therapies which reduce the pain. So this is the other modality of treatment.

3. Steroid injections: Apart from painkillers and physiotherapy, there are steroid injections as well which are not commonly practiced.Mainly due to more of an anti-inflammatory effect and the duration of relief to the patient is quite minimal. It is only a few weeks to a few months, so it is not commonly practiced.

As for surgical management methods, he listed –

1. Osteotomy surgeries: In this method, the doctors replace the joint or do an osteotomy corrective surgery where we reduce the deformity of the bone. These surgeries decelerates the rate of wear and tear. These are called osteotomy surgeries.

2. Replacement surgery: In replacement surgery, it can be either partial replacement or full replacement of the joint in the knee. For example, doctors can replace only a part of the knee that is affected. If it is the whole joint, the whole joint can be replaced.