Stiffness, Swelling and the Sticky Issue of Sugary Soda

knee osteoarthritisThose of us of a certain age, probably know all about osteoarthritis, the “wear and tear” disease in which joint cartilage is lost. Losing cartilage from your knee is similar to having the shock absorbers go on your car.  It leads to pain, stiffness and other symptoms.

According to a large 2007 study, nearly 20% of women and 15% of men over the age of 45 have  symptoms of knee osteoarthritis.

Until now, many experts thought disease progression was inevitable. I’m pretty sure that’s what my knee surgeon thinks. One such clue: he always says “when I see you again” rather than “if I see you again” at the end of every visit.

Bloomberg Moves To Ban Sugary Drinks In NYC Restaurants And Movie TheatersNow, for men at least, this may be about to change. A new study of more than 2,000 with osteoarthritis of the knee showed that disease progression in men is linked to consumption of sugary soda.

Researchers reviewed the records of 2,149 men and women with confirmed osteoarthritis of the knee.

All filled out dietary questionnaires that asked how many soft drinks, not including sugar-free beverages, they drank on average each week.

Every year for four years, the researchers tracked their osteoarthritis progression by measuring the space between the joints. The more cartilage that is lost, the less the space. Body Mass Index (BMI) was also measured.

After taking into account BMI and other risk factors, men who drank five or more soft drinks a week had twice as much narrowing of joint space compared with men who did not drink sugary soda.

man drinking sodaOur main finding is that the more sugary soda men drink, the greater the risk that knee osteoarthritis will get worse,” says researcher Bing Lu, MD, DrPh. Lu is assistant professor of medicine at Harvard Medical School and associate biostatistician at Brigham and Women’s Hospital in Boston.

If you’re thinking something along the lines of ‘Duh! Tell me something new. Soda=calories=weight gain= risk factor for osteoarthritis, think again.

Much to the researchers’ surprise, the link between knee osteoarthritis progression and sugary soft drinks could not solely be explained by weight.  When the men were divided into obese and non-obese, the link between sugary drinks and worse knee damage held true only in the non-obese men, suggesting that soft drinks worsen knee osteoarthritis independently of the wear and tear on the joints caused by carrying around excess weight.

So what’s a man who enjoys soda to do?  According to Lu the answer is simple. “just don’t drink it!”

Causes-and-Symptoms-of-OsteoarthritisAnother expert says that’s going too far. “As with everything, enjoy soda in moderation. If you are a man with knee osteoarthritis and are drinking a lot of soda, this might be a reason to curb back,” says American College of Rheumatology spokesman Scott Zashin, MD.

He argues that the study doesn’t prove cause and effect and needs to be repeated before any recommendations to patients can be made, he says.

Furthermore he advises, that in patients with osteoarthritis of the knee, every excess pound of weight is 4 extra pounds of dead weight on the knee joint.

And it’s not only Zashin who’s speaking out. The American Beverage Association (ABA), has also taken issue with the findings.

In a statement, the ABA writes: “The authors’ ‘novel  findings’ – as they call them – suggest only a possible association of soft drink consumption with osteoarthritis in knees, which they state cannot be proven without further testing. Consequently, this presentation fails to establish that drinking soft drinks causes any negative health outcomes or even that they are linked to negative health outcomes.”

Lu however is defending his work. He claims that certain ingredients in soda, including phosphoric acid, caffeine, as well as coloring and sweetening agents may affect absorption of calcium and overall bone health.

He even has an explanation as to why the link between soda and disease progression could not be established in women. “It could be due to sex hormones. For example, estrogen has been associated with cartilage degeneration. Further research is needed to understand the pathways.”

Although the jury is still out on this issue, it seems cutting back, or cutting out soda may not be a bad idea.

Could or would you give up your cola?  Let us know!

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Taking the Shots out of Orthopedic Surgery

As anyone who’s had knee or hip replacement surgery knows, post-op recovery can be long and painful. There’s the learning to walk again, the physical therapy and the dreaded daily injections in the belly.

While great strides have been made in surgery for degenerative joint disease, preventing post-op complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) remains problematic. Conventional antithrombotic agents (heparin and low-molecular-weight heparin) have to be given by injection into fatty subcutaneous tissue, usually into the leg or abdomen, for days or weeks after surgery and discharge from the hospital. Not surprisingly, acceptance of, and compliance with, thromboembolic prophylaxis is limited by the need for injections, the bruising and associated risks for bleeding.

Now it seems the days are numbered for injection therapy.  A recent meta-analysis of 22 randomized trials comparing oral factor Xa inhibitors with low-molecular-weight heparin injections in adults who underwent total hip or knee replacement has just been published in the Annals of Internal Medicine.

The results showed that new generation oral antithrombotic agents, including apixaban, edoxaban, and rivaroxaban, that do not require monitoring, actually led to fewer symptomatic deep venous thrombosis.

Furthermore, there was no difference between the groups in terms of mortality, non-fatal PE, major bleeding, or bleeding leading to reoperation. The study authors therefore predict that these oral agents will likely replace low-molecular-weight heparins.

As a likely candidate for future joint replacement, thanks to a family history of osteoarthritis, and joints wrecked by years of gymnastics and running, I for one am very grateful.

A Bad Break for PPIs

A question for all our orthopedic, primary care, emergency medicine and physical therapy readers. When your patients come into see you with fractures do you ask them about their stomach?  No! – Well, maybe you should.  According to a recent meta-analysis, some of the drugs most commonly used to treat acid reflux can lead to fractures.

This is no small problem.  Millions of people worldwide are currently using these medicines often on a long-term basis. Each year sales of such drugs top $30 billion.

The type of medicines we’re talking about are more commonly known as Proton Pump Inhibitors (PPI) or Histamine-2 receptor antagonists (H2RAs). Among the former group are the best sellers such as Prilosec, Prevacid, and “the purple pill”- Nexium.  Among the latter: Tagamet (cimetidine) and Zantac (ranitidine). many are available over-the-counter.

The authors of the meta-analysis found that PPIs, which block acid production by up to 98%, are associated with an increased risk of both hip and any type of fracture. On the other hand, no significant relation was found between the H2RAs and fracture risk. Interestingly, H2RAs block only 70% of gastric acid production.

It’s thought that bone fractures resulting from the use of PPIs are due to defective calcium absorption.  This can lead to hyperparathyroidism which in turn may modify acid-related enzymes in bones.

Given the widespread use of PPIs this study has great importance to public health. Clinicians should carefully consider their decision to prescribe PPIs for patients, especially the over-50’s who already have an elevated risk of fracture, and the orthopedic / emergency medicine community should routinely question their patients about the use of such drugs.