Part 13
Bones and Joints
ILLUSTRATION. Picture a woman whose first low-trauma fracture arrives before anyone has discussed bone health with her. She had been told she was doing well for her age. That phrase may offer comfort, but it cannot replace an assessment of fracture risk, strength, balance, and the home environment.
Clinical scenes in this edition are explicitly labeled illustrations. They describe imagined situations used to explain medical decisions, not documented patients, diagnoses, conversations, or treatment outcomes. They should not be read as evidence that a particular intervention works. Personal recollections are recollections, not medical records.
Evidence grade (draft mapping). 12 questions; a question with mixed evidence counts under each grade.
- 176. What is osteoporosis?Bone that has become thin and fragile enough to break from a minor fall, or sometimes from a cough or a sneeze.EEstablished clinical knowledge
- 177. How common and how serious is it?About one in two women and one in four men over 50 will break a bone because of it. A hip fracture is among the most dangerous events in later life.CObservational
- 178. Who should have a bone density scan, and what do the numbers mean?All women by 65 and men by 70, and earlier for anyone with risk factors. The key number is the T-score.GGuideline-based / consensus
- 179. What kind of exercise builds bone?Loading and impact. Bones respond to force. Walking and swimming are good for the heart and do little for bone density.Grade pending
- 180. What should I eat for my bones?Enough calcium, enough vitamin D, and more protein than you think.GGuideline-based / consensus
- 181. Are osteoporosis medications safe? I have heard frightening stories.For people who need them, the benefit is far greater than the risk. Fear of rare side effects has left many people untreated.ARobust human trials
- 182. Do hormone therapy and other treatments help bone?Menopause hormone therapy prevents bone loss and reduces fractures in appropriate women. Testosterone for male deficiency can improve bone density, but that does not establish fewer fractures.ARobust human trials
- 183. Do vibration plates and bone-loading machines work?Their effect on bone density is small, and none has been shown to prevent fractures.BLimited or small human studies
- 184. Do weight-loss medicines harm bone?Rapid weight loss by any method takes some bone and muscle with it. Strength training and protein reduce the loss.Grade pending
- 185. Is arthritis just wear and tear? Should I rest my joints?No, and no. Osteoarthritis is an active disease of the whole joint, and movement is its best treatment.ARobust human trials
- 186. What about injections for joints: steroids, gel, PRP, and stem cells?Steroid injections give short relief. The others are less effective than their marketing suggests.BLimited or small human studies
- 187. What should I do about back pain?Keep moving. Most back pain improves within weeks, and bed rest makes it worse.ARobust human trials