Bone Health

12 Things Every Woman Should Know About Stress Fractures

stress fractureLast week, Emory Orthopaedics & Spine Center physician, Oluseun Olufade, MD, attended “Ladies Night Out” at Emory Johns Creek Hospital. Ladies Night Out is an annual health event for women and provides them with a fun night of shopping, free health screenings and casual consultations with local physicians.

At the Emory Orthopaedics & Spine Center table, Dr. Olufade spoke with women about stress fractures and how to prevent them. Studies show that female athletes are more prone to stress fractures than male athletes. As a fun activity, attendees entered a free drawing for new running sneakers, a key item to preventing stress fractures and other orthopedic injuries. Four lucky women walked away from the event with new shoes, but we want to provide everyone with Dr. Olufade’s helpful tips. Below are 12 things every woman should know about stress fractures:

What is a stress fracture?

1. A stress fracture is a tiny crack in the bone caused by repeated stress or force, often from overuse.

What are the symptoms of a stress fracture?

2. Pain that worsens over time; limping or tenderness. Possible swelling around painful area.

What are the risk factors for stress fractures?

3. Increased amount, distance, intensity or frequency of an activity too rapidly.
4. Female gender: lower bone density, less lean body mass in the lower limbs, low-fat diet and a history of menstrual disturbance are all significant risk factors for stress fractures.
5. Poor footwear: affects the distribution of weight.
6. Sports specific: change in training pattern (i.e., introduction of hill running), change of surface (i.e., soft clay tennis court to a hard court).
7. Weak bones: from osteoporosis, medications or eating disorders.

How do I prevent stress fractures?

8. Set incremental goals: apply stress to the bone in a controlled manner to strengthen the bone over time. Try increasing distance by <10% per week to allow bones to adapt.
9. Build muscle strength in the legs to increase shock absorption and muscle fatigue.
10. Alternate activities to help prevent injury.
11. Warm up before exercising, including stretching.
12. Use the proper equipment, including footwear. Make gradual changes to shoes and running surfaces. Well-cushioned running shoes that fit well can prevent stress fractures (depending on various factors including weight and shoe durability). Runners should replace their shoes every 300-700 miles to allow adequate mid-sole cushioning.

Think you may have a stress fracture? Make an appointment with an Emory sports medicine specialist. We’ll get you up and running again!


About Dr. Olufade

olufade-oluseunOluseun Olufade, MD, is board certified in Physical Medicine & Rehabilitation, Sports Medicine . He completed fellowship training in both Interventional Pain Medicine and Sports Medicine. During his fellowship training, he was a team physician for Philadelphia Union, a major league soccer (MLS) team, Widener University Football team and Interboro High School Football team.

Dr. Olufade employs a comprehensive approach in the treatment of sports related injuries and spinal disorders by integrating physical therapy, orthotic prescription and minimally invasive procedures. He specializes also in concussion, tendinopathies and platelet rich plasma (PRP) injections. He performs procedures such as fluoroscopic-guided spine injections and ultrasound guided peripheral joint injections. Dr. Olufade individualizes his plan with a focus on functional restoration.

Dr. Olufade has held many leadership roles including Chief Resident, Vice-President of Resident Physician Council of AAPM&R, President of his medical school class and Editor of the PM&R Newsletter. He has authored multiple book chapters and presented at national conferences.

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What is the Sciatic Nerve? What is Sciatica?

Back PainOver 65 million Americans suffer from back pain. In fact, according to the National Institute of Neurological Disorders and Stroke, back pain is a leading cause of missed work and the most common cause of job – related disability in the United States. Many times, pain in the lower back could be caused by a condition called sciatica. Sciatica is a condition often caused by a ruptured or herniated disk that irritates the sciatic nerve. The sciatic nerve is formed from the nerve roots coming out of the spinal cord into the lower back. When the nerve is irritated it can cause debilitating pain, numbness or a tingling sensation down the leg and occasionally all the way to the foot. At times, the pain is so severe that the pain sufferer may lose control over the leg.

Causes of sciatica

Treatments for sciatica

Depending on the cause of the sciatica, it can take weeks to years to relieve the pain from the condition. Research has not shown that low activity versus high activity and physical therapy will help the symptoms. Although medications do not always relieve the pain in the sciatic nerve, medications are typically the first line treatment option. If medications don’t work, the physician will work with the patient to determine the next steps which could include surgery, epidural injection or alternative medicines.

When should you see a physician regarding sciatica and what type of physician should you see?

Patients with sciatica or similar conditions are typically seen by Orthopaedists or Neurosurgeons. At Emory Orthopaedics & Spine we like to see patients when pain failed to be relieved with activity modifications and OTC medication or if it is associated with sensory or motor deficits, such as numbness or weakness

Dr. Di CuiAbout Dr. Cui
Dr. Cui is a physiatrist at the Emory Orthopaedics & Spine Center who specializes in non-surgical management of back, spinal and neck pain. Dr. Cui completed his medical school and residency at the Emory University School of Medicine. He has a special interest in oxidative stress and nutrition, and how they are related to aging.

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What is an Osteosarcoma and What is the Best Way to Treat it?

Bone and soft tissue sarcomas are rare conditions that affect approximately 13,000 people each year. In the US, 10,000 are diagnosed with soft tissue sarcomas and approximately 3,000 are diagnosed with bone sarcomas, of which 1,000 are osteosarcomas.

The most common type of sarcoma that develops in the bone is called an osteosarcoma while sarcomas that develop in the connective tissue are called soft tissue sarcomas. Soft tissue sarcomas can develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. The rarity of sarcomas means most doctors seldom see one, which explains why patients are often referred to specialty hospitals where experienced surgeons utilize limb-sparing (no amputation) surgery whenever possible.

Understanding Osteosarcomas

Osteosarcomas are aggressive malignant bone tumors and are the most common type of bone cancer in young people. They usually occur between the ages of 10 and 25, but can occur at any age and are more common in males than females. They encompass about 20% of all primary bone cancers and it is estimated that the incidence rate in U.S. patients under 20 years of age is 5 per million. Osteosarcomas most commonly start in the ends of long bones of the arms or legs where new bone tissue rapidly forms.

Symptoms of Osteosarcoma

  • Pain near the affected bone is the most common osteosarcoma symptom
  • Swelling of the bones and joints. Noticeable swelling or protrusion near the location of the tumor
  • Brittleness/weakness of the bone which can lead to fractures
  • Difficulty moving during physical activity
  • Noticeable limp when the osteosarcoma is in the leg

Treatment for Osteosarcoma

Typically chemotherapy is given to shrink the tumor before surgery. Most often, chemotherapy results in a necrosis (or death) of the tumor and allows the physician to treat possible cells in the blood stream. In most cases, surgery is required to remove the section of cancerous bone. Limb sparing surgery (LSS) is a special operative procedure performed by oncology orthopedic surgeons and has become the accepted standard of care for patients with sarcomas of the extremities. Limb sparing surgery can be accomplished in approximately 90% of the cases. During limb sparing surgery, the cancer in the bone is removed surgically and the portion of the bone that was removed is either replaced with special metal prostheses or a bone allograft. An allograft is a bone transplant obtained sterilely from a person that has died and agreed to be an organ donor. Emory Orthopaedic surgeons have mastered the limb-sparing surgery in order to save as much bone as possible without compromising the ability to cure the patient.

Emory offers a unique multi – disciplinary treatment approach to bone sarcoma care. Emory Orthopaedic oncology surgeons collaborate with medical oncologists, radiation oncologists, pathologist, radiologists, thoracic surgeons, plastic surgeons and vascular surgeons to develop a treatment plan catered to each individual patient.

Dr. David MonsonAbout Dr. Monson
David K. Monson, MD, assistant professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery at Emory University Hospital Midtown, started practicing at Emory in 1988. Dr. Monson is an expert in the treatment of rare tumors (sarcomas of the bone and soft tissue). Dr. Monson’s specialties are Orthopaedic Surgery (Board certified since 1990) and Orthopaedic Oncology. His areas of clinical interest are orthopaedic tumors, sarcoma, and limb reconstruction.


Dr. Shervin OskoueiAbout Dr. Oskouei
Shervin V. Oskouei, MD, assistant professor of Orthopaedic Surgery at Emory University, is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. Dr. Oskouei started practicing at Emory in 2004. Dr. Oskouei is board-certified and fellowship trained in orthopaedic surgery. Combining his experience and interests with the state-of-the-art facilities of Emory University and the Winship Cancer Institute of Emory University allows Dr. Oskouei to treat patients with the latest modalities using a multi-disciplinary approach.

About Emory Orthopaedic Oncology
Dr. Monson and Dr. Oskouei lead the Emory Musculoskeletal Oncology and Limb Reconstruction program at Emory. The world – class program treats a variety of conditions, including benign and malignant tumors of the extremities and spine, as well as metastatic disease. Together, they offer a combined 34 years of clinical practice experience. They care for both pediatric and adult aged patients.

Both of these physicians belong to the Musculoskeletal Tumor Society which requires fellowship training in orthopaedic oncology. Physicians belonging to this group must also have a primary clinical focus in orthopaedic oncology. This is important for patients because it means the specialist you are seeing has had extra training in this area and is viewed by peers as an expert in the care of orthopaedic oncology. Patients should take the time to research physicians in their area to determine if they are seeing an orthopaedic oncology specialist that belongs to this organization.

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Take-aways from our Pediatric Orthopaedic Hip and Spine Chat with Dr. Fletcher

On February 5, 2013, Dr. Nicholas Fletcher, Emory Pediatric Orthopaedic Surgeon held a  live web chat to answer questions pertaining to the newest treatment options for pediatric orthopedic hip and spine conditions such as scoliosis, kyphosis, hip dysplasia, leg length differences and femoroacetabular impingement.

One of the most common pediatric orthopedic problems is hip dysplasia. Hip dysplasia occurs when the hip socket does not form correctly, which can lead to hip dislocation as a child grows, stated Dr. Fletcher in the chat. Unfortunately, hip dysplasia cannot be diagnosed in a child before birth, a great question which was asked by one of the chat participants. While hip dysplasia is not particularly common, mild abnormalities of the hip socket are regularly seen at birth, but parents should not be alarmed, as these abnormalities typically get better within a couple of months of a child’s life. One of the pediatric hip dysplasia treatment options Dr. Fletcher mentioned in the chat is called the Ganz Osteotomy, a procedure available at Emory. The procedure is used to realign the hip and settings of hip dysplasia when it is found in teenagers and adults.

Participants were also interested to learn that Emory is one of only a few centers in the southeast that offer hip preservation surgeries. Hip preservation is a surgical approach to hip problems in teens and young adults designed to prevent the need for hip replacement down the road. It usually involves realigning an abnormal hip socket into a more normal position or removing bone spurs in the hip that could lead to early arthritis.

Dr. Fletcher provided some great insights and answered some hard pressing questions from chat participants. If you would like to know more about the causes and treatment options of Pediatric Orthopaedic Hip and Spine conditions be sure to take a look at the live web chat transcript. Also, for more information on Scoliosis and on how to become a patient visit Emory Orthopedic and Spine online today.

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Did you know that July is Juvenile Arthritis Awareness Month?

We are all painfully aware that arthritis affects many older adults, but did you know that kids can develop juvenile arthritis?

Approximately 294,000 children age 16 or younger are affected by pediatric arthritis and rheumatologic conditions.
In adults, arthritis typically affects the joints. While juvenile arthritis can cause bone and joint growth problems, it also can affect the eyes, skin, and gastrointestinal tract.

The most common symptoms of juvenile arthritis are joint swelling, pain, and stiffness that won’t go away, particularly in the knees, hands, and feet. Symptoms are generally worse in the morning and after naps. Other signs of juvenile arthritis include:

•    Limping due to a stiff knee

•    Excessive clumsiness

•    High fever and skin rash

•    Swelling in the lymph nodes

The most common type of juvenile arthritis is juvenile idiopathic arthritis. (Idiopathic means “from unknown causes.”) You may have heard this referred to as juvenile rheumatoid arthritis. This type of arthritis is diagnosed when a child has swelling in one or more joints for at least six weeks.

There are several different types of juvenile idiopathic arthritis. The type is usually determined by the number of joints affected as well as by the results of a rheumatoid factor blood test. While children may have a genetic predisposition that makes them more likely to develop the disease, at this point, researchers have not determined a direct cause, and there’s no evidence that toxins, foods, or allergies can cause it. Most children with juvenile arthritis experience remission, when the symptoms get better or go away, and times when symptoms flare, or get worse.

If your child has juvenile arthritis symptoms, the first thing to do is get an accurate diagnosis. Your child’s pediatrician can run tests that will rule out other potential causes, but if the signs point to juvenile arthritis, he or she may suggest you make an appointment with a pediatric rheumatologist.

There is no cure for juvenile arthritis; however, a number of treatments can improve your child’s quality of life, including:

•    Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and analgesics to help relieve inflammation and control pain

•    Disease-modifying anti-rheumatic drugs (DMARDs) and a biologic response modifiers (biologics), which can alter the course of the disease, put it into remission, and prevent joint damage

•    Splints to help keep joints in the correct position and to relieve pain and orthopedics or shoe inserts to compensate for any difference in leg length or to improve balance

•    Physical therapy to help restore motion and flexibility in joints that have become stiff and occupational therapy to help children learn how to do basic activities without aggravating their arthritis

And, of course, it’s super important for kids with juvenile arthritis to eat healthy foods and get regular moderate exercise, to keep joints strong and flexible.

Does your child have juvenile arthritis? How does your family cope? We welcome your questions and feedback in the comments section below.

Osteoporosis: Not Just a Women’s Disease

Osteoporosis MenThought you were safe from osteoporosis because you’re a guy? Think again. Osteoporosis is not just a women’s disease. In fact, one in eight males will develop an osteoporosis-related fracture in his lifetime.

When you’re young, your bone is constantly changing—old bone is removed and replaced by new bone. Osteoporosis occurs when new bone is not generated quickly enough to replace old bone, leading to decreased bone mass and a weakened skeleton. This weakening, in turn, leads to an increased susceptibility to fractures. While more women than men develop osteoporosis, according to the National Institutes of Health (NIH), it still poses a significant threat to millions of men in the U.S.

Why do fewer men than women develop the disease? Men have larger skeletons—meaning more overall bone mass—and don’t undergo the same bone-loss-causing hormone changes that women deal with during menopause. Bone loss in men starts later and progresses more slowly. However, because men are living longer these days, osteoporosis has become an important public health issue.

While osteoporosis in women is generally age related, most men develop the disease for different reasons. Some of the risk factors that have been linked to osteoporosis in men include:

  • Smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
  • Chronic diseases that affect the kidneys, lungs, stomach, and intestines or alter hormone levels
  • Regular use of certain medications, such as glucocorticoids
  • Low levels of testosterone

A “silent disease,” osteoporosis progresses without symptoms until a fracture occurs. Those fractures most often are in the hip, spine, and wrist and can be permanently disabling. Hip fractures, in particular, are dangerous, as men who sustain hip fractures are more likely than women to die from complications.

In men, all too often osteoporosis isn’t diagnosed until a fracture occurs. If you have any of the lifestyle risk factors for developing the disease, or you experience a loss of height or change in posture, a fracture, or sudden back pain, tell your doctor. When detected before significant bone loss has occurred, osteoporosis can be treated with medication, improved nutrition, exercise, and lifestyle changes. If you think you may be at risk for osteoporosis, make an appointment with your Emory physician for a medical workup and bone mineral density test.

Do you have osteoporosis, or do you know someone who does? How are you dealing with it? We welcome your questions and feedback in the comments section below.

6 Ways to Stop or Reverse Bone Loss during Menopause

Prevent Bone Loss During MenopauseIf you’re a perimenopausal, menopausal, or even postmenopausal woman, this blog’s for you. You’ve probably heard that you’re likely to lose bone mass during menopause. The good news is you can take steps to help preserve and even build bone density before natures takes its toll.

Do these 6 things and you’ll enjoy stronger bones and better overall health:

  1. Eat Right. Make sure you’re eating a balanced diet that includes lots of fruits and veggies, whole grains, seeds and nuts, and lean protein. Avoid sugars, preservatives, fatty meats, and refined grains. It’s also a good idea to take a nutritional supplement formulated for bone health. In particular, make sure you’re getting enough vitamin D, which helps you absorb calcium, and vitamin K, which is essential to bone health.
  2. Strengthen Your Muscles. The best time to begin building your muscles is before you start losing bone mass. Exercise can help you regain bone as you build muscle. Even if you’ve already gone through menopause, you can still add bone mineral density with an exercise program. Non-stressful aerobic exercises, such as walking, swimming, and biking, are great, and yoga and Pilates also help to build muscles and bone density gently.
  3. Control Chronic Inflammation. Injuries, food allergies, and diseases such as diabetes, heart disease, high blood pressure, high cholesterol, and irritable bowel syndrome (IBS) can all cause chronic inflammation, and inflammation in or around the gut can affect your ability to absorb bone-building nutrients. Sugar, caffeine, and refined carbohydrates tend to increase inflammation, while daily omega-3 fatty acids decrease inflammation. Pay attention to how the foods you eat make you feel and control inflammation for better bone health.
  4. Get Your Hormones in Balance. Hormones fluctuate during perimenopause and menopause, and the jury is still out on how those hormones affect bone loss. Hormone replacement therapy (HRT) may or may not be right for you—that’s for you and your doctor to decide. But you can help keep your hormones in balance with a healthy diet, and you may also find that certain herbal therapies work for you.
  5. Be Mindful of How You Lose Weight. While maintaining a healthy weight is one of the best things you can do to protect your overall health, be careful of how you go about losing if you’re overweight. Postmenopausal women who lose weight also tend to lose bone. This is where a healthy diet, supplements, and exercise come in again, to ensure you get the nutrients your body needs while you maintain and build muscle mass and bone density.
  6. Relax. Stress and worry only make bone loss worse. When you’re stressed, your body releases cortisol, the fight-or-flight hormone, and cortisol can weaken the bones and cause other problems over time. Yoga, t’ai chi, and other mind-body practices can help reduce stress while building bone and strengthening muscles. And once again, a healthy diet and exercise are key to both your mental health and your bone health.

Are you perimenopausal, menopausal, or postmenopausal? What steps have you taken to maintain or improve your health? We welcome your questions and feedback in the comments section below.

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Can Soda Consumption Affect Your Bone Health?

Cola bone healthOur team gets lots of questions about bone health, ranging from questions like “does  soda decrease my bone strength?”  To “how much calcium and Vitamin D are needed to maintain bone health?” In honor of National Nutrition Month, last week, we shared with you details on the roles of Calcium and Vitamin D in your bone health, and foods you can consume to make sure you get enough of each. This week, we want to share some interesting findings from new research being conducted around soda, and its effect on your bone strength.

There are many activities and behaviors that can serve to either improve or worsen bone health, but many recent studies have been conducted to determine if there is a link between soda consumption and decreased bone health. Check out some interesting take- aways from just a few of those studies below:

  • According to findings from a study at Harvard, 9th and 10th grade girls who consume sodas are at three times the risk for bone fractures compared to those who don’t.
  • Research out of Tufts University shows that “women–but not men–who drank more than three 12-ounce servings of cola per day had 2.3 percent to 5.1 percent lower bone-mineral density in the hip than women who consumed less than one serving of cola per day.”1
  • In a 2010 study from the Journal of American Dietetic Association, 170 girls were  followed from age 5 to 15. Of those, the participants who drank soda at age 5 were less likely to drink milk throughout childhood than those who didn’t consume soda at age 5. Those who drank soda from the age of 5 were also  more likely to consume diets lacking in calcium, fiber, vitamin D, protein, magnesium, phosphorus and potassium.
  • In a 2001 study out of Creighton University Osteoporosis Research Center , researchers followed 32 people for a month and had them drink various  formulations of soda with differing levels of caffeine, phosphorus or citric acid so the research team could take urine samples and determine how much calcium the subjects were excreting. Those who drank caffeine-rich sodas excreted calcium; the others did not.

While all of the research conducted so far indicates that there is more to be done to directly tie cola consumption to decreased bone health, it is clearly a hot topic  for future medical investigation. We will follow up on our blog as more details emerge.


Vitamin D & Calcium – A Healthy Bone Building Partnership (Part I)

Our team gets lots of questions about bone health, ranging from questions like “does soda decrease my bone strength?” To “how much calcium and Vitamin D are needed to maintain bone health?” In honor of National Nutrition Month, we want to share some interesting findings from new research being conducted around Vitamin D and Calcium and suggest few ways to get more of both in your diet, if you need them.

According to the National Institute of Arthritis and Musculoskeletal and Skin Disease, a division of the National Institute of Health, “low Calcium intake throughout life is associated with low bone mass and high fracture rates.” And while Calcium is critical in building bone health and density, Vitamin D is needed for the body to absorb this Calcium. According to findings from the CDC last year, about 1/3 of all Americans are deficient in Vitamin D. So if you’re looking for ways to boost your Calcium or Vitamin D intake, where should you start? Well, first, check out the latest recommendations on Calcium and Vitamin D intake from the Institute of Medicine:

Calcium & Vitamin D Recommendations

Then, after taking a look at your own diet as it compares to these recommendations, determine whether you need more or less of either Calcium or Vitamin D in your diet. If you need more of either, below we’ve listed some sources of both Calcium and Vitamin D.

Good Sources of Vitamin D

  • Sunlight
  • Supplements
  • Food
    • Cod Liver Oil
    • Fatty Fish (Swordfish, Salmon, Tuna, Mackerel)
    • Fortified Orange Juice or Milk
    • Eggs (Vitamin D is in the yolk)
    • Fortified Dairy Products & Cereals

Good Sources of Calcium:

  • Dairy Products
  • Fortified Cereals and Soy Beverages
  • Tofu
  • Spinach, Soy Beans, Beet Greens & Collards
  • White Beans

As is always the case, you should consult with your physician before changing your intake of any vitamin or nutrient, so make sure to discuss your bone health concerns with he or she at your next visit to get advice specific to your needs. If you have additional tips and ideas on Calcium, Vitamin D, or bone health, please leave them for us in the comments below!