Joint pain stems from osteoarthritis (OA), a condition marked by the breakdown of cartilage – the connective tissue between bones. Without adequate cartilage, bones rub together, causing discomfort. OA is pretty common; the Arthritis Foundation says it affects 27 million Americans, mostly over 65. And the area most inclined to get OA? The knee: Half of adults will develop symptoms. (Other commonly affected areas include the hips and spine.)

Dr. James Dowd, an orthopedic surgeon at Jordan-Young Institute, an orthopedic practice in Virginia Beach, Virginia, says that knees are the likeliest to have problems because they do complex work—bending, rolling and twisting—and hold up most of our body weight. And if you’re overweight or obese, you’re putting extra strain on them too. “According to data published by the American Academy of Physical Medicine and Rehabilitation,” Dowd says, “for every 11-pound weight gain, there is a 36 percent increased risk for developing OA.” Healthy knees are like the rest of healthy bodies generally—they move around and don’t weigh too much.

Before you have significant damage, what can you do to keep your knees happy? None of us can go back to high school and avoid sports injuries, and some accidents will happen. But Dowd says there are lifestyle changes we can make, even as we age, to minimize knee stress.

“Stay moving,” he says. “It’s easy for joints to stiffen when you’re sedentary, so people should make it a point to stay active even if it’s taking a quick walk around the house at the top of every hour.”

Water-based activities can also be particularly good for strengthening knees. The water provides resistance without strain, pushing back against you just a little during movements. Strengthening muscles around your knee (or any joint) helps hold it straight, preventing twists and sprains and other nasty damage. Water aerobics and swimming can all make your knees happier for land-based activities. And they provide cardio workouts with low impact.

Dowd also advises paying attention to how your knees feel. Symptoms usually develop over time, and you’re not doing yourself any favors by waiting too long to see your doctor. “Many women delay treatment until the pain becomes too unbearable to tolerate,” cautions Dowd.

Early intervention means small changes instead of major surgery such as knee replacement. When you start to notice any pain in your knees, it’s time to talk with a doctor about lifestyle or exercise issues. You can start swapping out high impact activities for low impact exercises, and mixing up your exercise routines to work and strengthen different muscles, he says. You don’t have to eliminate a particular activity you love, but with a trainer or physical therapist, you can figure out ways to strengthen the muscles supporting your knee.

For many Americans, joint discomfort is that dark cloud hanging over all those sunny, summer plans. But it doesn’t have to be that way. Our friends at Cosamin for Joint Health have put together some essential travel tips to help make sure your next vacation is also a break from joint discomfort.

TRAVEL TIPS FOR JOINT COMFORT

Consider Space
No, we’re not suggesting you visit the Moon. We mean consider the personal space you have on the way to your destination. If you’re flying or taking a train, pay a little more for a seat with extra legroom so you can stretch out. If that price point is too high, try to get an aisle seat so you can easily get up and move around periodically. Keeping your joints limber while you travel is essential for arriving at your destination in comfort so you can get the most enjoyment out of that well-earned vacation.

Roll With It
When it comes to efficiently moving your belongings while you travel, nothing beats a quality rolling bag. By diverting extra weight from your body and reducing heavy lifting, you are taking all that unnecessary pressure off your joints. For even more joint relief, do your best to not over pack so transporting your luggage will be as cool and breezy as that ocean view.

Give It A Rest
It may sound like redundant advice for someone on vacation, but take some time to relax. If your trip involves a lot of walking and movement, be sure to plan some time-outs, whether it’s grabbing a refreshing beverage at a trendy cafe or stopping for a delicious snack. Even if you’re not particularly hungry or thirsty, the “people watching” is always worth the time.

Honesty Is The Best Policy
Chances are you’re not the only one on this vacation and that’s great! What is not great is lying to yourself or your travel partners about your comfort level. If you need a break or want to give that whitewater rafting lesson a pass, let your loved ones know. They will be happy to not see you in discomfort.

New Shoes, You Lose
Going on a more active vacation is probably not the best time to buy new shoes. Instead, go with a trusty pair that offers good support and a lot of traction. If you do want to purchase a new pair, do your research and find shoes designed to distribute weight and reduce stress on your joints. Be sure to give yourself a few weeks to break them in and ensure you are not adding to your discomfort.

Supplement Your Enjoyment
Take a premium glucosamine & chondroitin joint supplement that is clinically proven to help promote joint comfort and mobility both home and abroad. For those planning a more active getaway, a joint supplement specially formulated for faster action will help ensure comfort stays with you every step of the way. Just remember to pack enough pills to get you through your adventure!

For more information about how to improve your joint health, check out How Cosamin Works or talk to your physician about the benefits of Cosamin, a premium joint health supplement.

A release from the university reported that according to Dr. Sadanand Fulzele, bone biologist in the Department of Orthopaedic Surgery, the differences may help explain why the disease is more common in women. The discovery also points toward a more targeted way to diagnose and treat this “wear and tear” arthritis thataffects more than 30 million Americans and is fundamentally a destruction of the cartilage that provides padding between the bones.

The release quotes Dr. Monte Hunter, chair of the MCG Department of Orthopaedic Surgery and a coauthor of the study, as saying, “It’s a huge problem.” Today’s treatment addresses symptoms, such as inflammation and pain, and the bottom line for some patients is knee replacement. Clinicians like Hunter would like to provide patients additional options for diagnosing and treating this common malady of aging.

Synovial fluid is known to provide clues about joint health, so MCG researchers decided to look at what messages cells in the region were sending and receiving by looking inside traveling compartments in the fluid called exosomes, says Fulzele, corresponding author.

“What we found is there is no change in the number of exosomes, but a change in the microRNA cargo they carry,” Fulzele says.

They isolated the mostly round exosomes in discarded human synovial fluid from patients with and without osteoarthritis. They found in the males that 69 microRNAs were significantly downregulated and 45 were upregulated. In females, however there were 91 downregulated versus 53 upregulated.

Females just seemed more impacted: In total, they had more than 70 biological processes altered compared to males who had closer to 50, the researchers report.

Fulzele and Hunter suspect that the gender differences they found in exosome content helps explain gender differences in disease incidence and that estrogen was key to the differences.

Particularly in the females, they found microRNA that should be sending messages that are good for the joints, like promoting estrogen signaling and collagen-producing cells, turned off or otherwise altered.

Lower estrogen levels, like those that occur following menopause, prompt production of more cells that destroy bone. In this environ, those bone-consuming cells also tend to live longer, which can result in a net bone loss. Conversely, reduced osteoarthritis risk is considered a benefit or hormone replacement therapy.

MCG researchers’ hypothesize that estrogen plays an important role in determining which microRNAs the exosomes contain. In fact, when they used aromatase inhibitors to reduce the availability of estrogen, they found a small lineup of microRNAs decreased in number. When they treated cartilage cells from healthy females with exosomes from males and females with osteoarthritis, significantly fewer healthy cartilage cells lived after exposure to the exosomes from patients with disease. Expression of genes that make the extracellular matrix that is the framework of cartilage went down while expression of genes that promote inflammation increased.

They only found one microRNA, MiR-504-3p upregulated in both male and female osteoarthritis patients. Although it’s unclear what MiR-504-3p does, Fulzele thinks it degenerates cartilage, which is the crux of osteoarthritis. In future studies, they will use MIR-504-3p inhibitors to remove it from the equation and try to determine the function of this tiny piece of RNA.

All cells excrete exosomes as one way to communicate. They carry cargo like protein, lipids as well as microRNA, which can impact the expression and actions of many different genes. In the case of the synovial fluid, Fulzele says the exosome source is likely cells in the synovial membrane that lines the joints and produces the fluid. Wear and tear that comes with aging, and can be accelerated and aggravated by injury, can inflame the membrane, which may alter the cargo in the exosomes and the messages they carry, Fulzele says.

Knee replacement becomes the endgame for patients whose dwindling cartilage can literally translate to one bone rubbing against another.

“People understand bone on bone when they hear that,” Hunter says of the potentially excruciating and debilitating pain that may result. Early interventions include icing a swollen knee, taking anti-inflammatories and avoiding activities that are hard on the joints, says Hunter. They can also inject hyaluronic acid, the major component of synovial fluid, into the knee in an attempt to normalize the environment.

Today, a diagnosis is made based on the joint pain and stiffness patients report, a physical exam and X-ray. Physicians also often examine the synovial fluid, Hunter says. When a knee is swollen and warm to the touch, they will extract some of the fluid to look for problems other than wear and tear, like an infection and/or uric acid crystals, Hunter says. The crystals could be an indicator of gout, a type of arthritis that results from the body’s reaction to excessive levels of uric acid, which results from the breakdown of purines, chemicals found in meat, poultry and seafood.

Hunter hopes that soon he and his colleagues will also examine exosomes in the fluid for indicators of that patient’s specific instigators of cartilage destruction. They then hope to devise a cocktail – potentially a mix of microRNA inhibitors and joint health promoting microRNA mimics delivered in manmade exosomes – that can be injected into the knee to target and help resolve the debilitating destruction.

MCG researchers already are exploring ways to block the microRNAs that are causing destruction.

Other key collaborators include Dr. Ravindra Kolhe, molecular pathologist in the MCG Department of Pathology, and Dr. Mark Hamrick, bone biologist in the MCG Department of Cellular Biology and Anatomy.

While osteoarthritis is considered normal wear and tear, it’s multifactorial, says Hunter, the Dr. Charles Goodrich Henry and Carolyn Howell Henry Distinguished Chair at MCG. “There is a genetic component. Some of us have stronger cartilage than others. Some of us are made differently so the angle of our joints puts more pressure in some places.”

Risk factors include injury, overuse, increasing age, obesity, a family history, as well as being female, according to the Centers for Disease Control and Prevention. Sports with repetitive high impact, like running and basketball, can increase the risk.

A release from the publisher notes that the researchers found that if the procedure were restricted to patients with more severe symptoms, its effectiveness would rise and the practice would become economically more attractive than its current use.

According to the release, about 12% of adults in the US are affected by osteoarthritis of the knee. The annual rate of total knee replacement has doubled since 2000, mainly due to expanding eligibility to patients with less severe physical symptoms.

The number of procedures performed each year now exceeds 640,000 at a total annual cost of about $10.2bn (£8.3bn, €9.6bn). Yet health benefits are assumed to be higher in those with more severe symptoms before surgery.

So a team of researchers based in the US and the Netherlands set out to evaluate the potential impact of total knee replacement on quality of life in people with knee osteoarthritis.

They also wanted to estimate differences in lifetime costs and quality adjusted life years or QALYs (a measure of years lived and health during these years) according to level of symptoms.

They analyzed data from two US studies – 4,498 participants aged 45-79 with or at high risk for knee osteoarthritis from the Osteoarthritis Initiative (OAI) and 2,907 patients from the Multicenter Osteoarthritis Study (MOST).

OAI participants were followed up for nine years and MOST patients were followed up for two years. Quality of life was measured using a recognized score of physical and mental function, known as SF-12, and using some osteoarthritis specific quality of life scores.

They found that quality of life outcomes generally improved after knee replacement surgery, although the change was small. The improvements in quality of life outcomes were higher when patients with lower physical scores before surgery were operated on.

In a cost effectiveness analysis, current practice was more expensive and in some cases seemed even less effective compared with scenarios in which total knee replacement was performed only in patients with lower physical function.

“Given its limited effectiveness in individuals with less severely affected physical function, performance of total knee replacement in these patients seems to be economically unjustifiable,” write the authors.

“Considerable cost savings could be made by limiting eligibility to patients with more symptomatic knee osteoarthritis,” they add.

“Our findings emphasize the need for more research comparing total knee replacement with less expensive, more conservative interventions, particularly in patients with less severe symptoms,” they conclude.

A release from the university notes that the team randomly assigned 131 older adults with osteoarthritis to either the “Sit ‘N’ Fit Chair Yoga©” program developed by Kristine Lee or a health education program. Participants attended 45-minute sessions twice a week for eight weeks. Researchers measured pain, pain interference (how it affects one’s life), balance, gait speed, fatigue and functional ability, before, during and after the sessions.

Results from the study found that participants in the chair yoga group, compared to those in the health education program, showed a greater reduction in pain and pain interference during their sessions, and that reduction in pain interference lasted for about three months after the 8-week chair yoga program was completed. The 8-week chair yoga program also was associated with reductions in fatigue and improvement in gait speed during the study session, but not post session.

The release quotes Juyoung Park, Ph.D., co-author and co-principal investigator of the study, as saying. “With osteoarthritis-associated pain, there is interference in everyday living, limiting functional and social activities as well as diminishing life enjoyment. The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities.” Dr. Park is Hartford Geriatric Social Work Faculty Scholar and an associate professor in FAU’s College for Design and Social Inquiry.

Regular exercise has proven to help relieve osteoarthritis pain, however, the ability to participate in exercise declines with age, and many dropout before they can even receive benefits. Although the Arthritis Foundation recommends yoga to reduce joint pain, improve flexibility and balance, and reduce stress and tension, many older adults cannot participate in standing exercises because of lack of muscle strength, pain and balance as well as the fear of falling due to impaired balance. Chair yoga is practiced sitting in a chair or standing while holding the chair for support, and is well suited to older adults who cannot participate in standing yoga or exercise.

“Currently, the only treatment for osteoarthritis, which has no cure, includes lifestyle changes and pharmacologic treatments that are not without adverse events,” said Ruth McCaffrey, D.N.P., A.R.N.P., co-author and emeritus professor in FAU’s College of Nursing. “The long-term goal of this research is to address the non-pharmacologic management of lower extremity osteoarthritis pain and physical function in older adults, and our study provides evidence that chair yoga may be an effective approach for achieving this goal.”

The overall goal of this interdisciplinary program is to decrease pain, and improve physical and psychosocial functions of elderly individuals with osteoarthritis who are unable to participate in other exercise and yoga programs.

Park and McCaffrey conducted the study with Patricia Liehr, Ph.D., R.N., co-principal investigator, co-author and a professor in FAU’s College of Nursing; David Newman, Ph.D., co-author and an assistant professor in FAU’s College of Nursing; and Joseph G. Ouslander, M.D., co-author, senior associate dean of geriatric programs and chair and professor of the Department of Integrated Medical Science in FAU’s Charles E. Schmidt College of Medicine.

“The potential impact of this study on public health is high, as this program provides an approach for keeping community-dwelling elders active even when they cannot participate in traditional exercise that challenges their balance,” said Liehr.

Image credit: Florida Atlantic University

In real life, footwear magic is limited to “unloading” shoes that may help relieve knee pain from osteoarthritis. These unloading shoes have stiffer soles, and slightly tilted insoles that reposition the foot, intended to reduce (or unload) strain on the knee. But a study published online July 12, 2016, in Annals of Internal Medicine suggests that unloading shoes are no better than a good pair of walking shoes at making pain disappear.

About the study

Researchers randomly assigned 164 people with knee arthritis (age 50 or older) to wear either new unloading shoes or new conventional walking shoes every day for six months. By the end of the study, it appeared that both types of shoes were equally effective at reducing pain and improving physical function, with pain reduced an average of about 25%, and function improved by about 22%. It didn’t prove that both shoes are equally effective, but an editorial accompanying the study says the findings highlight “the promise of simple biomechanical interventions” to address knee pain.

Both shoes used in the study cost $180. But custom-made unloading shoes, and even custom-made insoles that can be inserted into a shoe, can cost many hundreds of dollars.

What to look for in a walking shoe

If you’re going to try a walking shoe to reduce your knee pain, look for certain features, such as:

• a “stability-type” sneaker with a rigid sole and supportive insole
• a slightly curved “rocker” sole that helps distribute the body more weight evenly as you walk. This sole may not be right for you if you have balance problems.

And remember that fit is important, too. Seek out:

• a wide, roomy toe area (what shoe salespeople call the toe box)
• length at least half an inch beyond your longest toe
• a sturdy area around your heel (called a heel counter), so your foot stays in place and doesn’t slip around, which can cause friction and pain.

“Most of the sneaker brands make this shoe (New balance, Brooks, Saucony, Asics), so they are widely available. The take home here is that any supportive, rocker-bottom type shoe makes walking with knee osteoarthritis easier,” says Dr. Holly Johnson, an orthopaedic surgeon and instructor at Harvard Medical School. “The other important thing is that keeping physically active is so crucial to bone and joint health. If the shoes make people feel better when they walk, and therefore they walk more, this leads to so many health benefits. Find something comfortable and go with it.”

Other options

Walking shoes aren’t the only way to relieve knee pain without surgery. “I see success stories without surgery every day,” says Dr. Clare Safran-Norton, Clinical Supervisor of Rehabilitation Services at Harvard-affiliated Brigham and Women’s Hospital.

Her top recommendations include:

• Physical therapy: Dr. Safron-Norton suggests that a person with knee arthritis undergo at least three months of physical therapy as a first line of treatment. The program should include a series of exercises to strengthen and stretch the muscles that support the knee.
• Weight loss: Shedding pounds reduces the pressure you place on your knee. That’s significant, since the force you place on your joints can be up to six times your body weight.
• Injections: Corticosteroid injections can temporarily reduce pain and swelling, which can make it less painful to take part in physical therapy.
• Acupuncture: The studies about whether acupuncture relieves knee pain are mixed, but Safran-Norton says the treatment is helpful to some people. “If the problem is pain, it may work. If the problem is biomechanical or weak muscles, it probably won’t.”
• Supplements: Research has provided mixed results on chondroitin and glucosamine supplements to relieve pain, but Safran-Norton says some of her patients feel the pills make a difference. Chondroitin sulfate helps to keep cartilage from deteriorating. Glucosamine stimulates cartilage formation and repair.

Don’t expect these things to work magic overnight. “You’ll feel a difference after going to physical therapy once or twice a week for two-to-four weeks,” says Safran-Norton. The rest of the methods are used best in conjunction with physical therapy, not in place of it, she advises.

With a little trial and error, you have a good chance of finding knee pain relief without surgery — and you may get a fairy tale ending. If knee pain persists, you may need to speak with an orthopaedic expert about surgery. But save that for a last resort.

Arthritis can attack joints in almost any part of the body. Some types of arthritis cause changes you can see and feel—swelling, warmth, and redness in your joints. In some kinds of arthritis, the pain and swelling last only a short time, but are very uncomfortable. Other types of arthritis might be less painful, but still slowly cause damage to your joints. Here, from the experts at the National Institute on Aging, is what you need to know about an all-too-common condition:

Types of Arthritis

Arthritis is one of the most common diseases in the United States. Older people most often have osteoarthritis, rheumatoid arthritis, or gout.

Osteoarthritis (OA) is the most common type of arthritis in older people. OA starts when tissue, called cartilage, that pads bones in a joint begins to wear away. When the cartilage has worn away, your bones rub against each other. OA most often happens in your hands, neck, lower back, or the large weight-bearing joints of your body, such as knees and hips.

OA symptoms range from stiffness and mild pain that comes and goes to pain that doesn’t stop, even when you are resting or sleeping. Sometimes OA causes your joints to feel stiff after you haven’t moved them for a while, like after riding in the car. The stiffness goes away when you move the joint. Over time, OA can make it hard to move your joints. It can cause a disability if your back, knees, or hips are affected.

Why do you get OA? Growing older is what most often puts you at risk for OA, possibly because your joints and the cartilage around them become less able to recover from stress and damage. Also, OA in the hands may run in families. Or, OA in the knees can be linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.

Rheumatoid arthritis (RA) is an autoimmune disease, a type of illness that makes your body attack itself. RA causes pain, swelling, and stiffness that lasts for hours. RA can happen in many different joints at the same time. People with RA often feel tired or run a fever. RA is more common in women than men.

RA can damage almost any joint. It often happens in the same joint on both sides of your body. RA can also cause problems with your heart, muscles, blood vessels, nervous system, and eyes.

Gout is one of the most painful kinds of arthritis. It most often happens in the big toe, but other joints can also be affected. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender.

Eating foods rich in purines like liver, dried beans, peas, anchovies, or gravy can lead to a gout attack in people with the disease. Using alcohol, being overweight, and taking certain medications may make gout worse. In older people, some blood pressure medicines can also increase the chance of a gout attack. To decide if you have gout, your doctor might do blood tests and x-rays.

Warning Signs

You might have some type of arthritis if you have:

Ongoing joint pain

Joint swelling

Joint stiffness

Tenderness or pain when touching a joint

Problems using or moving a joint normally

Warmth and redness in a joint

If any one of these symptoms lasts more than two weeks, see your regular doctor or one who specializes in treating arthritis, called a rheumatologist. If you have a fever, feel physically ill, suddenly have a swollen joint, or have problems using your joint, see your doctor right away.

Treating Arthritis

Getting enough rest, doing the right exercise, eating a healthy, well-balanced diet, and learning the right way to use and protect your joints are keys to living with any kind of arthritis. The right shoes and a cane can help with pain in the feet, knees, and hips when walking. But make sure the cane is fitted by a professional. Don’t borrow one from a friend or neighbor. There are also gadgets to help you open jars and bottles or to turn the doorknobs in your house.

Some medicines can help with pain and swelling. Acetaminophen might ease arthritis pain. Some people find NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen, naproxen, and ketoprofen, helpful. Some NSAIDs are sold without a prescription, while others must be prescribed by a doctor. Be very careful about possible side effects of some NSAIDs, whether sold with or without a prescription. Read the warnings on the package or insert that comes with the drug. Talk to your doctor about if and how you should use acetaminophen or NSAIDs for your arthritis pain. The U.S. Food and Drug Administration has more information about drugs such as those mentioned here.

Osteoarthritis (OA). Medicines can help you control the pain. Rest and exercise may make it easier to move your joints. Keeping your weight down is a good idea. If pain from OA is very bad, there are shots your doctor can give you.

Rheumatoid arthritis (RA). Treatment can help the pain and swelling. This might slow down or stop joint damage. You may feel better and find it easier to move around. Your doctor might also suggest anti-rheumatic drugs called DMARDs (disease-modifying antirheumatic drugs). These can slow damage from the disease. Other medicines known as corticosteroids (like prednisone) can ease swelling. These are strong medicine and should only be taken with a doctor’s prescription. Another kind of drug, called a biologic response modifier, blocks the damage done by the immune system. These may help people with mild-to-moderate RA when other treatments have not worked.

Gout. The most common treatment for an acute attack of gout is NSAIDs or corticosteroids. They can bring down the swelling, so you may start to feel better within a few hours after treatment. The pain usually goes away within a few days. If you have had an attack of gout, talk to your doctor to learn why you had the attack and how to prevent future attacks. If you have had several attacks, your doctor might prescribe medicines to prevent future ones.

Exercise Can Help

Along with taking the right medicine and properly resting your joints, exercise might help with arthritis symptoms. Daily exercise, such as walking or swimming, helps keep joints moving, lessens pain, and makes muscles around the joints stronger.

Three types of exercise are best if you have arthritis:

Range-of-motion exercises, like dancing, might relieve stiffness, keep you flexible, and help you keep moving your joints.

Strengthening exercises, such as weight training, will keep or add to muscle strength. Strong muscles support and protect your joints.

Aerobic or endurance exercises, like bicycle riding, make your heart and arteries healthier, help prevent weight gain, and also may lessen swelling in some joints.

The National Institute on Aging (NIA) has created the Go4Life® campaign to help you start and stick with a safe exercise program. You can learn all about it by going to www.nia.nih.gov/Go4Life. There you’ll find exercises, tip sheets, personal success stories, and more! You can even keep track of progress in your exercise program. You can also order Go4Life® materials in English and Spanish by calling the NIA at 1-800-222-2225 (toll-free).

Other Things To Do

Along with exercise and weight control, there are other ways to ease the pain around joints. You might find comfort by using a heating pad or a cold pack, soaking in a warm bath, or swimming in a heated pool.

Your doctor may suggest surgery when damage to your joints becomes disabling or when other treatments do not help with pain. Surgeons can repair or replace some joints with artificial (man-made) ones.

For more information on health issues from the National Institute on Aging, click here.

Injections of hyaluronic acid (HA) are a common treatment of pain in osteoarthritis of the knee – a condition that affects 27 million Americans, according to the Centers for Disease Control and Prevention. The injections replace natural HA that has depleted from the joints, which can cause pain and stiffness due to the lack of lubrication between bones moving against each other.

There are eight different HA products sold in the U.S. with annual sales approaching $1 billion. And while all of these products are approved by the FDA, studies have produced mixed results on their effectiveness, leading researchers and doctors to question how HA actually functions in the body.

A research group led by Lawrence Bonassar, professor of biomedical engineering, and graduate student Edward Bonnevie has discovered that another molecule, lubricin, helps anchor HA at the tissue surface, which, in turn, helps to move cartilage into a low-friction regime. “The implication of this finding is that the efficacy of HA treatment might depend on how much lubricin is in the joint at the time of injection, which could explain why clinical trials of HA have such variable outcomes and may also suggest new formulations of HA that might be even more effective in the clinic,” said Bonassar.

The study, published in the journal PLOS ONE, examined how multiple formulations of HA lubricated cartilage and found that they all worked by a similar mechanism, “one that is very similar to how a car hydroplanes on a wet road,” said Bonassar. Essentially, the viscous HA solutions form pressurized films that lower the friction coefficient of cartilage, particularly at higher sliding speeds. “For many years, people doubted that this mechanism could happen in cartilage because the tissue is both flexible and porous. In this paper, we show definitively that cartilage can move to this low-friction domain in the presence of highly viscous HA solutions,” said Bonassar.

Scientists from Fidia Farmaceutici S.p.A. co-authored the study and used the results to bioengineer a new derivative of natural HA. This new HA derivative, known as HYADD®4, has been approved by the FDA for clinical use in the U.S. and will be marketed under the name Hymovis® starting in March.

The conclusion is true no matter what age you are.

The review was published in the journal Osteoporosis International by leading bone and nutrition experts, in anticipation of World Osteoporosis Day on October 20.

According to a news release from the International Osteoporosis Foundation (IOF), the review summarizes the latest evidence relating to the nutritional needs of mothers, children and adolescents, adults and seniors, in relation to developing and maintaining a healthy skeleton. Placing particular emphasis on calcium, vitamin D and protein, it shows how adequate nutritional intake of these and other micronutrients can support the primary objectives for good bone health:

Achieving genetic potential for peak bone mass in children and adolescents

Avoiding premature bone loss and maintaining a healthy skeleton in adults

Preventing and treating osteoporosis in seniors

Findings from international studies and trials are summarized as well as current dietary guidelines.

Professor Cyrus Cooper, co-author and chair of the International Osteoporosis Foundation (IOF) Committee of Scientific Advisors, said, “This new report shows just how important nutrition is for our bone health throughout life. In fact, nutrition plays a key role in the development of a healthy skeleton even before birth. Healthy maternal diets as well as adequate vitamin D levels are associated with greater bone mass in the off-spring.”

The report also underlines how lifestyle trends which lead to poor diet and nutrient deficiencies are a growing cause of concern in people of all ages, and particularly in children. Milk and dairy products comprise the mainstay of calcium intake for most children, yet a decline in milk consumption has been observed across the world during the last few decades. Furthermore, vitamin D insufficiency is widespread among youth, which has led to recommendations in several countries for vitamin D supplements to be given to infants and young children.

In adults and seniors, studies have shown that calcium intakes are often considerably below those recommended by national guidelines. Similarly, alarmingly low levels of vitamin D have been found in populations around the world. Lifestyle factors such as excessive alcohol consumption, smoking, and a very high or low body mass index (BMI) also elevate fracture risk for a substantial number of people.

The researchers also analyze the impact of nutrition on falls and fracture prevention in seniors, who are a growing segment of the population and most affected by osteoporosis. The review shows how deficits in protein intake as well as malnutrition, which is sadly common in older people, can negatively affect their bone and muscle health. It also highlights how together with appropriate exercise, adequate nutritional intake in those at high risk of fracture plays an important complementary role to pharmacotherapy.

A release from the pubisher notes that the findings may be helpful for clinicians as they decide which treatments are best for different patients. Additional studies on the mechanisms involved the sex differences observed this study may also help researchers develop new treatment strategies for patients.

The release quotes lead author Dr. Emily Bartley as saying, “Many questions still remain as to why women with knee osteoarthritis are more sensitive to painful stimuli than are men. While therapeutic approaches to control pain are only beginning to take these sex differences into account, there is still quite a bit of research yet to be done to help reduce this gender gap and improve clinical therapies for men and women alike.”