By: TODD RUBIN, MD, HUGHSTON CLINIC ORTHOPAEDICS

In preparing for the colder, winter months, take a minute to consider bone health and ways to mitigate risk of musculoskeletal injury. Despite efforts to increase awareness, it is estimated that up to 75% of the US population has inadequate levels of vitamin D. More so, vitamin D insufficiency has been named a global epidemic and affects more than one billion people worldwide. Vitamin D deficiency results in preventable diseases such as rickets and osteomalacia, and has been linked to several medical and autoimmune disorders. In addition, vitamin D has emerged as a marker for bone health and is an important target for fracture prevention in at risk populations.

Vitamin D is unique because it is not found in fresh fruits and vegetables, the sources of many other essential vitamins. Vitamin D sources include fresh fatty fish, canned fish, eggs, fortified milk, orange juice, tofu, and cereal to name a few. Aside from the foods we eat, direct safe sun exposure can boost vitamin D stores and is the smartest, easiest, and least expensive option! During the winter months, consider as little as 10-15 minutes of midday sun time (lighter complexions), exposing as much skin as possible. For those with darker skin tones, consider up to two hours of sun exposure to produce the same stores of vitamin D. This essential vitamin plays a pivotal role in the body’s regulation of calcium and phosphate, and thus, is vital for maintaining normal bone quality, healing, and remodeling.

Risk factors for vitamin D insufficiency include malabsorption disorders, liver and/or kidney failure, obesity, increased age, ethnicity, sunscreen use, and geographic location (latitude). Furthermore, women who are pregnant or breastfeeding typically require higher intake of vitamin D per day. Current Institute of Medicine recommendations suggest that adults age 19-80 years take in 600 IU per day whereas those persons older than 70 years take in 800 IU per day. During pregnancy, the recommended intake increases to nearly 2000 IU per day and up to 4000 IU per day for nursing mothers. Check nutrition and supplement labels to ensure that the foods you eat are helping to reach your vitamin D goals.

In addition to diet, bone health depends on bone mass and density; both of which are influenced by regular stress. Exercise and routine weight bearing help to maintain bone mass, which typically peaks during the third decade of life and begins to decline thereafter. Routine exercise maintains strength, balance, coordination, and proprioception – all of which help to prevent falls and related fractures. For patients with joint pains or arthritis, yoga, swimming and cycling are great forms of exercise that minimize hip and knee impact.

Finally, arthritic symptoms tend to flare up during the winter months. Here are a few tips to help manage joint pain and prevent injury:

1.Warm soaks. Following an acute injury, ice and immobilization are often recommended to prevent acute swelling and inflammation. However, for chronic problems such as arthritis, warm compresses and/or warm soaks help to improve local tissue vascularity and reduce muscle spasms. For small joint arthritis in the hands, routine soaks three times per day using a pot of warm water and a household sponge may help to ease start up pain and stiffness. Use of gloves during the cold months also helps to maintain body warmth and prevent digital vasospasm.

2.Routine stretching. Most people rarely dedicate time to stretching prior to engaging in physical activity, and often stretch when the body is not properly warmed up. In order to maintain normal function, it is important to stretch each individual joint before and after exercise. This helps to dissipate stresses throughout the joint surface and helps to prevent stiffness. For patients with arthritis, routine stretching in the morning may also help to minimize pain related to the initiation of movement otherwise known as “start-up pain.” In addition to the larger joints of the lower extremity, it is equally important to stretch each individual joint in the hand and fingers to prevent joint contracture.

3.Anti-inflammatories. While routine use is not recommended, a short course anti-inflammatory medications may provide significant pain relief immediately following acute injury or during an arthritic flare. It is recommended to take these medications with food to prevent gastritis and other GI symptoms. Check with your physician prior to starting such a medication to make sure its use is safe and to avoid any serious drug interactions.


Jan Blog.Hughston.Dr Todd RubinDr. Todd Rubin is a fellowship trained orthopaedic surgeon who specializes in hand, upper extremity, and microvascular surgery. He is new to Nashville from New York and is accepting new patients at the Hughston Clinic Office located at Centennial Medical Center.