Chapter List

• Introduction
• Achilles Tendon
• Adrenal Glands
• Ankles
• Appendix
• Arteries
• Back
• Belly Button
• Birth Control
• Birthmarks
• Bladder
• Blood
• Body Hair
• Body Type
• Brain
• Breasts
• Cervix
• Childbirth
• Chin
• Circulatory System
• Clitoris
• Collarbone
• Digestive System
• Ears
• Elbows
• Emotions
• Endocrine System
• Energy
• Esophagus
• Eyes
• Fallopian Tubes
• Fat
• Feet
• Fertility
• Fingernails
• Gallbladder
• Gums
• Gynecological Exam
• Hair
• Hands
• Heart
• Hips
• Hormones
• Intestines
• Jaw
• Joints
• Kidneys
• Knees
• Larynx and Vocal Cords
• Lips
• Liver
• Lungs
• Lymphatic System
• Medical Tests
• Menopause
• Menstrual Cycle
• Moles
• Mouth
• Muscular System
• Neck
• Nervous System
• Nose
• Nutrition
• Ovaries
• Pain Relief
• Pancreas
• Pelvis
• Pregnancy
• Rectum
• Reproductive System
• Respiratory System
• Ribs
• Salivary Glands
• Scalp
• Sex
• Sexually Transmitted Diseases
• Shins
• Shoulders
• Sinuses
• Skeletal System
• Skin
• Skull
• Spine
• Spleen
• Stomach
• Stress
• Sweat Glands
• Tailbone
• Tear Ducts
• Teeth
• Throat
• Thyroid
• Toenails
• Tongue
• Tonsils
• Underarms
• Urinary System
• Urine
• Uterus
• Vagina
• Veins
• Vulva
• Wrists
• Shaping Up
• The Total Body Shaping Workoout
• Abdominals
• Biceps
• Buttocks
• Calves
• Chest
• Forearms
• Neck3
• Shoulders3
• Thighs
• Triceps
• Aerobic Conditioning

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Hips

Hips

To kids on the go, hips are just another body part to wiggle, wriggle and jiggle. From skateboarding to boogying, youthful gyrations require superb hip mobility. It's only as the years pass and girths grow that many of us start to worry more about the dimensions than the swivel of our hips.

Instead of focusing so much on the size of their hips, women need to get hip about the health of that region of their bodies, doctors say. In their thirties and forties there are a number of problems that women can experience in the hip region, including arthritis and bursitis.

Yet the big threat to women is a disease that doesn't actually strike until years later when they reach menopause. Osteoporosis, a disease in which bone density declines, places women at risk for disabling and even life-threatening hip fractures.

Now, not later--particularly when it comes to osteoporosis--is when you can take steps to safeguard the health of your hips, experts say.

Why We Sway

"The hip is what is referred to as a ball-and-socket joint," says Ira H. Kirschenbaum, M.D., arthritis and joint replacement surgeon at Westchester Bone and Joint Associates in White Plains, New York. It has a socket cup that is formed by the bones of the pelvis. The joint also has a ball at the top end of the thigh bone.

The ball fits securely into the cuplike cavity and is attached to the pelvic bone by a series of strong ligaments. This ball-and-socket design makes the hip joint both flexible and stable.

In terms of how the hip joint is constructed, there appears to be little difference between men's and women's hip joints, says Susan Larson, Ph.D., associate professor of anatomy at the State University of New York at Stony Brook. In women, however, hips tend to be wider, because they have a wider pelvis (which is needed to deliver babies). That extra dimension can contribute to knee problems, and it's the reason many women have a walking gait distinctly different from men's.

When we walk, we swing one hip forward. And as we take a step, that hip tends to drop a little lower than the hip of the supporting leg, explains Dr. Larson. Because a woman's pelvis is wider, that hip drop is more pronounced than it is in men. The result is that our hips tend to sway more when we walk.

Building a Better Hip Future

Even if you've been sashaying gracefully through adult life with little or no hip pain, you should start to think about the future state of your hipbones. Every woman needs to, according to Dr. Kirschenbaum. Here's why.

Bone is a dynamic structure that's continually remodeling itself. Old bone goes through a breakdown process called resorption while new bone is building up. When new bone is building up faster than old bone is being resorbed, bones get stronger. But if bone is being resorbed faster than it's being built up, bone is lost.

As we age, both men and women experience age-related bone loss, says Dr. Kirschenbaum. That's because the bone-building process doesn't quite keep pace with the breakdown process.

But women have it worse. In premenopausal years, it appears, the hormone estrogen plays a role in inhibiting bone resorption. Once estrogen levels decline, however, its protective action against bone resorption is gone, and women start to lose bone a lot faster than men do.

Where the Hip Breaks When a woman breaks her hip, the break usually occurs in a portion of bone called the femoral neck, according to Avrum Froimson, M.D., director of orthopedic surgery at Mount Sinai Medical Center in Cleveland. The femoral neck is located between two larger, chunkier pieces of bone--the ball-shaped head of the femur and the femur bone. Since the femoral neck is the thinnest bone in the area, when something gives, it's usually there. The circled area is the thin femoral neck of the hip joint--where a fracture is most likely to occur.

When women reach menopause and their estrogen levels drop, bone loss increases dramatically. The hips are one of the most vulnerable spots (the wrist and spine are also susceptible).

It's this rapid bone loss that can lead to osteoporosis. The very structure of the bone--the internal scaffolding--starts to thin out. Bone density declines and the bone grows weaker. When that happens, the bone is susceptible to fracture.

Some women are at greater risk for osteoporosis than others, observes Avrum Froimson, M.D., director of orthopedic surgery at Mount Sinai Medical Center in Cleveland. "If you're blond, blue-eyed and thin, then you are at higher risk than if you are dark-haired, dark-eyed and heavier." And if you have a family history of the disease--if your mother or your grandmother had a hip fracture--then you're probably at increased risk for the disease.

An estimated 20 million adults develop osteoporosis each year, and an estimated 250,000 postmenopausal women will suffer hip fractures each year because of the disease. A woman who lives to be 90 years old has a one in three chance of fracturing her hip.

Compared with heart disease or breast cancer, osteoporosis may seem less alarming. But the fact is, a hip fracture from osteoporosis can be difficult to recover from--so difficult, in fact, that many women never do. Some die from complications, while others are left disabled.

Amassing More Bone

You can't stop some loss of bone mass; it's an inevitable part of aging. But if you're in your thirties or forties, you can take many steps to help avoid the onset of osteoporosis. Here's what experts recommend.

Walk away from it. A regular program of weight-bearing exercise can help build your bone strength and fend off osteoporosis, says Dr. Kirschenbaum. Impact exercises such as walking, running or step aerobics are very effective. Women should aim for 20 to 30 minutes of continuous impact exercise a day, he says.

Consume calcium. Calcium is one of the building blocks that bone needs to replenish itself. So women need to make sure they have enough calcium in their diets, says Dr. Froimson.

The amount of calcium for premenopausal women is 1,000 milligrams a day, according to recommendations of the National Institutes of Health Consensus Panel. For postmenopausal women not undergoing hormone replacement therapy, the recommended amount jumps to 1,500 milligrams.

It's possible to get all that calcium from food sources--but make sure that the sources are low-fat or nonfat, so you don't put on extra weight while you're getting more calcium. Each one-cup serving of low-fat yogurt and each cup of skim milk has about 300 milligrams of calcium. So you can get the recommended level if you get four or five servings of those low-fat dairy foods every day. Other foods such as low-fat cheese, which contains about 170 milligrams of calcium, can also contribute.

Pop some extra. The calcium you get from food is the best kind, says Dr. Froimson, since it's more readily absorbed by your body than the calcium you get through supplements. But if you can't get all the calcium you need from food sources, ask your doctor about supplements. Many doctors recommend calcium supplements containing calcium carbonate.

Don't smoke bone away. Smoking can have a negative effect on bone density and aggravate your risk for the disease, says Gerald Eisenberg, M.D., director of the arthritis treatment program at Lutheran General Hospital in Park Ridge, Illinois. Do your best to cut back or give up the habit.

Know your medication. A number of medications, including antiseizure medications, anti-anxiety drugs and corticosteroids, have a thinning effect on bone. Women who take these medications may be at increased risk for hip fracture in their thirties and forties as well as in their later years, says Dr. Kirschenbaum. Ask your doctor about any medications that you're taking, and if they could cause bone-loss problems, find out if there are alternatives.

Replacement Surgery: What You Need to Know While the average age for hip replacement surgery is in the late sixties or early seventies, some women may need the surgery as early as their thirties or forties, says Ira H. Kirschenbaum, M.D., arthritis and joint replacement surgeon at Westchester Bone and Joint Associates in White Plains, New York. Among younger women who may need the procedure are those who had some type of hip disease when they were children and women with rheumatoid arthritis. The first question to ask, according to Dr. Kirschenbaum, is, "Do I really need the operation?" "There is clearly a limited life to hip replacement surgery," he says. If you have the surgery when you're relatively young, you may need what's known as revision surgery again in 10 to 15 years. Revision surgery is associated with more complications than the original hip replacements, he says. So the decision to have surgery should be very carefully considered. If you do need to have your surgery early, it's most important to decide who your surgeon will be, says Dr. Kirschenbaum. That person should be a hip specialist with advanced training and advanced experience.

Get tested. If you suspect that you may be at increased risk for osteoporosis because the disease runs in your family, ask your doctor to perform a bone density test. There are a number of different methods for assessing bone density, so ask your doctor about them.

Consider HRT. For women who have entered menopause, hormone replacement therapy (HRT) could be a way to prevent osteoporosis, experts say. That's because HRT formulations include estrogen to replenish the levels of natural estrogen that drop off at menopause--and with more estrogen in the system, there's less bone loss. Experts estimate that starting HRT at the onset of menopause can decrease your risk for osteoporosis by approximately 50 percent. But while HRT can benefit your bone strength, there are some risks associated with the treatment. Be sure to discuss all the risks and benefits of it with your doctor.

Joint at the Hip

While all women need to be concerned about osteoporosis, there are some women who are at high risk for two kinds of arthritis that can affect the hips: rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is a disease in which the bones and cartilage in the joints start to deteriorate, and the joints become inflamed and painful, says Dr. Eisenberg.

With osteoarthritis, stress, strain and damage to the joint cause it to shift out of alignment, which in turn causes added wear and tear. The joint begins to deteriorate.

Hip osteoarthritis "is definitely more frequent in people who are overweight," says Dr. Eisenberg. If you're 25 percent or more over your ideal body weight, that could lead to arthritis trouble, he says.

Anti-arthritis Advice

There are some steps that you can take to lower your chances for osteoarthritis. Even though you can't prevent rheumatoid arthritis, some of these same measures can also be useful for relieving rheumatoid arthritis pain in your hips. Here's what doctors suggest.

Lighten up. "Weight control is very important," says Dr. Eisenberg. By maintaining a healthy weight, you can help fend off osteoarthritis and decrease the pain of rheumatoid arthritis, doctors say. Stick to a low-fat eating plan and exercise regularly.

Wear flats. High-heeled shoes are death to the hips, says Dr. Kirschenbaum. That's because the ball-and-socket joint can be destroyed by anything that increases the force across the hip, and high-heeled shoes do just that. With your foot in a high-heel, too much force is transmitted to the hip joint, and that can wear out the joint, he says. "I tell my patients to wear Rockports, wear sneakers to work, wear oxfords or wear one-inch heels and nothing more. Wear soft-soled shoes your whole life."

Don't jar those joints. If you have either type of arthritis, you're better off with moderate exercise than with no exercise at all, according to Dr. Eisenberg. Try to avoid forms of exercise that are more jarring to the joints--jogging and aerobics--and aim for the gentler modes of sport, such as walking and swimming.

Bursa Woes

A source of hip pain for active women can be hip bursitis, says Dr. Kirschenbaum. That's an inflammation of the tiny fluid-filled sacs that act as a cushion where tendons attach to bone. "Generally, the number one cause of bursitis in the hip joint is overuse." Overenthusiastic aerobics can start bursa trouble--or walking 20 city blocks in high-heeled shoes. Or the bursa might start to swell after you take a bad fall.

If you have soreness or pain that your doctor says is caused by bursitis, here are some things you can do to ease the discomfort.

Pack it up. An ice pack can come to the rescue if you begin to feel hip pain. You should aim to ice the area for 20 minutes three times a day, says Dr. Kirschenbaum. "Also, every time you play sports--tennis, racquetball, aerobics--ice it down for 20 minutes after every event." Ice helps provide pain relief and facilitate healing by reducing inflammation and swelling. "I honestly believe that ice is going to win the war."

To effectively ice the hip, Dr. Kirschenbaum recommends freezing a Styrofoam cup filled with water. Once the water is frozen, cut one inch of Styrofoam off the bottom of the cup and rub the exposed ice over your hip. However, it is important not to overdo it. "Don't freeze the area. The key is the frequency, not the strength, of the ice treatments," he warns.

Pay attention to pain. "Any pain in your hip could be hip bursitis, so don't wait too long to attend to it," says Dr. Kirschenbaum. "If you can get in early with ice and natural treatment, you can win." If you wait too long, he warns, you might have to go to other levels of treatment, such as the use of anti-inflammatory drugs and cortisone injections.

Quench the flame. "The second thing that I tell people is that they can take some anti-inflammatory medications," says Dr. Kirschenbaum. Over-the-counter anti-inflammatory medications include aspirin, ibuprofen and naproxen (Aleve). "Acetaminophen is not an anti-inflammatory; it's just for pain relief."

Go gradual. If you are just starting out on an exercise program, it's important to take it easy. Don't overdo it at the beginning--and stop if you feel pain. "Build up gradually," suggests Dr. Eisenberg.

How do you tell if you're going too fast? If you feel sore or have pain for more than 24 hours after an exercise session, you're probably overdoing it, he says.

Consider a single shot. If you have serious hip bursitis, your doctor may want to give you an injection of cortisone, says Dr. Kirschenbaum. Almost 70 to 85 percent of hip bursitis cases are cured with one injection.