DEAR DR. ROACH: I have reached the beginning of osteoarthritis after a meniscus trim from years ago. Can platement-rich plasma (PRP) therapy, or anything else, regenerate cartilage? — E.C.
ANSWER: Loss of cartilage is an important part of the complex condition called osteoarthritis, along with osteophytes (“bone spurs”) and inflammation of the synovium (connective tissue that lines the joint and makes joint fluid). Unfortunately, despite decades of research, there are still no treatments that are proven to regenerate cartilage or halt the progression of osteoarthritis.
A recent trial of PRP injections in the knee failed to show any benefit to the cartilage or to overall pain levels, compared with a placebo injection of plain salt water. I don’t recommend PRP as a treatment for osteoarthritis of the knee. The main treatment for osteoarthritis of the knee is regular exercise and medications as necessary to reduce pain. Exercise has been shown to improve function, as well as relieve pain and protect the knee.
Many people still think that exercise will wear out the knee faster, but this is proven to be erroneous. The type of exercise that people will best tolerate depends on many things, including the severity of their arthritis, their weight and their degree of pain, and I often will refer my patients with osteoarthritis of the knee to a physical therapist, to help teach the best exercise plan.
Your story shows the importance of avoiding meniscal surgery when possible. We are far less likely to recommend surgery for a torn meniscus, because any cartilage you take out can hasten the progression of osteoarthritis. But, sometimes, it is necessary to relieve pain.
DEAR DR. ROACH: Are calcium supplements safe to take? Can they increase the calcium buildup in your arteries? There seems to be mixed messages on this subject. — L.K.
ANSWER: There are mixed messages because there are mixed results from large studies on this question, with one analysis of many studies showing a small increase in risk of developing blockages in the heart arteries among people who take calcium supplements, while another large analysis showed no increase in risk.
Blockages in the heart are made up of cholesterol plaque and calcium (among other components). In theory, the high amount of calcium in the blood after taking a calcium supplement could cause worse calcification of the arteries. (Calcium supplements do increase the risk of kidney stones, also presumably due to the transiently high calcium concentrations in the fluid filtered by the kidneys.) However, calcified plaque is probably less dangerous than non-calcified plaque, in terms of risk of a heart attack.
Still, because of the possibility of worsened heart disease risk, I typically recommend my patients get their calcium from their diet whenever possible. Dairy (especially Swiss-type cheeses) are excellent sources of calcium, but small fish with bones (sardines, anchovies, herring) are also good sources. Other sources include legumes, leafy green vegetables, calcium-fortified soy and nut milks, and fruit juices. Food calcium reduces kidney stone risk, and calcium in food is not suspected to increase heart risk.
There are times when calcium supplementation is so important that I still recommend it, such as in a person with osteoporosis who takes medication. The increase in bone buildup requires calcium, and if a person can’t get enough from their diet, then benefits of supplementation outweigh risks.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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