Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: I am a 53-year-old polio survivor just going through menopause and have several problems. I have weak and burning muscles, I wake up in the night for no reason and have extreme fatigue during the day. My doctor said my fatigue and muscle pain are caused by fibromyalgia and that exercise is the cure. But the exercise makes my muscles weaker and causes them to cramp so that sometimes I'm not able to turn over in bed. What am I really dealing with and what should I do about it?

A: Fibromyalgia is a condition characterized by muscle and joint pain and is defined as having a specific number of places that are tender to touch--called "tender points"--in specific locations: over the buttocks, upper chest, knees and elbows, as well as in hip, shoulder, neck and back muscles. Fibromyalgia is six times more common in middle-aged women than in men.

In one small study of polio survivors, 11 percent had pain at least as frequently as do those with fibromyalgia. But we never diagnose fibromyalgia in our patients because polio survivors have plenty of reasons besides fibromyalgia to have muscle and joint pain, like scoliosis and years of overusing weakening leg, arm and back muscles.

Fibromyalgia is treated with exercise, the opposite of how polio survivors' muscle pain and weakness should be treated, as your experience shows. Decreasing physical overexertion, using assistive devices and stretching muscles in a carefully tailored program--morning, evening and throughout the day--as well as pacing activities and resting: these are the keys to managing weakness, muscle pain and joint pain in polio survivors.

But how can you rest if pain keeps you awake? Those with chronic pain from any cause, including fibromyalgia, have disturbed sleep. Muscle pain and not sleeping create a vicious cycle, where pain causes poor sleep and poor sleep causes more pain. What's more, as many as half of our PPS patients and those with fibromyalgia have big-time sleep disorders--involuntary leg and arm muscle movements or sleep apnea--that prevent deep, restful sleep throughout the night. If you are waking at night or are fatigued during the day, a sleep study will rule out sleep disorders. In menopausal women, "silent" hot flashes and low hormone levels can cause disturbed sleep. So talk to your gynecologist about disturbed sleep, the need for a sleep study, daytime fatigue and possibly using hormone replacement therapy to help you sleep better.

Q: I am 62, had polio in 1946, and have always worn a weight-bearing long-leg brace. Last month I fell and broke my hip on the side where I wear the brace. The X-ray showed that I have severe osteoporosis. I thought only women who have menopause got osteoporosis.

A: Osteoporosis isn't just for women anymore. It has recently been recognized that men also lose bone as they get older. And the men who are at greatest risk for osteoporosis are those with muscle weakness. This is no surprise. Polio survivors who had lasting paralysis often have short legs, either because they didn't "push" on their leg bones (didn't stand on the leg because they used a weight-bearing brace, crutches or a wheelchair) or because their weak or paralyzed muscles didn't "pull" on bones. Pushing and pulling make calcium bind inside bones so they will grow.

The same lack of pushing and pulling over the years causes loss of bone--osteoporosis--in both women and men who have paralysis or muscle weakness. A Rancho Los Amigos study found that women polio survivors lose bone at a faster rate than women without disabilities. A Danish study found that polio survivors have as much as 50 percent less bone density in their more affected leg.

However, exercise or walking to "push and pull" on bones is certainly not a treatment for polio survivors' osteoporosis, since walking is a cause of PPS muscle weakness. All menopausal women polio survivors should have a bone density study--as should men who have paralysis or muscle weakness, use wheelchairs, crutches or wear braces--to see if they have osteoporosis.

Women can talk to their doctors about using hormone replacement to treat bone loss. Both women and men can consider taking calcium supplements and using anti-bone loss medications, such as Fosamax and Calcitonin. We have patients who use wheelchairs and who have never walked whose osteoporosis has been significantly decreased with medication.