At the age of 34, I was diagnosed as having osteopenia and began taking Calcichew 500mg twice daily. I am 58, and for the past three years I’ve had osteoporosis, despite exercising daily; I stopped taking the bisphosphonates I’d been prescribed due to side-effects. How can I prevent my bones from further degrading?
Anne-Marie Newby, via email.
Calcium supplements like Calcichew can help to protect your bones. Your letter emphasizes that these supplements aren’t enough.
Your lifestyle choices, such as avoiding excessive alcohol or smoking, can have a significant impact on your bone health. You also mentioned exercise.
This is one of the most important protective steps you can take, although it’s worth noting that not all exercise is equal when it comes to bone strength.
You should exercise at least three times per week to maintain healthy bones. Because this places stress on bones, it should not be considered weight bearing.
You work against gravity by doing weight-bearing exercises. Swimming and cycling, for instance, don’t really count in this context; yoga, walking, jogging and skipping do.
Good news: Exercise three times per week is possible. Evidence suggests it can dramatically reduce your risk of having a hip injury in those over 50.
Based on the ten-year likelihood of having a hip replacement or major fracture, your medical treatment will take place.
You should exercise at least three times per week to maintain healthy bones. You should do this weight-bearing exercise, as it puts pressure on the bones and triggers more bone growth.
This is calculated by your GP or specialist, and involves considering various factors, including current bone mineral density, height, weight, age and past history: the score is determined with a tool called FRAX — the Fracture Risk Assessment Tool.
The first-line treatment for most osteoporosis sufferers post-menopausal is bisphosphonates. Bisphosphonates slow down bone loss by osteoclasts cells.
However, your side-effects — which may have included flu-like symptoms, bone pain and tiredness — mean another drug choice must be made.
You have many options. Your position may be one that offers denosumab. This works directly on osteoblasts, the cells responsible for rebuilding healthy bone — and prevents osteoclasts forming.
It is administered as an injection once every six months.
An anabolic agent known as Teriparatide is required if your FRAX score indicates a high likelihood of fracture. It is administered as a daily injection to the most vulnerable patients. This drug mimics the effects of natural hormones, such as the parathyroid hormone which regulates calcium. It also stimulates bone-building cells.
You will be protected from hip fracture by either of these.
My 49-year old daughter suffered from acid reflux for over a decade. She is afraid of developing Barrett’s oesophagus and is considering an operation. Is it safe?
Joan Williams, Llanelli, Carms.
Your daughter’s symptoms are typical of gastro-oesophageal reflux, an uncomfortable condition that occurs when the valve between the lower end of the oesophagus and the stomach stops functioning, allowing stomach acid to spill upwards.
As in her case, reflux is often caused by a hiatus hernia — when the muscles of the diaphragm (the horizontal sheet of muscle that surrounds the oesophagus) become loose, so that the stomach pushes up into the chest, allowing the contents to push back up the oesophagus, causing heartburn, regurgitation and difficulty swallowing.
PPIs, Gaviscon, and other medications can all help. Lifestyle modifications, such as avoiding acidic or spicy foods, may also be beneficial. You could try to raise your daughter’s head so that gravity works.
However, symptoms still affect 10-40% of patients like your daughter.
The next step is an endoscopy — where a thin camera is inserted down the oesophagus to inspect the lining — and a biopsy to analyse cells on the oesophagus lining.
Your daughter’s symptoms are typical of gastro-oesophageal reflux, an uncomfortable condition that occurs when the valve between the lower end of the oesophagus and the stomach stops functioning, allowing stomach acid to spill upwards
This is to rule out other possible diagnoses such as eosinophilic oesophagitis, where the lining of the gullet becomes inflamed due to allergy, and to exclude Barrett’s oesophagus, a pre-cancerous condition where cells in this area start to change.
Patients should undergo pH monitoring to measure acidity. A probe attached to a long, thin flexible tube is then inserted into the stomach. This allows you to determine the acidity of the pain. This can help confirm that it is, indeed, acid reflux that’s causing the pain. Manometry is another important test that checks the muscles in the oesophagus.
Nissen fundoplication (keyhole surgery) is typically offered to patients, such as your daughters. This strengthens the valve-like action of the lower end. While the vast majority of patients given this are pleased with the results, around 10 per cent find the operation hasn’t helped.
At present, your daughter does not have Barrett’s oesophagus and it’s likely that relieving the reflux will prevent this occurring. I believe she should consider surgery.
Send an email to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email firstname.lastname@example.org — include your contact details. Dr Scurr can not enter into personal correspondence. Please keep your replies general and make sure to consult your doctor if you have specific health concerns.