I was diagnosed with osteopenia at the age of 34 and am taking 500 mg of Calcichew twice daily. I’m 58 years old and have been suffering from osteoporosis for the past 3 years, even though I’m exercising every day. Due to side effects, I stopped taking the prescribed bisphosphonates. What can you do to prevent further bone deterioration?
Anne-Marie Newbie, via email.
Taking calcium supplements such as Calcichew can help protect your bones. But, as your letter emphasizes, these are not enough.
Bone health depends on a variety of lifestyle factors, such as avoiding heavy drinking and smoking. And, as you say, there is exercise.
This is one of the most important protective steps you can take, but it’s worth noting that not all exercises are the same when it comes to bone strength.
For healthy bones, you need to exercise three times a week. This needs to support your weight as it stresses the bones and causes more bone growth.
Exercise that supports your weight means exercising against gravity. For example, swimming and cycling are not really counted in this context. I do yoga, walking, jogging, and skipping rope.
The good news is that exercising three times a week can make a difference and significantly reduce the risk of hip fractures in people over the age of 50.
Your treatment is based on a 10-year probability of a hip or other large fracture.
For healthy bones, you need to exercise three times a week.This should support your weight as it stresses the bones and causes more bone growth
It is calculated by your family or specialist and takes into account various factors such as current bone mineral density, height, weight, age, and past medical history. Scores are determined by a tool called FRAX (Fracture Risk Assessment Tool).
Bisphosphonates are the first-line treatment for most postmenopausal women with osteoporosis. These slow down the rate at which old bone is destroyed by cells called osteoclasts.
However, it has side effects such as flu-like symptoms, bone pain, and malaise, so you should choose a different drug.
There are several options. Usually, the female in your position may be offered denosumab. It acts directly on osteoblasts, the cells involved in healthy bone reconstruction, and prevents the formation of osteoclasts.
The drug is given as an injection every 6 months.
If the FRAX score is very high risk of fracture, an anabolic substance called teriparatide is needed. This is a daily injection for the highest risk patients. The drug also recreates the effects of parathyroid hormone, a natural hormone that boosts the activity of bone-forming cells and helps regulate calcium.
Any of these will make the brakes worse and protect you from hip fractures.
My 49-year-old daughter has been suffering from hiatal hernia and gastroesophageal reflux disease for over a year and has lost more than two days. She changed her diet and was given a proton pump inhibitor (PPI) and Gaviscon. She is afraid of Barrett’s esophagus development and is considering surgery. How safe is it?
Joan Williams, Lanerie, Calms.
Daughter’s symptoms are typical of gastroesophageal reflux disease. This is an unpleasant condition that occurs when the valve between the lower end of the esophagus and the stomach stops functioning and stomach acid spills upwards.
As in her case, regurgitation is often caused by hiatal hernia — when the diaphragm (horizontal sheet of muscle surrounding the esophagus) loosens, the stomach is pushed up to the chest and the contents are pushed back up the esophagus. Causes heartburn, regurgitation, and difficulty swallowing.
Drugs such as PPIs and the antacid Gaviscon can help as well as lifestyle changes, such as avoiding certain foods such as acid and spicy foods that irritate the valve. Gravity can help because your daughter could also try to raise the head of her bed.
Still, like your daughter, 10 to 40 percent of patients are still experiencing symptoms.
The next step is endoscopy (a thin camera is inserted into the esophagus to inspect the lining of the esophagus) and a biopsy to analyze the cells in the lining of the esophagus.
The symptoms of your daughter are typical of gastroesophageal reflux disease. This is an unpleasant condition that occurs when the valve between the lower end of the esophagus and the stomach stops functioning and stomach acid spills upwards.
This is to exclude other possible diagnoses such as eosinophilic esophagitis, where allergies cause inflammation of the inner layer of the galette, and Barrett’s esophagus, a precancerous condition in which cells in this area begin to change.
These patients also need to undergo pH monitoring (to measure acidity levels). Here, a probe at the end of a thin, flexible tube is inserted into the esophagus and left for several hours to see the relationship between pain and acid levels. This actually helps to confirm that it is acid reflux disease that is causing the pain. Another important test is manometry, which checks the muscles of the esophagus.
The surgery usually offered to patients, such as daughters, is a keyhole surgery called Nissen fundoplication, which strengthens the valve-like action at the lower end of the esophagus. The majority of patients given this are happy with the results, but about 10 percent feel that surgery has not helped.
Currently, your daughter does not have Barrett’s esophagus and it seems that mitigating regurgitation can prevent this. In my view, she would be wise to consider surgery.
Write a letter to Dr. Scar
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W85TT or email drmartin@dailymail.co.uk — include contact details. Dr. Scar cannot communicate personally. Reply should be made in general circumstances and always consult your family doctor if you have any health concerns.
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