A year and a half ago, I mentioned to my doctor that my 76-year-old father had recently been diagnosed with osteoporosis, after discovering he had fractured a vertebrae. She told me that many men do suffer from osteoporosis, particularly if they are small and slight – a frame I’ve inherited from him. But when I told her that my mother had also suffered from osteoporosis for over 10 years, she immediately arranged for me to have a bone scan. I kept putting it off, mainly because I was convinced that there was no way I could have osteoporosis. I was 49, very fit – I’m a member of a rowing and sculling club and train regularly, as well as swimming and doing Pilates and yoga once a week – and I eat healthily. Plus my parents had been much older when their osteoporosis was diagnosed.
Some weeks later, I arrived home to find a letter from my GP baldly stating that my scan revealed I had osteoporosis and asking me to come and see her. At the time my mother was very ill with cancer, so I felt upset and insulted – I did so much exercise, how dare they tell me I had osteoporosis? I melodramatically imagined myself as a fragile old lady, lying helpless in a hospital bed with a broken hip.
The next day, I was more rational – but still concerned. Would I have to stop skiing? What if I fell over? It began to dawn on me that most of the sports I enjoyed were not especially weight bearing, and I hated running and aerobics as they hurt my knees. I prefer to avoid drugs unless they are essential and take a holistic approach to health. I am a strong believer in therapies like acupuncture, massage and Chinese herbs. So I decided to look at alternative therapies and do something that would make me feel more in control of my osteoporosis. This is how I went about it:
GP’s letter arrives with the scan results attached and a prescription for calcium tablets, as well as a leaflet about osteoporosis. This explains that I have lost some bone material, making my bones less dense and more honeycombed. It also emphasises the importance of regular weight bearing exercise, such as walking or running, and explains that it is vital to include calcium and vitamin D in my diet.
I collect my Calcichew – the calcium supplement I’ve been prescribed – and it tastes quite pleasant. It’s also available without a prescription. My GP’s appointment book is full for weeks, so I arrange a phone consultation with her and browse the website of the National Osteoporosis Society (www.nos.org.uk).
I call the helpline (0845 450 0230) and speak to a very helpful nurse, who explains my bone density report. The “T-score” compares my bone density with a healthy 30-year-old adult of the same sex and ethnicity, and is expressed in terms of standard deviation from an average of 0. So my hip T-score of -1.7 indicates that it might become osteoporotic, while my spine T-score of -2.8 confirms osteoporosis (-2.5 is the point at which it becomes so). The ‘Z-score’ is calculated in a similar way and compares my results with those of other women my age. My hip score of -0.9 is OK, but my spine score of -2.0 is less good. However, the nurse reassures me that I have relatively mild osteoporosis and I feel a bit better.
Over the phone, my GP advises taking a bisphosphonate drug, aleondronic acid, shown to increase bone density and reduce the chance of fracture. This has to be taken first thing in the morning with a glass of water and then I have to stay upright for half an hour afterwards to avoid irritating my oesophagus. She reassures me that side effects are rare, but I speak to my gastroenterologist before taking it as I don’t tolerate acidic food and drink well.
I tackle the exercise question. My rowing and sculling is helping to build muscle, which is good for bone health, while yoga and Pilates help my flexibility – which will also reduce my chance of fractures.
So it makes sense to continue, but I switch from swimming to aqua aerobic classes that involve weight resistance. I ask for a workout programme at the gym – 15 minutes on a cross trainer is boring, but the weights afterwards I quite enjoy. I stop taking the bus to the tube and make myself walk instead (which is an excellent weight bearing exercise) and I even notice that I’m beginning to get a flatter stomach.
Hey, this is good!
I buy more 25ug vitamin D pills, which I’ve been taking for a deficiency that showed up on a blood test last year.
I find out that in northern countries, we don’t always get enough of this critical vitamin – which is essential for the absorption of calcium. Sunscreen cuts out the ultraviolet light necessary to absorb vitamin D, so in the summer months we are advised to get out in the sun twice a day for 10 minutes without wearing an SPF.
I go to see Ana Maria Lavin-Parot, an acupuncturist at the Kailash Centre of Oriental Medicine (www.kailashcentre.org) who explains that although acupuncture can help overall health, there is no evidence that it will aid bone density. In Chinese medicine, she says, osteoporosis is linked to a deficiency of kidney energy and the production of blood to nourish the bones. Kidney energy declines as we age, so Ana Maria suggests some Chinese herbal medicines that may help and suggests I see a nutritionist.
I re-read the dietary information that I’d been given by my doctor and the National Osteoporosis Society. The recommended daily calcium intake for people in the UK is 700mg a day, but people with osteoporosis may need more. Milk, yogurt and cheese, leafy green vegetables (a good source of vitamin K for the blood taking the calcium to the bones), beans, salmon, bony fish like sardines and herrings, tofu, oranges, almonds, sesame seeds, oats and many herbs are all good at providing this vital nutrient. Some bread and breakfast cereals are also fortified with calcium – check the labels. Having read all this, I increase my vegetable consumption and start adding sesame seeds to casseroles and salads. I also reduce the amount of meat I eat, because the leaflet given to me by my GP explains that as the body digests protein, it releases acids into the bloodstream that then have to be neutralised by drawing calcium from the bones. This explains why I used to get indigestion from red meat. I now cut a third off each supermarket chop or steak.
My gym programme is falling by the wayside – I just don’t have time. I’m walking more though, and I’ve started a dance class at the gym. It leaves me bright red in the face and my daughter is mortified by the idea of me learning hip-hop – but it’s really good fun.
I’ve cut down the amount of coffee I drink (I’m now on four to five cups a week max), but my efforts to drink less tea and alcohol have been less successful. I’ve also booked a holiday to Majorca – purely on vitamin D grounds, of course! I’ve spoken to my gastroenterologist, who says some bowel diseases can have an adverse impact on calcium and other vitamin and mineral absorption, so this should be investigated. It feels as if several things are coming together – I’ve made a good start and feel much more positive about my osteoporosis – as well as fitter and healthier – although the more I find out, the less I realise I know. I suspect the reasons I have this disease relatively young are perhaps more complicated than I thought…
Osteoporosis -the facts:
In the UK, almost one in two women and one in five men over the age of 50 will break a bone due to osteoporosis*. Osteoporosis means that bones are porous and prone to breaking, with broken wrists, hips and spinal bones being the most common fractures. Although it is not a fatal illness, the lifetime risk for a woman or man dying from hip fracture complications is the same for dying from breast and prostate cancer respectively**.
Two types of cells work on our bones – osteoblasts build up new bone, while osteoclasts break down old bone. From our mid-40s, osteoclasts take over and our bones gradually lose density. Some bone-loss is inevitable as we age – but fractures are not. Although the disease tends to be diagnosed once we’re over 50, it is very important to take preventative action while still young.
Not developing enough bone mass while young can increase your osteoporosis risk (for instance, suffering from anorexia as a teenager). Other risks include a family history, being underweight, early menopause and a deficiency of vitamin D and calcium. A wide range of drugs can slow bone loss and help improve bone density, while cutting down on caffeine, alcohol and cigarettes can also help, as these inhibit the absorption of calcium.
Heather was treated at the Kailash Centre, 7 Newcourt Street, London NW8 7AA. Call 00 44 (0)20 7722 3939
for more information, or visit www.kailashcentre.org.