I recently broke my ankle in a fall while running. I am otherwise in perfect health, but I have been told that because of my age – I am in my late 50s – I need HRT to protect against osteoporosis. The disease does not run in my family, I do not smoke and have no significant risk factors. Are hormones really necessary?
Osteoporosis is a disease that weakens bones by reducing their mineral density and mass.
We don’t routinely screen for the condition, so the diagnosis is often made after an injury like this. One in two women and one in nine men over the age of 50 in Britain will suffer a fracture as a result.
If someone has repeated fractures, or if osteoporosis runs in a patient’s family, doctors may consider looking for it. Other warning signs include long-term steroid use, prolonged underweight, or early menopause that reduces levels of bone-protecting estrogen.
So for someone in their 50s who is in good health, even with an injury but no other problems or warning signs, it would not be normal to immediately start treatment for osteoporosis or HRT.
If someone has repeated fractures, or if osteoporosis runs in a patient’s family, doctors may consider looking for it
If a doctor is concerned, he or she may refer you for a DEXA bone scan, which measures bone mineral density – usually in the hips and spine. If the bones are thinner than they should be, osteoporosis is diagnosed.
Alternatively, you could be diagnosed with osteopenia, which is the first stage of bone loss before full-blown osteoporosis occurs.
While some people may benefit from HRT or osteoporosis medications such as alendronate – both of which strengthen bones – others can get away with much simpler strategies.
These include calcium and vitamin D supplements and bone-strengthening exercises – the Royal Osteoporosis Society has excellent advice on its website (theros.org.uk).
If you don’t have menopausal symptoms or any other reason for needing HRT, it isn’t just prescribed for osteoporosis.
I am a 79 year old woman and have been taking statins for three years after a blood test gave me a cholesterol level of seven. My blood pressure was a little high, but not enough to require medication. I am not overweight and do not smoke, although I have had non-progressive multiple sclerosis (MS) since I was 36. Should I continue taking statins?
Statins are prescribed based on an individual’s overall risk of having a heart attack or stroke within the next ten years.
A tool called Qrisk was used to calculate this risk. The algorithm, developed in 2007, evaluates cholesterol levels, blood pressure, weight, blood sugar levels, age, family history of diseases and ethnicity. If this instrument finds that the risk is more than ten percent, we know that offering statins is a good idea to prevent serious problems in the future.
Due to around twenty different measures used to arrive at that risk score, this means that you can have two people with the same cholesterol level and only one of them being offered statins.
Someone in their late seventies with a cholesterol level of seven already has a high risk of heart disease and stroke. Age is a big factor, and five is usually the upper limit of normal. Even if blood pressure is regular, the ten percent risk threshold can be met when combined with the other treatment factors.
People talk a lot about statins and their side effects, but the majority of patients experience no problems while taking them.
Some time ago I was advised to eat walnuts, because they are rich in omega-3 and are good for the heart. But I’ve also heard that omega 3 can cause atrial fibrillation (AF). Is this true?
Omega-3 oils are part of a group of healthy fats that have health benefits – unlike saturated fats, which are linked to obesity and heart disease.
They keep the heart, blood vessels and lungs healthy and help the immune system ward off disease.
They have also been shown to reduce levels of unhealthy fats in the body, prevent blood clots, improve circulation, lower blood pressure and maintain a stable heart rhythm.
All this reduces the risk of heart attacks and strokes. For example, in Japan, where diets are rich in these fats, rates of heart disease are much lower.
Good sources of omega-3 oils include nuts and seeds – such as walnuts, flaxseed and canola – and mackerel, sardines and other oily fish. However, some research has suggested that people who take supplements containing more than one gram of omega-3 may be at a higher risk of developing AF, a condition that causes the heart to beat with an abnormal rhythm. It is also an established risk factor for stroke.
The daily recommended amount of omega-3 is about 500 milligrams – about half the amount found in standard supplements sold in Britain.
Further research is needed to clarify this link, but there is no concrete evidence that people who consume foods containing omega-3 are at risk.
The NHS does not recommend the use of omega-3 supplements, but should instead be consumed naturally within your diet to maintain levels at a safe amount.
Put tobacco style warnings on chicken? That is ridiculous!
I wonder how some public health experts get their ideas.
Last week, a team from the University of Durham suggested that placing tobacco-style warnings on meat packs could reduce consumption and improve health.
Should warnings be placed on meat products?
In addition to health warnings — including photos of people receiving CPR — the team added labels about agriculture’s negative effect on the climate and even how livestock could cause a new pandemic.
Many people they tested it on found the health warnings not credible. And no wonder: this is a completely crazy suggestion. We all need to eat, while no one needs to smoke, and meat in moderation isn’t bad for us – it’s a good source of protein, iron and other important nutrients.
Can’t we put the resources towards education about healthy eating and making fresh food cheaper, instead of another ridiculous gesture?
Feel free to talk about side effects
I am often asked questions about managing the adverse side effects of medications, both by readers and patients in my NHS clinic.
They will often say that they have soldiered on without wanting to burden anyone. But it is essential to discuss something like this with a doctor because there is a lot we can do, such as adjusting the dosage or switching to other medications.
And I would like to remind everyone of our national yellow card reporting system.
If you have used a drug or herbal remedy, had a vaccine or even used a medical device that had a negative impact, you must report it. This is how we learn about problems and it can protect us all from harm.
You can report any side effect to your pharmacist or doctor and ask them to make a yellow card report. Or you can do this yourself online by searching for MHRA Yellow Card.