UKH

Mrs Wilko is just recovering from a broken femur. At our age that is a common result of accident because of decline of bone mass and osteoporosis. Follow-up treatment includes the prescribing of calcium tabs, though I have heard a long time ago that these are difficult for the body to absorb. My sister is also taking calcium for the same condition but she is also taking Ibandronic acid once a month to aid absorption. Should Mrs W ask her GP about this? She is also being given Zoledronic acid infusions on an annual basis. Perhaps these are alternatives.

If anyone has any experience of such things or medical knowledge we’d be very grateful to hear.

As an aside, if the risk of fractures can be significantly reduced by such relatively simple, cheap and apparently safe treatments, why is it not on offer to all elderly people, (including men, who are also at risk). Surely this would save the NHS money in the long run, as well as saving a lot of pain and risks associated with surgery for the elderly.

Ibandronic and Zolendomic acid belong to the same group of drugs called bisphosphonates. There will be differences but they roughly do the same job in treating OP, there’s even evidence to suggest Zol is better in some circumstances and the reasons for choosing one over the other at this stage will include other personal and medical considerations.

Regarding the calcium, there’s a variety of different preparations that have higher absorption and are easier on the stomach, might be worth checking what you have and talking with your GP if this is causing problems. Remember more may not be better so work with your clinician.

-Translational medicine / medical products developer

I was assessed as osteopenic in 2013 and offered calcium with vitamin D tablets, which I took for a while, and Alendronic acid (cheapest bisphosphonate) which I rejected on doing a bit of online study - seemed to be an unusual use for a chemical originally meant for spraying on orange crops. Imperial college have done some important research on the use of bisphosphonates, using the Diamond light source to investigate how the internal structure of the bone changes with time, they recommend only 6 months of use before the bone actually becomes more brittle and liable to crack.

There is some good advice on osteoporosis on YouTube, currently the best advice seems to be vitamin D with vitamin K2 (menaquinone 7) and calcium from diet only, not tablets. Maybe vitamins A and E as well but K2 is the thing that puts calcium into bone instead of arteries.

My right femoral head was weak enough that it did not stand a hip resurfacing operation (the left one was fine) but the replacement ceramic device is working well and nothing has broken since despite my best attempts on the hills, bikes and climbing walls...

Cheap and effective treatment:  Eat more meat?

(Fractures are more common in vegans and vegetarians)

Good point - I was veggie for 28 years, not since 2014. Milk/kefir/yogurt and cheese are your friends too...

No personal experience but has she been checked for coeliac? Knowing that isn't going to reverse the osteoporosis (so may or may not be useful, really), but my mum only found out by complete chance that she had coeliac after an osteoporosis diagnosis in her late 50s. Turns out my sister has it too, and we suspect my grandma. She was completely asymptomatic but if she'd known earlier, it might have helped avert or reduce long-term issues like the osteoporosis perhaps. We also suspect that was why she was coming up as low iron for years despite supplements.

Relatedly, in the assumption that I've probably got it coming too, I'd welcome any reflections on climbing with osteoporosis. My mum, once very active, seems to live in terror of breaking anything now, which is a crying shame. 

It’s all about absorbability. Search vegetables calcium absorption for a list of the best foods. They also contain vit C which aids iron absorption.

Basically eat your greens - lots of them;  quadruple restaurant portions.

Ask for the results of her bone density scan. This tells you how brittle her bones are.

A) If the scan reports her bones are brittle then 5 years of a Bishosphonate medication will be required along with her calcium supplement. ( More than five years of treatment doesn’t seem to help reduce fractures any more than 5 years (think pumice stone to limestone after 5 years to marble after 10…. Marble is too dense and gets more brittle) 

Her team have decided on the bisphpsphonate as a Zolendronic acid infusion. It’s a good effective treatment. Your sisters ibandronic is an alternative 

B) If the bone density scan says the bones are okay , no point in making them more dense as it won’t reduce the break risk. All our bones can break in the wrong circumstances regardless of density.

Sounds like they are doing the correct things.

re the aside… Zolendronic is quite expensive as an infusion as it’s a hospital appointment,  nursing time etc. 
Many 10’s. of millions over 70 so treating all regardless of risk would waste resources and delay treatment for  those who need it most.

Bring slight, over 70’s , female, smokers, previous steroid users, loss of height or a low impact fracture are all risk factors and a few of them together may be a reason for a chat to a GP and maybe a bone density scan.

Hope that helps and if that’s unclear then maybe a chat to GP to understand the plan may help

Many thanks for all these contributions - ukc is becoming my first port of call for all sorts of issues!
This accident occurred while visiting my sister en route to the Plymouth-Roscoff ferry, so unfortunately our stay in Frome has turned from 2 nights into more like a fortnight. Sometime we have to drive home to Cumbria, about 5 hours without stops, which will be needed for us both. Not relishing that.

Our only route to GP advice from here is on the phone. We have an appointment for FtF 10 days from now, and some of the suggestions here will be useful back up knowledge to help with asking questions.

Good to know Debbie’s treatment and advice so far is on the right lines. A second opinion can be reassuring.

She is a bit concerned about swelling all the way up the leg, but the GP’s receptionist (!) said this was normal. I’m giving D a sub-cutaneous jab against blood clots daily.

Thanks for that - I learned a lot.

Mrs Wilco should also consider doing exercise that strengthens surrounding muscles and loads the bone appropriately. These are usually weight-bearing. A physiotherapist should be advising her about this. https://www.bonehealthandosteoporosis.org/patients/treatment/exercisesafe-m...

To use an analogy, an adequate diet will not strengthen muscles, exercise on its own will not strengthen muscles. To strengthen muscles both you need an adequate diet and exercise. The same is true for bones. 

Not all calcium is the same. Presumably the doctors prescribed calcium carbonate, but calcium citrate has 25% better absorption, especially in people with low acidity (such as people on PPI's like omeprazole). As others have said combining with vitamin C and D will also help absorption, you can buy tablets with all of these things stacked together. 

Resistance/strength training and loaded carries work wonders on older populations.

Before your downvote finger goes nuts I'm not suggesting some massive barbell, I'm talking about loads and exercises appropriate for the individual

Someone I knew used to rehab the frail as his living and has some amazing success stories 

I broke both my elbow and fractured the top of my femur in one simple fall off my bike. This was due to low bone density. It was minus 2.4. Osteoporosis is at minus 2.5. Once healed and walking again I was told to weight bear, exercise to sort the leg muscles out and to walk much more. Plus 2 calcichew with vit d per day. My low bone density was due to my age and the menopause. My scientific Dtr said I couldn’t improve my bone density only stop it going worse, as it is set in our 30’s. 
However, I was back on my bike in 4 months and two years after the accident I had improved my density to minus 2.1. So it can be done. I still take calcium daily 6 years later - have fallen off my bike since and have not broken anything again. ( yet!!) I sign up for the gym in winter and strengthen muscles there. 
this is just my personal experience and we are all different. Tell her to ask for a dexa scan to find out her bone density and take it from there? Eating more green veg can do no harm either. Kale is good. Any dark green leaves are good. Pumpkin seeds are good too. I have them on muesli or fruit at breakfast. Best of luck to her. 

Love the leaded glass inthe background of your profile picture, Linda

Try vegetable smoothies for breakfast. Much better than cereals.

https://www.bbcgoodfood.com/recipes/collection/vegetable-smoothie-recipes

You can always add some oats if you want more carbs. Always use organic ones (search oats pesticides).

When you get the results of the Dexa ( bone density scan) they can be a bit confusing. 
Negative scores below -1 are below average bone density for either ‘T’ or ‘Z’ scores. Normal for either score is considered to be -1 to +1. 

There’s a ‘ T’ score that compares the person against a ? normal 20-29year old I think.
For example a T score of - 2.4 is equivalent to a normal 85 year old. A T score of -2.1 is equivalent to a normal 80 year old. If your T score becomes less negative then you have definitely improved your own bone density.

Then there’s a ‘Z’ score again -1 to +1 is normal. This one is compared to people your own age/sex/weight etc so if your score gets less negative ( ‘ improves’ ) your bones may not have actually got more dense, you might have just lost less than the average person did over the years between the two scans…

Clear as mud? …,,sorry. Probably better explanations are available online. Or from one of the UKC statistics gurus.

Good luck

Got a source for that?? 

Also protein, which is not just about getting jacked. Just buy protein powder and throw a scoop in.

https://pubmed.ncbi.nlm.nih.gov/36129610/#:~:text=Studies%20that%20examine%....

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01815-3

https://www.ceu.ox.ac.uk/news/results-show-higher-fracture-risks-for-vegans...

No idea of the quality of the studies, but a 30 second google search yielded these.

Proper Greek yoghurt (not the 'Greek style' stuff) is also an excellent source of protein and calcium. Very handy for breakfast. The 5% and 10% fat ones are the best, the 0% fat one is pretty awful. I have it most days with a handful of blueberries/raspberries/blackberries, with a scope of protein powder mixed in sometimes.

Thanks. Admittedly I skimmed them, but the summary is that it's not vegan/vegetarian diets themselves that are the issue, rather *bad* diets - which for meat eaters are masked vis-a-vis bone density* as meat/dairy is inherently rich in the requisite micronutrients.