Q: I am 67 and have been diagnosed with osteoporosis in my neck and hip. After a bone scan, I was prescribed alendronic acid tablets to strengthen my bones – but the list of possible side effects is quite frightening. As I am not due another scan until 2020, I’m concerned about taking the tablets without knowing if there is any improvement in my bone density. What are my options?
A: Having osteoporosis (thinning of the bones) means you are more susceptible to ‘fragility fractures’ – which can happen after a minor fall – or even crushing a vertebra by bending over. You’ve had a Dexa scan (a type of X-ray) which measures bone mineral density with a T-score. In your longer email you tell me that yours is -2.6, which only just puts you in the osteoporosis range (of -2.5 and below).
Understandably you’re not keen to take medication without good reason. However, fragility fractures can lead to pain, disability and hospital admissions, as well as being associated with higher mortality rates.
The main treatment is with medicines known as bisphosphonates, such as your alendronate (alendronic acid) tablets. I often prescribe them but, as with any medication, they can have side effects including inflammation of the oesophagus and stomach. You mention in your email that a friend experienced necrosis (disintegration) in her jawbone after taking them. Please be reassured that this is very rare and usually only an issue if you already have tooth decay or infections. A dental check-up can establish whether alendronate is suitable for you.
You say that you are considering a private follow-up, sooner than the usual three-year scan, to see if your bones are improving. This is an option, but it may be costly and exposes you to extra radiation. Another way to find out about your risk of fractures is with the online Frax (fracture risk assessment) tool, which you can find on the National Osteoporosis website (nos.org.uk). It takes into account things that might lead to thinning of the bones including taking steroids and drinking more than three units of alcohol daily. The good news is that we can improve many of these factors by making diet and lifestyle changes, such as stopping smoking, doing regular weight-bearing exercise, getting enough calcium and vitamin D as well as maintaining a healthy weight.
Eating a Mediterranean-style diet rich in vegetables, nuts, olive oil, pulses, wholegrains and fish has been shown to reduce bone loss in people with osteoporosis. Looking after your gut can help too; in a Swedish study, older women taking probiotic supplements with the bacteria strain Lactobacillus reuteri had less bone loss. Finally, many menopausal women use HRT to reduce bone loss. For those under 60 who have no reason to avoid HRT, taking it to combat loss of bone density outweighs its possible risks.
Why kombucha is just my cup of tea
At home, we’re hooked on kombucha. It’s a refreshing fermented tea with a subtle sweet-and-sour flavour and a hint of fizz. We drink a G&T-sized glass of it before dinner. It has probiotic properties, and gut health nutritionist Tanya Borowski told me that a glass before meals gets the digestive juices flowing.
Kombucha can be expensive to buy but is extremely cheap to make. You need a living ‘scoby’ (symbiotic combination of bacteria and yeasts) which you can get in health-food shops or online – we were given ours a couple of years ago in a jam jar by a friend. Now it’s ten times that size and I pass a layer of it on to anyone I can persuade to try it. Then all you need is a large glass jar, black or green tea, unbleached sugar, filtered water and a week or so of fermenting to make a delicious soft drink which can be taken neat, diluted or with added flavours. Put it in a Kilner jar with a tap and keep it flowing. For instructions on how to make kombucha, see my book The Clever Guts Diet Recipe Book or go to cleverguts.com/get-fermenting. To order a copy for £11.99 until 25 November, go to mailshop.co.uk/books or call 0844 571 0640; p&p is free on orders over £15.