How do I choose the right exercise to strengthen my bones? DR MARTIN SCURR answers your health questions

I was diagnosed with osteopenia at 34 and took 500 mg of Calcichew twice a day. I am 58 years old and have suffered from osteoporosis for three years, despite daily exercise; I stopped taking the bisphosphonates prescribed for me because of side effects. What can I do to prevent further deterioration of my bones?

Anne-Marie Newby, by email.

Taking calcium supplements such as Calcichew will help protect the bones. However, as your letter points out, these are not enough on their own.

Bone health depends on a variety of lifestyle factors, including avoiding excess alcohol and smoking. And then, as you mention, there’s exercise.

This is one of the most important protective measures you can take, although it should be noted that not all exercise is equal when it comes to bone strength.

For healthy bones, you need to exercise three times a week. This should be load-bearing, as it puts pressure on the bone, which triggers the growth of more bone.

Weight-bearing exercise means you are working against gravity. Swimming and cycling, for example, don’t really matter in this context; doing yoga, walking, jogging and skipping.

The good news is that exercising three times a week can make a difference, and it’s been shown that it can significantly reduce the risk of hip fractures in people over 50.

Your medical treatment will be based on your ten-year likelihood of a hip fracture or other major fracture.

For healthy bones, you need to exercise three times a week. This should be load-bearing, as it puts pressure on the bone, which triggers the growth of more bone

This is calculated by your general practitioner or specialist and involves taking into account various factors, including current bone mineral density, height, weight, age and history: the score is determined using ‘a tool called FRAX – the Fracture Risk Assessment Tool.

For most postmenopausal women with osteoporosis, bisphosphonates are the first-line treatment. These slow down the rate at which old bone is broken down by cells called osteoclasts.

However, your side effects – which can include flu-like symptoms, bone pain, and fatigue – mean that another drug choice must be made.

There are several options. Generally, women in your position may be offered denosumab. This works directly on osteoblasts, the cells responsible for rebuilding healthy bone, and prevents the formation of osteoclasts.

The drug is given as an injection every six months.

If your FRAX score shows a very high fracture risk, you will need an anabolic agent called teriparatide. This is a daily injection for the most at risk patients. The drug also increases the activity of bone building cells, mimicking the effect of a natural hormone, parathyroid hormone, which helps regulate calcium.

Either will stop further deterioration and protect you from a hip fracture.

My 49 year old daughter has suffered from hiatus hernia and acid reflux for over a year, losing over 2 st. She changed her diet and was given a proton pump inhibitor (PPI) and Gaviscon. She is afraid of developing Barrett’s esophagus and is considering an operation. Is it safe?

Joan Williams, Llanelli, Carms.

Your daughter’s symptoms are typical of gastroesophageal reflux disease, an uncomfortable condition that occurs when the valve between the lower end of the esophagus and the stomach stops working, allowing stomach acid to flow upward. .

As in her case, reflux is often caused by a hiatus hernia – when the muscles of the diaphragm (the horizontal sheet of muscle that surrounds the esophagus) relax, so the stomach rises up into the chest, allowing the contents to push back. into the esophagus, causing heartburn, regurgitation and difficulty swallowing.

Medicines such as PPIs and Gaviscon antacid can help, as can lifestyle changes, including avoiding certain foods such as acidic and spicy dishes, which irritate the valve. Your daughter might also try raising the head of the bed, so gravity can help her.

Even so, 10-40% of patients, like your daughter, still have symptoms.

The next step is an endoscopy – where a thin camera is inserted into the esophagus to inspect the lining – and a biopsy to analyze cells in the lining of the esophagus.

Your daughter's symptoms are typical of gastroesophageal reflux disease, an uncomfortable condition that occurs when the valve between the lower end of the esophagus and the stomach stops working, allowing stomach acid to flow to the stomach. high.

Your daughter’s symptoms are typical of gastroesophageal reflux disease, an uncomfortable condition that occurs when the valve between the lower end of the esophagus and the stomach stops working, allowing stomach acid to flow to the stomach. high.

This is to rule out other possible diagnoses such as eosinophilic esophagitis, where the lining of the esophagus becomes inflamed due to an allergy, and to rule out Barrett’s esophagus, a precancerous condition where the cells in this area begin to change.

These patients should also 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 in situ for a few hours to check the relationship between pain and acid levels. This can help confirm that it is the acid reflux that is causing the pain. Another key test is manometry, which checks the muscles in the esophagus.

Typically, the surgery offered to patients like your daughter is a keyhole procedure called Nissen’s fundoplication, which enhances the valve-like action at the lower end of the esophagus. While the vast majority of patients given this are satisfied with the results, around 10 percent find that the operation did not help.

Right now, your daughter does not have Barrett’s esophagus, and reflux relief is likely to prevent this from happening. In my opinion, she would be wise to consider surgery.

Write to Dr Scurr

Write Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk – include your contact details. Dr Scurr cannot enter into personal correspondence. Answers should be taken in a general context and always consult your GP for any health problem.

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