I was recently diagnosed with osteoporosis in my lower back and my GP prescribed alendronic acid. I took it for a month but stopped due to the side effects. Now I just take vitamin D and magnesium, eat a calcium-rich diet and do weight-bearing exercises. Will this be enough?
Eleanor Edward, Swansea.
Lifestyle measures are unlikely to have enough impact on their own. Bone is always being absorbed and remanufactured, but in osteoporosis bone is broken down quicker than it is replaced.
Alendronic acid belongs to a group of drugs called bisphosphonates, which reduce the rate at which bone breaks down.
Alendronic acid must be taken on an empty stomach in the morning with at least 200ml of water. It is essential that you avoid food and remain upright for another half an hour (picture posed by model)
But alendronic acid can have unpleasant side effects, including oesophagitis – pain in the oesophagus (the food pipe) that can make it difficult to swallow food. This is why the tablets must be taken on an empty stomach in the morning with at least 200ml of water. It is essential that you avoid food and remain upright for another half an hour. This reduces the risk of stomach acid containing the drug leaking back up the oesophagus, which can trigger oesophagitis.
Another bisphosphonate, ibandronic acid, is taken as a monthly tablet (alendronic acid is taken weekly) and is less likely to cause gastric side effects.
If this, too, causes problems, another option is an intravenous infusion of zoledronic acid. This is given only once a year, and as it goes directly into the bloodstream, gastro-intestinal side effects do not occur.
An alternative to bisphosphonates is denosumab, which works in a similar way but is injected once every six months.
Your GP may refer you to an osteoporosis clinic for this. Waiting times can be significant so, in the meantime, keep up with the weight-bearing exercise and calcium-rich diet.
Over the past two years, I’ve had awful aches and pains in the calf muscle of my left leg when standing or walking even short distances. I had a triple heart bypass using veins from that area – could that be the cause?
Name and address supplied.
Let me reassure you that the removal of a vein from the leg to create the vascular bypass needed for your operation is not the cause of the pain.
In your longer letter, you state that you have been told by a doctor that you need to have the arteries in your leg examined to check for circulation problems.
If this is indeed the cause, then it relates to the arteries that supply blood to the muscle, rather than the veins (such as the one removed for your bypass) which drain blood away.
Cramp-like pain in the muscle during exercise, which is only relieved by rest, is known as intermittent claudication.
It’s the result of a reduction in blood flow to the muscle due to furred-up arteries – similar to the angina pain people experience in their chest because of restricted blood flow to the heart.
What’s puzzling is that your longer letter mentions you have already undergone a Doppler ultrasound test to measure blood flow in the affected leg but it found no evidence of circulation problems.
Complicating matters further is the fact that you have a history of sciatica in both legs, which has caused you similar pain.
This all suggests the root cause is a trapped nerve or nerves, possibly due to a degenerative spine problem such as worn-away discs or even spinal stenosis (where the space around your spinal cord becomes narrowed). This can happen with age. I recommend that you talk to your GP about investigations such as scans to identify the cause.
