An interesting article in The Mail today:
Quote:
How avoiding the sun to protect against skin cancer has left Georgia Coleridge facing the threat of brittle bones
By Georgia Coleridge
2 June 2009
Until my friend collared me at a party, I’d never thought much about my bones. ‘I’ve just found out that my bone density isn’t great,’ she said. ‘I wish I’d known earlier about osteoporosis. Promise me you’ll have a scan.’
The conversation seemed surreal. Surely osteoporosis had nothing to do with either of us. I had assumed it affected only a minority of elderly ladies.
I might well have forgotten my friend’s warning, but the next day I had a doctor’s appointment and I found myself asking about bone density. ‘You’re only 43,’ he said. ‘It’s a bit early to worry. You keep fit, don’t you? You get some sunshine?’
‘Ha!’ I said. ‘Exercise and sunshine aren’t really my thing. I’m usually indoors, tapping away on my computer.’
His reaction was both immediate and surprising. All trace of nonchalance disappeared and I felt my first surge of apprehension. Looking back, I don’t know what I had expected - a blood test, maybe - but I left clutching a referral to a private clinic with a state-of-the-art Hologic Discovery QDR bone scanner.
The scan itself was simple and painless. I lay on my back, with my ankles braced against two blocks, then the scanner slid over my body, precisely measuring my hip and lower back.
There’s nothing like being pinned to a piece of strangely shaped hospital equipment to focus the mind. Visions of my bone tissue, described by the assisting nurse as ‘a Crunchie chocolate bar’, crowded my imagination. The denser the honeycomb, the stronger my bones would be.
If I was lucky, I might have built up enough bone mass in my teens and 20s to last the rest of my life. But bone cells, like skin cells, are constantly being broken down and built up, and over the years women who don’t have good genes or a good diet, who smoke and drink too much, who don’t take enough exercise or get enough sunshine, can lose a lot more bone than they replace.
It’s such a slow process that most of us won’t notice or give a moment’s thought to it until the menopause, when levels of oestrogen (a natural bone protector) decline and our bones start becoming fragile, fast.
Osteoporosis affects around three million people in Britain; 50 per cent of us women will become old ladies with osteoporotic fractures, snapping wrists and hips like dry twigs if we fall, shrinking and curving over like crones in a fairy story as our vertebrae begin to crumble.
I left the clinic with that nagging ‘what if ’ feeling that wasn’t assuaged by a hospital leaflet about ‘bone density, sunshine and vitamin D’. Like many women, I’m susceptible to scare stories about sunlight and skin (that catalogue of beauty and health disasters, ranging wrinkles to cancer), and I’ve always worried about my husband, whose idea of a perfect holiday is to fly somewhere close to the Equator and soak up as much sunshine as he can.
I’m fair-skinned and freckly, and unless I cover up or ladle on sun cream, my skin can blister like bubble wrap. I’ve always felt more comfortable in the shade or even indoors. How ironic, then, to think that all my efforts to save my skin had provided a potential recipe for osteoporosis.
Bones need calcium, but I didn’t know that however much milk, cheese and oily fish I devoured, my body would have trouble absorbing it unless I also had a good supply of vitamin D - a staggering 90 per cent of which is manufactured when bare skin is exposed to sunlight.
Apparently, we should all be going outside three or four times a week, for at least 20 minutes, exposing about a fifth of our body to the light. But women like me who cover up, always wear sun cream, live in a northern climate and stay indoors too much could be storing up trouble.
I was already rethinking my wardrobe (swapping my trousers for a knee-length Nanette Lepore skirt to give my milk-white legs a blast of ultraviolet) when my doctor called with the scan results.
‘You shouldn’t panic,’ he said, ‘but the bone density in your spine is at the very low end of normal for your age.’
In five years’ time, he counselled, without oestrogen coursing round my body every month, he might prescribe HRT; but, disconcertingly, until then he had no suggestions. The technical term for the state of my spine is ‘mild osteopenia’.
Uneasy at the idea of doing nothing at all, I spent a confusing afternoon Googling ‘osteoporosis’ and ‘osteopenia’. I read that while HRT used to be the preferred medication, its link to breast cancer has now led specialists to prescribe drugs called bisphosphonates, such as alendronic acid, instead.
They have a downside, too: some patients suffer such terrible heartburn that they won’t take it for more than a year.
On the upside, the World Health Organisation has launched an online Fracture Risk Assessment Tool called FRAX to assess whether sufferers need medication - a test anyone can access, but few GPs know about.
Trying not to panic, I booked myself an appointment with Dr Stephanie Kaye, a consultant rheumatologist at the Lister Hospital in West London.
Patients tend to be sent to her only after an unusual fracture caused by something seemingly innocuous - ‘such as dropping a dog lead on their foot’.
Few premenopausal patients get referred for investigative or preventative treatment.
Dr Kaye explained that, in the majority of cases, osteoporosis is mostly genetic, so statistically I’m lucky my mother has never had a hip fracture or a dowager’s hump, and that my diet is good - I eat lots of fresh, healthy food.
Just as I was beginning to feel relieved, Dr Kaye zeroed in on my sun phobia, insisting on a baseline blood test to check my parathyroid, calcium and vitamin D levels in particular.
When the results came back, my vitamin D levels were so low I was immediately called back in for an intramuscular injection and prescribed a daily calcium/vitamin D supplement.
Dr Kaye suggested I get another bone scan in a year, and encouraged me to do at least 30 minutes of exercise a day, something like brisk walking or jogging, as the thump-thump vibrations stimulate bone growth.
This was another wake-up call, as I’m naturally sedentary and haven’t done enough exercise for years. Though my weekly yoga class helps my bones by gently stressing them in a number of unusual positions, it simply hasn’t had enough impact.
The phrase ‘go to the gym’, once consigned to the bottom of my life list - I always had a book to write, children to look after, parties to go to first - was now something I couldn’t put off ‘until tomorrow’.
After my scan, and Dr Kaye’s advice, and driven by genuine fear, it was time to face up to my primary school hangups and shake off the tired old script that I could never be sporty.
I bought a pedometer and set myself the ambitious target of 10,000 steps a day (Dr Kaye suggested 5,000 minimum). These days, I take the stairs instead of the lift, and park the car farther away, then walk. Whenever I’m falling short of my 10,000-step goal, I go to a Power Plate studio.
I’m surprised how challenging the change in lifestyle has been. Switching to skirts, taking supplements, going out sometimes without sun cream and attending a few exercise classes doesn’t sound like much of a change, but shifting long-held habits feels like a big step.
I don’t know what will show up on my next bone scan, but I am optimistic. It feels good that I’m heading towards my 50s having faced up to my anxieties about exercise and my paranoia about the sun. By trying to ensure my bones are heavier than before, at least my bundle of insecurities feels lighter.
• This article is from the July ‘Ageless’ issue of Vogue, out Thursday.
Visit the National Osteoporosis Society at Nos.org.uk
http://www.dailymail.co.uk/health/a...ttle-bones.html
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