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Hrt: if i am unable or unwilling to take hrt, what else can be done about osteoporosis? HRT: IF I AM UNABLE OR UNWILLING TO TAKE HRT, WHAT ELSE CAN BE DONE ABOUT OSTEOPOROSIS?
The most effective way of reducing your chances of an osteoporotic fracture are to build up your bone mass during your youth by taking plenty of exercise (which strengthens bones), by eating a diet high in calcium, by avoiding drastic dieting and by not smoking. This ensures that you reach the menopause with your bones as strong as your basic genetic make-up allows.
From the menopause onwards you need to continue with exercise, and with calcium in your diet. Many women worry about putting on weight at this time, so they cut down on the dairy products that contain calcium to protect their bones, which is a pity. If you take very little calcium in your diet, calcium supplements may be helpful. Bones also need a small amount of vitamin D, and for most people, the best way to take in vitamin D is to expose your skin to sunlight: about 30 minutes a day in winter and summer is ideal, long enough for the vitamin to be produced in the skin, not long enough to run the risk of skin cancer. Large doses of vitamin D (as are found in some tablets, for example) can actually be harmful to bones.
If you have osteoporosis of the spine, your doctor will be able to tell you about a new treatment called etidronate, marketed by Norwich Eaton under the brand name of Didroncl PMO. This is a non-hormonal treatment, so it is suitable for many women who cannot take HRT. It has the advantage that, taken regularly, it can lead to a small buildup of bone that has been lost. It is taken on a cyclical basis - 14 days of etidronate followed by 76 days of calcium supplements. This cycle is then repeated over and over for three years or more. Didronel PMO appears to have few side-effects (mainly minor stomach upsets) but, being non-hormonal, it does not give any improvement of menopausal symptoms. It is only available on prescription, is particularly suitable for older women, although there is no upper or lower recommended age, and is intended as a treatment for osteoporosis of the spine, not of the hip. Didronel PMO is also likely to be helpful to men who suffer from osteoporosis.
Whether or not you decide to take hormone replacement therapy to prevent or delay osteoporosis, is a decision you will want to make after thinking about it carefully. Although it is never too late to start, for it to be most effective you should take it for at least five years, preferably starting within two or three years of the menopause. If you are at a high risk of developing osteoporosis, a much longer period may be necessary for you, and you will need to balance the slightly increased risk of developing breast cancer (if you take it for 10 or 15 years or more) against the risk of developing a condition that can cause considerable pain and deformity.
For decades, women suffered in silence from osteoporosis, while their doctors regarded it as just one of the consequences of old age - inevitable, unpreventable, untreatable and boring. It has recently been described as 'a preventable disease that is not being prevented, a treatable disease that is not being treated'. Even in 1990, out of the 2 nulhon women in the UK who suffer from this condition, only 76,000 received any treatment at all, and 90 per cent of those received only calcium and painkillers. Only a tiny minority received HRT.
Things are changing at last, however. More and more women have heard of osteoporosis, and know what it is. Doctors have a clearer idea of how to diagnose and treat it. It is becoming a high-profile disease, the subject of hundreds of research projects in the UK alone. That this is happening is due almost entirely to the work of the National Osteoporosis Society. Founded in 1986, it now has over 14,000 members, with local groups in most parts of the country. The Society aims to keep osteoporosis very much in the public eye, to raise money for research, to make sure government ministers and the Department of Health are constantly aware of the enormous amount of work that still needs to be done in research, bone scanning, treatment, prevention campaigns, etc. The National Osteoporosis Society has regular programmes to up-date doctors about osteoporosis so that they can help their patients more. It runs information campaigns on osteoporosis in pregnancy, osteoporosis in men, the importance of screening and of HRT, and, very importantly, to make sure that all sufferers receive treatment.
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