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Osteoprosis and women

Matt Roberts and osteoporosis  
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Did you know the lifetime risk for women dying from hip fracture complications is equal to the risk of dying from breast cancer? For example, 20% of women who suffer a hip fracture die within the next 12 months.

Broken bones caused by osteoporosis are not only excruciatingly painful, but can also have a serious impact on quality of life. Hip fractures can lead to serious disability and can result in the need for constant care.

Despite the fact that half of women in the UK over 50 will suffer a bone fracture, recent research shows that only 4% fear developing osteoporosis and fracturing a hip, compared with 56% of women who are afraid of developing cancer.

As part of Osteoporosis Awareness Month the Alliance for Better Bone Health hope to encourage women to take precautionary measures against osteoporosis through the launch of the Act Now Protect The Future guide. Aimed at women of all ages, the guide contains simple and constructive advice on everyday changes you can make to improve your bone health and prevent brittle bones. The guide was developed by a leading group of health and wellbeing experts.

Matt Roberts will be live online in the studio on Friday 30th June at 1.30pm offering simple and constructive advice to women to help them prevent or manage osteoporosis. He will be joined by Dr Dawn Harper and Dr Richard Keen, contributors to the Act Now Protect The Future guide.

TRANSCRIPT:

Host: Murray Norton (MN)

Guests: Dr Richard Keen (RK)

Dr Dawn Harper (DH)

Matt Roberts (MR)

MN: Hello, and welcome to the show. I’m Murray Norton. Today we’re talking about osteoporosis. Let’s start with a few facts about osteoporosis: first of all, osteoporosis is something that affects an awful lot of women, and even more than that, and there is a fascinating fact for you and a serious one, the lifetime risks of dying from osteoporosis are exactly the same and equal to that of breast cancer. Now if that doesn’t make you sit up and take notice, goodness only knows what will. It is Osteoporosis Awareness Month, and because of all of that we have a guide. Let me just hold up this guide so that you can see this guide a little bit closer on. This, ladies and gentlemen, is the guide. The guide is the ‘Act Now, Protect The Future’ guide and that has been produced by the Alliance for Better Bone Health. So, with that very much all in mind, who wrote it and what’s it all about? Well, three of the panel that wrote this guide are joining us in the studio: Dr Richard Keen, Dr Dawn Harper, and Matt Roberts, who’s a fitness-training expert. Welcome all; thank you very much indeed for coming along. This fact that I started off with, is a really scary one: 20% of women who suffer a hip fracture will die within the next twelve months, the same as that for breast cancer.

DH: It is a very frightening statistic, and one that I think people are not aware of. You know we’re very good today I think about breast health, and we’re certainly getting better about heart health, but we don’t think about our bones, and it’s even more serious than the one in five, because actually six months down the line from a hip fracture, one in two women will still not be able to dress themselves, and in general practice I see that as people who go from a completely independent life, to actually being housebound, with huge packages of care in the home, or even worse in a residential home – they lose their quality of life, so we can prevent hip fractures, really important that we do.

MN: It’s a question that Becky has asked – what exactly is osteoporosis? Now I’m going to come to that in just a second but Richard, just come to you: these facts and figures we’ve had here, we’ve known them for a long time, and yet we’re surprised by them now – is the message just not getting through?

RK: I mean, I think that’s one of the problems, I think, you know, your bone health is very important and yet people just seem to disregard it, and perhaps just think of it as an old person’s disease, but actually, you know, it’s very important that you take action for your bones when you’re a lot younger because you can maximise how strong your bones are going to be, and then you can improve things all the way through, and I think the message just hasn’t got through.

MN: Matt – health, fitness, training, as Richard rightly said, we think of this as an old person’s disease if you like, something that old people are going to suffer from, but actually you can take action at a very young age.

MR: It’s crucial people start from an extremely young age, you know, the teen years for girls are absolutely fundamental for forming good bone density, by the time we’re in our 20s it’s pretty much completely formed, so looking at some ways of preventing it, going backwards quite frankly, to the 20s and 30s in those categories – got to make sure that those years where you’ll perhaps be in University and drinking too much and smoking too much, not doing enough – how bad is that for you? Well, very bad indeed. We need to be very preventative and make sure we get people going far more active and the most appropriate ways to create good bone density and good bone thickness, and then hopefully not have problems 30 years later when it really could become a problem.

MN: I’ve got a question here from Becky who asks, what exactly is osteoporosis?

DH: Well osteoporosis as it’s name suggests, is porous bone, is thin bone, and actually you’re so right, people out there get very confused. A lot of people I see in surgery confuse osteoporosis with osteoarthritis – the two are totally different…

MN: I was going to say – what is the difference?

DH: Totally different. Osteoarthritis is, if you like, an inflammatory wear and tear on the joints; osteoporosis is thin bones, and the really crucial important point about this is that you don’t get symptoms from osteoporosis, so people think that they’ll get a bit of back pain, they’ll get a bit stiff in the morning, and then they’ll think about their bones.

MN: Sure.

DH: But you don’t feel anything until you’ve fractured a bone, so, you can have osteoporosis, walk around, be completely normal, feel great…slightly minor trip, bit of a fall, would expect to just graze yourself maybe, and you’ve fractured a hip. And you know, that’s devastating. So it’s really important that we get people to know the difference between the two and to think about their bones early.

MN: If you don’t know about the symptoms Richard, how do we find out if someone has osteoporosis, or can we do checks along the way?

RK: Well the only way you can really tell when you’ve got osteoporosis, is to have what’s called a bone density scan, or a DXA scan is the other sort of term, and this is a very simple, low dose x-ray test that will measure the bone strength in your spine, and in your hip, and that really is the only way that you can tell if anyone has got osteoporosis, you can’t tell it from ordinary x-rays or anything like that, or a blood test, or other sorts of things, you need to have a sort of a test of the bone strength in the spine and the hip. And it’s basically a procedure that takes about five minutes, it’s not a claustrophobic scan or anything like that, it’s very simple, very easy to do, and will provide the assessment of whether you’ve got osteoporosis or not.

MN: I’m guessing that if somebody is of, I don’t know, let’s just pick an age out of the air, let’s say 50years of age; female, 50 years of age – will I have osteoporosis, will I not? How do I find that out? What should I do?

DH: A great case study, because you’re so right actually, average age of the menopause in this country is 50-52. As women we start off with smaller bones so we’ve got less to lose, and we know that oestrogen protects our bones. When we go through the menopause and we lose our oestrogen, we then really start to lose bones. So it is exactly that group of women – post-menopausal women that are most at risk. Hopefully, what the ‘act now, protect the future’ guide is going to do and what we’re trying to do here is to raise awareness so that people are thinking about it before 50, but, certainly at 50, you know, if you’ve got risk factors you need to be going to chat to your doctor about what you can do to help yourself.

MN: Right so it’s a case of acting at that particular point, having the checks put in place then. A question’s come in from a couple of people and that is about affecting – does it just affect older people, or can osteoporosis affect people of a younger age? Chloe came in with this question.

DH: Certainly the older you are, the more you are at risk. However, there are some groups of people who are at risk of developing osteoporosis much younger, and that would be people who are taking steroids, and some people need to you know, if you’ve got severe asthma or rheumatoid arthritis you might well be on steroids from a young age, and so you may be at risk. The other very significant group is anorexic girls and I do see very young women with significant osteoporosis who’ve suffered with anorexia, and that is because, when you become very thin you stop your periods, and when you stop your periods, you lose that oestrogen, you lose that protection so effectively you’re going through that low oestrogen stage earlier in life.

MN: So, in special cases….

DH: Absolutely.

MN: We’ve got a question that’s come in, I think it’s a great time to ask this question. Zoe is lactose intolerant, and what can she do to help protect her at that stage? I guess by lactose intolerant that means calcium supplements which didn’t have lactose would be fine but milk, ordinary drinking milk, which we take as one of the great things to have, is not allowed for Zoe.

DH: Certainly, I mean I think, you know, dairy products are our greatest source of calcium in our diet. What Zoe’s going to need to do is take a look at her other foodstuffs – fish and so on, that will also contain calcium and try to make sure that she’s taking adequate calcium in her diet from other sources, ok. I’m not a great fan of going straight into supplements, but I think I’m a great believer in trying to do things with a good balanced diet but if she’s genuinely lactose intolerant and can’t take dairy products, if she cannot get her calcium levels up to the level we’d want them to be and there’s stuff in the up now guide that will tell you what your daily intake ought to be, then she needs to think about calcium supplements.

MR: But there are great substitutes too on the dairy substitute site, things like soya products are actually remarkably high in calcium, so you can actually have some substitutes that are a direct substitute rather than being something that’s strange. And also things like dark green vegetables, you probably draw enormous quantities of calcium from those, and if you’re not taking on dairy foods you get very good at getting calcium from those products. So having a good healthy eating programme rather than pure supplementation definitely is the way to go ideally.

MN: It’s very interesting, there’s a question in from Natalie – is it better to get calcium from dairy or supplements?

DH: Well I think we’re unanimous!

MN: That’s your answer – dairy every time!

RK: As Matt said, sort of, broccoli, spinach, they all contain calcium, and if you can get it all through that then you’re going to have a much more balanced diet that just taking all supplements.

MR: And also bony fish – if you have that in your diet as well. Really creates some variation as a fantastic great eating programme, and then you get loads of calcium in so there’s loads of ways of doing it.

MN: There’s a lot of this all contained within this guide.

MR: There’s lots of great tips for different categories of ages, whether you’re in your 20s, 30s, 40s, 50s and beyond – there’s tips in there for each category to ensure that that category gets what it needs. If it’s children we’re talking about having maybe a yogurt pot at the end of a meal, if it’s adults who are in their 40s we’ll have maybe some bony fish as part of your programme. So each category has its own specific dietary demands and it’s all within the plan.

MN: Right, I want to talk about treatments and treatments for osteoporosis, and there are obviously various treatments for it, and I wanted to start Matt, with you, if you like – the prevention of the side of this which is what this is all about – ‘act now, protect the future’. It starts from an early age and exercise at any age, now I know in the guide there are exercises for different age groups. Is that because people can do physically more things at certain ages?

MR: Well that question – it’s easy in the world to say that someone who needs to prevent osteoporosis from occurring – well, go for a jog – it’s weight bearing, it’s going to be impact, it’s fantastic…but if you’re 60 and you’ve never jogged before you just don’t want to do that! So it’s not really practical. So it’s about getting people to have ideas – what do you do, what can you do that’s not just that obvious thing? And if you are in your 50s and 60s, there are some fantastic body weight exercises you can do which hugely increase bone density. Also it’s not just about going to the gym and doing the obvious gym exercises. Do some functional exercises instead, do step ups with a shoulder pass with a ball, twist your body a bit while you’re doing a step up, make your body work dynamically, really work every single muscle, every single bone, hopefully get some pressure against it, some stress, that increases bone density – so I’d rather people had that approach rather than the conventional approach, that’s what we try to highlight in the areas of the, the decades of your life, is what you can do to ensure you get the appropriate work done – if you’re in your 20s, you know, don’t just think about going to the gym, go and do team sports, go and actually have some fun with it. Be high impact, be aggressively competitive and go and actually make the bones stay strong. In your 30s and 40s and 50s, look at things like pilates, yoga, hiking – you know, get yourself out there, get your bum into gear and actually move a bit, but don’t just sit there thinking it’s going to be okay because it’s really not. We’ve got to make sure we act now to prevent future problems.

MN: A question in from Lucy, and I’ll put this straight back to you Matt. Lucy says “I am overweight for my height, does that mean I’m more likely to get osteoporosis in later life?”.

MR: No it doesn’t. It’s something which is important, I think Dawn touched on this earlier as well, it’s actually quite interesting that people who are most at risk are actually far thinner than being overweight so no it’s not the issue. It could be, it could be that someone who is overweight happens to have a high propensity to get bone density loss, because maybe their diet is poor and their exercise levels are very low, but people who are thinner, generally speaking, are at higher risk.

MN: Alright. Dawn, do you want to back that up now?

DH: Yes, I would absolutely reiterate that. That I think it is thin people who are most at risk but as Matt said – unfortunately when we’re very overweight we tend to do less exercise. You know, you get into this sort of catch 22, and the lack of exercise will put you at risk if you’re overweight. Certainly, having a low body mass index – it’s the very thin people that I see have osteoporosis young.

MN: Alright. Not necessarily then Lucy but thank you very much for the question. Margie has sent a question, thank you very much indeed. She wants to know – how important is diet to osteoporosis if you’ve already hit your 30s. Again, we’re talking about ‘act now’ but it’s never too late I guess is what you’re going to say. I understand that by the age your body is losing calcium from your bones rather than building it up from your 30s onwards. Can you halt that at any age?

MR: There is a search that I’ve read, that says that exercise can increase bone density very mildly – 2/3/4 % maybe, which ok it’s a small percentage if it does exist at all but point is, you’re not going backwards. So if you stay the same, well there’s your win, that’s the ideal situation, and exercise certainly does that, and I think that diet without question does that because you’ve got the calcium that you need to ensure your bones stay strong. So in your 30s, you’re at a perfect time to ensure that you prevent further changes in a negative sense.

MN: Richard.

RK: Yeah I think again in your 30s there is a tendency that the body is starting to lose bone strength a bit, you know, if you can maintain a good intake of calcium and vitamin D in particular and also do the exercise then you will stave off that sort of aging process. So again, it’s important not just to think that you do all the exercise up to the age of 20 and then stop, because then yes you will just accelerate that downward decline so you’ve got to carry on with those measures.

DH: I mean I think it’s never too young to start, and it’s never too old, you know, you’ve got to keep at it, this is not a quick fix.

MN: It’s a lifestyle thing.

DH: It is.

MN: Alright, we’ll come back to lifestyle in just a second. Here’s a confusing question, it is “How much exercise do I need to protect myself from osteoporosis? Are some exercises better than others?” It comes from someone called John. So – men and osteoporosis? Does that happen? Can it not? You’re saying yes? Because when you were saying earlier on I was thinking it’s nothing to do with guys.

DH: No, one in two women over 50 will develop osteoporosis, but one in five men will, so yes it does affect men too, and weight bearing exercise is the big thing but I mean Matt will talk about exercise. I always say your skeleton’s like anything else – if you don’t use it you lose it, it’s as simple as that.

MN: Men tend to do more high impact, by the nature – and I’m not being sexist here, I’m talking about football and rugby and sports that we would do as team sports and then we kind of stop doing them but we still think we should go out there pounding the pavement so we do more damage by doing those sort of things?

MR: By doing the high impact exercises? Oh no, no…absolutely not. I mean without question you’re doing things there which create massive bone density. The more that you can do that’s impact based, that trauma that you create – it sounds an awful word but trauma’s positive, you’re creating some vibrations, some shock to the bone, you’re creating this use of muscles and tendons which pull on the bone structures and create bone density – all of those, well the more the better. And having an impact from a rugby tackle bizarrely is quite good, and it…

MN: It doesn’t feel like it!

MR: No, exactly. Tennis players and bone density – tennis players have much more bone density in their tennis playing arm than their non-tennis playing arm, so you can make all these things very positive, and it’s crucial that in the 20s and 30s when your body’s more flexible, that you do impact sport, and you have fun doing it all. When you’re in your 40s and 50s there’s clearly a downside to doing impact sports because you’re less flexible, it definitely hurts a lot and you stay hurt rather than being fixed, so there’s things that we have to change. Now, for guys in particular, generally speaking there’s more of a desire to do weight training, and weight training’s just as good as doing impact work. So you can go to the gym, you can lift weights, do body weight work as well, and that will create bone density. As time goes by it does change, but you never stop, you keep on doing it, you just evolve over time.

MN: I’m stunned that there are one in five men with osteoporosis, because I naturally thought when you were talking about causes, that it was predominantly women.

DH: No, well it is predominantly women, it is, but yes, I’m afraid you don’t get away with it!

MN: It’s for us as well guys...we’re halfway through. Matt I know you’ve got some exercise sheets and people can send away for them. Have you got some?

MR: They’re right here actually; they’re very simple, very much a magazine style format. I truly believe that the best way to make someone stay motivated on a routine program is to make it as simple as possible. What we’ve got here for example – you can see this on the camera, is the 20-40 age category, a whole range of great exercises, anything from things you recognise – you know, simple things like half press-ups – everyone can do those, come on, it’s not that hard to do, and doing a squat with a shoulder press. Again it’s all about having things which are functional training, things that replicate what you do in your day-to-day existence. You don’t really tend to do many sort of gym-based type things in reality every day but you will do things like lifting a box above your head to put onto a shelf. You’ve got the cardiovascular element as well, which is equally important, not just from the point of view of bone density but just generally. Please don’t think we’re just looking at bone density, we’re all about making you fitter and healthier generally. Help your heart and lungs get stronger, help you lose some body fat, because hey, we should. So in here there’s a real total routine for everybody to do. It happens to make your bones stronger as well, so it’s well worth having a good read through the sections appropriate to you. You can get this from us, and make sure that you read it, use it, do it and feel better.

MN: Alright, I’ll give you that address right at the end. Before we do, I’m guessing that for the consultant, for the doctor, if you’re dealing with someone with osteoporosis, it’s far better you’re dealing with someone who is pretty much healthier apart from that apart than somebody who’s pretty much in an unhealthy state right across the board?

DH: Oh always, yeah. Apart from anything else, you know, if we’re going to be advocating the exercise, much easier for you to get out and exercise if you haven’t got heart disease and lung disease and if you’re not grossly obese maybe and joint pains and that kind of thing so yeah I mean, always, whatever the condition, it’s much nicer if it’s just that one! But you know, life’s not like that, and often you see people who’ve got lots of different problems. One of the main problems, the one that we talked about right at the beginning was hip fractures. Richard, why the hip in particular? I mean, I’m guessing it’s a very big bone in the body really isn’t it, so if something’s going to go it’s going to be that one.

RK: Well yes, and it’s just the fact that if you fall over and you’re an older person, and you fall over you normally will just fall onto your side and you’ll break your hip, and then that involves, you know, being rushed into hospital, an emergency operation, and we know that, you know, that one in five of those ladies that are admitted with a hip fracture will be dead within 12 months. So that’s really the most devastating of the consequences and then there’s the, you know, knock on effects as Dawn was saying as regards to the loss of independence, and fear is something else that often we find that the patients, they just do not then want to go outside again, that they’re petrified of falling over, they change their lifestyle completely.

MN: Quite a radical change.

RK: Yeah it’s a completely radical thing. And then there are knock on effect as well, you know, it might happen to your grandmother, but then of course she then ends up living with you and so there’s a whole knock on effect to sort of, to social things, so hip fracture is very devastating and there are about 70 to 80 thousand of those fractures each year.

MR: I mean if someone’s exercising, the exercising person has a 20-45% increase in bone density of their hip in relation to someone who doesn’t exercise, so you instantly make yourself have a much lesser chance of actually damaging your hip.

RK: And if you exercise, your muscles are stronger, so you’re less likely to fall over, and your balance is better and all these sorts of things which are really important.

MN: Is it something that’s hereditary? Question from Freda thank you, she said “Mum’s had osteoporosis, does that mean I’m likely to get it too?”.

RK: There’s a high chance, we know osteoporosis does run in families and if your mother has had a hip fracture, or has got osteoporosis, that would be one of the triggers that should get you to then see your GP to see about getting checked for whether you’ve got osteoporosis.

MN: So it’s a warning sign.

RK: Yeah.

MN: Are GPs sympathetic and on board and understanding of this?

DH: I hope so.

MN: You hope so, you can’t speak for the whole profession!

Dr DH: I hope so! I think unfortunately, I mean, if we’re going to be really honest, the availability of this special scan that Richard was talking about – the Dexa scan – the availability of that on the NHS is not the same across the country, and in some places there are really quite long waits. But, you know, it’s not prohibited to think about having a scan done privately if you really are worried – we’re talking in the region of £100-150 probably from your local private hospital, and I really do believe that actually it’s the only way of knowing, so if you are at risk you are eligible on the NHS, but you know, if you’re bothered about it, and you’re having difficulty, then it’s another option.

MN: Actually, question just from Karen. She said, “Is it really true that as many women die from osteoporosis as do from breast cancer?”. You know, the fact we were coming up with right at the beginning there, I just wanted to reiterate those figures that we were talking about.

RK: Yeah. There’s 70,000 people having a hip fracture, and then you take one in five of those actually dying: you get a certain number of people that die because having had a hip fracture, and then you work that out with breast cancer and you come up with the same figures.

MN: OK. The facts are there, and they don’t lie, and we have the experts here to back it up as well. So get hold of a guide like this one and we’ll tell you how in but a couple of minutes time. Jennifer wants to know, “How do I find out which treatment is best for me?”.

Dr DH: Right well I’d say talk to your doctor, alright, lots of different treatments out there.

MN: What sort of treatments are there?

DH: Well, the gold standard now, would be a group of drugs called the bisphosphonates, but even amongst them there are variations, they’re not all the same so, some of them’ll be taken once a week, some will be taken once a month, some will protect just the spine, others will protect both the spine and the hip. So I think probably the way to get the best treatment actually – have a look at the guide, be as well-informed as you can be and then pop and see your doctor and have a chat, and make sure that you’re on the best treatment for you.

MN: You say that treatments differ because patients differ?

Dr RK: Yeah, I mean there will be patients who have other sort of health problems, they may be on other tablets, they obviously have their own lifestyle, you know, and again it’s a matter of trying to find out which tablet fits in with what they do in their life, because the most important thing is to find the right tablet for that patient so they’ll take it, because if they don’t take it it’s not going to work. So, it is the thing of having the dialogue with your doctor to actually work out what’s going to be best.

Dr DH: And as they say life isn’t black and white it’s shades of grey, you know, and it’s a case of fine tuning to get the best thing for each individual so you’ve got to talk to your GP, you know, and if you don’t get on particularly well with one doctor go and talk to another one because, you know, it is important that you understand why you’re taking a treatment, and that you are engaged in that decision-making process because you will, as Richard said, you’ll be much more likely to carry on taking it.

MN: OK, we’ve had some of these questions, or covered some of the subject of these questions so for those that have heard these ones forgive us. Sally’s just sent a question into us – “What is a bone scan?”.

DH: OK..

MN: And is it painful? Is it difficult?

DH: Not painful at all, it takes very little time, it’s all over and done with in 5 or 10 minutes. The really important message, actually, for Sally, is that it doesn’t involve a tunnel. I see lots of people who are quite worried…

MN: The word ‘scan’.

DH: Exactly, they think they’re going to go into a tunnel, and just immediately, they’re terrified of it. A lot of people find that a really claustrophobic experience – this is not that at all. You simply lie on a bed and enjoy the 5minutes rest. You lie on a bed and an arm just moves across you, alright, it’s as simple as that, you’re not in a tunnel, it doesn’t involve any needles, it’s absolutely painless, and it’s very quick.

MN: It’s as simple as that. Let’s go back to exercise, we were talking about exercise, and Matt I happen to know you have been the exercise trainer for many a star – the Spice Girls and movie stars, and all sorts of people. Are people like that aware at a young age? I guess it’s a bit like selling pensions. At 20 you don’t want to know about it do you?

MR: Interestingly enough actually, the people who are the celeb market are probably most informed of all. They read more, they employ people like me to try and tell them more so they’re actually very aware of, in lots of cases, most of the problems that exist. The main problem that exists in relation to celebrities isn’t them, it’s the way that they’re covered, and if you look at the market today for magazines, all the kind of glossy gossip magazines that are out there, every single week, week in week out it’s either they’re too fat or too thin, and if they’re too thin, well we have a real issue because actually they’re a role model and it’s a classic case that if you look in the papers now, World Cup fever’s about us, who’s on the cover of most papers every day? It’s Victoria. And god bless her, she’s fantastic for what she’s doing for herself but actually, in my personal opinion, she’s a bit too thin, and the chances are, I don’t know, the chances are that she’s not eating enough food, and the chances are therefore, that her calcium levels are quite low. If that’s a role model, that’s an aspirational figure for young females, then we are creating problems for celebrities. At the other end of the spectrum we’ve got Charlotte Church, who I think’s the number one most looked up to female celeb in the country which is a frightening thought.

DH, Dr RK and MN: Hahahaha

MR: It really is, it sends a shiver through my spine.

MN: I love you Charlotte.

MR: Your time’s up. But what worries me most is, young girls aspire to her lifestyle, and young girls in this country now are smoking and drinking much more than ever before.

MN: It’s an interesting point isn’t it. It’s this 20/30s women smoking really heavily.

MR: Because Charlotte Church does and her ilk and therefore it seems normal and OK. With guys in particular, the irony is, you know, our role models for guys, for young guys, is footballers, who are active, who are sporty, you know, it’s about being in shape, healthy. So with females, who are most at risk, it’s a big big problem. We need to find some really fantastic, iconic, healthy, sporty women.

DH: I’d really reiterate that because actually I tell you, when I see patients in surgery, the vast majority are overweight, a significant number are clinically obese, and then there are a few who are very thin. I see frighteningly few people who I would consider have normal body mass index, and that’s, you know, that is a real worry I think.

MN: Let’s just talk about body mass index for a moment. That’s an important reading, and I guess for most of us we wouldn’t know what our, I have no idea what my body mass index is.

DH: OK, dead easy to calculate, all you need to know is your height in metres and your weight in kilos, and it is simply your weight in kilos divided by the square of your height in metres, and you should have a body mass index of between about 18 and a half and 25. If it’s over 25, you’re overweight, if it’s over 30 – a dreadful word, but you are clinically obese, and if you’re down at the 18, you know, you are too thin – that is unhealthily thin.

MN: It’s interesting, we’ve ended up talking as much about being unhealthily thin as overweight, and it’s a danger either side really isn’t it? I never thought we’d be talking about people being too thin as much as a danger as being.

DH: Well when it comes to bones it really is an issue.

MN: It is one of those things. Devina had a question for us: “Is there anything I can do better to protect myself regarding diet?”. We’ve covered a great deal of this. Healthy lifestyle, we all know healthy lifestyle but we don’t really adhere to it do we?

DH: Well because we live in a quick fix culture which’d much sooner take a pill and carry on misbehaving. You know let’s face it that’s much easier! Certainly…don’t quote me! Certainly I think, you know, this is a life solution. We might have touched on it, this is not sort of doing something for a week or a month, this is actually adopting a whole healthy lifestyle plan really, for life.

MR: It sounds really obvious and sounds really like your mum talking, but the dietary advice would probably be ‘drink more water, eat your greens, have a glass of milk’, and you know, just be generally healthy in an old fashioned sense.

MN: When you say old fashioned sense, I just want to pick up on this, is there some modern phenomena in terms of osteoporosis? I guess it’s always been there but we tended to have more greens and we tended to have more milk. I remember drinking milk as a kid a lot more than I do now and it was more readily available.

MR: The difference is we have an abundance of food now, the overall volume of food has increased, therefore there probably is more calcium going in as a net amount. But we’re taking away a lot by having an unhealthy lifestyles. So we’re having less exercise or less manual activity, whether that be work or play, and we’re having too much to drink, and a lot to smoke, you know, all these things have an input. So, whilst our increase in calories is huge, we’re leeching more calcium out of our bones and making it worse – we’ve got a catch 22.

DH: Actually one of the other things we haven’t touched on is fizzy drinks, our kids are drinking a lot more fizzy drinks, and fizzy drinks will stop us from using the calcium in our diet so effectively so they’re really bad for your bones.

MN: One for you Richard, this is Keely. Hello Keely, she says “My gran’s had a hip fracture, how worried should I be about her health?”.

RK: About her health?

MN: Yes.

RK: Well I suppose if, hopefully the gran’s survived, so hopefully that will be good news, erm, I mean basically, even if she’s had a hip fracture, the good thing is that, you know, all the treatments that we talked about, there are treatments out there that can prevent then, further fractures occurring. So again the important thing, and unfortunately it doesn’t happen all the time, is that, you know, when you leave hospital you should end up being on some treatment, but if you’re not, then you’re going to need to go back to the doctor and the GP to get some treatment prescribed, but I mean, you know, if she’s on treatment for the future, then that will mean that hopefully gran will do quite well.

DH: Have a look at the guide.

MN: OK, we’re almost out of time. I was just going to say, if you could wrap it up in just a couple of words, for you doctor it would be, get a hold of the guide?

DH: I think get a hold of the guide. I mean, it’s very reader friendly, and it is directed at different age groups as well, and it just gives you the information that you need to start thinking about your bones.

RK: OK, well I’ll reiterate again, if you act now you can protect the future, but, equally, it’s never too late. So whatever age group, even if you’ve had your hip fracture, it’s still important for you.

MR: I say start moving, get back to basics, you know, really look at your diet and take a good look at yourself. How much do you want to create a problem in your future life? Probably not at all, so act now and prevent the problems in the future.

MN: If you want the guide, it’s very simple. All you need to do is to phone 0208 392 6924. Thank you all very much indeed for coming in, and thanks for pointing out not only the dangers but the remedies as well, and hopefully the awareness of osteoporosis awareness month will have its affect this time round. We sincerely hope so. Thank you very much indeed for your questions. Matt, Richard and Dawn thank you very much indeed for joining us, and we’ll catch you next time on webchats.

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