I was recently diagnosed with osteoporosis in my lower back and my GP prescribed me alendronic acid. I took it for a month but stopped due to side effects. Now I only take vitamin D and magnesium, eat a calcium-rich diet and do weight-bearing exercises. Will this be enough?
Eleanor Edward, Swansea.
Lifestyle measures alone are unlikely to have enough impact. Bone is constantly being absorbed and rebuilt, but in osteoporosis, bone is broken down faster than it is replaced.
Alendronic acid belongs to a group of medicines called bisphosphonates, which slow the rate at which bone breaks down.
Alendronic acid should be taken on an empty stomach in the morning with at least 200 ml of water. It is essential to avoid food intake and remain upright for another half hour (photo of the model)
However, alendronic acid can have unpleasant side effects, such as oesophagitis (pain in the oesophagus that makes it difficult to swallow food). For this reason, the tablets should be taken in the morning on an empty stomach with at least 200 ml of water. It is essential to avoid food intake and to remain upright for an additional half hour. This reduces the risk of stomach acid containing the drug flowing back into the oesophagus, which can cause 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 is also causing problems, another option is an intravenous infusion of zoledronic acid. This is given only once a year and, because it goes directly into the bloodstream, there are no gastrointestinal side effects.
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 purpose. Waiting times can be significant, so in the meantime, continue with weight-bearing exercise and a calcium-rich diet.
For the past two years, I have had terrible pain in the calf muscle of my left leg when standing or walking even short distances. I had a triple heart bypass using veins in that area. Could that be the cause?
Name and address provided.
Let me assure you that the removal of a vein in your leg to create the vascular bypass necessary for your operation is not the cause of your pain.
In your longer letter, you state that a doctor has told you that you need to have the arteries in your legs examined to check for circulation problems.
If this is indeed the cause, then it is related to the arteries supplying blood to the muscle, rather than the veins (like the one removed for the bypass) draining blood.
Cramp-like pain in the muscle during exercise, which is only relieved by rest, is known as intermittent claudication.
It results from a reduction in blood flow to the muscle due to clogged arteries, similar to the angina pain people experience in the chest due to restricted blood flow to the heart.
What is puzzling is that his longer letter mentions that he had already undergone a Doppler ultrasound test to measure blood flow in the affected leg, but it found no evidence of circulation problems.
To further complicate matters, you have a history of sciatica in both legs, which has caused you similar pain.
All of this suggests that the root cause is a trapped nerve or nerves, possibly due to a degenerative problem with the spine, such as worn discs or even spinal stenosis (where the space around the spinal cord narrows). This can happen with age. I recommend you speak to your GP about investigations such as scans to identify the cause.