Ask the doctor: How safe are pills for crumbly bones?

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After a recent fall where I broke my pubic bone, I was advised to take alendronic acid once a week. However, I am unsure whether to take this medication, as I have read there can be complications if you have a tooth extracted, and it can also harm the gullet. Should I take the tablets? Patricia White, Denham, Bucks. In osteoporosis, more bone is broken down than is reformed, and this leads to the bones thinning

Your fall sounds painful, and I hope you are on the road to recovery.

I assume that after this incident you were diagnosed with the brittle bone disease osteoporosis.

The medicine your doctor has advised you to take, alendronic acid, is one of the bisphosphonates and is given to strengthen fragile bones.

It might surprise some readers to learn that bone is not a static solid structure like marble and stone, but is constantly being broken down and then reformed.

However, in osteoporosis, more bone is broken down than is reformed, and this leads to the bones thinning.

Most postmenopausal women have some degree of thinning due to the loss of the hormone oestrogen, which helps reduce the rate at which bone is broken down.

This age-related bone thinning is called osteopenia, and is as inevitable as wrinkles or silver hair. If the bone thinning is particularly severe, this develops to osteoporosis — and you are at risk of fracture.

Bisphosphonates such as alendronic acid help halt this process by reducing the rate of bone breakdown.

However, the tablets are poorly absorbed, with less than 1  per cent of the dose being taken up by the body.

To optimise absorption, it’s vital you take the dose on an empty stomach first thing in the morning, and not eat or drink anything for at least half an hour.

The tablet should also be taken with a large glass of water to minimise the chances of it getting stuck in the gullet.

As you are aware, bisphosphonates can irritate the stomach lining and increase acid production, so it is also worth making sure you remain upright — seated or standing — to reduce the chances of acid splashing up from the stomach.

Patients with osteoporosis are often low in vitamin D and calcium and it’s important to take supplements of these as well, but at a different time of day to avoid anything that may interfere with the bisphosphonate absorption.

The other complication your doctor rightly mentioned is a osteonecrosis of the jaw.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.Always consult your own GP with any health worries.

This is a rare but nasty side-effect of bisphosphonates, where trauma — such as having a tooth extracted — triggers the jaw bone to break down.

Although difficult to treat, this complication affects less than one person in any 10,000 who have been taking the drug in any given year — and it may be as rare as one  in 100,000.

It also tends to be a complication in patients who receive the bisphosphonate by injection, or in those with cancer or a compromised immune system.

The general view is you are better off in terms of risk and benefit to take the alendronic acid than worry about that rare complication, because the benefits of taking the drug are potentially considerable.

A number of trials have shown this drug increases bone density and reduces the risk of fractures.

For instance, one study on 2,000 women with low bone density at the hip found bone density increased by 4.1  per cent, resulting in a 30  per cent lower incidence of hip or wrist fracture.

You have been given good advice — it’s well worth going ahead.

For the past six months I’ve had an odd sensation which feels like my skin is crawling, as if I’ve just had a fright. It starts on my scalp and runs down my body. It happens at no particular time — while I’m out shopping, or sitting at home. I wonder if you can shed any light on this unpleasant occurrence?I am 73. Mrs M. Mattinson, North Yorkshire.

My suspicion is that these unnerving events are caused by a condition called formication.

The name comes from the French word for ant  — un formi — and, as you know, this puzzling condition triggers the sensation of insects crawling on the skin, as well as itching and tingling.

The cause for this largely remains a mystery, but it’s thought the sensations may be the result of nerves in the skin sending faulty signals to the brain.

There seem to be a number of triggers: one is a drop in levels of the female hormone oestrogen that happens during the menopause, or when hormone replacement therapy is stopped.

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The hormone is needed for healthy skin, and low levels may cause the nerves to send faulty messages.

Formication is also linked to diabetic neuropathy — where high blood sugar levels lead to the nerves of the skin being damaged — or can be a side-effect of medications such as methylphenidate (used in attention deficit disorder), amphetamines or cocaine.

In a person of your age group, who is healthy and not taking any of these medications or substances, then simple ageing of the skin may be to blame.

As we get older, skin produces fewer natural oils, causing it to become drier. This lack of oils also seems to affect the function of nerves — and can result in these strange sensations.

The best strategy for you, given your good general health and the lack of  obvious trigger factors, is to make sure that you regularly use a moisturiser or  emollient cream.

Apply it all over before getting into the shower or taking a bath, and then once again after drying.

Although you will not be moisturising your scalp — which is where you say your sensations start — the skin acts as one organ, so keeping the rest of the body moisturised should help  settle the episodes after a  few weeks.

There is nothing to lose — it is a cheap strategy and well worth a try.

By the way... Time to get tough on alternative medicine Neon Roberts was caught in a tug of opinion about what might be best

My heart goes out to the estranged parents of Neon Roberts, the seven-year-old boy with brain cancer.

They are faced with the awful dilemma of how their child should be treated.

The father wanted him to have orthodox care with brain surgery followed by radiotherapy, but the mother wanted to avoid radiotherapy, and insisted on complementary therapies instead.

A judge has ruled the little boy should undergo radiotherapy, but this sad case reminds us that even in the most advanced societies, there will always be those who are happier and more secure trusting their fate to mythology and belief rather than the hard edges of orthodox medical care that can seem patronising and uncompromising.

This seems especially true when it comes to cancer treatment, about which many people feel rather more pessimistic than the reality deserves.

Neon was caught in a tug of opinion about what might be best and it took the jurisdiction and force of a judge to make a decision.

It is the duty of authority to give clear and comprehensive guidance in such matters: otherwise what can people rely on, apart from anecdote or the internet?

Henry Vlll grappled with such concepts when he set about applying some  reliability and rigour to the muddle of healthcare when he established the Royal College of Physicians and the Royal College of Surgeons in the 1500s. It was a brilliant start.

In a continuing effort to improve the system, the Blair government created the body of law that resulted in the National Care Standards Commission — it turned out to be a farce, and was transformed via a series of useless bodies into what we now know as the Care Quality Commission.

This regulator is supposed to inspect services and facilities providing treatment, and, we might assume, have some idea about both care and quality.

But the conflict over the treatment of young Neon Roberts reminds us there are numerous options for the treatment of illness, serious and otherwise, which lie totally outside the NHS.

These are unregulated, yet they offer cures which promise apparently miraculous outcomes and are highly appealing to the vulnerable.

The Care Quality Commission says simply: ‘The efficacy of treatments is not within the judgement of the CQC.’

At this moment, GPs are bracing themselves for a new system of inspections by the CQC, despite already being regulated by the General Medical Council and other bodies.

But if you are in ‘alternative’ medicine, you can promise anything and offer whatever treatment, but you will not be inspected.

When is the spotlight going to illuminate the dubious activities of the crank sector?