Really interesting podcast explaining osteoporosis and about diet and exercise to avoid it by Prof Tim Spector and Prof Cyrus Cooper

[tangocharlie]

This is really easy to understand with useful analogies and gives some interesting tips about bone-strengthening exercises and the advantages of an overall healthy diet on bone health. Controversially it also puts the cat amongst the pidgeons by saying taking calcium supplements is pointless, they used to recommend them but research doesn't now back that up. But these two are world-leading bone experts not quacks - so where does that leave us? You decide

youtube.com/watch?v=09iguXG...(Not working as expected?)

[Hoofprints]

I will have a listen - thank you for posting.If calcium supplements are useless, what exactly do they suggest for those of us who aren't very mobile and can't exercise?

Also wondering what they think of vit D supplements, as a friends young daughter had an early spinal fracture caused not by a lack of calcium, but a lack of vit D. She takes vitamin d ever since and has had no further problems as far as I am aware.

[tangocharlie in reply to Hoofprints]

They say the long-term studies don't support mass population prescriptions of Vit D and calcium but it might be useful in the older population. There are other options for people at high risk of osteoporosis such as bisphosphonates. It's a really detailed podcast and worth listening to it all and taking notes. I'd imagine if you get a spinal fracture when young there might be something else going on? I have no idea if there is a direct link between lack of Vit D and fractures at any age. They do say Vit D is useful if you are on other bone-strengthening supplements as it helps absorbsion. For example if you're on Zoedronic acid infusions

[Hoofprints in reply to tangocharlie]

Sounds like I'll have to listen to the podcast on a day when the brain fog is not too dominating then! 😄 I don't like the idea of biphosphonates , but suppose they are better than the alternative

[tangocharlie in reply to Hoofprints]

same here, I'm wary of taking any meds having had the experiences of steroids and other meds and their side effects for many years. But I think we do need to do something, well I do anyway, to try and prevent fractures happening again. It's a matter of weighing up risks and we are at higher risk due to steroids

[tangocharlie in reply to Hoofprints]

It also depends on how immobile you are. He suggests things like heel drops and push ups against a wall even if you can't manage skipping for 2 minutes. Another specialist physio recommends things like 'stomping' you feet down as you get up from sitting. And even if you're sitting most of the time, get up out of the chair as often as you can seems to be a good mantra for health generally not just strengthening bones

[Hoofprints in reply to tangocharlie]

Sounds more hopeful than I thought for the likes of me then 👍🏻 Thanks for clarifying that

[PMRpro Ambassador in reply to Hoofprints]

Taking the lift up and the stairs down, stomping like a toddler, is an idea ...

[DorsetLady PMRGCAuk volunteer in reply to Hoofprints]

The reason to take calcium/extra calcium when on steroids is explained here- this is just one source but there are many with similar comments -

The body's ability to produce strong, dense bones is a juggling act between natural processes that build up bone and ones that break it down. Corticosteroids tend to both reduce the body's ability to absorb calcium and increase how fast bone is broken down. The more of these drugs you take and the longer you take them, the greater your risk of developing osteoporosis.

The podcast wasn’t specifically related to steroids and the affect it has on bones, but a general overview of Osteoporosis.

[Hoofprints in reply to DorsetLady]

Thank you - that's helpful

[tangocharlie in reply to DorsetLady]

Yes I get that, but the point they make in this video, which I find very surprising, is that they say it is a good healthy overall diet that contributes to bone health, there is no evidence that adding calcium through supplements helps they say or even having a diet high in calcium such as dairy products. To quote Tim Spector 'just because bones have calcium in them doesn't mean that putting calcium in your tummy improves your bones'. They mention Asian populations who don't do dairy yet have lower rates of osteoporosis. Getting enough protein is important too and lots of plant based food. It does seem to be important to take vit D when on bisphosphonates though as it helps with absorbtion. A lot of what is in this video goes against what we currently think we know and are told so it's all very confusing.

[DorsetLady PMRGCAuk volunteer in reply to tangocharlie]

Yes it is confusing - I saw it a few months ago when it first came out and thought that -having just rewatched it this afternoon, still not 100% certain of what is the best way. Probably depends on who you talk to!

I think what’s he’s getting at is that supplements aren’t the best way - getting calcium naturally is… but if you can’t get enough through natural foods then what’s the option? Plus, as I understand it, steroids reduce the efficacy of calcium - so we need to top up daily intake from somewhere.

[tangocharlie in reply to DorsetLady]

I don't think anybody is. Dr Emma Clark in the pMRGCAuk talk on Saturday recommended calcium as does the ROS. Look like it's new information that not everybody is aware of and I'm sure there are debates going on in osteoporosis circles. I do trust Cyrus Cooper and TIm Spector though, both very esteemed scientists and doctors and eminent in their fields. What I take away from this is that it's complicated, there is no straightforward answer or easy way forward to try and maintain bone density as we age. They did support bisphosphonates for older people though and those of us at higher risk

[PMRpro Ambassador in reply to tangocharlie]

"both very esteemed scientists and doctors and eminent in their fields"

So are the others. In a few years time, TS and CC will also be suplanted. I've been watching this since before TS went to uni - just! Everything changes every few years. And TS has come out with things that he says amaze him that I knew in my 20s so not entirely sure why HE didn't. He's busy making money - it isn't all philanthropy!!!

[tangocharlie in reply to PMRpro]

Cyrus Cooper is one all rheumatologists look up to though, including our Dr Mackie. Yes TS has 'gone commercial' but I can't blame him for that and I like the way what he does is evidence and epidemiologicially (sp? )based. I think like Michael Mosley who I've also learned so much from he enjoys being an iconoclast and breaking myths. It's not to late for you to write a best-seller health book Pro! "Things I knew then that I wish others knew now". There are probably people beavering away in his labs saying 'I could have told him that' lol

[PMRpro Ambassador in reply to tangocharlie]

They are - but just bear in mind that there isn't a scientist born who doesn't believe they have the unique insight and no-one else does!! I've worked with enough of them ...

[tangocharlie in reply to PMRpro]

😆😆 and like you say there's no way of knowing til time tells us they were right or wrong or some new theory or information comes along.

[PMRpro Ambassador in reply to tangocharlie]

Exactly! And if you had ever sat in a meeting you would know how they are at daggers drawn defending their concept. Occasionally it spills over to dinner - but living alongside it for 40 years or so as I did does give a rather different view on it.

[tangocharlie in reply to PMRpro]

BTW, when I was first dx with PMR and went on steroid I was also put on Adcal calcium and vit D tablets. I stopped at some point because they disagreed with me and with all the allergies that surfaced around then and also because I had such a positive DEXA scan I thought I didn't need them. At some point it seems from reading on here GPs started to prescribe Alendronic Acid instead but that was nenver mentioned to me. So I'm wondering why the switch came, is AA cheaper or deemed to be more effective? Or have I misunderstood and some people are still prescribed Adcal?

[PMRpro Ambassador in reply to tangocharlie]

It isn't an either/or. If you are on any bisphosphonate you need an adequate supply of calcium and vit D to avoid becoming hypocalcaemic as the bisphosphonate sequesters calcium to the bones. Low calcium can make you very ill.

[tangocharlie in reply to PMRpro]

How come nobody's ever told me that? I know I'll need Vit D along with the Romo but nobody's mentioned anything else. People only seem to mention they're put on AA so I assumed Adcal had been dropped. Perhaps I should post a question asking who's on what?

[PMRpro Ambassador in reply to tangocharlie]

Here we are told to take calcium and vit D - first time Christian had mentioned it for me and when OH was put on Prolia, the local osteoporosis wizardess told him he needed calcium - though his diet was appalling compared to mine!!!

[PMRpro Ambassador in reply to tangocharlie]

Please bear in mind this is all aimed at normal healthy bodies. We are on a long term medication that tends to flush calcium out of the body - having extra sloshing around means there is a better chance of enough being absorbed. Supplements aren't ideal. dietary nutrients are better absorbed and metabolised. All Big Manufacturing, just like Big Pharma. Neither are entirely bad, neither are entirely good.

[Miserere]

Thanks for highlighting this, tangocharlie - some interesting insights, especially regarding exercise. We can each do the best we can and, of course, we can't turn back time. However, it's good to hear a discussion aimed specifically at our bones - although it seems they still rely on the DXA scan which I think did not help in your case?

I also wonder about vitamin D - I have increased my dose during a recent bout of covid (my first) and have kept it up for the time being. I've never taken calcium as I remembered there were contraindications for blood vessels and I don't eat much in the way of dairy.

I think we each have to find our own way through to the diet that suits us best - obviously a healthy one but whether vegetarian or carnivorous I think depends on the individual. I've just read 'The Great Plant-Based Con', Jayne Buxton - purely because it was on the library shelf when I went in - it also contains useful information and references people like Malcolm Kendrick, Zoe Harcombe, Aseem Malhotra etc. as well as Tim Noakes among others. It was interesting to read and then hear this.

Onward and upward - I've always been a walker and hope to continue now the new knee is behaving better. I may start to add in some of the other exercises - i.e. heel raises.

Thanks again for the useful information. X

[tangocharlie in reply to Miserere]

ooh that book sounds interesting, I haven't heard of it or read it but have come across those names when researching low carb and keto diets. What is 'the con'? about eating plants?

[Miserere]

It is more about a plant-based diet not being as healthy as it is purported to be. Also, we can be intolerant to oxylates and other elements present in some plants. That's why I think we all need to find our own way.

Some people find immense relief and better health on a carnivore diet; others on a vegan diet - although they do point out how many vitamins and minerals you can be deficient in if you don't eat animal protein. I know the nutritionist I consulted when PMR first began asked me about my diet and I had been vegan in the past. He was very scathing and likened it to eating 'nothing.' However, again, what suits one may not suit another.

I read as much as I can about nutrition just to learn more and more. Most of the people that make sense to me would rather people ate well than took medication and I can appreciate that approach. I'm never sure with Zoe as he does seem to push a plant based way of eating. We eat meat, fish, eggs and above ground vegetables generally including plenty of salads. It seems to suit us and that's what I think we all need to search for.

I do read Malcolm Kendrick's blog sometimes - I love his approach and sense of humour. Zoe Harcombe also makes sense to me as well as many of the others. She had been a long-term vegetarian I think before she started eating animal protein again. I also like Sarah Myhill. You just have to research until you find what suits.

[tangocharlie in reply to Miserere]

Yes like exercise it's omportant to find/eat/do what you enjoy as that's sustainable adn you'll stick to it in the longer run. However I enjoy cheese and onion crisps and prosecco far more than the kale I know would do me more good. Joking apart, what seems to work for me is low-carb 80% of the time combined with time restricted eating so I don't eat anything that spikes my blood sugars in the danger time windows when Pred raises them. And exercise makes perfect sense but I'm still confused about that too, because some of the thigns I like doing like swimming if I do too much can bring on a pain and flare in my shoulders as the PMR rears up. I guess the old cliche of 'everyting in moderation'

[Miserere]

Absolutely! An occasional Prosecco is very enjoyable as far as I am concerned. A little of ..

I would say our diets have a similar principle. As far as exercise goes I am very good at drowning, so walking is my go to and I do sometimes do somatics - not that they help with weight-bearing - plus occasional yoga. I should probably do more but I am just at the stage where I can go for longer walks again and climb up and down gentle hills so at least it's an improvement.

As you say, everything in moderation if it suits you.

[tangocharlie in reply to Miserere]

What's somatics please? Walking is good weight-bearing exercise.

[Miserere]

Somatics is a slower practice than yoga - I've found it good for relaxation and easing movement - so, for instance, 'arch and flatten,' a gentle movement that arches and flattens the spine in turn immediately eases any back pain for me. Martha Petersen is the woman who taught my teacher, Liz Underwood, and her classes have been great for me. I do it as I need it, particularly if I find any tension in the muscles. Sometimes I also throw in a bit of yoga but somatics eases walking as it works on the core to support the walking movement. That's probably not the best explanation but it's a lovely gentle practice which relaxes and eases. Here's Liz's website which might explain more or look up Martha Petersen - Somatics.

intelligent-movement.co.uk/

[tangocharlie in reply to Miserere]

I'll look into that thanks. ATM the specialist physio I see re my spinal fractures has told me to go very slowly ad cautiously. I used to dabble in yoga and pilates but still can't straighten my back out and lie down on a mat on my front or back so I'm doing a bit of armchair yoga on zoom. There is a pilates class near me run by a woman who had similar fractures so knows all about the best way to procede adn hopefully I'll get to that in say 6 months. I have to go very very gently so I don't break another bone in the meantie and am trying to chase getting the Romo started. Everything closed for summer. A friend who is a GP said never be ill in August, all the consultants are away on holiday and the hospitals are staffed by newly-qualified inexperienced very junior doctors!

[Miserere in reply to tangocharlie]

Yes, of course, you need to take things slowly and find the best way for you. I hope things begin to ease for you and good to hear you have found a good physio (worth a lot) and you know someone with similar fractures who is able to do pilates. As with food, we all need to find what suits us individually - the great thing is to keep an enquiring mind. Best of all wishes to you, tangocharlie x