I have always had asthma, for which I need the steroid prednisolone. As I also have osteoporosis, my GP wants me to take alendronic acid to protect my bone density – but I’m worried about the side-effects. I’m 82.
Gordon Lang, Bedfordshire.
Dr Martin Scurr replies: Prednisolone is a corticosteroid that relieves breathlessness by reducing inflammation in the airways. But long-term use can increase the risk of osteoporosis, as it can speed up the breakdown of bone cells quicker than new ones are made.
The best treatment to prevent osteoporosis is alendronic acid, a bisphosphonate drug that works by slowing down the rate at which bone is broken down.
However, it can have side-effects such as heartburn, nausea and abdominal pain.
If that’s the case, your GP can refer you to a specialist for an annual infusion of zoledronic acid, another bisphosphonate.
The procedure takes about 15 minutes – and as it’s a blood infusion, it does not have the gastrointestinal side-effects linked with taking this type of drug orally.
On the first infusion, some patients experience mild flu-like symptoms for a day or so. These can be eased with paracetamol.
Another alternative is a six-monthly subcutaneous injection of denosumab. Both these drugs can reduce the risk of fractures by more than 50 per cent.
I’d urge you not to allow fear about potential side-effects to put you off effective treatments.
Your letter mentions you also have heart problems. Your complex medical picture means protecting yourself against a bone fracture should be a high priority, as weaker bones – and falls – will almost inevitably lead to surgery under anaesthetic, which comes with its own risks for you.
For over a year my wife has suffered severe vertigo. No doctor has been able to provide a treatment. Her blood pressure is often erratic and on the high side.
Clive Caldwell, Hampshire.
Dr Martin Scurr replies: Vertigo is a type of dizziness where it feels as if you or your surroundings are spinning, even when you’re stationary. Other common symptoms include nausea, vomiting, sweating and unsteadiness.
The most common diagnosis is benign paroxysmal positional vertigo (BPPV), where tiny calcium crystals become dislodged and end up in the semicircular canals of the inner ear.
These structures are integral to our sense of balance and contain microscopic hairs that detect when the head moves and send that information to the brain. The BPPV symptoms occur as the crystals roll about in the semicircular canals, resulting in erroneous information about the head’s position being sent to the brain.
Another common cause of vertigo is Meniere’s disease – a disorder of the inner ear: one theory is that there is an excess of fluid within the semicircular canals. Meniere’s is associated with hearing loss and tinnitus (but you don’t mention these).
Vertigo can also be triggered by labyrinthitis – inflammation in the inner ear thought to be caused by a virus. In this case a bout of acute vertigo is then followed by persistent symptoms that can last for many months.
Persistent vertigo might also originate in the brain. For instance, as a result of a mini stroke in the part involved in balance and movement (symptoms would usually also include an unstable gait and difficulty speaking).
Or it could be a vestibular migraine, where bouts of vertigo can last hours or days (but, despite the name, there may not even be a headache).
I do not know of a link between vertigo and high blood pressure – I’d suggest that perhaps the anxiety about the state of her health could be causing your wife’s erratic blood pressure.
It is unclear whether she’s seen a neurologist, but if BPPV has been ruled out, I’d suggest you discuss this with her GP: an MRI scan could shed useful light on the cause. She could also mention her raised blood pressure.
In my view… We need donor breast milk banks
Our knowledge about the gut microbiome – that community of microbes that lives in our intestine – is advancing at an astonishing pace.
We now know, for instance, that it controls inflammation and secretes chemicals that communicate with the brain. So it’s not surprising to learn that researchers are beginning to look at the relationship between the microbiome and neurodevelopmental conditions, such as ADHD.
This could have implications for how we feed newborn babies. We already know that the microbiome of babies fed with manufactured milk is different from that of breastfed babies. For instance, human milk contains protective molecules that cannot be created synthetically.
It’s time we thought about enhancing the NHS-linked breast milk banking service, much as we have for blood.
Currently, donor breast milk is collected primarily for medically vulnerable babies. Maybe this should become more widely available for women who are unable to breastfeed.
