Dr Dawn Harper is working with Ostentia- the first ever at home osteoporosis screening test. We caught up with her to ask her about osteoporosis and veganism as this can be a worry for plant based eaters.
What is osteoporosis for those who don't know?
Osteoporosis is often referred to as brittle bone disease and it basically means- thinning of the bones. It is much more common in women than it is in men. This is for two main reasons- firstly we start off with a smaller skeleton so we've got less to lose but also we know that the female hormone oestrogen has a protective effect on our bones. What that means is- when we lose our natural oestrogen around the menopause- if we don't go on HRT- our bones start to thin much more rapidly.
Why are vegans warned about this disease?
The way our skeleton works is- our bones get thicker and denser up until our mid-twenties and then they start to plateau out. We actually lose a bit of our bone density from our thirties onwards. In women, that accelerates around the time of the menopause. We need a calcium rich diet throughout life but we are only building quite early on. For most people, their main source of calcium is probably dairy products but for strict vegans- those are totally excluded. That doesn't mean to say that vegans can't get enough calcium- they absolutely can- they just need to think about it a little more.
How can vegans make sure that they are getting enough calcium? Which plant-based foods are rich in calcium?
Green leafy vegetables are great; things like cabbage, watercress, kale, broccoli are all very good sources of calcium. Tofu is also a good source of calcium- you can get calcium-fortified cereals and breads, mixed nuts and seeds, chickpeas, kidney beans and oranges have a reasonable source of calcium too. There are plenty of foods vegans can focus on in order to make sure they get their required calcium intake.
What I usually say to people is to look at your diet. In my experience, vegan diets are often very healthy because they are people who think really hard about what they are eating. They are almost certainly not eating fast foods and that kind of thing. We advise that you should be having around 800-1000mg per day. If you look at your diet and you know that you are low on calcium and you are not getting that then take supplements. For my patients who I know are already at risk of osteoporosis or have what we call osteopenia (that is the borderline area between normal bone density and ones that are classified as too thin) then I would often advise calcium supplementation.
Do vegans need to increase their calcium intake at any time such as during pregnancy or later in life?
Our calcium requirement does change throughout life. National Osteoporosis Society has dome great figures about what the recommendations are at different times of life. That is the same whether you're non-vegan or vegan. If you're vegan you just need to think a little bit harder about it.
Why are at home tests like Osentia important for vegans?
What would happen to today in general practice is that if somebody has a fracture- most commonly of the wrist or the hip from a relatively minor fall- we refer people for something called a DEXA scan. So, if you take a little trip on the pavement and put your hand out to save yourself at a walking pace you wouldn't expect to break your wrist. Obviously, if you fall off a galloping horse at speed and you break your wrist- that would be an appropriate break.
Your bones can be quite thin even before they show up on an x-ray- they may look normal on an x-ray but they are already thinning. What the Osentia test does is it's a combination of technology that looks at nail or toenail clippings. It analyses the protein in that clipping which scientists have shown correlate to the strength of the bones. They then ask you to fill in a questionnaire, which asks about the basic risk factors. These are things like a family history. We know that if you have a first-degree relative who has suffered from osteoporosis that increases your risk. It talks about smoking and drinking history because we know that people who drink alcohol to excess and smokers are more prone to thin bones. The combination of the questionnaire and the analysis of the nail clipping gives a relative risk of having thinner bones or having a fracture in the future. You receive your results via email or via post and your risk comes back either green, amber or red. This means low risk, moderate risk or high risk. Anyone with a high risk should be coming to see the likes of me. Where I see the Ostentia test fitting in is a bit like most at home testing kits- probably with the exception of pregnancy tests. If we rewind the clock 20 years ago, if a woman came in with a positive home pregnancy test- we would always repeat it with a lab test. We don't do that anymore- we know that those tests have been around for a long while and they are so accurate that a positive at home test is a diagnostic text.
Whereas, with most home tests- they fit into clinical medicine by flagging up people who are at risk and who need further investigation. Just as if someone comes into me having done a home diabetes test that has indicated a high risk- I would repeat that with a lab test. So, if someone came into me with a high risk Ostentia test, I would then refer on for a DEXA.
I know that they are doing ongoing research and it is possible- the more this is researched and looked into that this could become either a routine screening test in the NHS or even a diagnostic test. At the moment, I would still go on and do a DEXA scan.
Why do you think there is such a large number of women who don't know what it is?
I think there is an enormous amount of confusion out there. When I talk to patients about osteoporosis, obviously, I am still very much an NHS GP, but people get osteoporosis and osteoarthritis confused. People expect that they are going to get aches and pains- some kind of warning sign that all is not right in their bone health.
The truth is- osteoporosis has no symptoms whatsoever. Bones can be very thin and you won't get aches and pains and you won't have any warning signs whatsoever until they break. That of course is excruciatingly painful and although it is not life threatening, it is very much life changing. I see people who have been living very fulfilled, independent lives who fracture their hip, they lose their confidence. They sometimes go from living alone and very independently to not being able to manage and that is really sad.
What is next for you?
Oh crikey- what is next for me? Lots! I am whizzing off now to go and have a meeting with a publishing house about an exciting new book project that I am hoping to be working on. I am very much NHS and always have been but I am actually going to start one day a week with Freedom Health in Harley Street in private practice- I am starting that in the next couple of weeks. Then lots and lots of charity stuff in the offing, which is really exciting so I am not hanging up my stethoscope just yet!
Available at www.superdrug.com or www.osentia.co.uk
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