Why have I been told that I need HRT after breaking my ankle?

I recently broke my ankle in a fall while running. I’m in perfect health otherwise, but have been told that due to my age – I’m in my late 50s – I need HRT to protect against osteoporosis. The disease doesn’t run through my family, I don’t smoke and have no notable risk factors. Are hormones really needed now?

Osteoporosis is a disease that weakens the bones by decreasing their mineral density and mass.

We don’t routinely screen for the condition, so it is often diagnosed after an injury such as this. One in two women and one in nine men above the age of 50 in the UK will suffer a fracture because of it.

If someone has repeated fractures, or if osteoporosis runs in a patient’s family, doctors might think to look for it. Other warning signs include long-term steroid use, being underweight for long periods or going through an early menopause which reduces the levels of bone-protective oestrogen.

So for someone in their 50s who is in good health, even with an injury but no other problems or warning signs, it wouldn’t be normal to immediately start osteoporosis treatment or HRT.

If a doctor has concerns they might refer you for a DEXA bone scan, which measures bone mineral density – usually in the hips and the spine. If the bones are thinner than they should be, osteoporosis is diagnosed.

Alternatively you could be diagnosed with osteopenia, which is the initial stage of bone-loss before full-blown osteoporosis.

While some people might benefit from HRT or osteoporosis medication such as alendronate – both of which strengthen the bones – others can get away with far simpler strategies.

These included calcium and Vitamin D supplements as well as bone-strengthening exercises – the Royal Osteoporosis Society has great advice on its website (theros.org.uk).

If you have no menopause symptoms or other reason to require HRT, it would not be prescribed just for osteoporosis.

I am a 79-year-old woman and have been taking statins for three years after a blood test gave me a cholesterol reading of seven. My blood pressure was a little high but not enough to need medication. I am not overweight and don’t smoke, although I have had non-progressive multiple sclerosis (MS) since I was 36. Do I need to keep taking statins?

Statins are prescribed based on an individual’s overall risk of having a heart attack or stroke within the next ten years.

Calculating this risk involves a tool called Qrisk. Developed in 2007, the algorithm evaluates cholesterol levels, blood pressure, weight, blood sugar, age, family history of disease and ethnicity. If this tool detects the risk to be more than ten per cent, we know that offering statins is a good idea to prevent serious problems in the future.

As a consequence of some 20 different measures used to reach that risk score, it means you could have two people with the same cholesterol level and only one of them might be offered statins.

Someone in their late 70s with a cholesterol reading of seven already has a high risk of heart disease and strokes. Age is a big factor, and five tends to be the upper limit of normal. Even if blood pressure is regular, combined with the other factors the ten per cent risk threshold may be met for treatment.

People talk a great deal about statins and their side effects, but the majority of patients have no problems while taking them.

I was advised some time ago to eat walnuts because they are high in omega-3 and good for the heart. But I’ve also heard that omega 3 can cause atrial fibrillation (AF). Is this true?

Omega-3 oils are part of a group of healthy fats which have health benefits – unlike saturated fats, which are linked to obesity and heart disease.

They keep the heart, blood vessels and lungs healthy as well as helping the immune system to ward off disease.

They have also been shown to lower levels of unhealthy fats in the body, prevent blood clots, improve circulation, lower blood pressure and maintain a steady heart rhythm.

All of this reduces the risk of heart attacks and strokes. In Japan, for instance, where diets are rich in these fats, there is a much lower rate of heart disease.

Good sources of omega-3 oils include nuts and seeds – such as walnuts, flaxseeds and rapeseed – and mackerel, sardines and other oily fish. However, some studies have suggested that people who take supplements containing more than one gram of omega-3 may be at higher risk of developing AF, a condition which causes the heart to beat with an abnormal rhythm. It is also an established risk factor of stroke.

The daily recommended amount of omega-3 is about 500 milligrams – roughly half of the amount found in standard supplements sold in the UK.

Further work is needed to clarify the link, but there is no concrete evidence that people consuming foods containing omega-3 are at risk.

The NHS doesn’t recommend taking omega-3 supplements, but instead it should be consumed naturally within your diet to keep levels at the safe amount.

Put tobacco-style warnings on chicken? That’s ridiculous!

I do wonder how some public health experts dream up their ideas. 

Last week a team from Durham University suggested that slapping tobacco-style warnings on packets of meat could reduce consumption and improve health. 

Alongside health warnings – which included pictures of people being given CPR – the team added labels about the negative effect of farming on the climate and even how livestock could cause another pandemic. 

Many people they tested it on didn’t find the health warnings credible. And no wonder – this is a totally loony suggestion. We all need to eat, whereas no one needs to smoke, and meat in moderation isn’t bad for us – it’s a good source of protein, iron and other key nutrients. 

Can’t we channel resources into teaching about a healthy diet and making fresh food cheaper, rather than another ridiculous gesture?

Do speak up about side effects

I’m often asked about dealing with the adverse side effects of medicine, both by readers and patients in my NHS clinic.

Often they will say they’ve struggled on without wanting to bother anyone. But it’s vital to discuss anything like this with a doctor as there is a lot we can do, such as adjusting doses or switching to other drugs.

And I’d like to remind everyone about our national Yellow Card reporting system.

If you’ve taken a medication or herbal remedy, had a vaccine or even used a medical device that had a negative impact, you should report it. This is how we find out about problems and it can protect us all from harm.

You can report any side effect with your pharmacist or doctor and ask them to do a Yellow Card report. Or you can do this yourself online by searching MHRA Yellow Card.