THE VETERAN LEFTIES of the 1960s, including such stalwart campaigners as Harold Pinter and Michael Foot, defied the bitter cold of Hyde Park to climb the rostrum and address a million or so marchers. Even those who disagree with them couldn’t fail to be impressed by the way their words gripped the crowds. Their rhetoric was delivered with passion, despite the fact that their chilled limbs, joints and spines must have been feeling the wear and tear of a lifetime of marches.

Those who tottered slightly as they climbed the steps to the rostrum will, if they had thought about it, have attributed it to their arteries, and will have been unaware that one of the contributory causes of an unsteady gait in older age is osteoporosis. One in five men in their seventies and one in two women at this age suffer from it.

Osteoporosis is a relatively silent condition, which becomes obvious only when limbs break or the spine becomes rounded as vertebrae collapse. Every year 60,000 hips, 50,000 wrists and 40,000 vertebrae fracture as a result of osteoporosis. Many of the elderly are unaware that they are suffering from the condition, but modern scanning, such as with an EBT scanner, shows that they are living in a fool’s paradise. When I had a scan two weeks ago I was expecting to be told that I had an osteoarthritic spine, but was amazed, and slightly offended, to discover that it was also osteoporotic. It explains why my sons tell me that I am shrinking.

Harold Pinter and Michael Foot, having carefully mounted the steps to the stage, looked out on to a sea of predominantly young and middle-aged people. People start to lose strength in their bones after the age of 30, and thereafter they need to maintain strong bones by regular — but not excessive — weight-bearing exercise (brisk walking is excellent, but swimming doesn’t help the spine and lower limbs). They should also follow a diet rich in calcium and vitamin D, and get enough sunlight — a natural source of vitamin D.

As the politicians looked out on to the sprinkling of elderly people in the crowd they should have considered the importance of keeping people at home and active in the community rather than incarcerated in old people’s homes. Thirty per cent of those aged over 65 who live in an institution have a serious fall each year, as do 45 per cent of those aged 80 or above. Between 10 and 25 per cent of them suffer injury, and 6 per cent of falls result in a fracture. More worryingly, 30 per cent of those who fracture a hip do not survive for more than a year. Even those who recover, or who are not seriously injured, suffer a grievous blow to their confidence, so that they become housebound and timid when they walk.

A recent survey has shown that more than 70 per cent of people living in institutions are deficient in vitamin D, which is essential for the absorption of calcium. Not only do older people tend to keep out of the sun but many, unlike those in Hyde Park, lose their mobility. Even if they are exposed to sunlight, there is evidence that their skin absorbs vitamin D less well than that of younger people. The ability to absorb vitamins from foods also decreases with age.

One woman, Linda Edwards, who died recently, did more than anyone in the UK to raise awareness of the problems of osteoporosis, and the need to treat it. She worked as director of the National Osteoporosis Society for more than 16 years. She encouraged doctors and the public to understand that deaths from fractures among the over-sixties could be prevented.

The first line of treatment is to maintain the intake of calcium — and hence also of vitamin D — so that loss of bone mass is prevented and the architecture of the bones is preserved. High-strength calcium plus vitamin D (such as Calcichew-D3 Forte) is a supplement which is essential for all high-risk groups — standard calcium and vitamin D tablets contain inadequate amounts of calcium. Bisphosphonates should also be taken — I always prescribe Fosamax to be taken once a week, but that is a personal preference. When taking bisphosphonates it is even more important that the patient should be taking an adequate supply of high-strength calcium and vitamin D at the same time.

The role of HRT in preventing osteoporosis is controversial, but it should be remembered that the mortality following a fractured femur is greater than that from breast cancer, with which HRT has been linked. The primary objective of HRT is to treat the symptoms of the menopause, rather than to preserve bones. HRT should be prescribed only for a relatively short time and discontinued in a woman’s mid to late-fifties; regular mammography is essential during this period.

Linda Edwards would have received the prestigious Kohn Foundation Award this June for her service to the prevention and treatment of osteoporosis. Although she has sadly died, the award will be received on her behalf. A greater memorial to her work would be the universal acceptance that nearly all older people need high-strength calcium and vitamin D supplements, most will also need Fosamax or another bisphosphonate sooner or later, and some women will need HRT to treat menopausal symptoms.

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