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Can we test you?

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Written by Administrator    Dec 13, 2008 at 03:29 PM

 
Most people are suitable for the type of bone density scan that we offer.  

It is rare that we have visitors with conditions that mean we have to send them away without a scan (most people who are not suitable for our scan will already be receiving medical advice or treatment, and, where necessary, bone density scanning)… but it does happen.

If you have any of the conditions we have mentioned below but would still like to visit us for an appointment without a scan: to chat about reducing fracture risk, and how to maintain bone density through lifestyle, diet and exercise (For example, to enhance the benefits of any medication you may be taking), we can offer an appointment, with an information pack, at a reduced rate. Feel free to contact us if this interests you!

 

Check with your GP first… Before you have a heel ultrasound bone density scan - if:

 

You are younger than 30

 

You are older than 80

 

You have a condition that may lead to a significant variation of bone density throughout your body

 

Bone density varies throughout your body, and a small amount of variation is normal. Some things may increase the variation of bone density in your body, however. This may make the result of our scan more unreliable. In certain cases, we can still test people – for example, if you have prolonged immobilization of your arm, our machine may still give you an accurate risk assessment for hip fracture, which would be useful. You would need to consider that the bone density in the affected limb may be lower than the heel ultrasound reading. However, we strongly recommend that you check with your GP first if any of the following applies or has applied to you.

 

Please note: We have tried our utmost to include every condition that may cause significant variation of bone density throughout the body, but we cannot guarantee that this list is exhaustive. If you have any concerns, or an unusual medical condition, please feel free to contact us before you visit.

 

Localized osteoporosis:

 

Localized osteoporosis can be described as a patch or area of osteoporosis in the body with a clearly defined border.

 

Causes of localized osteoporosis include:

 

Regional Osteoporosis:

 

Regional osteoporosis is an area of the body with lower bone density. Unlike localized osteoporosis, it does not have a clearly defined border.

 

Regional osteoporosis may be found in people who have, or have had:

 

Disorders of Bone Density – sometimes cause abnormally, and deceptively, high or ‘good’ readings:

 

These are rare. If either of these applies to you, speak to your GP about measures you can take to reduce the risk of fracture:

 

Who should NOT have a heel ultrasound bone density scan?

 

We recommend that you do not have a bone density scan with us if:

 

  • You have already had a DXA  scan (Also known as DEXA, measuring the hip and spine directly) within the past three years and are wishing to see if your bone density has improved or deteriorated. Our scan will not be able to tell you this. You need to use the same machine to compare results. If it has been longer than three years since your last DXA scan, ask your GP if you are eligible for a repeat DXA scan before you visit us, and if you are not eligible, then we may be able to help you – but contact us first.
  • You have already had osteoporosis diagnosed and are taking medication for bone density (If you are taking calcium and vitamin D supplements, for example, Adcal, Calcichew, Osteocare - that is fine). Our scan has not - yet - been approved for monitoring response to medication in individuals.
Last Updated ( Feb 27, 2011 at 03:07 PM ) See more news items...
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Test your Vitamin D Levels!

 

An NHS run service from the comfort of your home!

 

We are delighted to hear that Sandwell and West Birmingham Hospitals NHS Trust are offering a postal Vitamin D testing service. The test is an extremely fair price, at £28.00. You simply order a testing kit over the telephone, using your debit or credit card to pay, and the test kit is sent out to you. Follow the instructions on the kit, post it back -and your results are either emailed or posted back to you, according to your preference. No travelling necessary!

 

Given the prevalence of low levels of Vitamin D in the UK, this is an extremely valuable service. And we don't think it could be much easier to do than this! 

 

For your Vitamin D test simply follow this link: 

 

www.vitamindtest.org.uk

 

Easy!

...read more
Vitamin B12 Vitamin B12 is important for bone health:

http://onlinelibrary.wiley.com/doi/10.1359/JBMR.041018/full

The subject is still being researched: and as far as we can tell, the mechanism by which B12 affects bone density is yet to be understood.

It seems to us that this information is most important for people who have conditions which may affect their ability to absorb the vitamin - it seems that having low levels of Vitamin B12 in the bloodstream may be linked to lower bone density.

We think that the vegetarian society has a good article about B12 - particularly because reliable sources of B12 are only available from animal produce (vegans need to ensure that they eat fortified foods, or supplement). This article tells you how much B12 you need per day:

http://www.vegsoc.org/info/b12.html

Here is a list of foods that contain Vitamin B12, and the amoung of B12 they provide:

http://ods.od.nih.gov/factsheets/vitaminb12.asp#h3

Apparently soil contains quite a lot of Vitamin B12 (We're certainly not going to recommend people stop washing their vegetables though!).
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Vitamin D Update Very important...

July's edition of Osteoporosis International included essential updates aboutVitamin D, fracture risk, and health:

Increasing evidence shows that the current mainstream guidelines for vitamin D intake are inadequate.

If you have had a bone density test with us, before July 2010, it is very important that you familiarize yourself with these updated guidelines. In fact, we recommend ALL women (and men!) living in the UK do so... and also be aware that we STRONGLY suspect over the next few years these guidelines will be revised - in an upward direction! This is certainly NOT a situation where the recommendations are set in stone!

Let's get started. The link below is particularly important for the over 60s; it is the International Osteoporosis Foundations' (known as the IOF) position statement for Vitamin D requirements for older adults:

Dawson-Hughes, B., Mithal., A., Bonjour, J.-P., Boonen, S., Burckhardt, P., Fuleihan, G.E.-H., Josse, R.G., Lips, P., Morales-Torres, J., & Yoshimura, N. (2010). IOF position statement: vitamin D recommendations for older adults. Osteoporosis International, 21: pp.1151-1154.

Link to news release here:

http://www.iofbonehealth.org/news/news-detail.html?newsID=327

Next: This large, heavyweight, review article, put forward a strong case for much higher intakes of vitamin D - even compared to the new IOF guidelines:

Bischoff-Ferrari, H.A., Shao, A., Dawson-Hughes, B., Hathcock, J., Giovannucci, E., Willet, W.C. (2010).  Benefit-risk assessment of vitamin D supplementation . Osteoporosis International, 21: 1121-1132

Link to the article here:
http://www.ncbi.nlm.nih.gov/pubmed/19957164

Here are a few key points from the benefit-risk assessment article:

  • Our analysis suggests that mean serum 25(OH)D levels of about 75 to 110nmol/l (30 - 44ng/ml) provide optimal benefits for all investigated endpoints without increasing health risks. These levels can be best obtained with oral doses in the range of 1,800 to 4,000 IU of Vitamin D per day (45 - 100µg per day); further work is needed, including subject and environment factors, to better define the doses that will achieve optimal blood levels in the large majority of the population.
  • The reliable evidence that excess vitamin D can cause hypercalcemia [excessive calcium in the bloodstream, sometimes seen as a sign of Vitamin D toxicity or overdose] comes from daily intakes of Vitamin D greater than 100,000 IU [!] which are far higher than those necessary to achieve benefits.
Just to put this in perspective, 100,000 IU of vitamin D is 500 times the current RDA for the under 50s, and over 160 times the RDA for individuals over the age of 60. In other words, if you want to overdose on Vitamin D, you've really got to make an effort to do it!

Another heavyweight study here:

Leidig-Bruckner, G., Roth, H.J., Bruckner, T., Lorenz, A., Raue, F., Frank Raue, K. (2010) Are commonly recommended dosages for vitamin D supplementation too low? Vitamin D status and effects of supplementation on serum 25-hydroxyvitamin D levels-an observational study during clinical practice conditions.Osteoporosis International, June 17th - Epub ahead of print.

Even if you simply read the last few sentences of the abstract, you get the idea - again, 2,000 - 3,000IU of Vitamin D per day are necessary to obtain a meaningful benefit:

Linkto abstract here:
http://www.ncbi.nlm.nih.gov/pubmed/20556359

We say:

There are 5 different D vitamins: Vitamin D3 is synthesized endogenously (i.e., it is the one you make in your body). The other name for Vitamin D3 is cholecalciferol. Some supplements contain Vitamin D2, also known as ergocalciferol. There is some debate as to whether Vitamin D3 is ‘better' or more effective in supplement form - at the moment it would appear that both D3 and D2 can be beneficial in improving your Vitamin D status.

It is a BIG shame that ‘Vitamin' D is so called; it makes it very hard to stop thinking of it as something you obtain in sufficient quantities in your diet. Better to give it its other name, cholecalciferol. 

Let's think of cholecalciferol as a chemical, or more accurately, a hormone, that your body produces when it is exposed to sunlight (rather like plants photosynthesize in sunlight). Diet is NOT a sufficient source of cholecalciferol.

Having a sufficient intake of cholecalciferol (through sunlight or supplement), and optimal levels of vitamin D in your bloodstream (known as optimal serum 25(OH)D, or serum 25OHD, 25-hydroxyvitamin D), will provide other benefits, as well as reducing your risk of fracture. There are also strong associations with bowel cancer, other nasty, killer, cancers, multiple sclerosis, depression and other mental health problems - to name but a few.

As it is unadvisable to obtain the revised quantities of cholecalciferol from food (Well - at a stretch you could - but after all of the pints of milk and portions oily fish you had eaten, you would either be fat and/or deficient in other vitamins and minerals - you wouldn't be able to eat much else), you need to make the decision: Sunlight, or supplement? Or (probably best) both?

TAKE ACTION:

How much sun exposure?

When humans (and nearly all known life on this planet) evolved, they evolved in the sun. Outdoors. We spend an unprecedented amount of time indoors - and our vitamin D status is poor as a result.

Here is a useful calculator that you can use to help you decide how much sun exposure you should be aiming for (NB! Sunscreen dramatically reduces or even stops vitamin D production):

http://zardoz.nilu.no/~olaeng/fastrt/VitD-ez_quartMED.html

We think that these guidelines are pretty conservative - note that they say ‘minimum sun exposure'. Furthermore, you need to commit to doing this regularly, and for life. Pretty difficult in our climate, particularly if you work full time.

Conversely, avoid excessive sun exposure - this simply means: don't let yourself burn. That will increase your risk of skin cancer (There is evidence that excessive sun exposure increases your risk of the less deadly, nonmelanoma skin cancers (usually these are easily treatable) - but maybe not the deadly skin cancer, melanoma - interesting, eh). Be aware that it takes a few hours AFTER your sun exposure before you can tell how much you have 'caught' the sun, so don't wait until you burn before you get into the shade! Adequate cholecalciferol will reduce your risk of some of the nastiest cancers there are - for example, bowel cancer. We think it is worth the increased risk of non-melanoma skin cancer, in order to reduce your risk of the really dangerous cancers. There is more information about this in Holick's book 'The Vitamin D solution' - see below for more details.

Recommending what supplements to take, and how much, is out of our area of qualification; however, we can soon recommend some important and fascinating books by experts on the subject. In fact, until mainstream guidelines catch up, we consider it an essential requirement to read at least one of these books:

The Vitamin D Solution - Michael Holick PhD, MD. This book also has useful guidelines for sun exposure. A ‘bigger' read than ‘Power of Vitamin D' - lots of statistics, facts and figures. The Question and Answer section at the back of the book is very good, we think worth the price of the book itself! Michael Holick is Professor of Medicine, Physiology and Biophysics and director of the General Clinical Research Center at Boston University Medical Centre.

Note that Holick and Zaidi do not agree on calcium requirements. We concur with Zaidi - mainly because of concern that excessive calcium intake might increase heart disease risk  ; we'll let you read the books though.

We have ordered a couple of other books on the subject - we'll post any that we feel are of value! If you have found anything informative, do let us know!

A question Tracey and I are often asked is: do we take any supplements?

The answer is - yes, for the past few months! We both take between 3,000 and 5,000 IU of Vitamin D per day - unless we are outside for a few hours in the day, or on holiday in a sunny climate (in other words, we're taking these supplements practically every day!)

We also take a multi vitamin and mineral tablet every day - A ‘complete' one - there are all sorts of brands on the market, e.g., Sanatogen ‘Gold', Centrum one a day. Isobel is currently taking one that Tesco manufacture - most main supermarkets have a cheaper ‘rival'!

We have yet to find a ‘complete' supplement that contains anything but a small fraction of the cholecalciferol required - so don't think you have adequate serum 25(OH)D status simply because you're taking a multivitamin! Further, there is no chance that the Vitamin D in the multivitamin will tip us into the ‘overdose' level. Also, check the label of any supplements you are taking to ensure that you DON'T overdose on Vitamin A - that IS toxic in excess (bone resorption, and therefore weakening, being one of the main problems!). When it comes to Vitamin A, don't go over 100% of the RDA when you supplement.
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Adequate Vitamin D... ... IS VERY important for bone health!

Please read the update about Vitamin D as well!

You may be aware that vitamin D is one (of many) important micronutrients that your body uses to build and maintain your bone strength. Fewer people are aware that having low levels of vitamin D in the bloodstream can also lead to impaired balance (known more specifically as 'body sway' in scientific circles). Most osteoporotic fractures happen as a result of a fall; therefore, if an individual is vitamin D deficient, their fracture risk is increased in two very important ways. Here are a couple of articles on the subject:

http://jama.ama-assn.org/cgi/content/abstract/291/16/1999

https://www.thieme-connect.com/ejournals/abstract/eced/doi/10.1055/s-2001-14831

http://cat.inist.fr/?aModele=afficheN&cpsidt=1398002

Concerned? For a general overview about what to do, the relationship between vitamin D and bone health, and in particular, which populations are at increased risk of deficiency, we think that this article is very comprehensive:

http://www.nof.org/prevention/vitaminD.htm

An important thing to note here (and this is true for any vitamin or mineral), is that it is never a case of 'the more you take, the better' - or that 'everyone needs to take supplements!'Rather, it is a matter of ensuring that your intake is adequate. If you have any disorders of 'malabsorption' - in other words, problems absorbing whatever you are eating, e.g. Crohn's disease, Celiac disease (And other conditions mentioned in the above article), or, for example, you avoid the sun altogether, it is important to ensure that your vitamin D status is not compromised, and you take measures to counteract it.
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Our promise to you Our aim is to help to reduce the prevalence of fractured bones in the UK.

When it comes to the advice that we give individuals who have a bone density scan with us, we promise to act with honesty, and professional integrity. In order to do this, we also promise to keep our knowledge of osteoporosis and fracture prevention up to date.

Why has this post come about?

In the past, we have been contacted by individuals who are keen to use our service to help them promote supplements or nutritional 'aids'. In the past we received these calls only rarely and we tended to ignore them; more recently, we have noticed an increase in this type of interest - we thought we had better set the record straight!

1. We do not accept commission - from anyone - for promoting or supporting any product, whether or not it has been proven to have an effect on bone density. We have a strong stance on this, because we believe that it may compromise the advice we give you. We do promote certain products, books, and services - but only because there is an extensive body of evidence that demonstrates that whatever we are promoting has a valid chance of either increasing bone density or reducing fracture risk.

2. In the overwhelming majority of places we test, it is the establishment that takes a small fee for having us. This is a modest amount which is solely to reimburse the establishment for the use of their space, and for making their members or employees aware of our impending visit. A number of establishments have wanted 'more money' for hosting us - we politely decline these arrangements.

3. If you are interested in promoting a medication or supplement, and using us to help you do so - don't give up just yet: before you contact us, make sure that you have an extensive body of evidence to support that whatever it is that you are promoting will reduce fracture risk. If you can provide us with peer reviewed journals, we will look at them and decide whether there is evidence enough for us to work with you. One journal will not be enough - ideally your product or service will have support from either a large meta analysis (As found in, for example, the Cochrane Collaboration) or approval from the F.D.A.; or be recognised as an effective treatment by N.I.C.E.

Be warned! We are also avid readers of Quackwatch! Even if you do have an extensive reference list to support you, we will not accept payment for promoting your service, but we may accept payment for providing tests free of charge to a population who will benefit from what you provide.

4. In many cases we will accept advance payment for providing bone density tests to an organisation. A number of council offices, universities, and schools have paid, or subsidized, us to provide their staff with low cost or free bone density tests. This is fine, as the organisation is not a 'vested interest' group and our accepting payment to provide the tests to the staff for free will not compromise the advice that we give the individuals that we test.

5. If you are a gym, fitness, leisure or health centre, we may well be interested in working with you, because there is longstanding evidence to support exercise for the reduction of fracture risk. We sing the praises of many of the health centres that we work with - in particular, some of the ladies only health franchises (even though there is often some healthy rivalry between those franchises!) offer an invaluable service to their members and quite literally transform the lives of some of the ladies that have had the good sense - or fortune - to join. We don't need to accept payment to say this - if you go along to some of the places we have tested (check out future events for more), you can speak to the members yourself!

We really hope that this clarifies our position. If you've read this and would like to arrange a day with us, great - we look forward to working with you! Go to Hosting a Day for more info.
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