DR ELLIE CANNON: Why was I told I needed HRT after I broke my ankle?

I recently broke my ankle in a fall while running. I’m otherwise in good health, but I’ve been told that because of my age – I’m in my late 50s – I need HRT to protect against osteoporosis. The disease does not occur in my family, I do not smoke and have no significant risk factors. Are hormones really necessary?

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

We don’t often screen for the condition, so the diagnosis is often made after such an injury. One in two women and one in nine men over 50 in the UK will suffer a fracture as a result.

If someone has recurrent fractures or osteoporosis in a patient’s family, doctors may consider looking for them. Other warning signs include long-term steroid use, persistent underweight, or early menopause, which leads to a decrease in bone-protective estrogen levels.

So it would not be normal for someone in their 50s who is in good health despite an injury but no other problems or warning signs to immediately start osteoporosis treatment or HRT.

If a doctor is concerned, he or she may refer you for a DEXA bone scan, which measures bone mineral density — usually in the hips and spine. If the bones are thinner than they should be, osteoporosis is diagnosed.

Alternatively, you may be diagnosed with osteopenia, the first stage of bone loss before full osteoporosis occurs.

While some people may benefit from HRT or osteoporosis medications such as alendronate—which strengthens both bones—others can get away with much simpler strategies.

This includes calcium and vitamin D supplements and bone-strengthening exercises – the Royal Osteoporosis Society has excellent advice on its website (theros.org.uk).

Unless you have menopausal symptoms or another reason to need hormone replacement therapy, it is not prescribed just for osteoporosis.

I am a 79 year old woman and have been taking statins for three years after a blood test showed my cholesterol level was seven. My blood pressure was a little high, but not so high that I needed medication. I am not overweight and do not smoke, although I have suffered from non-progressive multiple sclerosis (MS) since I was 36 years old. Should I continue taking statins?

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

An instrument called Qrisk was used to calculate this risk. The algorithm, developed in 2007, assesses cholesterol levels, blood pressure, weight, blood sugar levels, age, family medical history and ethnicity. If this tool determines that the risk is more than ten percent, we know that offering statins is a good idea to prevent serious problems in the future.

Because of the twenty or so different measurements used to determine this risk score, it means that two people have the same cholesterol levels and only one of them can get statins.

Anyone in their late seventies with a cholesterol level of seven is already at high risk for heart disease and stroke. Age is an important factor, and five is usually the upper limit of normal. Even with regular blood pressure, in combination with the other treatment factors, the risk threshold of ten percent can be reached.

There is a lot of talk about statins and their side effects, but most patients have no problems taking them.

Some time ago I was advised to eat walnuts as they are rich in Omega-3 and good for the heart. But I’ve also heard that Omega-3 can cause atrial fibrillation (AF). Is it true?

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

They keep the heart, blood vessels and lungs healthy and help the immune system fight disease.

It has also been proven to reduce the amount of unhealthy fats in the body, prevent blood clots, improve blood circulation, lower blood pressure and ensure a stable heart rhythm.

All this reduces the risk of heart attacks and strokes. For example, in Japan, where the diet is rich in these fats, the rate of heart disease is much lower.

Good sources of omega-3 oils include nuts and seeds – such as walnuts, flaxseed and canola – as well as mackerel, sardines and other fatty fish. However, some research suggests that people who take supplements containing more than one gram of omega-3 are at increased risk of developing atrial fibrillation, a condition that causes the heart to beat at an abnormal rhythm. It is also an established risk factor for stroke.

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

More research is needed to clarify this connection, but there is no concrete evidence that people who eat foods containing omega-3 are at risk.

The NHS does not recommend the use of omega-3 supplements, but should instead be included naturally in the diet to keep levels at a safe level.

Chicken with tobacco-like warnings? That’s ridiculous!

I wonder how some public health experts come up with their ideas.

Last week, a team from Durham University suggested that putting tobacco-style warnings on meat packaging could reduce consumption and improve health.

Should warning labels be placed on meat products?

In addition to health warnings – including photos of people receiving CPR – the team added evidence about agriculture’s negative impact on the climate and even that livestock farming could cause a new pandemic.

Many people they tested it on didn’t find the health warnings credible. And no wonder: it’s a completely crazy proposition. We all have to eat, no one has to smoke, and meat in moderation is not bad for us – it’s a good source of protein, iron and other important nutrients.

Can’t we invest resources in educating people about healthy eating habits and the cheaper of fresh food instead of another ridiculous gesture?

Feel free to chat about side effects

I am often asked questions about dealing with adverse medication side effects from both readers and patients in my NHS clinic.

They will often say that they continued to fight without wanting to burden anyone. But it is essential to discuss something like this with a doctor as there is a lot we can do, such as adjusting the dose or switching to other medications.

And I would like to remind everyone about our national yellow card reporting system.

If you have taken a medicine or herbal remedy, received a vaccine, or even used a medical device that caused negative effects, you must report it. It’s how we find out about problems and it can keep us all safe from harm.

You can report any side effects to your pharmacist or doctor and ask them to prepare a yellow card report. Or you can do it yourself online by searching for the MHRA Yellow Card.