Dr Bernadette Carr answers your questions on PCOS and osteoporosis

Q. My sister fell recently and fractured her wrist. She was told by her doctor she has osteoporosis. What can I do to reduce my risk of developing the condition?

A. Osteoporosis occurs when bones become brittle and fragile due to a reduced bone density which in turn increases risk of fracture as impacts that would not ordinarily cause any damage make bones susceptible to breaking.

Bones grow and develop throughout childhood and adolescence when maximum bone density can be expected to be laid down. After the age of 35, bone density generally begins to decline. The elderly and especially women after the menopause are at an increased risk of decline in bone density.

Certain risk factors will make a person more likely to develop osteoporosis than others. These include: low body weight, alcohol consumption, family history, poor calcium intake, amenorrhoea (absence of periods in women) and smoking. Weight-bearing activity and a diet rich in calcium and vitamin D may have a certain protective effect.

Osteoporosis will generally not be associated with any symptoms and the first presentation is often with fracture after a fall. Loss of height with age may be an indicator of the condition due to compression fractures in the spine. If your doctor feels you are at high risk you may be referred for a test called a DEXA scan which measures bone density.

Lifestyle changes can help reduce risks of osteoporosis. These include a diet which provides an adequate source of calcium and vitamin D which can be found in dairy products such as milk and yogurt — many of which are now fortified with extra vitamins and minerals. Your doctor may also advise the use of supplements if necessary.

If you think you are at risk of osteoporosis you should discuss the condition with your GP to see what management is appropriate as in some severe cases intensive medical management will be necessary.

Q. I have been recently diagnosed with PCOS. What is this and what can I do about it?

A. PCOS, or Polycystic Ovary Syndrome is a very common collection of symptoms relating to a woman’s hormones and ovulation. The condition can be diagnosed if a woman experiences two of the following: very few/ no periods, excess facial and body hair as well as skin changes such as acne, a raised blood testosterone level and the presence of multiple small cysts on the ovaries noted on a pelvic ultrasound scan.

PCOS may also have several other manifestations such as obesity and insulin resistance. Women with this condition may also develop problems with cholesterol and an increased risk of diabetes.

There are many strategies for managing PCOS. Losing weight can be very helpful in women who are overweight with PCOS, however a significant proportion of women with the condition will have a normal BMI. Lifestyle changes to diet and exercise can be very successful in achieving this.

Irregular periods will typically be managed with the use of a combined oral contraceptive pill or a progesterone tablet. This will stimulate a regular “withdrawal bleed” on a monthly basis. This is important with women who ovulate very infrequently as it will prevent the lining of the womb from becoming too thick which may be a risk factor for developing cancer of the womb.

Acne and excess skin hair can be treated with a wide variety of options. Your GP may prescribe antibiotic creams or tablets for acne and in many cases electrolysis or laser skin removal may be helpful to achieve the desired cosmetic result.

Often the combined oral contraceptive pill will help improve acne symptoms.

Women with PCOS who are trying to conceive may need assistance in stimulating ovulation. Good success can often be achieved with the use of the drug clomiphene citrate which will stimulate the release of an egg from the ovaries of the woman. Blood monitoring as well as monitoring of the development of the eggs in the ovaries will generally be done by a specialist in gynaecology.

PCOS is a very manageable condition, the aim of this management is generally symptom-control as well as lifestyle change to ensure a healthy BMI and ensure treatment of any associated conditions such as diabetes or high cholesterol.