There are some other even less common potential side-effects, such as low calcium levels - the risk is greater in patients who have vitamin D deficiency vitamin D helps the body absorb and use calcium or too little calcium in their diet.
Most doctors prescribing a bisphosphonate tablet also ask their patients to take a supplement of calcium with vitamin D. A rare complication of bisphosphonate treatment is severe musculoskeletal pain - this can come on at any time, at the start of treatment, or later.
Even more rare is osteonecrosis of the jaw, where the jaw bone breaks down. Good dental care and hygiene minimise the risk. Finally, I must mention the complication of atypical fracture of the femur the thigh bone - where the bone fractures gradually and spontaneously, without any trauma.
This is the one side-effect of bisphosphonate therapy that is specific to long-term treatment, ie, treatment lasting more than seven years. It seems paradoxical that drugs given to strengthen bone can actually cause the bone to become brittle, but it seems to be linked with over-suppression of bone turnover the process by which the bone is broken down and re-formed. This complication affects around just 50 in , people taking the drug, and it is usually preceded by pain in the groin or thigh, lasting some weeks.
This is something to watch out for in your sister. The potential benefits must be weighed up against these relatively uncommon hazards of long- term treatment.
Treatment for ten years is not unusual, even though most doctors tend to stop at five years if the patient's bone mineral density is stable and they suffered no spontaneous spinal fractures before treatment. However, in women at high risk of fracture the studies show there are benefits without an increased risk of adverse effects when treatment is continued for ten years.
Your sister's doctor will no doubt consider whether it is the bisphosphonate that's causing her symptoms. On the other hand, it may be the drug that he least wishes to stop, at least for now. The NHS learns nothing from history The NHS is about 50, short of the number of clinical staff needed to provide a safe and effective service, a report by the medical protection Society MPS warned recently.
By 'clinical staff', we mean doctors, nurses, dietitians, physiotherapists and all of those professionals involved in the care of sick patients. This is a matter of great concern, given the massive cutbacks we are facing in healthcare, not to mention the push for routine care to be provided on a seven-day basis, despite the revelation that the data upon which this need is based now appears to be questionable.
These various pressures, which threaten the quality and safety of medical care, only serve to confirm my view that the Department of Health and NHS England have very little grasp of how to run a healthcare system. This was driven home to me this month when I was reading about Sir Frank Whittle, the inventor of the jet engine. Sir Frank's engine first took to the skies in , yet the Air Ministry decided that jet engines were 'impracticable' and dismissed this technological advance.
However, because the concept was not deemed worthy of being kept secret, despite it being wartime, Germany was free to read Frank Whittle's patent. They did recognise the potential and in three years had an operational jet fighter. This piece of history mirrors the lack of vision that bedevils the development of the NHS. Did no one realise, for instance, the devastation that the European Working Time Directive which puts a block on the number of hours doctors can work would cause as long-refined, and carefully evolved, consultant-led teams were dissolved as rotas were forcefully created.
Has there been no recognition that as 60 per cent of all medical students are women there might be some subsequent manpower considerations, for example, if they choose to work part-time after having children? And with general practice currently getting less than 10 per cent of the overall NHS budget although there are now promises of more - but how much? Namely, that GPs are under such strain that many are retiring early and fewer young doctors are choosing general practice as a career.
None of this will change until politicians and the powers-that-be learn to look beyond their noses, and see the bigger picture - or become visionaries. Don't hold your breath. Share or comment on this article: My heart beats slowly - should I be worried?