Back to the bone

ANNA was working part-time in a nursing home when she started to get twinges in her back. She assumed these symptoms, spasms and pains, were triggered by lifting patients, and deliberately ignored them turning her attentions to her education and getting into medical school.

But, around a month later, while making lunch at home, she was overwhelmed by an "excruciating pain" that shot up her back from the base of her spine.

"My first thought was to lie down, in case I crashed to the floor unconscious," she says.

"I seriously thought I must be dying."

A GP assumed she'd slipped a disc - though she was not sent for an X-ray - but, almost six months later, tests confirmed that Anna had osteoporosis, the debilitating bone disease which causes porous, crumbling bones that fracture

easily.

To most people, this painful, and usually crippling, condition is associated with old ladies (caused by the decline of natural oestrogen levels after the menopause). However, specialists increasingly point to significant bone loss in young women, some in their 20s and 30s. While Anna's case is extreme - and explained by anorexia at the age of 16 - researchers say that regular dieting and low calcium diets, smoking and drinking, combined with a lack of exercise, is a youthful prescription for early fractures.

Bones usually thin out slowly from around the age of 35, often without aches or stiffening. For some years, bone loss can continue at a rate of five per cent a year and the first sign that anything is wrong might well be a fracture, often after a minor fall. Some women inherit brittle bones while others are, unknowingly, more susceptible, losing bone faster during pregnancy.

A strong, healthy bone has a honeycomb of tiny holes supported by a surrounding structure containing calcium, protein and collagen. In thinning bones, these holes grow larger and the supporting structure weaker leaving it more susceptible to fractures.

The National Osteoposrosis Society says one in three women over the age of 50 break a bone because of osteoporosis. Every day, 40 people die largely because of a badly broken hip or pelvis. The danger, say specialists, is that the age this begins is getting earlier and earlier.

This could be down to the fact that recent research suggests us women don't consider looking after our bones as a major health concern. Even fewer go for a bone density scan.

In America, however, the question now being discussed is whether all women between the ages of 20 and 30 - not only those at high risk - should have a scan to establish the strength of their bones in relation to their age.

Anna adds: "Bone scans showed clearly that my awful pain was the result of compression fractures of two vertebrae - though, in fact, I always felt that a slipped disc could not be the real explanation"

"I was shocked to realise I was two inches shorter. I had been 5ft 11in, the tallest of four sisters, so the change was obvious. The curve in my lower back, and also my waist, had gone. Everyone noticed."

It was then medical officials suspected her eating disorder may have been to blame.

For two years, from the age of 16, she had been anorexic. The problem started with trying to lose weight for the summer; she eventually dropped from 11 stone to six.

Anna was a classic case - a middle-class, slightly obsessed, clever girl who was convinced that not eating was the way to control her life. She lived on melon for breakfast, a tomato for lunch and lettuce and tomato for supper.

Baggy layers and boots were her camouflage.

After losing two years of schooling, she realised she wanted to go to university like her friends. And she still wanted to be a doctor. Reason eventually won the day and she realised that to control her life she had to eat. She expects to be a fully qualified psychiatrist soon.

Yet, the legacy of her eating disorder remains. Her periods, which stopped at the age of 16, took several years to return to normal.

"In effect, I had had a premature menopause, and my bones were deprived of oestrogen, like those of a menopausal woman, at a time when they had not even reached full growth. They were also deprived of calcium and other minerals vital for bone growth"

Another problem came from her baggy clothes which did not expose her skin to the good effects of the sun. Sunlight helps special cells in the skin produce vitamin D, essential if bones are to make use of calcium.

When she was 19, scans showed that her bones were substantially less than the lowest normal density for a woman of 35.

"I was still at high risk for another fracture, so I was put on a high dose oral contraceptive to boost oestrogen levels and started eating calcium rich foods. I am not keen on milk, so I eat lots of cheese and yoghurt."

Exercise is not her forte, but she is trying harder. She now walks to and from the hospital where she works.

"I have also worked hard with exercises to reintroduce a waist, but I still find skirts ride up my ribs. I am a tube really, with long legs and a shortened flat back"

Married, ironically, to a dietician, she still worries about her future.

"My periods are normal, but I cannot be sure that pregnancy will be unaffected. I might lose bone very fast."

She hopes the latest research will clarify the relationship between bone loss and early diet, exercise or lack of it, and other influences.