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Chapter 1: What is the importance of calcium in bone health?
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We've just finished our discussion with Dr. Sergeant Zach Verghese on the topic of calcium. She is a consultant diabetes endocrinology and general internal medicine specialist. And I think that interview was amazing because it made me inspired to look after my calcium levels a bit more. But I didn't feel panicked about it or that I had to rush out and buy any supplements or anything.
I thought it was really helpful. And the thing that I think is so great for this episode of Doctor's Notes is that Sargent is... I would say unusually passionate about calcium. I don't recall ever meeting any, maybe anyone, but certainly any medical colleagues who really cared about calcium. You know, we all knew it was important.
I'm not sure I've ever met anyone who cares about anything quite as much as Sargent cares about calcium, parathyroid hormone. bone health, and all of the other things she's interested in. That's right. So that is what we're digging into in Doctor's Notes, and especially a bit more on osteoporosis. We know there will be lots of listeners who are interested in this.
We've had lots of people write in about it. We are going to do a separate episode on osteoporosis itself, but we wanted to get a bit further into it with Sarjan because it tells us a lot about calcium and its management in the body. Zandi, let's open the notes. Open the notes. Sergeant, thank you so much for staying with us for Doctors' Notes.
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Chapter 2: How does osteoporosis relate to calcium levels?
So when we were primitive fish, basically.
That's it, exactly. And then what's really interesting about the parathyroid hormone is it's thought that the parathyroid glands developed almost 375 million years ago.
So this is before the first dinosaurs, isn't it? This is pre-mesozoic.
Right. And it's thought to be one of the reasons that animals were able to evolve from an aquatic to a terrestrial environment, so moving from the sea to the land. So when they've looked back at the gills of fish and parathyroglans, they've got some common genes and they're thought to have a common evolutionary basis. So it's a really important hormone that defends our calcium levels.
So you mentioned these fish.
Yeah.
The fish are swimming around in a sea which has loads of calcium dissolved in it. So they don't have to worry about this. When I think it was Tiktaalik that the first fish crawls out onto land to become, eventually become us. Did the parathyroids we think, are they in the gills?
Yes. So that's a really good question. So the genes that are associated with the evolution of internal gills and the genes that are associated with parathyroid glands are very similar. And this was found by researchers at King's College. They looked at genes and they looked at the evolution of those genes.
So it looks like there's a similarity in the evolution of the parathyroid glands might well have been from the gills of prehistoric fish.
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Chapter 3: What role do hormones play in calcium regulation?
So even my patients in their 90s go to three exercise classes a week and do Tai Chi and dancing. So exercise definitely. And the third thing is exercise. assessing your fracture risk, which is looking at your risk of having a fracture in the next 10 years. And there's an online calculator from the University of Sheffield.
And if you have a high fracture risk, then taking a medication to reduce that fracture risk and reduce your risk of fractures and protect your bones.
What medications work?
There's a lot of medications. We use bisphosphonates. Bisphosphonates are basically like a hook that sit on your bone surface and then the osteoclasts come along and they try and engulf them and they kill the osteoclasts. They lift up from the bone surface and stop the osteoclasts working. So bisphosphonates are great and they still keep working even after you've stopped taking them.
So bisphosphonates are a key drug for osteoporosis. They reduce the risk of fractures by between 50% of their tablets to 70%. Wow. So they're really, really good medications. And we take them from between 5 to 10 years if they're tablets or 3 to 6 years if they're infusions. Amazing. So that's an anti-resorptive agent. There are other anti-resorptive agents.
Denosumab stops your osteoclasts from maturing. And then we more recently have bone building agents, anabolic agents. So these help your osteoblasts. So they help your osteoblasts make new bone. And these are versions of your parathyroid hormone. So it sounds confusing because I've told you already that if you have too much parathyroid hormone, you have thin bones.
So if you have continuous parathyroid hormone, that stimulates your osteoclasts. When you have intermittent parathyroid hormone, that stimulates your osteoblasts. It helps you build bone. So we now have drugs, teriparatide, abaloparatide, that you can take for one to two years, and that will help you build new bone.
So there's lots and lots of things that older people or people with osteoporosis who are younger can do. And if people are listening to this thinking, well, I've got a family history of this, I'm worried about my bones. Is that reason enough to, if you're over, you know, if you're in your 50s, is that post-menopause perhaps, is that reason enough to go and see your GP and say like a bone scan?
Like what's the route into managing your risk? Because it's symptom free until you break a bone, isn't it?
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