Question

I have several family members who have developed osteoporosis (thinning of the bones) in later life – some of whom have had nasty fractures as a result – and I understand that people with ME may be at increased risk of developing osteoporosis.
Why is this? Is there anything we can do to reduce this happening? And is there any treatment for osteoporosis?

Answer

There are three important reasons why people with ME/CFS are at increased risk of developing poor bone health and osteoporosis:

• Decreased activity, especially in people who are moderately or severely affected. Reduced mobility isn’t good news for the overall health of bones and muscles.
• Vitamin D deficiency due to lack of exposure to sunlight. This is more likely to occur in people who are moderately or severely affected and are largely or totally housebound.
• Calcium deficiency may occur if someone is taking a restricted diet.

To try and reduce these risks make sure you are not deficient in calcium or vitamin D by:

• Having some daily exposure to sunlight, especially between late March and the end of September and between 11am and 3pm,
• Taking a daily vitamin D3 supplement containing 10 iu or 400 micrograms of vitamin D3,
• Eating a healthy balanced diet that includes foods containing calcium and vitamin D and protein (for muscle health).

Calcium-rich foods include milk, cheese and dairy products; green leafy vegetables such as broccoli and cabbage – but not spinach as this contains oxalic acid which reduces calcium absorption; soya beans; tofu, nuts, bread and any food made with fortified flour; fish that have edible bones such as sardines and pilchards.

Foods containing vitamin D include oily fish such as salmon; eggs; fortified fat spreads and fortified breakfast cereals

Also, stop smoking and reduce alcohol intake to no more than 2 units per day – which should not be difficult if you have ME/CFS.

The final piece of advice that is normally given to people to reduce the risk of developing osteoporosis obviously concerns the benefits of exercise, including weight-bearing exercises. Whilst people with less severe ME/CFS will be able to do some walking, which is certainly helpful, weight-bearing exercises are clearly not going to be possible for people with ME/CFS.

If someone does develop osteoporosis there are several treatment options available:

• Calcium and/or vitamin D supplements will be required if blood levels are low,
• Antiresorptive drugs (examples include Alendronate and Risedronate) help to decrease the rate of bone turnover,
• Anabolic therapies stimulate bone formation.

Whilst drug treatments for osteoporosis can be very effective they do have side-effects – some of which 0verlap with symptoms. Feedback to the ME Association indicates that this can be a significant problem for some people with ME/CFS. So there may be a process of trial and error to find the right drug.

The NHS: Osteoporosis

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture). The most common injuries in people with osteoporosis are:

• • broken wrist,
  • broken hip,
  • broken spinal bones (vertebrae).

However, breaks can also happen in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine. Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain.

Although a broken bone is often the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have broken, making it difficult to support the weight of the body.

The NHS: Osteoporosis | June 2019

More information

• Vitamin D & Deficiency
  We explain what vitamin D is and why it is so important, how it occurs naturally, the supplements that are available, whether deficiency is likely in ME/CFS, and how it can be treated.
• Diet – Healthy Diet in ME/CFS
  The ME Association's diet and nutrition advisers examine the role of what we eat and how it can help our health when suffering with ME/CFS. They also suggest ways we could improve what we eat and how we eat it.
• Diet Trends and ME/CFS
  Sue Luscombe is the Diet and Nutrition adviser to the ME Association and she reviews dietary trends and asks whether they are helpful to people with ME/CFS.
• Vitamin Supplements
  We address questions such as, is there any evidence that people with ME/CFS are vitamin-deficient? Do they need to be taking what can be quite expensive supplements? And, do vitamin supplements pose any harms to health?
• Nutrition Assessment & Malnutrition
  We review the importance of nutrition and the dangers of malnutrition, especially in people severely and very severely affected by ME/CFS.
• Sensitivities, Intolerances, and Hypersensitivities in ME/CFS
  We provide information and practical self-help management tips on how to cope with most of the common sensitivities, intolerances, and hypersensitivities that can affect people with ME/CFS.