Visit to the offices of Humanity First last Sunday to discuss their work and have a Skype conversation with staff and students at the Masroor Senior Secondary School in The Gambia. They are delighted with the Avebury Library, acknowledged as a model for other libraries

Bone density

From King's:

Further to your recent outpatients appointment and bone density scan, I am writing to you with the results of your investigations.  As we discussed in clinic, the scores obtained on bone density assessments represent the number of standard deviations (sd) below the mean bone mineral density for 30 year old women in the King’s catchment area.  A person is diagnosed with osteoporosis if their bone density lies more than 2.5 sd below the mean, or if they are 1.0 sd below the mean with a fracture suggestive of the condition.  I have included your bone density results from this year and from your previous results in 2009:

2009       Lumbar Spine: -1.8; Femur -1.6

2013       Lumbar Spine: -0.9; Femur -2.0

These results show that there has been a fall in your bone density at your hips of about 5.5%.  The increase in bone density seen in your spine is likely to be spurious and is something we see frequently due to degenerative, “wear and tear”, in the spine that artificially raises the apparent density of the bones. 

With the treatment that you have received, we would expect, at best, that your bone density would remain static and not fall.  In all of the treatment categories we would expect a proportion of non-responders and it may be that this treatment has not been effective for you.  Nevertheless you have not sustained another fracture in the intervening period.  In terms of what options are available to you now, they are as follows:

1)      Opt for no further treatment, a “watch and wait strategy”, with a view to only considering treatment if you sustain another fracture.

2)      Opt to commence another treatment, called Denosumab (Prolia), which is an antibody that prevents the cells that erode bone from binding to it.  This is administered as an injection, under the skin, every six months.  It requires twice yearly blood tests and clinic visits, though we are working towards an agreement where this medication can be given, under a shared care agreement, by GPs.  The likely course would be at least 5 years.  In terms of side effects, it can cause: urinary infections; upper respiratory infections; muscle pain; constipation; and back pain.

Haematology August 12

Hb                  10.2
WBC                2.91
Platelets         554
Neutrophils        1.25

Platelets about the same, higher than the top of the normal range 450. Hb about the same, neutrophils down from 1.63 last time. Neutropenia (neutrophil count lower than 1.7) means a lowered resistance to infection, but no suggestion was made that it should be treated.