I’ve got crumbly bones — so can I go on my motorbike?

Every week Dr Martin Scurr, a top GP, answers your questions

I HAVE osteoporosis due to radiotherapy for cancer. I take calcium and have denosumab injections, but heard this can make thigh bones susceptible to breakage.

I compete in motorcycle offroad trials, but broke a rib and was advised not to ride again. How serious is the risk? I am 67. Roy Beatty, Swanley, Kent.

O STEOpOROSIS, where the bones become fragile and break, is more common in women, but can also affect men. In your case, it has occurred as a result of cancer treatment. My feeling is that the radiotherapy is not to blame, as this would have been given to a local area.

I suspect the cancer you had was prostate — forgive me if I’m incorrect — but, if it was, it’s likely you also had hormone therapy, which suppresses male hormones that ‘feed’ the cancer. A possible consequence is osteoporosis.

The percentage risk figures you mention in your longer letter are based on bone density scans: these indicate that you have a significant level of risk (12 per cent) of a fracture anywhere in the body and a 3.9 per cent risk of a hip fracture specifically.

A hip fracture is most worrying as it can, among other things, lead to significant blood loss and seriously affect mobility, which, in turn, can lead to potentially life-threatening complications, such as blood clots.

The treatments you are taking will help. Bone is constantly being broken down and absorbed by the body, before being built up again.

Denosumab — given as twiceyearly injections — reduces the activity of the cells responsible for the reabsorption, so increasing bone density and strength.

It is recommended for treating and preventing osteoporosis in hormone- sensitive prostate cancer that has not spread, and is proven to be effective in increasing bone density.

In combination with the calcium tablets, this will help reduce your risk of fractures. (Many doctors also advise taking vitamin D, as it helps the body absorb calcium.)

Denosumab doesn’t generally cause many side- effects, but it can lead to musculoskeletal pain, raised cholesterol and cystitis.

There is also a risk of low calcium levels, but you are combating this with supplements.

It is true the use of denosumab for several years raises the risk of so- called ‘ atypical’ fractures, usually of the thigh bone (femur). This is where the bone breaks spontaneously, with no trauma. THERE

is also the risk of osteonecrosis of the jaw, where the jawbone breaks down. However, these complications are rare.

Off-road motorcycling is bound to increase the risk of fractures, as falls are inevitable. So, even as a keen motorcyclist myself, I suggest the time has come for you to retire from off-road trials.

Why not look at riding the North Coast 500 in Scotland instead? It’s spectacular — and safer.

TWENTY years ago, I was told constant pressure in my left ear was due to chronic congestion in the Eustachian tube.

Recently, I felt the pressure was increasing and was told the only treatment was a grommet procedure, but that this might not help. What’s the worst that could happen? My tinnitus is also louder in that ear.

Ian Campbell, Watford, Herts. THE worst that could happen is the surgery will not ease your symptom — there are no other serious risks, only minor ones from the general anaesthetic.

But the real question is whether the pressure in your ear is caused by chronic congestion in the Eustachian tube or is related to your tinnitus.

If it is the former, a grommet may help; if the latter, it will not.

The Eustachian tube connects the middle ear cavity, the space behind the eardrum, to the area behind the nose above the throat, — the nasopharynx. Its role is to equalise pressure inside the head with that outside it.

If the feeling of pressure is related to the Eustachian tube, this is usually the result of inflammation throughout the nose and sinuses, typically caused by infection or allergy. This can also affect the blood vessels here and may block off some of the spaces and channels, including the Eustachian tube.

If the tube is blocked, you feel a sense of pressure because the air pressure is not being equalised.

A grommet is a tube resembling a collar stud with a hole through the middle. It is inserted via a tiny incision in the eardrum and, by opening up a passage to the middle ear cavity, it equalises the air pressure between the middle ear and the outside world.

The grommet itself is necessary to stop the incision from rapidly healing, though it will eventually drop out. By then, the Eustachian tube malfunction may have settled, especially if you are using prescribed nasal steroid drops to suppress chronic inflammation.

However, 20 years seems a very long time for such chronic congestion to persist.

If a grommet fails to resolve the pressure, it would suggest your symptom relates to the inner ear.

This would be a sensorineural problem, which is where the inner ear has been damaged — for instance, by noise exposure, viral infection or even medication.

This can lead to tinnitus, where treatment essentially involves distraction therapy, such as white noise, to help you live with it.