Dear WDDTY:

Three months ago, my 74 year old mother slipped and broke her leg, and was subsequently diagnosed as having osteoporosis. Her surgeon recommended that she start a three year course of Didronel. My mother is not keen on taking this drug, having always preferred homeopathic treatment and a natural diet to treat any problems (she is a vegetarian and prefers to avoid dairy products).

She lives in Africa, and has had skin cancer for several years, and consequently avoids the sun as much as possible.

From reading your article, the solution is not simple, as aging seems to decrease the body's ability to deal with a large number of essential functions, from the "waning ability of the kidneys to synthesize calcitriol" to "low stomach acid which seriously impairs calcium absorption from the digestive tract".

Could you recommend suitable vitamin/mineral supplements? Her diet consists of mainly fruit and vegetables, with I suspect little emphasis on foods containing calcium, such as you mentioned in your article. How would you advise on her surgeon's insistance that Didronel is the only route open to her? Dawn Welmans, Horsham, W Sussex.....

Harald Gaier replies:

Although vitamin D conforms to the definition of a hormone because it is a precursor to a substance the body produces, it differs from the hormones we have criticized because, unlike estrogen, it is not a substance produced by our own bodies. We must get vitamin D from the outside the sun or in foods or supplements, whereas women's bodies inherently produce estrogen, even after the menopause. Our article recommended 400 units a day, recognized as a safe level.

Furthermore, we don't take a stance for or against any philosophy or substance; we simply examine the evidence (or lack thereof) concerning safety or effectiveness on each treatment individually.

As for our second reader, I'd recommend having her mother tested for the level of stomach acid production (which you can have done in any major southern African city).

If it is found to be low, your mother can take supplements of betaine hydrochloride and pepsin, which will bring up stomach acid production to normal, and thereby greatly improve her absorption of food and supplements. I'd also suggest that she consume calcium rich vegetables and non-meat foods such as mentioned in my article and supplement with vitamin D.

For information about individual supplementation, we recommend that she see an experienced nutrtional practitioner, who will design a programme for her based on her diet. (Or ring the Nutricentre for avice on individual supplements; tel: 0171-436-5122).