Latest / The Body Pod / Strong to the Core: Bone Health, Menopause & Midlife Strength with Dr. Kristi DeSapri

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Strong to the Core: Bone Health, Menopause & Midlife Strength with Dr. Kristi DeSapri · The Body Pod

0:00
Speaker 1: Hi.
0:00
Speaker 2: Everyone. My name is Haley and this is Laura, and
0:03
Speaker 2: welcome to the Body Pod. All right, welcome to the
0:13
Speaker 2: body Pod everyone. We are thrilled to have doctor Christy
0:16
Speaker 2: Dysaffary on to talk about all things bone health. This
0:22
Speaker 2: has been such a hot topic and I'm anxious and
0:27
Speaker 2: just excited to dig into your mind because you're on
0:30
Speaker 2: the front lines. We are a little bit in a
0:33
Speaker 2: different way in the trenches, but you are You're the
0:37
Speaker 2: first line of defense. So first of all, welcome to
0:41
Speaker 2: the Body Pod.
0:42
Speaker 3: Thank you Haley and Laura. I'm so excited to be
0:44
Speaker 3: here talk to you about what you do and share
0:47
Speaker 3: what I do so we can reach more women.
0:49
Speaker 2: Yes, absolutely, So what inspired you to specialize in bone
0:54
Speaker 2: health in this midlife women's area.
0:58
Speaker 3: Yeah? I love that question because I get it often
1:00
Speaker 3: when I started my practice Bone and Body Women's health
1:05
Speaker 3: here in little Little Winnaka, Illinois, which is a suburb
1:08
Speaker 3: of Chicago, and people often say why bone, like you know,
1:12
Speaker 3: and now I feel like I don't actually need to
1:14
Speaker 3: answer why bone, because, like you mentioned, more women care
1:17
Speaker 3: about what's happening at midlife and menopause and beyond, So
1:22
Speaker 3: you know, my focus in osteoporosis. Bone health started back
1:27
Speaker 3: when I was interested in guynecology and menopause and midlife
1:30
Speaker 3: women's health, starting when I was you know, in college
1:33
Speaker 3: and medical school, and then went on to do a
1:35
Speaker 3: fellowship with the Cleveland Clinics specifically focusing on menopause and perimenopause.
1:39
Speaker 3: And that was before I say it was cool, you know,
1:43
Speaker 3: I was trendy. You know, I used to you know,
1:46
Speaker 3: sort of like not want to share what I did,
1:48
Speaker 3: or it was kind of like, oh, that's a weird focus,
1:51
Speaker 3: you know, sort of get like a kind of conversation stopper.
1:54
Speaker 3: But now it's obviously a conversation starter. And I try
1:57
Speaker 3: to tell, you know, my friend, I get a million
2:00
Speaker 3: messages and texts from friends about herey, menopause, menopause, and
2:03
Speaker 3: bone health. So my areas just just sort of, you know,
2:06
Speaker 3: trickled down from the menopause. And I also just saw women,
2:09
Speaker 3: you know, who had osteoporosis and they weren't really sure
2:13
Speaker 3: who to go to, you know, they went to a
2:15
Speaker 3: roe metologist or an endocrinologist, or they'd had a fracture
2:18
Speaker 3: and they'd seen an orthopedic surgeon. And I sort of
2:21
Speaker 3: felt like you know who takes care of osteoporosis, and
2:24
Speaker 3: some guynecologists did it, and I had some amazing mentors
2:26
Speaker 3: at the Cleveland Clinic who you know, I got to
2:29
Speaker 3: learn from, And I thought, this is a really neat field.
2:31
Speaker 3: It matches you know, clinical you know, we have to
2:33
Speaker 3: take a good history and talk to women through the
2:36
Speaker 3: health of their lifespan and health span. But also there's
2:39
Speaker 3: some science involved with the DEXA scan and with the
2:42
Speaker 3: you know consideration of meta you know, some labs and
2:45
Speaker 3: medical work up that we have. So it's really a
2:47
Speaker 3: nice field. And the people in this field are amazing
2:50
Speaker 3: as well. I have some great mentors and colleagues, So
2:53
Speaker 3: it's just been really great. And I think with the
2:55
Speaker 3: avid of more doctors, clinicians, allied health professionals like you're
3:00
Speaker 3: cells that you know, want to talk to women about menopause, midlife,
3:03
Speaker 3: muscle and bone makes my job easier too.
3:06
Speaker 1: Well, you've been in this space for a while, then,
3:10
Speaker 1: how has it most changed from when you started to
3:14
Speaker 1: right now?
3:16
Speaker 3: Yeah? So yeah, I mean I think that the change
3:20
Speaker 3: has literally been sort of like the sea change of
3:22
Speaker 3: women educating and you know, sort of advocating more for themselves.
3:27
Speaker 3: You know, I had a patient even tell me that yesterday.
3:29
Speaker 3: Sort of like the cart, you know, is the horses
3:31
Speaker 3: out of the bar. Now for women, we just have
3:33
Speaker 3: so much more information, we kind of still have to
3:35
Speaker 3: parse out what's true, what's related, and what's for us,
3:40
Speaker 3: you know, which is you know, individualized because there's no
3:42
Speaker 3: one size fits all. We know that in pretty much
3:44
Speaker 3: every sphere of women's health, right from our hair, skin nails,
3:47
Speaker 3: to our pregnancy and delivery choices. So, you know, I
3:51
Speaker 3: think what's changes there's just more options. There's more advocacy obviously,
3:56
Speaker 3: you know, podcasting, social media, soelebrities money poured into this area.
4:02
Speaker 3: I mean, I think science is always a little behind, right,
4:06
Speaker 3: and so we need more research, more interest, more clinicians
4:10
Speaker 3: to understand, you know, all about you know, what happens
4:13
Speaker 3: at menopause, in midlife and beyond, so we can all
4:15
Speaker 3: be on the same page. I think that's really important
4:18
Speaker 3: and where I think a lot of the discussion is now.
4:22
Speaker 2: Yeah, well, I know we've this is a question I'm
4:26
Speaker 2: sure everyone asks. You know, we know in at least
4:29
Speaker 2: the United States, it's what sixty two sixty five where
4:33
Speaker 2: you could get a DEXA scan or when it's recommended
4:37
Speaker 2: for you to get a DEXA scan. And I think
4:39
Speaker 2: the message is pretty clear for most women that we've
4:42
Speaker 2: got to attack this earlier. But can you go over
4:46
Speaker 2: because I know that the women in perimenopause that still
4:50
Speaker 2: feel or are almost into per menopause, still feel like
4:55
Speaker 2: you know, that is light years away. That's like a
4:58
Speaker 2: world away and it's not going to come up, but
5:00
Speaker 2: it's a coming. So can you talk about the difference
5:04
Speaker 2: between the T score and the Z score and what
5:07
Speaker 2: we need to know with those numbers?
5:10
Speaker 3: Okay? Sure? So there was a lot of good questions
5:12
Speaker 3: tucked in there, So I would start with, you know,
5:16
Speaker 3: parsing out a little bit about what you said, like
5:18
Speaker 3: a baseline screening DEXA. So I think, you know, most
5:21
Speaker 3: of the medical societies, you know, recommend that you get
5:24
Speaker 3: a women, you know, get a baseline bowmen oral density
5:27
Speaker 3: at sixty five. But when we look at like the
5:30
Speaker 3: World Health Organization and we look at the statistics of
5:33
Speaker 3: you know, the amount of women that then have osteoporosis
5:36
Speaker 3: or low bone mass by the age of sixty five,
5:38
Speaker 3: it's close to forty percent of women. So we're missing
5:42
Speaker 3: then a lot of women, and we say the statistics
5:44
Speaker 3: of one in two women over the age of sixty,
5:46
Speaker 3: over the age of fifty excuse me, who have an
5:49
Speaker 3: osteoporosis related fracture. You know, we're missing a lot of
5:52
Speaker 3: years that we could you know, intervene. And so when
5:56
Speaker 3: we think of, you know, when we should be getting
5:58
Speaker 3: or when we should recommend or when women should advocate to,
6:01
Speaker 3: you know, to get a DEXA scan for themselves, it's
6:04
Speaker 3: generally around the time of the menopause transition. So that
6:07
Speaker 3: could be the two to three years before and the
6:10
Speaker 3: two to three years after menopause. That's sort of what
6:12
Speaker 3: we consider the menopause transition. Because you're right that we
6:17
Speaker 3: know that, you know, menopause isn't a light switch, it's
6:19
Speaker 3: not an on and off, right. We do know that
6:21
Speaker 3: in the bone health world, specifically that bone mineral density
6:24
Speaker 3: starts to decline two to three years before the final
6:27
Speaker 3: menstrual period and then the two to three years afterwards.
6:30
Speaker 3: And so that and some women can you know, lead
6:32
Speaker 3: to up to ten percent bone loss, which is a
6:36
Speaker 3: whole t score on your bone mineral density or DEXA testing,
6:40
Speaker 3: which again helps us sort of standardize bone strength and
6:44
Speaker 3: bone density. So that's a lot, and it's certainly a
6:47
Speaker 3: lot for women who might be coming to the perimenopause
6:50
Speaker 3: with a low peak bone mass, or a family history
6:53
Speaker 3: of osteoporosis, or you know, any secondary cause of bone loss.
6:57
Speaker 3: And so maybe you were shadowing me in clinic today
7:00
Speaker 3: because I had a patient who was you know again,
7:04
Speaker 3: you know, forty six, with a strong family history of osteoporosis,
7:09
Speaker 3: with low you know, a low lower body mass, just
7:12
Speaker 3: constitutionally lower calcium intake. She wasn't really considering vitamin DA
7:17
Speaker 3: is important. No one really educated her on that, but
7:19
Speaker 3: she knew that she'd seen her mother and her grandmother
7:22
Speaker 3: have osteoporosis and some sequel and so naturally when we
7:25
Speaker 3: do her bone density, it's lower on the lower side,
7:29
Speaker 3: and it was lower than maybe her someone who's a
7:32
Speaker 3: similar age, race, and sex match, which is her Z score.
7:35
Speaker 3: So that compares, that's what you see on that testing,
7:39
Speaker 3: and we know that if the Z scores are starting
7:41
Speaker 3: to drop, you know, below minus one or minus close
7:44
Speaker 3: to minus one point five, you know, and then we
7:46
Speaker 3: go through menopause, then we're setting ourselves up for low
7:49
Speaker 3: bone mass osteopenia or osteoporosis later down the road. Especially
7:53
Speaker 3: if we wait to do a dex at sixty five, right,
7:56
Speaker 3: we've missed the boat completely. So it is important, especially
8:00
Speaker 3: important to know your family history and some of those
8:03
Speaker 3: things that I mentioned. You know about you know, calcium,
8:06
Speaker 3: vitamin D, exercise, your reproductive status, if you had earlier
8:10
Speaker 3: menopause or skipped a lot of periods we call amen arehea.
8:14
Speaker 3: That's really important too for bone health. So it's all
8:17
Speaker 3: kind of connected, right. It's why we take a good
8:19
Speaker 3: history and we understand what happened before menopause is important
8:23
Speaker 3: to help us understand how that's going to look. Things
8:25
Speaker 3: are going to look later as well, and so critically
8:28
Speaker 3: important in the I would say the fortieth you know,
8:31
Speaker 3: forties to early fifties. Does that answer some of your questions?
8:36
Speaker 2: I want to know how much does genetics play? Is
8:39
Speaker 2: it fifty percent?
8:40
Speaker 3: Is it?
8:41
Speaker 2: Is there a way to know?
8:42
Speaker 3: Yeah, a round of percent. Yeah, So you know, genetics
8:46
Speaker 3: is a huge percentage. You know, there's you know a
8:48
Speaker 3: lot of what we call like our studies when we
8:50
Speaker 3: look at the variability, it can be anywhere from like
8:53
Speaker 3: thirty to seventy percent of our bone mass is inherited.
8:56
Speaker 3: So that's a pretty big percent. But again, when you
8:59
Speaker 3: start to hear like my mom, my grandmother, my sister,
9:03
Speaker 3: you know, things like this, this is a clue, right,
9:05
Speaker 3: And I think that's the one of the one of
9:07
Speaker 3: the you know, the pearls that we have, you know
9:10
Speaker 3: now going through you know, perimenopause and menopause for a
9:13
Speaker 3: lot of women, I would say in their fifties and
9:14
Speaker 3: sixties that maybe we didn't have for women in their
9:17
Speaker 3: you know, sixties, seventies, eighties, that the clue of like oh,
9:20
Speaker 3: my mom had osteoporosis, or my mom had rheumatoid arthritis
9:23
Speaker 3: and then she ended up having a fracture, or my grandmother,
9:26
Speaker 3: you know, she lost height and then ended up breaking
9:29
Speaker 3: her hip. You know, things like that. So our histories
9:32
Speaker 3: can really help us. So again, I mean, I think
9:36
Speaker 3: educating ourselves, that's why we do these you do this podcast, right,
9:39
Speaker 3: That's why I do a lot of what I do, right,
9:41
Speaker 3: so we can make some educated decisions for ourselves for
9:45
Speaker 3: these decades of life and then beyond. So we're not
9:47
Speaker 3: just thinking about treating osteoporosis and talking about the medications
9:51
Speaker 3: when it's you know, maybe too late to prevent.
9:54
Speaker 2: Okay, I'm freaking out right now. I just had a
9:56
Speaker 2: massive light bulb moment. I don't know why this all
10:00
Speaker 2: just came together, because I'm talking about this all the time.
10:03
Speaker 2: My grandmother had osteoporosis so bad that they couldn't even
10:09
Speaker 2: operate on her.
10:11
Speaker 3: On her spine or on her hip. Yes, and here
10:14
Speaker 3: I am.
10:15
Speaker 2: I had back surgery when I was seventeen, and I
10:17
Speaker 2: blame it on my grandma.
10:18
Speaker 3: And I don't know why.
10:19
Speaker 2: I just assume because I'm strength training all the time,
10:23
Speaker 2: and I you know that I wouldn't even There's no
10:26
Speaker 2: way I would have low bone masks.
10:28
Speaker 3: But I might. You might. I don't know how old
10:31
Speaker 3: you are, but I do think forty seven. Okay, Okay,
10:34
Speaker 3: so you would be a prime candidate for a screening
10:36
Speaker 3: bone density. The hardest part about that is just here
10:39
Speaker 3: in the United States, you know, sometimes finding someone who
10:43
Speaker 3: will order that for you. Sometimes the insurance wants to
10:46
Speaker 3: deny that. But if you have a family history of mastereoprosis,
10:49
Speaker 3: and if you have one risk factor meaning like low
10:52
Speaker 3: bone you know, you low body mass or you know,
10:54
Speaker 3: menopause or family history or certain medical condition, surgical conditions,
11:00
Speaker 3: medications that might impact the bone, then that should be
11:02
Speaker 3: covered right. And it's a dexa scan. Again we're talking
11:06
Speaker 3: about it, but for most people who understand, but a
11:08
Speaker 3: dexa scan is a low radiation, painless exam. It takes
11:12
Speaker 3: about ten minutes and it scans your spine and both
11:15
Speaker 3: of your hips ideally sometimes your one third forearm, and
11:18
Speaker 3: it looks at the cortical bone and the tribecular bone,
11:21
Speaker 3: which are two of the most important bones in our
11:23
Speaker 3: body that you contribute to bone strength. And so certain
11:27
Speaker 3: areas have more trabecular bone than cortical bone. Sometimes we
11:30
Speaker 3: see it change in the bone density, quicker in the
11:33
Speaker 3: trabecular bone, or there's more remodeling. But this can kind
11:36
Speaker 3: of give us clues to you know, how what is
11:39
Speaker 3: our peak bone strength or what is your bone strength now?
11:42
Speaker 3: And I absolutely think like what you're saying, And I
11:44
Speaker 3: know you ladies are huge, you know advocates for you know,
11:48
Speaker 3: strength training, and your you look incredibly strong to me,
11:51
Speaker 3: and I know this is important part of your life,
11:53
Speaker 3: which is great and messaging and that can you could
11:56
Speaker 3: still continue to do that and that's important part of
12:00
Speaker 3: you know, healthy aging in general, but sometimes all of
12:03
Speaker 3: our good healthy habits like not smoking and eating calcium
12:06
Speaker 3: rich foods and things, we still could have low bone mass, right,
12:10
Speaker 3: and then we still need to like work on that
12:11
Speaker 3: or still need to understand, you know, components of that.
12:13
Speaker 3: Maybe it's a hormonal piece, maybe it's something else that
12:16
Speaker 3: we can intervene on.
12:18
Speaker 2: I'm literally so interesting.
12:22
Speaker 1: I want to know your results in a world.
12:25
Speaker 2: Okay, so if we look at the risk factors, So
12:28
Speaker 2: obviously genetics is is much bigger than I thought. I
12:31
Speaker 2: would not have guessed it was that big, but it
12:34
Speaker 2: makes sense. So we have we have genetics. When you
12:38
Speaker 2: said maybe didn't get to their peak bone mass, would
12:44
Speaker 2: that go for women that suffered or girls that suffered
12:48
Speaker 2: low energy availability, red ass, stress fractures, things like that,
12:53
Speaker 2: if they were under eating, underfueling, over exercising, that is
12:58
Speaker 2: a risk that becomes a risk factor from what you
13:00
Speaker 2: did in previous decades.
13:02
Speaker 3: It absolutely can, especially you know, like you said, the
13:05
Speaker 3: relative energy deficiency syndrome or right overtraining, underfueling specifically for
13:11
Speaker 3: things like stress fractures, that's pretty common. And actually see
13:14
Speaker 3: a lot of that and like even you know weekend
13:16
Speaker 3: warriors or athletes in their thirties and forties, you know,
13:19
Speaker 3: training for certain things and maybe no one's checked their
13:22
Speaker 3: vitamin D or talk to them about their calcium demands. Particularly,
13:25
Speaker 3: you know, as we become a perry and postman, apostal woman,
13:28
Speaker 3: or footwear or not cross training, these things are all important. Yeah,
13:33
Speaker 3: I mean sometimes those those stress fractures are those things
13:36
Speaker 3: come in their twenties, but those can come at any
13:38
Speaker 3: decade of life. Really again, because when we think about
13:41
Speaker 3: a fracture, it's either you know, we're having either more
13:44
Speaker 3: bone breakdown than bone formation, or we're having loading of
13:48
Speaker 3: the bone in a way that the bone cannot sustain. Right,
13:52
Speaker 3: So stress fractures and osteoporosis related fractures are actually kind
13:56
Speaker 3: of they kind of like are in two separate lanes.
13:59
Speaker 3: I mean, for sure, you can have both, especially if
14:02
Speaker 3: you're low and calcium and vitamin D. But oftentimes stress
14:05
Speaker 3: fractures are things like metatarsal like our foot fractures, ephemeral
14:10
Speaker 3: neck fracture, a tibio plateau which is like your knee,
14:13
Speaker 3: those are a sacral or a pelvis fracture sometimes can
14:16
Speaker 3: be signs of a stress fracture versus an osteoporocess related
14:22
Speaker 3: fracture is more generally a fall from a standing height
14:25
Speaker 3: or less. So those could be things like a rest fracture,
14:28
Speaker 3: a hip fracture, but not necessarily. Some women who have
14:32
Speaker 3: a very low spine bone mineral density or T score
14:35
Speaker 3: can develop a vertebral fracture, so from inappropriate bending, lifting, twisting, turning,
14:42
Speaker 3: loading of the bone. So I've seen that in some
14:44
Speaker 3: women who exercise, you know, have been doing exercise or
14:47
Speaker 3: inappropriate training, you know, and that's unfortunate. So we talk
14:51
Speaker 3: a lot about how to exercise appropriately if you have
14:54
Speaker 3: a low spine bone mineral density, because again, the goal
14:57
Speaker 3: with all of our thinking about bone health is to
15:00
Speaker 3: to maintain bone health and strength and reduce our risk
15:02
Speaker 3: of a fraction, right, because that's the outcome we're trying
15:05
Speaker 3: to prevent.
15:06
Speaker 2: Okay, so let's move onto the exercise uh prescription, because
15:13
Speaker 2: I want to know from the physician side, what do
15:18
Speaker 2: you recommend to somebody that says, say, has osteopenia like
15:22
Speaker 2: maybe a negative one, to someone that has osteoporosis like
15:27
Speaker 2: a negative three. Obviously that that advice and treatment is
15:31
Speaker 2: going to.
15:31
Speaker 3: Be quite different. Yeah, absolutely, So here here's the like,
15:36
Speaker 3: here's the state. You know, here's what we understand is
15:38
Speaker 3: you know, sort of like again clinicians physicians in the
15:41
Speaker 3: osteoporosis world. And you have to remember that you know, science,
15:44
Speaker 3: you know, and particularly exercise science. You know, we have
15:47
Speaker 3: a lot of small studies, less than one hundred women,
15:51
Speaker 3: short periods of time, so it's not the same quality
15:54
Speaker 3: of evidence we have with you know, let's say our
15:57
Speaker 3: pharmacology studies, right with like our drug trial that include
16:00
Speaker 3: seven thousand women and follow them over years and we
16:03
Speaker 3: see the medication working. So this is where I think
16:06
Speaker 3: there's it's a little bit apples and oranges, and potentially
16:09
Speaker 3: why when we go to you know, like our rubutologists
16:13
Speaker 3: are endochronologists who are who are you know, classically trained
16:17
Speaker 3: and we read our medical guidelines, and the medical guidelines
16:20
Speaker 3: on osteoon exercise in osteoporosis are like three paragraphs, right
16:25
Speaker 3: versus you know, twenty pages on like medications and calcium
16:29
Speaker 3: and vitamin D. And it's just because again we don't
16:32
Speaker 3: have a lot of great research in this area. We
16:35
Speaker 3: have some to guide us, and the guides are generally,
16:39
Speaker 3: you know, the one study that has been done that
16:42
Speaker 3: has been done, you know, and it was done well,
16:44
Speaker 3: and it was done over you know, a longer period
16:45
Speaker 3: of time at least you know, eight nine months, was
16:47
Speaker 3: called the Lift More Study and it was done in
16:50
Speaker 3: New Zealand and it took women with osteoporosis osteopenion and
16:54
Speaker 3: randomized those women to an exercise regiment where they did
16:58
Speaker 3: you know, consistent multi days a week of you know,
17:01
Speaker 3: doing weightlifting and doing things like deadlifting and overhead press
17:05
Speaker 3: and back extension and squats and jumping and sort of
17:10
Speaker 3: like a chin up drump drops and things of that
17:12
Speaker 3: nature versus women who just did like walking and stretching.
17:15
Speaker 3: And the women who did resistance exercise naturally, they improve
17:18
Speaker 3: their bone density and their spine and their femoral neck,
17:21
Speaker 3: which is the area of our hip that we can
17:23
Speaker 3: scan with a dexa versus placebo. So that gives us,
17:27
Speaker 3: you know, some great information that like, yes, we know
17:31
Speaker 3: loading the bone, we know adding more than your own
17:34
Speaker 3: body weight makes more of a difference. And it makes
17:37
Speaker 3: sort of sense right when we think about physiology. But
17:41
Speaker 3: then we look at like out other things like is
17:44
Speaker 3: walking enough? What about pilates and yoga, what about pickleball?
17:48
Speaker 3: What about you know, so because again people you know,
17:51
Speaker 3: we don't people don't just lift weights, or some people
17:53
Speaker 3: don't have access to that or don't know how to
17:54
Speaker 3: do that. So I think it becomes very much an
17:57
Speaker 3: exercise prescription, like you said, of adding in some resistance
18:01
Speaker 3: and weight bearing because of the liftmore study that we
18:03
Speaker 3: have and figuring out a way to do that safely,
18:05
Speaker 3: whether it's either with a trainer, whether it's hiring someone,
18:09
Speaker 3: whether it's following you know, you know, a prescription that
18:13
Speaker 3: I share with some of my patients, whether it's connecting
18:15
Speaker 3: with like a bone fit or an O narrow program
18:17
Speaker 3: with these are people who are specifically focused on, like
18:20
Speaker 3: a trainer or physical therapist on helping them with osteopenia
18:24
Speaker 3: osteoporosis at varying degrees. You know, I always think, you know,
18:28
Speaker 3: doing aerobic exercise and some jumping exercise is important. It's
18:32
Speaker 3: good for our cardiovascular health, it's good for our bone density,
18:35
Speaker 3: it's good for our brain heart. So doing something of
18:37
Speaker 3: that nature, you know, within your scope of what you
18:40
Speaker 3: can do, and then balance and posture things we forget about.
18:44
Speaker 3: I think the areas of exercise that have helped us
18:46
Speaker 3: with that are things like pilates, yoga. These are areas
18:50
Speaker 3: that taichi that are often based in balance and I
18:53
Speaker 3: mean as we age that can decline a little bit, right,
18:56
Speaker 3: and so just consistently trying to do that as you know,
18:59
Speaker 3: as much as doing compound weights, exer with balance, you know,
19:03
Speaker 3: or just balancing on one leg for thirty seconds and
19:05
Speaker 3: then taking it from there. But that is something that
19:08
Speaker 3: is easy and cheap and free, is what I say.
19:10
Speaker 3: And so adding trying to do some of that and
19:13
Speaker 3: so really tailoring with what people can do with their time,
19:16
Speaker 3: their you know, resources, and also what they like to do, right,
19:21
Speaker 3: because if you don't like to do it, you won't
19:22
Speaker 3: do it, and why and the why behind it?
19:26
Speaker 2: Okay, so how do you feel about there's been a
19:30
Speaker 2: little bit of research with weight advest and there's some
19:35
Speaker 2: controversy there. There's definitely opinions and that in that space
19:39
Speaker 2: as well as like a vibration plate. What do you
19:45
Speaker 2: think that, what's the outlook from the research there and
19:49
Speaker 2: is it something that you recommend?
19:51
Speaker 3: Yeah, so I think that the vibration plate. Again, we've
19:55
Speaker 3: had this around for a long time. I mean the
19:58
Speaker 3: vibration plate. I say, you know, for a of people
20:00
Speaker 3: if you want to work on like your balance or
20:02
Speaker 3: have an extra challenge with the vibration. But the reality
20:05
Speaker 3: is the amount of vibration that's needed to like maybe
20:07
Speaker 3: affect a change in the Again, the bone mineral density
20:11
Speaker 3: is quite high, and so you need a lot of
20:14
Speaker 3: vibration for a long period of time, a certain amount
20:17
Speaker 3: of hurts to actually you know, change that. And again
20:19
Speaker 3: when we look at like the research behind the vibration
20:22
Speaker 3: plate and some of that, it's it's very you know,
20:26
Speaker 3: small and inconsistent. So if I say, if you want
20:29
Speaker 3: again practice your balance or add that in, that's fine.
20:32
Speaker 3: It's not usually my first line of recommendation. Again, just
20:36
Speaker 3: because I follow the evidence. The weighted vest is interesting.
20:40
Speaker 3: I mean, I definitely think it is a little bit
20:43
Speaker 3: of a hack, a little bit of a trend. But
20:45
Speaker 3: also like again the idea that it's adding resistance or
20:49
Speaker 3: loading the bone is the same, you know, it's it's
20:53
Speaker 3: sort of the same extension as you know, doing some weightlifting,
20:56
Speaker 3: like doing a bicep curl and putting a weighted vest on.
20:59
Speaker 3: So there is some research against small studies less than
21:02
Speaker 3: one hundred women who have osteopenia who wore of weighted
21:05
Speaker 3: best while they were walking or exercising for more than
21:08
Speaker 3: three hours a week at about five to ten to
21:12
Speaker 3: up to fifteen percent of their body weight, showing that
21:14
Speaker 3: it had an effect size on their bone min oral
21:16
Speaker 3: density more than a placebo. So I say, oh, that's positive.
21:20
Speaker 3: You know, it's not negative. Starting low and going slow
21:24
Speaker 3: as long as women don't have back pain. I have
21:26
Speaker 3: seen it be you know, moderately a you know effect,
21:30
Speaker 3: you know, having a small effect. I think again, time
21:32
Speaker 3: will tell, larger research will help us. But I think
21:35
Speaker 3: if women want to do that, and that wants to
21:38
Speaker 3: be part of the treatment algorithm in terms of thinking
21:41
Speaker 3: about lifestyle and potentially medications or hormones and this, they say,
21:47
Speaker 3: all the power for it. And I see a lot
21:48
Speaker 3: of women in my neighborhood walking with the weighted FST.
21:51
Speaker 3: I'm sure you do too, yes.
21:53
Speaker 2: Yes, well, okay, So to kind of backpedal a little bit,
21:58
Speaker 2: back to the relative energy deficiency in sport, okay, with
22:04
Speaker 2: that being a risk factor when we get post mental puzzle.
22:09
Speaker 2: The bone is is pretty susceptible. It doesn't like not
22:13
Speaker 2: having enough calories.
22:16
Speaker 3: It can yeah, well, especially calcium. So it's interesting. So
22:19
Speaker 3: what happens, you know, again when we have more bone
22:22
Speaker 3: breakdown than bone formation, is the osteoclass outpaced the osteoblast.
22:27
Speaker 3: And then again the sort of think about like if
22:29
Speaker 3: you think about bone as sort of like a like
22:31
Speaker 3: a structure or you know, sort of a lattice structure
22:34
Speaker 3: that you're starting to take out little pieces and then
22:37
Speaker 3: eventually sort of if you take out enough, right, the
22:39
Speaker 3: building collapses when there is less you know, structure there
22:43
Speaker 3: and less calcium particularly you know, that's mineral helping us
22:47
Speaker 3: mineralize and strengthen the bone. That can predispose to you know,
22:50
Speaker 3: to fractures and to again low bone density. So it's interesting,
22:55
Speaker 3: you know, around the time of menopause where some people
22:57
Speaker 3: are taking out like dairy or gluten or for whatever
23:00
Speaker 3: whatever reasons, we actually do need a lot of calcium,
23:03
Speaker 3: you know, we do need more calcium or enough calcium
23:05
Speaker 3: to help maintain the bone strength or help when we
23:08
Speaker 3: have more of that bone turnover. And I think that's
23:10
Speaker 3: something that we don't hear a lot of messages about,
23:13
Speaker 3: but it is important. It doesn't need to be that
23:15
Speaker 3: you're drinking a gallon of milk a day or anything,
23:17
Speaker 3: but getting close to one thousand to twelve hundred milligrams
23:20
Speaker 3: of calcium daily, either through dietary sources, plant based sources,
23:24
Speaker 3: or supplementation is possible, and so I oftentimes you have
23:29
Speaker 3: women think about that at least and oftentimes two calcium
23:32
Speaker 3: rich foods have a lot amount of protein, which is
23:34
Speaker 3: another again thing that we're talking a lot more about.
23:37
Speaker 3: And of course protein is helpful for restoring muscle, and
23:40
Speaker 3: that's so important as we also go through the perimenopaus
23:43
Speaker 3: and menopause, right, we know that there is some muscle
23:45
Speaker 3: loss that happens, you know, slowly through that period of time,
23:48
Speaker 3: but then more precipitously, you know, as we get to
23:51
Speaker 3: the seventieth and eightieth decades of life as well.
23:54
Speaker 2: Well. The statistics are pretty I was going to start
23:58
Speaker 2: with this, but then I got so excited I didn't.
24:00
Speaker 3: Okay, we're backtracking.
24:02
Speaker 2: Every three seconds an osteoporosis related fracture occurs, and once
24:07
Speaker 2: an osteoporosis related fracture occurs, one in five women will
24:10
Speaker 2: refracture in the next five years.
24:12
Speaker 3: Right, right, yep, you did your homework, so sad, Yes, statistic, right,
24:19
Speaker 3: and so and so this is the reason rise so
24:21
Speaker 3: much number. We talked a lot about prevention, like you know,
24:24
Speaker 3: in terms of like knowing your numbers, getting a DEXA,
24:27
Speaker 3: thinking about your calcium, vitamin D, family history, exercise. Potentially again,
24:32
Speaker 3: if you're a candidate for menopausal hormone therapy and you know,
24:37
Speaker 3: we know that that can prevent bone loss. We know
24:39
Speaker 3: that we women who are low absolute risks for fracture
24:42
Speaker 3: within a time period since the menopause without any contradications
24:45
Speaker 3: just has a lot of bone benefits in addition to
24:48
Speaker 3: of course helping with you know, sleep, sexual function, hot flashes,
24:52
Speaker 3: you know, hair, skin, you know, all these other things.
24:56
Speaker 3: But if you do have osteoporosis, like the statistic of
24:59
Speaker 3: if you've had one fracture, you're you know, twenty percent
25:03
Speaker 3: of women will refracture, you know, in the in the
25:05
Speaker 3: years following and probably the first one to two years
25:08
Speaker 3: that the risk is the highest is because whether you know,
25:11
Speaker 3: you're the bone is a little bit destabilized, whether you're
25:13
Speaker 3: at a higher a fall risk, whether we've you know,
25:15
Speaker 3: found that there's a bone mineral density and a bone
25:18
Speaker 3: quality you know, concern there and it's what I do
25:22
Speaker 3: see in clinical practice, right, so it's why we want
25:24
Speaker 3: to prevent the next fracture. And if you have osteoporosis,
25:27
Speaker 3: and if you've had a fracture, we consider that severe
25:30
Speaker 3: osteoporosis and then think about treatment. So then you're you're
25:34
Speaker 3: not just you know, in the realm of you know,
25:36
Speaker 3: let me do some calcium and vitamin D. I mean
25:39
Speaker 3: I I always say to him, that's that's fine, and
25:42
Speaker 3: those are the that's kind of the lowest, you know,
25:44
Speaker 3: that's the thing that we should all be doing. But
25:46
Speaker 3: then we need to really address the problem at hand.
25:48
Speaker 3: Just like if you had a heart attack and we
25:50
Speaker 3: would just say, okay, you know, you know, get out
25:52
Speaker 3: there and do a little bit more walking, right, try
25:55
Speaker 3: not to have another one. You know, we'd say, okay,
25:57
Speaker 3: let's let's really treat this condition. I think sometimes as
25:59
Speaker 3: women and right, unless we can see it and feel it,
26:01
Speaker 3: we don't necessarily do that. But the sequality of a
26:04
Speaker 3: fracture is is pretty life changing, you know, the hip fractures,
26:09
Speaker 3: pelvis fractures, you know, not just you know, disability, but
26:12
Speaker 3: like you know, pain or long term consequences. And I
26:16
Speaker 3: see it day to day and so even vertebral fractures.
26:19
Speaker 3: You know, this can change your height, this can change
26:21
Speaker 3: your vowels. It's these are not just inconsequential. So again
26:24
Speaker 3: it's like take it seriously, find someone that can talk
26:26
Speaker 3: to you about it. Think research your options. There are
26:29
Speaker 3: a lot of great, safe, aft approved effective options to
26:32
Speaker 3: reduce your risk of another fracture. And that's what's again
26:35
Speaker 3: really important. When you've had a fracture, we call that
26:38
Speaker 3: secondary treatment or you know, preventing a secondary frat.
26:41
Speaker 1: And is that when you start the medication or once
26:44
Speaker 1: someone gets you know, a low bone down stay scan,
26:49
Speaker 1: like when do you treat it with medication?
26:51
Speaker 3: Yep? Yeah, so very much like you know many of
26:55
Speaker 3: our other you know things, maybe menapausal hormone therapy is
26:58
Speaker 3: one that we you know, we are starting to think
27:00
Speaker 3: more about, like using us a prevention right of preventing
27:03
Speaker 3: fractures at helping our sleep and our hot flashes and nights.
27:07
Speaker 3: What's before they get you know, so bad that we're like, oh,
27:10
Speaker 3: let's crawl our way back. But for the for osteoporosis,
27:13
Speaker 3: you know, we have large buckets of medications. A couple
27:16
Speaker 3: of the medicines you know, prevent more bone from being lost,
27:20
Speaker 3: so they work on the osteoclast, and then other medicines
27:23
Speaker 3: work to build new bone or form new bone, and
27:25
Speaker 3: then we have one medicine that kind of does both
27:28
Speaker 3: so very much. What we do is we say, okay,
27:30
Speaker 3: like let's look at the DEXA, look at your fracture risk,
27:33
Speaker 3: look at all your clinical variables. You know, do you
27:35
Speaker 3: have any medical history, do you have any aversion to
27:38
Speaker 3: a medication, any reason we couldn't use this, that or
27:40
Speaker 3: the other, and then want to match that fracture risk
27:43
Speaker 3: with the treatment we recommend. So if you're at high
27:45
Speaker 3: very high risk, we want to think about using the
27:47
Speaker 3: medications that are going to improve your bone density the
27:50
Speaker 3: most quickly as and reducing your fracture risk the most
27:54
Speaker 3: effectively and also quickly. Right, So that makes a lot
27:56
Speaker 3: of sense. And so those are you know, some of
27:58
Speaker 3: the bone builders in their name are their brand names
28:01
Speaker 3: are FORTEO and Timlows and a Vanity And then sometimes
28:05
Speaker 3: you know, we also use medications like Prolia, which is
28:09
Speaker 3: an anti resorptive medication or reclass So those are some
28:12
Speaker 3: medicines that are you know, people might hear, you know,
28:15
Speaker 3: sort of discussed. If the risk is lower, then we
28:18
Speaker 3: think about things like hormone therapy or maybe oralis phosphonates
28:22
Speaker 3: or even a medication called reloxaphene or you know those
28:25
Speaker 3: circuit of medications. So it just really depends on where
28:28
Speaker 3: the bonancy is the lowest. Have you had a fracture,
28:31
Speaker 3: Let's look at your obviously preference, you know, all of
28:33
Speaker 3: these things go into.
28:34
Speaker 2: It a whole treatment plan. So all right, GLP ones,
28:41
Speaker 2: So how does this affect if any bone bone health?
28:47
Speaker 3: Yeah, so I think again, like this is such an
28:49
Speaker 3: evolving area. You know, I think that the issue is
28:53
Speaker 3: we you know, we really haven't like done bone mineral densities,
28:58
Speaker 3: you know, routinely right on you know, women and men
29:01
Speaker 3: starting g LP one medications because we didn't really know
29:04
Speaker 3: what we know, like you know, fat loss and you
29:07
Speaker 3: know that can happen, but we didn't really realize what
29:09
Speaker 3: the body composition changes might be. And now I feel
29:12
Speaker 3: like we're understanding. You know, when you lose a fat
29:15
Speaker 3: mass you or you lose you know, weight, you're going
29:17
Speaker 3: to lose both fat bone and you know, you know,
29:20
Speaker 3: muscle potentially if you're not doing things to reverse it,
29:23
Speaker 3: like adequate protein, resistance training, you know, things of that nature.
29:27
Speaker 3: So I think there's a wide variety of what's going
29:30
Speaker 3: on out there, as you probably hear in your landscape too.
29:33
Speaker 3: So there is a potential that you can lose bone
29:35
Speaker 3: mineral density. And we've known that from you know, when
29:38
Speaker 3: we when from bariatric surgery, so you know, prior to
29:42
Speaker 3: bariatric surgery, most you know, individuals get a whole body
29:46
Speaker 3: dexa where they look at their bone mineral density and
29:48
Speaker 3: they get a dexa so they know where they're starting from,
29:52
Speaker 3: and then after that they do it again. So like,
29:55
Speaker 3: potentially that needs to be in our algorithm, it's not yet.
29:59
Speaker 3: I do that personally and I practice. If people are
30:01
Speaker 3: on a JLP one, I check if they've come to
30:03
Speaker 3: me after being on it for six months or a year,
30:05
Speaker 3: I'm like, well, we should, you know, check your bone density.
30:07
Speaker 3: I mean, naturally, those are many women coming to me
30:09
Speaker 3: between forty and sixty anyway, so they're going to get
30:11
Speaker 3: a dexa. But I think that's an important thing. So
30:15
Speaker 3: I think again, time will tell how much bone you know,
30:19
Speaker 3: will be lost. I think it depends on where people
30:22
Speaker 3: are starting from and what they do. I think more
30:26
Speaker 3: we're can be concerned about the muscle loss and the sarcopenia.
30:29
Speaker 3: Uh also that that is a huge, you know concern,
30:34
Speaker 3: especially for long term use, especially as when we know
30:36
Speaker 3: with aging we're going to lose the muscle mass. So
30:39
Speaker 3: I think time will tell, Like I think there's not
30:41
Speaker 3: enough high quality of research to tell us, but there's
30:43
Speaker 3: some theoretical concerns for sure.
30:47
Speaker 2: So then if we are losing and I think that's
30:51
Speaker 2: a major point to reiterate, is that so many women
30:57
Speaker 2: have no idea that if they go on this aggressive
31:01
Speaker 2: or prolonged calorie deficit diet that it can be pulling
31:07
Speaker 2: from bone. Like that just wasn't it. They, at least
31:10
Speaker 2: from from the women that are coming in in my world,
31:13
Speaker 2: there's that they didn't even think that was a thing.
31:16
Speaker 2: And so you know, if we if we keep building
31:19
Speaker 2: and we're building muscle, then we're also working on building
31:23
Speaker 2: bone too.
31:24
Speaker 3: Correct Muscle and bone for sure talk to each other.
31:27
Speaker 3: I mean, I think this is the thing, you know,
31:29
Speaker 3: that we're going to learn more about in the next
31:31
Speaker 3: you know, I would say five years, because there's so
31:34
Speaker 3: much more research and muscle now and like what's contributing
31:37
Speaker 3: to muscle growth and sustaining motherrooals and what exercise do
31:40
Speaker 3: we do that to do that and whether it helps
31:43
Speaker 3: you know, the bone mineral density improve as well, I
31:46
Speaker 3: think what we'll see so, I think we're going to
31:49
Speaker 3: see much more of that you know, coming as well.
31:53
Speaker 3: And I yeah, I think it's really important to think
31:55
Speaker 3: about both. So bone is not just static, it's dynamic
31:59
Speaker 3: and it's changing just like muscle is. And the best
32:01
Speaker 3: way to check it again is the bone mineral density
32:03
Speaker 3: that we have now or the body composition scan that
32:06
Speaker 3: can look at all those three characteristics as well.
32:09
Speaker 2: Okay, so really the DEXA is what's needed, uh as
32:15
Speaker 2: the gold standard. But you know, there's there's there's some
32:19
Speaker 2: different methods out there were some you know skills and
32:22
Speaker 2: embody that can kind of show bone, but that like
32:26
Speaker 2: we we we really don't want to rely on that
32:29
Speaker 2: if we have other options, if women have other options available.
32:33
Speaker 3: Yeah, I think I think you know for sure that
32:36
Speaker 3: there's so, I mean, there's so much out there now. Yes,
32:38
Speaker 3: the inbody can be very helpful. It's an indirect measure,
32:41
Speaker 3: you know, a bioimpedance and looking at the different muscle, fat,
32:44
Speaker 3: and bone. It has a little bit less hydration status
32:48
Speaker 3: is a little bit less impact than it is with
32:49
Speaker 3: the DEXA scan. So you know, ideally you could sometimes
32:53
Speaker 3: say do the Dexa scan in the morning, et cetera.
32:56
Speaker 3: But again, I think, just thinking about it, you're already, like,
32:59
Speaker 3: you know, we've already made a change if you're thinking
33:01
Speaker 3: about or if you're educating your you know, clients or
33:04
Speaker 3: our patients about saying, okay, are you thinking about calcy?
33:07
Speaker 3: Are you thinking about protein? Should you maybe meet with
33:09
Speaker 3: a registered dietitian, what about doing some resistance training? I
33:12
Speaker 3: think this is all you know important, And I think again,
33:16
Speaker 3: just we've known even taken from like you know, if
33:19
Speaker 3: we look at the risk factors for usteoporosis, you know,
33:21
Speaker 3: sedentary lifestyle is one of the risk factors, right because
33:24
Speaker 3: again we're not moving our bone bodies, we're not loading
33:28
Speaker 3: the bone. You know, that's always a concern for me
33:30
Speaker 3: when I think about like young kids on devices. You know,
33:34
Speaker 3: That's why I'm always selling my kids get off their devices.
33:37
Speaker 3: That'll be like probably on my grief, get off your device,
33:39
Speaker 3: go offside and play, because I'm like, oh my god,
33:43
Speaker 3: this is bad for their bones and I think that
33:45
Speaker 3: there's like a lot of the pediatric endochronologists sort of
33:48
Speaker 3: say the same thing. So it affects all of us
33:50
Speaker 3: at all levels, right, not just the menopause women.
33:53
Speaker 2: Yeah, I didn't even think about that. But I have
33:56
Speaker 2: another quote from you.
33:59
Speaker 3: Okay, I love these.
34:00
Speaker 2: I have a bunch of Christi quotes that I'm loving
34:03
Speaker 2: and I hope I don't mess them up or maybe
34:05
Speaker 2: you don't remember saying them, but I love this. What
34:07
Speaker 2: is good for the brain, it's good for the heart,
34:09
Speaker 2: is good for the bones.
34:11
Speaker 3: Yeah. Yeah, so there's so many, so much. I mean,
34:14
Speaker 3: as we do this more and more, right, you probably
34:16
Speaker 3: see so many things are connected, right when we talk
34:19
Speaker 3: to our patients. I mean, I love what I do,
34:22
Speaker 3: and I think, you know, we can help women in
34:24
Speaker 3: so many ways when we think about like pillars of health, right, hormones, sleeve, nutrition, exercise,
34:31
Speaker 3: chronic stress, factors, our medical history. That comes to us
34:35
Speaker 3: just because right, So, but yeah, I think that is
34:39
Speaker 3: you know, when we think that pribaby is taken from
34:41
Speaker 3: when we think about exercise, but also we think about hormones,
34:44
Speaker 3: it's the same application, right, we think about estrogen hormones,
34:48
Speaker 3: particularly again, if you're a candidate for those because I
34:50
Speaker 3: know that there's lots of then out there with estro
34:52
Speaker 3: receptor positive breast cancer, cardiovascular disease, which doesn't mean you
34:55
Speaker 3: can't get any treatment or suffer through whatever symptoms, or osteoporosis.
35:00
Speaker 3: There's lots of options. But right, we do know, right
35:02
Speaker 3: from a lot of our studies, our observational studies, the
35:06
Speaker 3: Women's Health Initiative study that you menopausal hormone therapy helps
35:11
Speaker 3: you know, prevent cardio masters, these helps vent osteoporosis, you know,
35:15
Speaker 3: helps with again you know, sleep quality helped reduce our
35:18
Speaker 3: risk of osteoporosis, relative fracturers, prevented diabetes, you know all
35:23
Speaker 3: of that. So there's you know again, I think it's
35:25
Speaker 3: it's thinking about you know, the individualized you know, risk
35:28
Speaker 3: benefit risk ratio when you're thinking about how to make
35:31
Speaker 3: some of these choices. And I think that's a lot
35:32
Speaker 3: of the guests you've had on have sort of shared
35:35
Speaker 3: the same the same line of thinking.
35:38
Speaker 2: I'm still kind of blown away that only like under
35:42
Speaker 2: ten percent of women are taking hormone therapy given I mean,
35:48
Speaker 2: and I think that's going to change over the next
35:50
Speaker 2: you know, decade.
35:52
Speaker 3: But Wow.
35:52
Speaker 2: Yeah, I mean after all of this, I'm like, really
35:55
Speaker 2: less than ten percent?
35:57
Speaker 3: Yeah, I think, you know. I mean now there's shortages
35:59
Speaker 3: of some of our patches and things like that, so
36:01
Speaker 3: I don't know. I think it's probably exploded. And again
36:05
Speaker 3: I think that you know, there was a pendulum and
36:07
Speaker 3: I think it's coming back more to the middle. And
36:09
Speaker 3: how great that we have more you know, research information,
36:12
Speaker 3: and then we just need more clinicians trained, right, I
36:15
Speaker 3: mean the statistics that you know, even you know, doctor
36:18
Speaker 3: Rachel Rubin you know shared that, you know when she
36:20
Speaker 3: was talking with the FDA, And how little we have
36:22
Speaker 3: you know, prescribing prescribers because the box warning is concerning,
36:27
Speaker 3: or because we don't have consistent messaging because we're not
36:30
Speaker 3: trained to know that, right the residents, the fellows, the
36:33
Speaker 3: medical students. So like elevating that training helps us, all right,
36:36
Speaker 3: So we're saying consistent messages, not that I'll have patients
36:39
Speaker 3: come in and say, well, my intern is said never hormones,
36:42
Speaker 3: like never, I would never, you should never go on hormones,
36:46
Speaker 3: And it's like, where does that come from? Right, There's no,
36:49
Speaker 3: there's no that's a personal opinion. Or is this like
36:51
Speaker 3: based in science. You know, it's like me saying, you know,
36:55
Speaker 3: never go on you know, antidepressants, like what like why
36:58
Speaker 3: would I say that? Like that's a visual choice, right,
37:01
Speaker 3: So I think we need some of those blanket statements
37:03
Speaker 3: to go away. And I'm so proud of you know,
37:05
Speaker 3: all my menopause colleagues and friends that we're all sort
37:08
Speaker 3: of saying some consistent messaging and standing up to the
37:11
Speaker 3: FDA and some of these other powers that be so
37:15
Speaker 3: to really help our patients. It's what we do day in,
37:17
Speaker 3: day out. But it's great to see on like a
37:19
Speaker 3: massive level.
37:21
Speaker 2: Yes, come on America.
37:25
Speaker 1: Good for you guys helping us along.
37:30
Speaker 3: Yeah, it's fun, but you too. I mean I think
37:32
Speaker 3: we all, you know, play our part right, consistent messaging,
37:35
Speaker 3: telling people they could be active, Keith's dating active, give
37:38
Speaker 3: them the tools, it all matters.
37:40
Speaker 2: Yeah. So when we hit like, so the statistic and
37:45
Speaker 2: I might get this wrong, but it's somewhere once you
37:48
Speaker 2: are in the menopause transition, so three years before maybe
37:51
Speaker 2: two to three years after that, you can lose somewhere
37:54
Speaker 2: between seven and twenty percent or something.
37:59
Speaker 3: Correct. Yeah, So again when we mentioned you talked about
38:02
Speaker 3: that that trabecular bone and cortical bone those bone sites.
38:05
Speaker 3: The cortical bone is more in our long bones and
38:08
Speaker 3: on our growing bones like our wrist and our hip,
38:11
Speaker 3: and trabecular bone primarily concentrated in our spine. But yeah,
38:14
Speaker 3: so with the remodeling or that outpacing of the bone,
38:18
Speaker 3: you know, resorption and the bone formation, some women can
38:21
Speaker 3: lose up to twenty percent of their bone masks through
38:23
Speaker 3: that time. Particularly you know women, if you're starting with
38:26
Speaker 3: the low bone density and then you're going through that,
38:29
Speaker 3: you're going to obviously notice the drop more. You know.
38:31
Speaker 3: I use the analogy often of like a bone bank.
38:33
Speaker 3: So if you're starting low and you go through menopause
38:36
Speaker 3: and you're gonna you know, you're going to you know,
38:38
Speaker 3: do some more you know, take you know, deposit air
38:40
Speaker 3: deaficing from your bone density, then you're going to end
38:43
Speaker 3: up with lower bone mass. Right, It just makes sense
38:46
Speaker 3: right when we look at the equation. So so yeah,
38:49
Speaker 3: so it's even more important, right why you want to
38:51
Speaker 3: know your bone mass, you know, from the start ish
38:53
Speaker 3: or your risk factors and then where you might end
38:56
Speaker 3: up because I know the times where I see women
38:59
Speaker 3: who are like sixty two, sixty three and that's their
39:02
Speaker 3: first decks or sixty five and they're very you know,
39:05
Speaker 3: frustrated that they have osteoporosis. It's like, well, you know,
39:09
Speaker 3: we just you know, the medical system failed you, right,
39:12
Speaker 3: we just didn't do the deck soon enough. We didn't
39:14
Speaker 3: capture this. It's like if we did a cholesterol after
39:16
Speaker 3: your heart attack and showed that your cholesterol was two
39:19
Speaker 3: fifty and we could have prevented something. So again it's
39:22
Speaker 3: like knowing or you know, knowing earlier always helpful, right,
39:26
Speaker 3: you know, getting ahead of these curves is always helpful.
39:28
Speaker 3: And if you do have osteoporosis, then treating it and
39:30
Speaker 3: I always say not being scared to treat it. Medicine
39:32
Speaker 3: is not you know, a failure. You know, it's like, okay,
39:35
Speaker 3: it's actually it could be preventing a fracture if you
39:38
Speaker 3: haven't had one, or preventing a second fracture. So I
39:40
Speaker 3: think sometimes we think it's a failure if we have
39:42
Speaker 3: to try something or do something. Maybe something this is
39:45
Speaker 3: more of my patients or in the natural you know
39:47
Speaker 3: approach versus the maximalist approach. But there's many ways to
39:51
Speaker 3: come to a conclusion. Where you feel safe and comfortable
39:53
Speaker 3: treating your osteoporosis, whether it's hormones or medications obviously including lifestyle, calcium,
39:57
Speaker 3: vitamin D in all of those things. So I always say,
40:00
Speaker 3: it's not a failure right to treat the osteoporosis it's getting. Actually,
40:03
Speaker 3: it's treating a condition that you would have a sequalite
40:07
Speaker 3: from if you didn't. And it's a tough one though.
40:09
Speaker 3: It's a tough one because I think sometimes that we think, oh,
40:12
Speaker 3: it's aging and it's a older women's disease. But you know,
40:15
Speaker 3: when we look at the statistics, like you know, they
40:18
Speaker 3: think about fourteen percent of women have a diagnosed of
40:21
Speaker 3: osteoporosis between forty between fifty and fifty nine. Listen, like
40:25
Speaker 3: twenty to thirty percent when you're sixty to seven, you know,
40:28
Speaker 3: sixty to seventy. So that's a large majority of women.
40:31
Speaker 3: It's a large percentage, right, So you're with it. You're
40:34
Speaker 3: with you know, So it's not like this is so uncommon.
40:37
Speaker 3: And again the soquality we're trying to prevent us that
40:40
Speaker 3: is that fracture.
40:42
Speaker 2: So for for osteopenia, if somebody comes in with with
40:46
Speaker 2: low bone mass, is that what it's called.
40:48
Speaker 3: Now it is, You've got it right.
40:50
Speaker 2: So like the negative one is like just the like
40:54
Speaker 2: the start of osteo like a very yeah minus one
40:57
Speaker 2: point one or minus yeah, minus one point one to
41:00
Speaker 2: minus two point four on that deck set.
41:02
Speaker 3: It's done correctly at one of the clinical sites like
41:05
Speaker 3: the spine or the or the femeral neck or the
41:08
Speaker 3: hip is osteopenia. Yes, And sometimes there's something called the
41:12
Speaker 3: trabecular bone score, which is a bone marker of like
41:16
Speaker 3: bone micro architecture or you could say like bone quality
41:19
Speaker 3: or how well your bone is organized. Sometimes that can
41:21
Speaker 3: also push us in one direction or the other.
41:24
Speaker 2: Oh okay, good to know. So if somebody comes in
41:27
Speaker 2: with that, say negative one point one, and they do
41:32
Speaker 2: nothing over say one to two years, while they might
41:37
Speaker 2: have just gone through metopause and they have you know,
41:39
Speaker 2: one to two years where you might have this window
41:43
Speaker 2: I don't know if windows the right word, but if
41:46
Speaker 2: you do nothing, no treatment, no exercise, nothing, how like,
41:52
Speaker 2: is there an average of a percent of how the
41:56
Speaker 2: bone would change?
41:57
Speaker 3: Yeah? So again, like when we I think around you
42:00
Speaker 3: gave the example around the time of like menopause, so
42:03
Speaker 3: that woman could lose you know, again, on average in
42:06
Speaker 3: the spine seven to ten percent of their herbon den
42:10
Speaker 3: see the largest is probably about twenty percent. We do
42:13
Speaker 3: know that there's some like age related losses like ABS.
42:15
Speaker 3: We get further from the time of menopause, which can
42:18
Speaker 3: be about a half a percent a bone loss a year, right,
42:22
Speaker 3: So that could be I call that kind of like
42:24
Speaker 3: the trickle down approach. So like women who like have
42:26
Speaker 3: a lostiopedia for like fifteen years and eventually they're going
42:30
Speaker 3: to maybe develop osteoporosis. But it's also where like if
42:33
Speaker 3: you know they're vitamin D or calcium deficient, that might
42:36
Speaker 3: speed up the process of bone loss. Or let's say,
42:39
Speaker 3: you know, if there's medications like an aromatase inhibitor, if
42:42
Speaker 3: you have a breast cancer diagnosis or a stere you know,
42:45
Speaker 3: multiple steroids either injections or taken orally if you need
42:49
Speaker 3: to use them for a certain condition like a rubetologic
42:51
Speaker 3: or autommune condition, that might speed up you know, bone loss.
42:55
Speaker 3: And then if we see you know, a recheck ADEXA
42:58
Speaker 3: in two or three years and you've had war bone
43:00
Speaker 3: density loss, then maybe we would expect that means we
43:03
Speaker 3: have to put on our thinking caps and say why
43:06
Speaker 3: is this? Is it a calcium, is it a vitamin D?
43:08
Speaker 3: Is it a metabolic bone? Reason? Right, that's mostly what
43:11
Speaker 3: I spend most of my day doing. You know that.
43:14
Speaker 3: You know that we're having a change in the bone
43:15
Speaker 3: densy or is it hormonal or is it age related?
43:18
Speaker 3: You know that sort of thing. But when you say
43:20
Speaker 3: do nothing, it's always hard because many no one does
43:23
Speaker 3: nothing right because most people are like, Okay, I'm going
43:25
Speaker 3: to try and get some calcium, or I'm going to
43:27
Speaker 3: get my vitamin D up or I know I need
43:30
Speaker 3: to be doing some exercise. I hear that often, but
43:34
Speaker 3: you know, what do I do? So? I think the
43:35
Speaker 3: most important message from your question is that like that
43:37
Speaker 3: we re rescan. If we do get like a osteopenia
43:42
Speaker 3: or an osteoporos we rescan. And if you get a
43:45
Speaker 3: normal DEXA and you're forty five, then I would say
43:47
Speaker 3: you're good for at least until the time of metopause,
43:50
Speaker 3: like around if that's fifty to fifty one for on average.
43:53
Speaker 3: If it's earlier, we do we could recheck. But if
43:55
Speaker 3: it's later, great, But we are we are feeling like
43:57
Speaker 3: we're in a good safety net.
43:59
Speaker 1: There are there any other supplements besides vitamin D and
44:04
Speaker 1: calcium that you recommend to your patients.
44:07
Speaker 3: Yeah, so this is when great questions. So you know,
44:11
Speaker 3: adequate calcium, Vitamin D really important. Vitamin D we can
44:14
Speaker 3: check on a blood test. Calcium we really can't. There
44:18
Speaker 3: is something called the twenty four hour you're in calcium
44:20
Speaker 3: collection that sometimes we do if we're if we again
44:24
Speaker 3: want to work out an osteoporosis diagnosis to make sure
44:27
Speaker 3: that there's no like problems absorbing calcium or hyper excretion
44:31
Speaker 3: of calcium. So there's some two extremes there, so you
44:34
Speaker 3: might be asked to do that testing and that's some
44:36
Speaker 3: part important. And then in terms of like you know
44:39
Speaker 3: again adequate protein probably important again because that muscle bone crosstalk.
44:45
Speaker 3: We know, you know, certain things like potentially there is
44:49
Speaker 3: where like again, there's a lot of potential things like
44:51
Speaker 3: maybe collagen. There's some small research you know that shows
44:55
Speaker 3: that collagen might be helpful. Our bones are made up
44:58
Speaker 3: of collagen. Whether ingesting collagen and helps our bones is
45:02
Speaker 3: a question mark, but there's some small evidence you know
45:05
Speaker 3: to that. To that standpoint, things like heavy metals like
45:09
Speaker 3: strontium and boron. Again, they've been studied, but there I
45:14
Speaker 3: see in my mind more you know, risk than benefit
45:16
Speaker 3: for those those are heavy metals, they deposit in the liver.
45:20
Speaker 3: They call some GI side effects, so I don't recommend
45:22
Speaker 3: those routinely. So again it's mostly you know, calcium, vitamin
45:27
Speaker 3: D again talking that takes up a lot alliance share
45:31
Speaker 3: of you know, what we think about in the in
45:33
Speaker 3: the bone. Sometimes vitamin K two can be helpful if
45:37
Speaker 3: people are not getting a lot of that in their diets.
45:39
Speaker 3: So there's some benefit that vitamin K two can help
45:42
Speaker 3: support the bone cell, the bone forming cells. So these
45:45
Speaker 3: are small things. I say, sure, we can add the
45:46
Speaker 3: K two, and we can add the vitamin D and
45:49
Speaker 3: the calcium and the and the collagen if you want.
45:52
Speaker 3: There's some studies on prunes. I know, the study is
45:54
Speaker 3: very like out there that you know, six to nine
45:57
Speaker 3: prunes a day might help the bone tensity. So again,
46:00
Speaker 3: and this is the like, if we're thinking, like let's
46:01
Speaker 3: do the kitchen sink approach, we can add some of
46:03
Speaker 3: these you know, small things that might make a little
46:06
Speaker 3: bit of a you know, a benefit. So those are
46:09
Speaker 3: the things that I think.
46:10
Speaker 1: About, and those are things that aren't going to hurt
46:12
Speaker 1: just out. So even if a friend you're not benefiting
46:15
Speaker 1: per se, like with your bone, it's going to add something. Right.
46:21
Speaker 3: There's even research now going on, like you know creatine, Right,
46:24
Speaker 3: will that help the bone? I mean it helps the
46:25
Speaker 3: must a little bit. Again, so will it help the
46:27
Speaker 3: bone mineral density a little bit? Potentially? That's the same thing.
46:31
Speaker 3: So I say, okay, if these are the things that
46:33
Speaker 3: we want to like be adding, if you're not like
46:35
Speaker 3: they're not hurting, But again, is it another thing we
46:38
Speaker 3: want to make sure that Again, if it's a supplement,
46:39
Speaker 3: we're getting a third party tested supplement, we're checking for
46:42
Speaker 3: you know, the purity. All these things are also important, right,
46:46
Speaker 3: and then the cost that comes along with it. So
46:48
Speaker 3: I think, again, like the a lot of the times,
46:51
Speaker 3: it is a little bit individuals. What are you doing?
46:52
Speaker 3: What do you want to add? How much do we
46:54
Speaker 3: want to you know, think about these It's sort of
46:57
Speaker 3: what I would say supplemental things.
47:00
Speaker 2: Is there an area if we look at we know
47:02
Speaker 2: that we get the wrist, the lumbar, the hip, and
47:09
Speaker 2: the femoral head. Is there one I mean, none of
47:13
Speaker 2: them are great, but if you is there one that's worse.
47:16
Speaker 2: If you're like, this is more of a problem than
47:19
Speaker 2: the others.
47:20
Speaker 3: Yeah, that's a good question. So what we see a
47:24
Speaker 3: lot in the menopause, you know, is we might see
47:26
Speaker 3: like a lower spine bone density, and again potentially our
47:30
Speaker 3: lower peak bone mass might be more reflected in that
47:32
Speaker 3: trabecular bone, so in our spine or if there's a
47:34
Speaker 3: lot of bone turnover going on. But when we look
47:37
Speaker 3: at like big ticket item, I would say, you know,
47:40
Speaker 3: what you're asking me is if your bone mineral density
47:43
Speaker 3: you know, is low like minus two point five or
47:46
Speaker 3: lower really at any age, we know that that's a
47:49
Speaker 3: very strong predictor of a hip fracture. So again, the
47:53
Speaker 3: lower the bone density, think about it as more like
47:55
Speaker 3: you know, fragile or thinner bones, bone micro arctucture being compromised,
47:59
Speaker 3: you're higher risk for having a hip fracture, and that
48:02
Speaker 3: just increases as we age. Right, So you know, I'm
48:05
Speaker 3: less concerned. Maybe someone is I concern in a different way.
48:09
Speaker 3: Let's put it this way. If someone who is fifty,
48:12
Speaker 3: you know, fifty two, Let's say you know, postmenopausal and
48:14
Speaker 3: is fifty two, as a hip a T score of
48:17
Speaker 3: minus two point five in her hip versus someone who's
48:20
Speaker 3: maybe seventy five and has a minus three point one
48:23
Speaker 3: in her in her hip because she's older, more likely
48:27
Speaker 3: to fracture, maybe have other medical conditions and break a
48:30
Speaker 3: hip and then have the sequality of you know, not
48:33
Speaker 3: being able to walk or be live independently or things
48:36
Speaker 3: of that nature. Versus someone who's fifty. I'm saying, Wow,
48:39
Speaker 3: your bondency is low to start, and if we do
48:42
Speaker 3: our math, you're going to live for another thirty years,
48:46
Speaker 3: because that's on average how long we know women are living,
48:49
Speaker 3: particularly if there's no other competing you know, risk factors there.
48:52
Speaker 3: So I'm also saying, wow, we've got a long way
48:55
Speaker 3: to go, and we don't want you to lose this bondency.
48:57
Speaker 3: We have to do something to either build your bondency
48:59
Speaker 3: or be to maintain it over a period of time.
49:01
Speaker 3: But this isn't just what I'm saying. This is also
49:04
Speaker 3: our clinical guidelines that say that there is a correlation
49:08
Speaker 3: with your risk of a fracture and your t score
49:13
Speaker 3: your hip, and then if you're treated for osteophorosis, there's
49:16
Speaker 3: also a correlation that you'll fracture your hip less So
49:18
Speaker 3: we call that on treatment T score also correlates with
49:22
Speaker 3: reducing your risk of a fracture. So there's there's a
49:24
Speaker 3: catch twenty two there.
49:26
Speaker 2: Wow, So what would be the top maybe two to
49:31
Speaker 2: three labs or assessments that you would recommend women, you know,
49:37
Speaker 2: get the screenings that they should ask their physician for sure.
49:42
Speaker 3: So first, you know, I think you guys are becoming
49:44
Speaker 3: like bone heads. You're having excell bone help, so your
49:48
Speaker 3: minds are blown. I can see for sure. We talked
49:52
Speaker 3: about the DEXA a lot, so again, find a place
49:54
Speaker 3: you can get a dexa, ask your you know, guide
49:56
Speaker 3: to coologist, intern as specialists, you know, whoever to get
50:00
Speaker 3: a dexa. Checking your vitamin D you know, very easy. Also,
50:04
Speaker 3: making sure your cerrum twenty five hydroxy vitamin D is
50:07
Speaker 3: being checked important Again, there's no easy way to do
50:11
Speaker 3: calcium assessment, but thinking about the calcium in your diet,
50:14
Speaker 3: the quality of the calcium you know in your diet
50:16
Speaker 3: very important. You know. If ADEXA is not freely accessible,
50:21
Speaker 3: there is an online fracture risk tool called the FRAC score,
50:25
Speaker 3: which is again you can google fracts f R A
50:28
Speaker 3: X and that can tell you putting in your your
50:31
Speaker 3: you know, your age and your height and your weight
50:33
Speaker 3: and some of the other variables we assess for fracture
50:36
Speaker 3: risks can be something that you can do or even
50:37
Speaker 3: bring that to your you know, clinician to talk about
50:40
Speaker 3: bone health and oh maybe my risk is a little
50:42
Speaker 3: bit higher, or maybe I want to kind of talk
50:44
Speaker 3: about this, or what do you know about this? I
50:46
Speaker 3: think that's really important. And of course I see so
50:49
Speaker 3: many women from all the decades, so I think, just again,
50:52
Speaker 3: when you say, what one thing I would say, you know,
50:55
Speaker 3: talking about your menopause symptoms or have being asked about
50:59
Speaker 3: like how are you period's going? What symptoms are you
51:01
Speaker 3: noticing when you're between forty and fifty five, sixty seventy?
51:05
Speaker 3: You know, these are all important things to being asked.
51:08
Speaker 3: Now we're finally able to recognize some of these, you know,
51:11
Speaker 3: the myriad of symptoms, and everyone's symptoms are a little different.
51:14
Speaker 3: But being asked like what's new, what's changed? You know,
51:17
Speaker 3: what could we correlate to maybe hormones? I think is
51:19
Speaker 3: hugely important.
51:21
Speaker 2: Yeah, I mean, wow, I have I have so much
51:25
Speaker 2: more on my list. I'm really I'm really more almost.
51:29
Speaker 3: Yeah, no, yes, I know, I know, but I think
51:33
Speaker 3: it's been I think we've hit a lot of great topics. Really,
51:35
Speaker 3: it's a lot of the highlights. So that's good too. Okay.
51:39
Speaker 2: So on a closing note, if you could wave a
51:44
Speaker 2: magic wand and have every woman forty plus understand one
51:48
Speaker 2: thing about her health, what would it be?
51:51
Speaker 3: Okay, Well, I'm in of course tailor this to like,
51:53
Speaker 3: you know, bone health, because again bone and body women's
51:56
Speaker 3: sell this is important. And I think again an area
51:59
Speaker 3: like you mentioned, even the outset that is getting a
52:02
Speaker 3: little bit more traction right both, you know, I think
52:04
Speaker 3: we've talked about contraceptives, and we're learning more about menopause,
52:08
Speaker 3: and there's so many areas within menopause, you know, thinking
52:11
Speaker 3: about you know, sexual health, thinking about you know, cognition,
52:15
Speaker 3: thinking about sleep, thinking about the musco sell little symptoms.
52:19
Speaker 3: I mean, I would bucket osteoporosis are throughout you know,
52:22
Speaker 3: joy nakes and pains, muscle changes, all of that is
52:26
Speaker 3: in that bucket, which I think is great because there's
52:29
Speaker 3: more identification on that. So I mean, I think if
52:32
Speaker 3: I could wave a magic wand, I think we've we've
52:35
Speaker 3: talked a lot about it is to like know you're
52:37
Speaker 3: you know, think about bone health, you know, before it's
52:40
Speaker 3: too late. So whether that's a DEXA or a fracture
52:43
Speaker 3: risk assessment, or say yeah, I need to be doing
52:46
Speaker 3: some resistance training. I need to know. Ask my mom,
52:49
Speaker 3: you have osteoporosis, you know, thinking about those those things,
52:53
Speaker 3: and I think, again, it touches. It's not just in
52:56
Speaker 3: a silo, right, it touches a lot of the other
52:59
Speaker 3: parts of the thing that we're talking about before we
53:01
Speaker 3: hit menopause and after. So that's what I would say.
53:05
Speaker 2: Well, I am I'm gonna go look at the fracks test, okay,
53:11
Speaker 2: and I'm gonna go a DEXA. I mean I was
53:15
Speaker 2: waiting a couple I mean, I'm almost forty eight, so
53:18
Speaker 2: I'm not too far away from from, you know, menopause,
53:24
Speaker 2: so it's a coming. So I don't know why I
53:29
Speaker 2: was thinking that I would just wait because, yeah.
53:32
Speaker 3: Let me know your results. Oh I'm curious. That was
53:35
Speaker 3: like a I mean, is it right? I mean again,
53:38
Speaker 3: I think for anything, you know, sometimes we get people.
53:41
Speaker 3: It's nice to get. Also, let's I'm assuming. I'm just
53:44
Speaker 3: assuming here's this bone densis being normal because you're a strong,
53:47
Speaker 3: fit woman. But who knows but it's also if it's normal,
53:49
Speaker 3: it's like reassuring. I'm like great. Sometimes it's like I
53:52
Speaker 3: love i love telling people they're bone density is strong.
53:55
Speaker 3: I'm like, great news. I give them a smiley face.
53:57
Speaker 3: I'm like, this is amazing. Keep doing you're doing either
54:01
Speaker 3: hit the genetic jackpot and you're doing the right thing.
54:04
Speaker 3: So it's also good to get good information sometimes or
54:07
Speaker 3: or or information that helps guide us or push us
54:10
Speaker 3: on the right path. Right, it's not all I think
54:12
Speaker 3: sometimes we came for the doctor. It's all doom and gloom. Right,
54:14
Speaker 3: it's like, oh, great, tell me my cholesterols. Either tell
54:17
Speaker 3: me this, that and the other. It's sometimes it could
54:20
Speaker 3: be positive, but I think that's like you know again, also,
54:23
Speaker 3: or it can be enlightening, let's put it that way.
54:26
Speaker 2: Yes, absolutely well, doctor dysopri thank you so much for
54:31
Speaker 2: spending your time. I know it's the end of the
54:33
Speaker 2: day for you. So thank you for sharing, sharing all
54:38
Speaker 2: of your wisdom and education with us. Where can women
54:41
Speaker 2: find you?
54:43
Speaker 3: Yeah? Great? Of course this is my pleasure too. So yeah,
54:47
Speaker 3: so I am. I have a website, Bone and Body
54:50
Speaker 3: Women's Hell. That's my practice, and you can you know,
54:53
Speaker 3: find that I do some social media, more is hopefully coming.
54:58
Speaker 3: I'm a busy practicing clinician, so I do a lot
55:00
Speaker 3: of teaching and educating. I have some of those on
55:03
Speaker 3: my website and looking forward to sharing this podcast with
55:06
Speaker 3: my members and I see patients in Illinois. I also
55:09
Speaker 3: have a Florida telehealth license. I do do some educational
55:13
Speaker 3: consults as well, so yeah, you can find me there.
55:16
Speaker 2: Great, Well, you'll have to get in Colorado and Utah,
55:20
Speaker 2: so Lauren.
55:20
Speaker 3: And I can. Okay, I know, maybe for my retirement
55:24
Speaker 3: a bunch of years away down the road, but I
55:26
Speaker 3: the mountains are calling and E're beautiful there.
55:29
Speaker 2: Yes, well, thank you so much, Christy, and we will
55:32
Speaker 2: definitely keep keep doing what you're doing, and we will
55:37
Speaker 2: definitely keep following you for up to date advice and
55:41
Speaker 2: evidence based information. So thank you for sharing your.
55:44
Speaker 3: Time with us. Oh you're welcome. Thank you, thanks for listening.
55:47
Speaker 2: Everyone.
55:48
Speaker 1: If you enjoyed this episode, so youase consider giving us
55:51
Speaker 1: a five star rating and sharing the body Pod with
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Speaker 1: your friends.