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Strong Bones, Strong Future: Prevent and Treat Osteoporosis · Bryan Health Podcasts

• 0:03
  Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.
• 0:05
  I'm Melanie Cole.
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  And today we're talking about bone health, and specifically osteoporosis.
• 0:11
  Joining me today is Kelsey Baxa.
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  She's a family nurse practitioner at the Bone Health Clinic at
• 0:17
  Crete Area Medical Center.
• 0:19
  Kelsey, thank you so much for joining us today.
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  Tell us, what is osteoporosis?
• 0:25
  What is that term we hear, osteopenia?
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  And what's the difference between the two?
• 0:31
  Kelsey Baxa: Hi, Melanie.
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  Thanks for having me.
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  So, osteoporosis is something that can affect women and men.
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  However, women are more likely to get osteoporosis just based on physiology.
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  So, it's something I'm very passionate about explaining
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  and educating my patients on.
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  Osteoporosis is a natural aging process.
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  Our bone doesn't turn over as quickly as it did when we were younger,
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  especially after we go through menopause, after we lose some of
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  those estrogen hormones, mostly in our probably late 40s to early 50s.
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  So, I think a lot of us don't really think about how important it is to
• 1:16
  go ahead and start thinking about our bone health when we're young.
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  But that's something that I try to teach my patients about.
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  So, osteoporosis can be diagnosed three different ways.
• 1:29
  One, by a DEXA scan, which is by far the most common.
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  A DEXA scan is similar to an X-ray.
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  We take pictures of your lumbar spine, your hip, and occasionally your forearm.
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  And we measure your bone density based on something called T-scores.
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  So, in my mind, T-scores are what our bone density looks like compared to
• 1:53
  an average 30-year-old that is our base or that's when our bone density
• 1:58
  actually peaks is at about age 30.
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  And so, we're comparing our bone density now to our peak bone density to see
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  how much it's changed or declined.
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  Once we have your T-scores, I review those in detail or your provider
• 2:14
  can review those in detail with you.
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  But osteoporosis is a T-score of -2.5
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  or lower.
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  And at that point, I would consider prescription treatment.
• 2:27
  Osteopenia is kind of "pre-osteoporosis end."
• 2:33
  we want to make sure that we're kind of looking into this and that we're
• 2:36
  trying to do something about it.
• 2:39
  Osteopenia is basically eventually going to transition
• 2:43
  to osteoporosis at some point.
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  And so, it's not a bad idea to go ahead and get a DEXA scan and
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  do that maybe before you're 50.
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  Try to have a baseline scan at maybe age 40 or 45.
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  And knowledge is power, right?
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  So the more we know about what our T-scores are doing, the
• 3:02
  earlier we can start identifying those trends and treating.
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  Melanie Cole, MS: Well, thank you so much for that explanation of
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  the difference between those two.
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  So, tell us how common this is.
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  You mentioned just a little bit about it in men and women,
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  and it's more common in women.
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  But what do we know about the prevalence between men and women?
• 3:21
  Kelsey Baxa: We know that one in two women over age 50 are going to get osteoporosis
• 3:27
  and suffer some sort of a fracture.
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  So, it's very prevalent.
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  About one in four men over age 50 are going to sustain osteoporosis
• 3:36
  or a fracture at some point as well.
• 3:38
  Melanie Cole, MS: Wow.
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  Those are really interesting statistics.
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  So complications, you just mentioned fracture.
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  So, what does that mean?
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  Tell us a little bit about those complications, the fractures, the
• 3:49
  posture, the things that happen to us if we develop osteoporosis.
• 3:55
  Kelsey Baxa: So, if we develop osteoporosis, it doesn't only
• 3:59
  put us at risk for fracture, but it also affects our posture.
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  And so, we can develop something called kyphosis, the hunched over look.
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  And that actually has its own complications if it's bad enough.
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  It can sure affect breathing.
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  It could even affect swallowing.
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  But honestly, I think that the most important thing here is just
• 4:22
  understanding that there's other complications besides fractures.
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  So, it can affect your quality of life.
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  I really think it's important to think about how do you want to age.
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  Do you want to age in your home or do you want to age,
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  unfortunately, in a skilled facility?
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  Some people don't make it back home after a hip fracture.
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  So, lots of complications.
• 4:44
  Melanie Cole, MS: Yes, that's true.
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  We haven't really talked a little bit about causes.
• 4:49
  So, tell us how we get this.
• 4:53
  Kelsey Baxa: So yeah, there's a lot of risk factors that we want to think
• 4:57
  about when we're one-on-one talking with patients about osteoporosis.
• 5:01
  But the most blatantly obvious for women is, actually when
• 5:05
  you go through menopause.
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  If you needed to have a hysterectomy early, possibly because of anemia or
• 5:11
  chronic bleeding, that puts you at risk.
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  The general aging process, again, we're probably all at some point
• 5:19
  going to get some thinning.
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  But family history is a huge one.
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  So, if you have a first-degree relative with a hip fracture, that puts you
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  at high risk for having osteoporosis.
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  Being petite and not having a lot of body mass can put you at risk
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  for osteoporosis, also for fracture.
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  And then, height, so height loss.
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  If you are someone who's lost more than two inches, since your peak height,
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  all of those things kind of put you at risk for the diagnosis of osteoporosis.
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  Other things include hyperparathyroidism, more of a secondary cause.
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  So, there's actually something going on where your calcium
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  levels are not normal in the blood because of a hormonal condition.
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  And some patients who have kidney stones or maybe high calcium in
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  their urine also are at risk.
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  So, those are things that I think it's important to look at when we're
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  trying to diagnose osteoporosis.
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  Melanie Cole, MS: We're going to talk about treatment options from you.
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  But what can we do as we're thinking about, you know, our futures?
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  Maybe when we're younger and we can start doing some of these things, or as we get
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  close to perimenopause and menopause, what are some things that we can do
• 6:32
  that can maybe slow the process down?
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  Kelsey Baxa: I think this is something that we can try to
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  prevent or we can slow down.
• 6:39
  I think the most important nutritional items that we can do
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  to kind of keep our bone health in check is vitamin D and calcium.
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  I think of them as the nutrition of our bones.
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  Almost all of us in the Midwest are going to be low in vitamin D.
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  So, I typically order a vitamin D.
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  And I would encourage patients to get a serum vitamin D level
• 7:03
  done and just see where that's at.
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  Now, each dose for each person is going to be maybe a little different
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  based on what your serum vitamin D is, but most of us in the Midwest
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  are going to be considered low.
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  calcium is another really important item for bone health.
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  I try to encourage my patients to get calcium through their diet if possible.
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  Most women over 50 are going to need about 1,200 milligrams of calcium a day.
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  You can only absorb 600 milligrams at a time though, so taking
• 7:35
  two calcium supplements at once is not usually helpful.
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  It's not harmful, but you're not going to get everything out of that.
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  So, dietary first and then supplement second.
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  Other items that have been like popular or are being studied right now are vitamin
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  K, which helps the absorption of calcium.
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  There's still studies being done.
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  They're coming out with more information about how helpful
• 8:00
  that can be for bone health.
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  Melanie Cole, MS: Wow, that's really great information.
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  That's cool to hear about some of the studies and what they're looking
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  at for this because it is such a prevalent problem, as you said.
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  So now, when you think of treatment options for us, we hear about
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  these medications and things in the media and commercials.
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  And tell us a little bit about some of the treatment options that you offer
• 8:23
  Kelsey Baxa: Sure.
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  So, I think it's really important to try to treat osteoporosis from
• 8:29
  not just a medication standpoint, but also make sure that we're
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  utilizing other options that are non-pharmacological or not prescription.
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  So, I really encourage my patients if they're willing, I think it's great
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  to get into an exercise program.
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  It doesn't have to be anything too crazy, but really just we want
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  to use our bodies as resistance.
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  So, things like Tai Chi, yoga, walking, swim.
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  I also encourage my patients to go through a course of physical therapy
• 9:01
  to work on balance and gait training and just to make sure that they know
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  what puts them at risk for fall.
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  So, those are things that anybody can do.
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  You know, you don't need to be on a prescription to do those things.
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  But in terms of prescription medicines, there's a couple of
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  different classes of medicines.
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  I would typically recommend someone in the pre-osteoporosis or osteopenia range,
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  maybe we start with something more of like a tablet, like a Boniva or a Fosamax.
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  And those medications have studies that show that they increase lumbar
• 9:38
  spine bone density, and they reduce your risk of a lumbar spine fractures.
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  So for patients though who have already suffered a fracture or are
• 9:48
  at high risk for osteoporosis, more studies are coming out saying that
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  high-risk patients should be started on a medication in the anabolic class.
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  So, those medications are injections, but what they do is they help
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  build our bone density up to as high as we can try to get it.
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  And then, we want to keep those gains that we made with other medications,
• 10:14
  Melanie Cole, MS: Well, you've given us so much great information.
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  Kelsey, tell us a little bit about how you schedule with the bone clinic
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  or to discuss all the things you've talked about here with us today,
• 10:25
  you know, to discuss that screening with your primary provider with you.
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  Tell us a little bit about how we schedule and your best advice for people
• 10:34
  looking to learn more about osteoporosis.
• 10:37
  Kelsey Baxa: You can schedule an appointment at the bone clinic at
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  Crete Area Medical Center on your own.
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  You can call and tell the schedulers you want to be scheduled
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  for a bone clinic appointment.
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  And at that point, you would see myself and we would view your DEXA
• 10:54
  in detail, view your history in detail, and I would educate you about
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  what I think your best options were.
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  However, if you're trying to get scheduled or talk with your primary
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  provider, I think it's just important to speak up and let them know that you're
• 11:09
  interested in talking about bone health.
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  Oftentimes, we get so wrapped up in other items like blood pressure and diabetes
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  that I feel like this gets missed.
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  And so, it's okay to be your own advocate and ask your provider to
• 11:23
  go ahead and discuss this with you.
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  Melanie Cole, MS: That is such great advice, Kelsey.
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  If we don't take care of ourselves, we can't take care of the ones that we love.
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  So gosh, what great advice you gave us.
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  Thank you so much.
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  And I'd also like to thank our Bryan Foundation partner,
• 11:38
  Inpatient Physician Associates.
• 11:40
  To listen to more podcasts from our experts, please visit
• 11:43
  bryanhealth.org/podcasts.
• 11:45
  That concludes this episode of Bryan Health Podcast.
• 11:48
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• 11:56
  Until next time, I'm Melanie Cole.