Latest / Clearly Hormonal / Ep 23: Bone Health 101: What Every Woman Should Know

Transcript

Ep 23: Bone Health 101: What Every Woman Should Know · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:07
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:31
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:41
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:46
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:55
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:57
  Dr. Komal Patil-Sisodia: Today we are starting a three part series, all about your bones.
• 1:01
  Dr. Komal Patil-Sisodia: Yes, those silent, sturdy structures that are holding you upright and you might not be thinking about, you might not be thinking about them much, but they really do matter more than you realize.
• 1:11
  Dr. Komal Patil-Sisodia: And here's why this episode is so important.
• 1:14
  Dr. Komal Patil-Sisodia: One in two women over the age of 50 will experience a fracture due to osteoporosis, but that doesn't have to be your story.
• 1:23
  Dr. Komal Patil-Sisodia: While that is a powerful statistic, it is also a preventable one, and you have the power to take action before the fracture occurs.
• 1:30
  Dr. Komal Patil-Sisodia: That's what today's episode is all about.
• 1:32
  Dr. Komal Patil-Sisodia: So let's dig in and talk about your bones first.
• 1:36
  Dr. Komal Patil-Sisodia: Bones are built like your homes, so I want you to think about your bones, like your favorite home renovation show.
• 1:44
  Dr. Komal Patil-Sisodia: My favorite show is Fixer Upper and has been for a long time.
• 1:46
  Dr. Komal Patil-Sisodia: I love Chip and Joanna Gaines.
• 1:48
  Dr. Komal Patil-Sisodia: I think they're so funny and relatable.
• 1:51
  Dr. Komal Patil-Sisodia: Unfortunately, when I was younger, I really loved Trading Spaces, and I think that show made me somewhat delusional.
• 1:57
  Dr. Komal Patil-Sisodia: When I was in my intern year, I decided to try and paint my apartment.
• 2:00
  Dr. Komal Patil-Sisodia: I ended up picking what I thought were red and beige and they ended up being red and yellow.
• 2:05
  Dr. Komal Patil-Sisodia: And my apartment looked like a McDonald's.
• 2:08
  Dr. Komal Patil-Sisodia: It's really important for people who are remodeling homes, obviously, to know what they're doing.
• 2:12
  Dr. Komal Patil-Sisodia: I did not know what I was doing when I was painting mine, but the good news is that your bones do know what they're doing.
• 2:18
  Dr. Komal Patil-Sisodia: And so let's think of your bones, like your favorite home renovation show inside your body.
• 2:23
  Dr. Komal Patil-Sisodia: Your bones are undergoing constant remodeling.
• 2:26
  Dr. Komal Patil-Sisodia: It's a process that involves three types of cells.
• 2:29
  Dr. Komal Patil-Sisodia: Number one, osteocytes.
• 2:31
  Dr. Komal Patil-Sisodia: You want to think of these as your architects that are monitoring your bone health and directing any change.
• 2:36
  Dr. Komal Patil-Sisodia: They're basically telling.
• 2:38
  Dr. Komal Patil-Sisodia: Every cell that is working on maintaining the strength of your bones, what to do.
• 2:43
  Dr. Komal Patil-Sisodia: Number two are the osteoclasts, and these are like your demolition crew, breaking down old bone and making sure that the aged bone is being chewed up so that it can be replaced by brand new bone.
• 2:55
  Dr. Komal Patil-Sisodia: And the osteoblasts.
• 2:56
  Dr. Komal Patil-Sisodia: These are your builders and they are laying down fresh, strong bone.
• 3:00
  Dr. Komal Patil-Sisodia: So the way that I divide it up in my mind is when I'm watching fix or upper, the osteocytes are like Joanna Gaines.
• 3:08
  Dr. Komal Patil-Sisodia: Who is like the master visionary planner of the whole?
• 3:13
  Dr. Komal Patil-Sisodia: Renovation project.
• 3:15
  Dr. Komal Patil-Sisodia: And then the osteo class, which are like the demo crew are like chip gains.
• 3:19
  Dr. Komal Patil-Sisodia: We all know he loves demo day, so imagine him coming in there with his sledgehammer and taking things out.
• 3:25
  Dr. Komal Patil-Sisodia: And then the osteoblasts, those are the builders.
• 3:28
  Dr. Komal Patil-Sisodia: So these are all the people who are working on building up the newly gutted home into something beautiful.
• 3:35
  Dr. Komal Patil-Sisodia: And even though we think of our bones as being hard and unchanging, they're actually alive.
• 3:41
  Dr. Komal Patil-Sisodia: They're constantly.
• 3:42
  Dr. Komal Patil-Sisodia: Shifting and rebuilding to meet the demands of your everyday life.
• 3:46
  Dr. Komal Patil-Sisodia: Without this constant remodeling bones would snap under even regular movements, like all the twisting, bending, jumping, walking, running, that we do on a daily basis or even throughout our lifetime.
• 4:00
  Dr. Komal Patil-Sisodia: So it's important to know that your bones are number one, constantly remodeling so that they can stay healthy.
• 4:06
  Dr. Komal Patil-Sisodia: So this beautiful system of your bones constantly remodeling by breaking down and then rebuilding usually stays balanced until menopause hits.
• 4:16
  Dr. Komal Patil-Sisodia: Menopause is when estrogen starts to decline.
• 4:19
  Dr. Komal Patil-Sisodia: And because estrogen is supporting the remodeling process, that's when your bone health starts shifting and changing.
• 4:26
  Dr. Komal Patil-Sisodia: We reach our peak bone density in our lifetime, around the age of 35, and for some women it may extend into their early forties, but after that, as estrogen levels begin to decline our bone strength gradually starts to decrease as well.
• 4:42
  Dr. Komal Patil-Sisodia: The osteoclast will keep demoing away, but the osteoblasts, which are the builders slow down significantly, and so that imbalance will lead to weaker more brittle bone over time.
• 4:54
  Dr. Komal Patil-Sisodia: So what exactly is osteoporosis?
• 4:57
  Dr. Komal Patil-Sisodia: It is a condition where your bones become less dense and more fragile over time.
• 5:02
  Dr. Komal Patil-Sisodia: And the way that we know this is we use a test called a DEXA scan or a bone density scan, which will give us a T-score that compares your bones to that of a healthy 30 to 30 5-year-old woman.
• 5:16
  Dr. Komal Patil-Sisodia: It.
• 5:16
  Dr. Komal Patil-Sisodia: What we look for is how many, what we call standard deviations below the bone health of a healthy 30, 30 5-year-old woman you are.
• 5:25
  Dr. Komal Patil-Sisodia: And this is how we categorize it.
• 5:27
  Dr. Komal Patil-Sisodia: Normal bone density is where your T score is between zero and minus one.
• 5:33
  Dr. Komal Patil-Sisodia: So that's one standard deviation below.
• 5:35
  Dr. Komal Patil-Sisodia: That of a 30 to 30 5-year-old woman, and that is generally okay.
• 5:39
  Dr. Komal Patil-Sisodia: Your bones are normal, bone density at that point.
• 5:42
  Dr. Komal Patil-Sisodia: Osteopenia, which is now referred to as low bone mass or low bone density.
• 5:48
  Dr. Komal Patil-Sisodia: Is a T score between minus one and minus 2.4.
• 5:52
  Dr. Komal Patil-Sisodia: This is that precursor stage to osteoporosis.
• 5:56
  Dr. Komal Patil-Sisodia: And osteoporosis is a T score minus 2.5 or lower.
• 6:02
  Dr. Komal Patil-Sisodia: But you wanna know what the real danger of all of this is you will not feel it happening.
• 6:06
  Dr. Komal Patil-Sisodia: Osteoporosis is often referred to as a silent disease because there are no clear symptoms until a fracture happens, and pain finally brings it to light.
• 6:16
  Dr. Komal Patil-Sisodia: So your first and only symptom of osteoporosis is going to be.
• 6:21
  Dr. Komal Patil-Sisodia: A fracture.
• 6:22
  Dr. Komal Patil-Sisodia: You may feel fine and even strong, but you don't know that you may still be losing bone mass silently, and that is why it is so important to talk to your doctors about getting a DEXA scan in a timely manner.
• 6:38
  Dr. Komal Patil-Sisodia: I once had a patient in her eighties who saw me regularly for her thyroid management.
• 6:42
  Dr. Komal Patil-Sisodia: I had been seeing her for years and every year I encouraged her to get a DEXA scan because she was well past the age.
• 6:48
  Dr. Komal Patil-Sisodia: That is recommended by some of the societies that.
• 6:51
  Dr. Komal Patil-Sisodia: Manage the guidelines around osteoporosis, and she always said, I feel fine.
• 6:56
  Dr. Komal Patil-Sisodia: I'm active.
• 6:57
  Dr. Komal Patil-Sisodia: No one in my family has osteoporosis.
• 7:00
  Dr. Komal Patil-Sisodia: I don't want to do anything about it.
• 7:01
  Dr. Komal Patil-Sisodia: I don't want to know.
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  Dr. Komal Patil-Sisodia: I don't want treatment.
• 7:03
  Dr. Komal Patil-Sisodia: I'm fine.
• 7:04
  Dr. Komal Patil-Sisodia: I don't have osteoporosis.
• 7:06
  Dr. Komal Patil-Sisodia: Then one year she walked into my office and she was in a back brace.
• 7:10
  Dr. Komal Patil-Sisodia: When I asked her what happened, she said that she fractured her spine just while moving a coffee table.
• 7:15
  Dr. Komal Patil-Sisodia: And that one moment changed everything for her: her independence, her mobility, her confidence, and that's why I always say knowledge is power at every stage of your life.
• 7:29
  Dr. Komal Patil-Sisodia: The more you understand your body, the better equipped you are to make informed, confident decisions about your health.
• 7:38
  Dr. Komal Patil-Sisodia: Let's talk about understanding what your risk is for developing osteoporosis.
• 7:43
  Dr. Komal Patil-Sisodia: I usually divide it into two buckets, what you can control and what you can't control.
• 7:48
  Dr. Komal Patil-Sisodia: Those are referred to as modifiable.
• 7:51
  Dr. Komal Patil-Sisodia: And non-modifiable risk factors.
• 7:53
  Dr. Komal Patil-Sisodia: So the modifiable risk factors are things that you can change, and this includes things like smoking, drinking more than two alcoholic beverages per day, having a sedentary or inactive lifestyle, not getting enough calcium or vitamin D, and not getting enough protein, which will weaken your muscles and raise your fracture risk over time.
• 8:14
  Dr. Komal Patil-Sisodia: These are all things that you can start working on today as measures to keep your bone as healthy as possible.
• 8:21
  Dr. Komal Patil-Sisodia: What you also need to be aware of are your non-modifiable risk factors, meaning the things you can't change or may not be within your circle of control to change.
• 8:31
  Dr. Komal Patil-Sisodia: And the number one for this is age, especially post-menopausal women.
• 8:36
  Dr. Komal Patil-Sisodia: Over the age of 50, we can't control that.
• 8:39
  Dr. Komal Patil-Sisodia: We're all getting older.
• 8:40
  Dr. Komal Patil-Sisodia: I wish we could, but we're not there.
• 8:42
  Dr. Komal Patil-Sisodia: Gender is the second risk factor on the list Women are at higher risk of osteoporosis than men.
• 8:52
  Dr. Komal Patil-Sisodia: Family history is third on the list.
• 8:54
  Dr. Komal Patil-Sisodia: If you have a family history of osteoporosis or fractures, your lifetime risk is increased.
• 9:00
  Dr. Komal Patil-Sisodia: You can't control what happened to mom or grandma, but you can know about it and be aware so that you're getting screened at an appropriate time.
• 9:08
  Dr. Komal Patil-Sisodia: There are certain medical conditions such as rheumatoid arthritis, if you've ever had an eating disorder, chronic kidney disease, all of these things can lead to.
• 9:18
  Dr. Komal Patil-Sisodia: Developing osteoporosis sooner than your average person.
• 9:21
  Dr. Komal Patil-Sisodia: And then long-term medications is last on the list.
• 9:25
  Dr. Komal Patil-Sisodia: So things like steroids or even potentially GLP one agonists where you are getting muscle loss if you're not paying attention to your diet.
• 9:33
  Dr. Komal Patil-Sisodia: All of those things can contribute.
• 9:35
  Dr. Komal Patil-Sisodia: And lastly, and very importantly, if you are of Asian or Caucasian descent.
• 9:41
  Dr. Komal Patil-Sisodia: Your lifetime risk of developing osteoporosis is going to be higher.
• 9:46
  Dr. Komal Patil-Sisodia: Largely because women in these groups tend to start out with lower bone density.
• 9:52
  Dr. Komal Patil-Sisodia: It's not about blame or saying, I didn't do enough to take care of my bones.
• 9:57
  Dr. Komal Patil-Sisodia: It's always about being aware and being proactive about your.
• 10:02
  Dr. Komal Patil-Sisodia: So when should you be screened?
• 10:05
  Dr. Komal Patil-Sisodia: There are two key guidelines that help determine when a DEXA scan is needed.
• 10:09
  Dr. Komal Patil-Sisodia: The US Preventative Services Task Force, or U-S-P-S-T-F, and the American College of Obstetrics and Gynecology, also known as acog.
• 10:20
  Dr. Komal Patil-Sisodia: Recommend that women over the age of 65, regardless of risk factors should be screened.
• 10:26
  Dr. Komal Patil-Sisodia: Women under the age of 65 who are postmenopausal and have high risk for fractures should be screened according these to, according to these two governing bodies.
• 10:38
  Dr. Komal Patil-Sisodia: According to these two professional societies, according to these two groups, the American Association of Clinical Endocrinologists, which is what I tend to follow as an endocrinologist, recommends that all women over the age of 50 who are high risk for osteoporosis should be screened.
• 10:57
  Dr. Komal Patil-Sisodia: So if you're post-menopausal and you fit into any of those categories that we've discussed, it's time to start talking to your provider about getting a scan.
• 11:06
  Dr. Komal Patil-Sisodia: Here's what I want you to remember from today's episode.
• 11:11
  Dr. Komal Patil-Sisodia: These are three takeaways that I hope that you'll carry with you and do something about.
• 11:16
  Dr. Komal Patil-Sisodia: Number one, your bones are alive and dynamic.
• 11:19
  Dr. Komal Patil-Sisodia: Think of them like a house that is under constant renovation.
• 11:22
  Dr. Komal Patil-Sisodia: There's demoing and rebuilding that's happening, and when you hit menopause, the demoing starts increasing and the rebuilding slows down.
• 11:31
  Dr. Komal Patil-Sisodia: So that's why we have to do something about it.
• 11:33
  Dr. Komal Patil-Sisodia: Number two.
• 11:34
  Dr. Komal Patil-Sisodia: Osteoporosis is serious but silent.
• 11:37
  Dr. Komal Patil-Sisodia: You will not know it's there until something breaks.
• 11:41
  Dr. Komal Patil-Sisodia: Literally a fracture is going to be your first and only symptom of osteoporosis, and that is the only time you will feel something.
• 11:49
  Dr. Komal Patil-Sisodia: Okay.
• 11:49
  Dr. Komal Patil-Sisodia: And then number three, awareness is your first line of defense.
• 11:53
  Dr. Komal Patil-Sisodia: Understanding your risk factors, knowing that you can act on the modifiable ones and starting that conversation early are all going to get you to a place where you can be healthier for longer.
• 12:05
  Dr. Komal Patil-Sisodia: There are statistics that show as we get older, our mortality from fractures increases significantly.
• 12:12
  Dr. Komal Patil-Sisodia: The mortality rate of an osteoporosis related fracture after the age of 85 has a mortality of 50%.
• 12:20
  Dr. Komal Patil-Sisodia: Over the age of 75.
• 12:22
  Dr. Komal Patil-Sisodia: It is 20 to 40%.
• 12:24
  Dr. Komal Patil-Sisodia: We can do so much better for people out there who are struggling with osteoporosis and give them a better quality of life for the long term.
• 12:34
  Dr. Komal Patil-Sisodia: In our next, so coming up in part two of this series, which is Bone Health 102, we are going to explore number one, what actually hap, we're going to explore what actually happens during a DEXA scan meeting.
• 12:50
  Dr. Komal Patil-Sisodia: How is it done?
• 12:51
  Dr. Komal Patil-Sisodia: How frequently do you need to get it done?
• 12:53
  Dr. Komal Patil-Sisodia: We're going to talk about how you interpret the bone density results, and then we're going to talk about what you can do from nutrition to exercise, meaning non-pharmacologic treatment to strengthen your bones and prevent loss.
• 13:06
  Dr. Komal Patil-Sisodia: And then our third episode will focus mostly on the medications, so you can have a better understanding of these medications when they're being recommended to you.
• 13:20
  Dr. Komal Patil-Sisodia: That's all for today.
• 13:21
  Dr. Komal Patil-Sisodia: I'll see you on the next episode.
• 13:25
  Dr. Komal Patil-Sisodia: Hey there.
• 13:25
  Dr. Komal Patil-Sisodia: Quick announcement before you go.
• 13:27
  Dr. Komal Patil-Sisodia: I've officially opened my own practice.
• 13:29
  Dr. Komal Patil-Sisodia: It's called Eastside Menopause and Metabolism based right here in Redmond, Washington.
• 13:34
  Dr. Komal Patil-Sisodia: I'm so grateful to be helping women navigate perimenopause, menopause, and metabolic health.
• 13:39
  Dr. Komal Patil-Sisodia: It's truly some of the most fulfilling work I've ever done.
• 13:42
  Dr. Komal Patil-Sisodia: If you're interested in working with me, head over to eastside mm.com.
• 13:46
  Dr. Komal Patil-Sisodia: You can book a consultation and stay tuned.
• 13:48
  Dr. Komal Patil-Sisodia: I'll be launching a membership program as well as an online course for those of you outside of Washington.
• 13:54
  Dr. Komal Patil-Sisodia: Lots more to come, so keep listening and thank you for being here.