Latest / Clearly Hormonal / Ep 25: Preventing Fractures: Osteoporosis Medications Explained

Transcript

Ep 25: Preventing Fractures: Osteoporosis Medications Explained · 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 is the third and final installment in our Bone health series.
• 1:02
  Dr. Komal Patil-Sisodia: I was debating how I was going to record this.
• 1:05
  Dr. Komal Patil-Sisodia: Episode because osteoporosis medications are not the most interesting.
• 1:11
  Dr. Komal Patil-Sisodia: And like I've said on previous podcast episodes, they've gotten a really bad rap for how they were used when they initially came out.
• 1:18
  Dr. Komal Patil-Sisodia: So I know this subject isn't exactly going to win a popularity contest at a dinner party, but we're going to go through osteoporosis medications anyway because I think it is important for you to know.
• 1:29
  Dr. Komal Patil-Sisodia: And while this topic may not be the most exciting thing that you have listened to all week, the impact that these treatments can have on your life is huge.
• 1:39
  Dr. Komal Patil-Sisodia: We are talking about the difference between staying active and independent or being sidelined by a fracture.
• 1:47
  Dr. Komal Patil-Sisodia: So give me the next however many minutes it takes me to get through this.
• 1:50
  Dr. Komal Patil-Sisodia: Stick with me.
• 1:51
  Dr. Komal Patil-Sisodia: I'm gonna break down the different osteoporosis medication options, who they're for and what you need to know about side effects, timing and how to make a choice for yourself.
• 2:02
  Dr. Komal Patil-Sisodia: I'll try and share a few patient stories along the way as well to keep it a little interesting.
• 2:06
  Dr. Komal Patil-Sisodia: But I think that you'll walk away with a good understanding of what you need to be thinking about when you're offered osteoporosis medications.
• 2:16
  Dr. Komal Patil-Sisodia: So let's talk a little bit about why medications matter.
• 2:18
  Dr. Komal Patil-Sisodia: When we talk about osteoporosis, what we're really talking about is the risk of fragility fractures.
• 2:25
  Dr. Komal Patil-Sisodia: Those are the breaks that will happen from a fall if that occurs from standing height or even something as simple as bending over to pick up a box.
• 2:33
  Dr. Komal Patil-Sisodia: I think I shared a story in one of the earlier podcasts about one of my patients who.
• 2:38
  Dr. Komal Patil-Sisodia: Was refusing to get screened for osteoporosis and just went along for several years.
• 2:43
  Dr. Komal Patil-Sisodia: Post menopause was doing fine until she went to move her coffee table and then she sustained a compression fracture to her spine.
• 2:50
  Dr. Komal Patil-Sisodia: Her life was changed because the fracture wasn't just inconvenient.
• 2:55
  Dr. Komal Patil-Sisodia: She had long-term pain, loss of mobility, and in addition to those two symptoms.
• 3:01
  Dr. Komal Patil-Sisodia: Fragility fractures can decrease life expectancy, which is crazy.
• 3:06
  Dr. Komal Patil-Sisodia: We want people to have a good quality of life for a long time.
• 3:10
  Dr. Komal Patil-Sisodia: But here's the good news.
• 3:12
  Dr. Komal Patil-Sisodia: Osteoporosis medications have actually been shown to prevent fractures, and it's not just in the spine, but in the other bones to including the hip.
• 3:20
  Dr. Komal Patil-Sisodia: Now, who is going to be most likely to need these medications?
• 3:24
  Dr. Komal Patil-Sisodia: Generally, women who have a bone density T score of minus 2.5 or lower.
• 3:29
  Dr. Komal Patil-Sisodia: That's the official definition for osteoporosis.
• 3:32
  Dr. Komal Patil-Sisodia: Those who have had a hip or spine fracture, or those who have a high risk of fracture based on something called a FRAC score.
• 3:39
  Dr. Komal Patil-Sisodia: And that is, calculation that they do based on your bone density scan.
• 3:44
  Dr. Komal Patil-Sisodia: And you may have readings that are in the pre-stage of osteoporosis that we call osteopenia, but this calculation looks at what your lifetime risk is for hip fractures or other major fractures.
• 3:57
  Dr. Komal Patil-Sisodia: And if the risk of a hip fracture is 3% or higher.
• 4:01
  Dr. Komal Patil-Sisodia: In the next 10 years, or the risk of a major osteoporotic fracture is 20% or higher in the next 10 years, then we recommend that you undergo treatment.
• 4:11
  Dr. Komal Patil-Sisodia: So let me tell you about one of my patients.
• 4:15
  Dr. Komal Patil-Sisodia: Let's call her Rose.
• 4:16
  Dr. Komal Patil-Sisodia: Rose, thought of herself as just being a little clumsy.
• 4:20
  Dr. Komal Patil-Sisodia: One icy morning she slipped and fell and broke her hip and spent months recovering.
• 4:26
  Dr. Komal Patil-Sisodia: Only later did she learn that she had osteoporosis for years and that there were treatments that could have reduced her risk dramatically, and she really regretted not following up sooner.
• 4:36
  Dr. Komal Patil-Sisodia: Let's talk about what you do before you hit that point.
• 4:40
  Dr. Komal Patil-Sisodia: The first line therapy of osteoporosis is a class of medications called antiresorptives and these slow down the breakdown of bones.
• 4:48
  Dr. Komal Patil-Sisodia: So if you think back to the first episode when I was explaining how.
• 4:52
  Dr. Komal Patil-Sisodia: The bones work, there are two sets of cells.
• 4:54
  Dr. Komal Patil-Sisodia: You have your osteoblasts, which are laying down brand new and your osteoclasts, which are chewing up the old bone to remodel them.
• 5:01
  Dr. Komal Patil-Sisodia: So this group of medications will slow down the osteoclast, which are the ones that are in charge of breaking down the old bone that needs to be remodeled.
• 5:11
  Dr. Komal Patil-Sisodia: The first line therapy are known as oral bisphosphonates, and these are things like alendronate or and oftentimes their first choice, they can cut the risk of spine fractures in half, sometimes a little bit more, and lower hip fracture risk by about 40%.
• 5:28
  Dr. Komal Patil-Sisodia: Alendronate is usually taken once a week.
• 5:31
  Dr. Komal Patil-Sisodia: is taken weekly or even monthly.
• 5:34
  Dr. Komal Patil-Sisodia: And then there's another medication called ibandronate.
• 5:37
  Dr. Komal Patil-Sisodia: It mainly helps the spine.
• 5:38
  Dr. Komal Patil-Sisodia: It doesn't have as good of.
• 5:39
  Dr. Komal Patil-Sisodia: Hip fracture data, but it's there as an option when you take these pills.
• 5:44
  Dr. Komal Patil-Sisodia: Here's a pro tip.
• 5:45
  Dr. Komal Patil-Sisodia: You take these pills first thing in the morning with water on an empty stomach, and because they're a little bit bigger, you have to stay upright for at least 30 minutes to an hour, and this will protect your esophagus and your stomach lining.
• 5:57
  Dr. Komal Patil-Sisodia: If you have conditions like acid reflux or difficulty swallowing, getting down big pills, if these pills are tricky for you to take, then.
• 6:06
  Dr. Komal Patil-Sisodia: There is an IV form of this called zoledronic acid that is given once a year through an iv.
• 6:14
  Dr. Komal Patil-Sisodia: You're monitored for a little bit after you take it, and then you don't have to worry about taking a pill every week, every month, or anything like that.
• 6:22
  Dr. Komal Patil-Sisodia: And then you just go back again for your next infusion in 12 months.
• 6:26
  Dr. Komal Patil-Sisodia: So when you're taking the pills, generally we will use them for five years before we give you a break unless your bone density is getting worse.
• 6:34
  Dr. Komal Patil-Sisodia: And then we'll switch to something else.
• 6:35
  Dr. Komal Patil-Sisodia: And with the IV form, the zoledronic acid, we will give that for about three years before we pause and reassess and see where your bones are.
• 6:43
  Dr. Komal Patil-Sisodia: Now if none of these medications work particularly well for you, there's another medication in this group of antiresorptives called denosumab.
• 6:52
  Dr. Komal Patil-Sisodia: It works by a little different pathway, but it's a shot that's given every six months, and it is a great option if you cannot take bisphosphonates.
• 7:00
  Dr. Komal Patil-Sisodia: Say you have the stomach issues, you can't take the oral ones, or you had a reaction to the IV infusion, but here's a warning with this one, you cannot just stop it suddenly, and doing that will cause rapid bone loss.
• 7:12
  Dr. Komal Patil-Sisodia: And the potential for multiple spine fractures.
• 7:15
  Dr. Komal Patil-Sisodia: So you need a plan for transitioning off of it.
• 7:17
  Dr. Komal Patil-Sisodia: What I do in my practice Is when somebody completes a course of denosumab.
• 7:22
  Dr. Komal Patil-Sisodia: So generally that is a shot every six months for five to up to ten years, six months after their last shot, I'll give them a dose of the IV zoledronic acid, and that is to seal in the effects of the denosumab.
• 7:36
  Dr. Komal Patil-Sisodia: Most people will tolerate that pretty well.
• 7:39
  Dr. Komal Patil-Sisodia: And then we watch and see how the bone density is doing before we decide whether we're gonna need to start medication again or potentially transition to another therapy.
• 7:50
  Dr. Komal Patil-Sisodia: Now let's get to the important parts.
• 7:52
  Dr. Komal Patil-Sisodia: A lot of people are really worried about the safety of these medications, and I have said multiple times before that these medications when they first came out were not used appropriately.
• 8:03
  Dr. Komal Patil-Sisodia: By physicians and not because they were doing it on purpose, but just because we didn't know as much about the drugs then as we do know now.
• 8:11
  Dr. Komal Patil-Sisodia: So my recommendations tend to be that when you start on an oral bisphosphonate, you can take it for about five years before you have to take a break.
• 8:22
  Dr. Komal Patil-Sisodia: If you're doing the IV version, somewhere between three and five years because it sticks around in your system for a while.
• 8:27
  Dr. Komal Patil-Sisodia: And the way that these medications work is to slow down the osteoclasts, which are chewing up the old bone that needs to be remodeled.
• 8:36
  Dr. Komal Patil-Sisodia: And when you stop that process for too long, you actually can set yourself up for a higher risk of atypical fractures.
• 8:44
  Dr. Komal Patil-Sisodia: And I think that's where people get scared of these medications because when they first came out, people were using them for 5, 10, 15 years without taking a break.
• 8:54
  Dr. Komal Patil-Sisodia: So a lot of women suffered.
• 8:56
  Dr. Komal Patil-Sisodia: Atypical fractures, but since we have learned more about these drugs, if you use them in a way where you're being monitored consistently and you know when to start and stop, it can actually create such a better outcome for women who are struggling with osteoporosis.
• 9:13
  Dr. Komal Patil-Sisodia: Other side effects with these medications tend to be with the oral bisphosphonates, like the alendronate, because you have to stay upright for an hour if it's causing you any GI irritation.
• 9:24
  Dr. Komal Patil-Sisodia: That tends to be the most common side effect for the IV zoledronic acid.
• 9:29
  Dr. Komal Patil-Sisodia: That is generally that one's pretty well tolerated, but some people will get like a flu-like reaction to the infusion.
• 9:37
  Dr. Komal Patil-Sisodia: And there are several protocols that physicians can give their patients prior to getting the infusion and after getting their infusion, that can maybe lessen the side effect of that IV infusion.
• 9:48
  Dr. Komal Patil-Sisodia: Now, the biggest concern that I typically hear from my patients when they're coming in outside of the atypical fractures is the issue with jaw problems.
• 9:56
  Dr. Komal Patil-Sisodia: And I really wanna talk about this because I think that this is grossly overblown.
• 10:02
  Dr. Komal Patil-Sisodia: The jaw problems happen when you are giving zoledronic acid or denosumab more frequently than the regimen that you give for.
• 10:14
  Dr. Komal Patil-Sisodia: Osteoporosis.
• 10:15
  Dr. Komal Patil-Sisodia: For example, in people who have cancer, they're often used to stabilize bone metastases so that people don't fracture from the bone mets.
• 10:23
  Dr. Komal Patil-Sisodia: In that case, people are getting zoledronic acid twice a year.
• 10:26
  Dr. Komal Patil-Sisodia: They're getting denosumab maybe somewhat more frequently than every six months.
• 10:30
  Dr. Komal Patil-Sisodia: And because you're getting so much drug that can impact.
• 10:34
  Dr. Komal Patil-Sisodia: The ability to heal from a dental procedure.
• 10:37
  Dr. Komal Patil-Sisodia: And so I will always counsel my patients that if you have upcoming invasive dental work, and when I say invasive dental work, where you need.
• 10:46
  Dr. Komal Patil-Sisodia: A tooth extracted or a tooth implanted, we're actually drilling into the jaw bone.
• 10:52
  Dr. Komal Patil-Sisodia: That is where you need to discuss a plan with your doctor and make sure that you have a good plan in place to heal from the procedure.
• 11:00
  Dr. Komal Patil-Sisodia: If you talk to your dentist, they can give you some guidance around how long you need to be off of those medications before getting your dental work done.
• 11:10
  Dr. Komal Patil-Sisodia: Usually, if I haven't even started meds, I'll have people get their dental work done and heal for a few months before we.
• 11:18
  Dr. Komal Patil-Sisodia: Start therapy for them.
• 11:19
  Dr. Komal Patil-Sisodia: So I hope that's helpful.
• 11:21
  Dr. Komal Patil-Sisodia: But please know that if in the hands of a doctor who is experienced with these medications, the likelihood is that you'll see benefit to your bone and that you will not see these side effects.
• 11:34
  Dr. Komal Patil-Sisodia: Now, I can't guarantee that for everybody because rare things happen.
• 11:38
  Dr. Komal Patil-Sisodia: But again, in the hands of somebody who's trained to use these, they can be very effective tools for managing your bone health and preventing fractures.
• 11:47
  Dr. Komal Patil-Sisodia: Now, let's talk about the next class of medications, and these are called anabolic or dual action therapies for very high risk patients, right?
• 11:55
  Dr. Komal Patil-Sisodia: And these are people who have had vertebral fractures, multiple fractures.
• 12:00
  Dr. Komal Patil-Sisodia: Hip fractures plus low bone density.
• 12:03
  Dr. Komal Patil-Sisodia: Usually if a T score is less than minus 3.5, I will at least have a conversation with my patients about these medications and they are teriparatide and abaloparatide, which are basically synthetic parathyroid hormone that is given in a daily self-administered.
• 12:22
  Dr. Komal Patil-Sisodia: Injection that you take daily for two years.
• 12:25
  Dr. Komal Patil-Sisodia: A lot of people just balk at that and they're like, ah, I don't know that I want to give myself a shot.
• 12:29
  Dr. Komal Patil-Sisodia: But these medications are actually the first to have been shown to build bone, which is phenomenal.
• 12:34
  Dr. Komal Patil-Sisodia: You don't see that necessarily with the other medications, but these are reserved for patients with more serious bone disease.
• 12:43
  Dr. Komal Patil-Sisodia: It's important to note that.
• 12:45
  Dr. Komal Patil-Sisodia: People can only use these once during their lifetime.
• 12:48
  Dr. Komal Patil-Sisodia: You do it one time for two years, and it's not really available again after that just because of the potential side effect profile of these medications.
• 12:57
  Dr. Komal Patil-Sisodia: Additionally, if you have a condition called Paget's disease or you have received radiation to an area that's affecting the long bones in your body.
• 13:07
  Dr. Komal Patil-Sisodia: Teriparatide and abaloparatide are not recommended because they can increase the risk of osteosarcoma in patients who fall in those two categories, not otherwise.
• 13:16
  Dr. Komal Patil-Sisodia: And then we have the next drug romosozumab, which is a once monthly injection for 12 months this one in particular, works in two ways.
• 13:25
  Dr. Komal Patil-Sisodia: It builds bone and it slows breakdown.
• 13:31
  Dr. Komal Patil-Sisodia: All three of these medications need a dose of zoledronic acid after the therapy is completed in order to seal in the effects.
• 13:39
  Dr. Komal Patil-Sisodia: So it will not take you away from zoledronic acid but zoledronic acid is used at least once afterwards.
• 13:53
  Dr. Komal Patil-Sisodia: For the Romosozumab, it's important to note that there were studies showing that it may increase the risk of heart disease.
• 13:59
  Dr. Komal Patil-Sisodia: So in somebody with a recent heart attack or stroke, I tend to avoid these medications.
• 14:13
  Dr. Komal Patil-Sisodia: So my next patient, Sophia.
• 14:18
  Dr. Komal Patil-Sisodia: Had two spine fractures within a year, and we started her on an anabolic medication.
• 14:25
  Dr. Komal Patil-Sisodia: I think we decided on a vide, and within months, her bone density started to climb for the first time.
• 14:40
  Dr. Komal Patil-Sisodia: Prior to that, other medications had kept it stable, but then when she fell and had the fracture.
• 14:47
  Dr. Komal Patil-Sisodia: That's when we decided we needed to uplevel her therapy.
• 14:50
  Dr. Komal Patil-Sisodia: It really helped with her pain due to the fractures as well as rebuilding that bone.
• 14:55
  Dr. Komal Patil-Sisodia: So these tools could be fantastic for treating compression fractures.
• 14:59
  Dr. Komal Patil-Sisodia: I usually like to save them for that.
• 15:03
  Dr. Komal Patil-Sisodia: And now our last category of medications.
• 15:05
  Dr. Komal Patil-Sisodia: These are known as the selective estrogen.
• 15:09
  Dr. Komal Patil-Sisodia: Receptor modifiers.
• 15:11
  Dr. Komal Patil-Sisodia: These are used in women who have breast cancer because they do reduce the risk of breast cancer.
• 15:16
  Dr. Komal Patil-Sisodia: The one that has the most benefit for osteoporosis is one called raloxifene.
• 15:21
  Dr. Komal Patil-Sisodia: Raloxifene will protect against vertebral fractures or spine fractures and will reduce breast cancer risks.
• 15:28
  Dr. Komal Patil-Sisodia: So in women who've had breast cancer and get started on this, it's like a twofer.
• 15:33
  Dr. Komal Patil-Sisodia: There's no hip benefit though.
• 15:34
  Dr. Komal Patil-Sisodia: And if there is a high risk for a person to have.
• 15:39
  Dr. Komal Patil-Sisodia: Blood clot, then this medication is not necessarily the best choice.
• 15:43
  Dr. Komal Patil-Sisodia: The next question I get very frequently is about menopause hormone therapy.
• 15:48
  Dr. Komal Patil-Sisodia: So this is where it gets interesting.
• 15:50
  Dr. Komal Patil-Sisodia: Menopause hormone therapy is really only approved for osteopenia to prevent progression to osteoporosis.
• 15:57
  Dr. Komal Patil-Sisodia: But there are studies that show when women who have osteoporosis and are postmenopausal are put on menopause hormone therapy.
• 16:06
  Dr. Komal Patil-Sisodia: It reduces fracture risk by 20 to 40%.
• 16:10
  Dr. Komal Patil-Sisodia: The problem is that if you stop the menopause hormone therapy, any benefit of that goes away.
• 16:15
  Dr. Komal Patil-Sisodia: I think we need more studies because for a long time the recommendation was that women stopped menopause hormone therapy after five years, and now I think we are realizing that women can be on it for longer than was previously recommended.
• 16:31
  Dr. Komal Patil-Sisodia: So I think that more studies are needed there.
• 16:33
  Dr. Komal Patil-Sisodia: It is not, again, an FDA approved indication for osteoporosis, though the studies suggest.
• 16:39
  Dr. Komal Patil-Sisodia: Long-term use could be beneficial.
• 16:43
  Dr. Komal Patil-Sisodia: And then the last one is calcitonin, which, gosh, I don't think I've ever prescribed that for osteoporosis.
• 16:48
  Dr. Komal Patil-Sisodia: It's not for long-term prevention, but if a patient has just recently had a fracture, this can actually help with pain from that fracture.
• 16:57
  Dr. Komal Patil-Sisodia: You can use it for a short period of time until you get them transitioned over to another medication.
• 17:03
  Dr. Komal Patil-Sisodia: And that brings me to my last patient, we'll call her Blanche.
• 17:07
  Dr. Komal Patil-Sisodia: She has a strong family history of breast cancer and because of that, we opted to, and she'd had some abnormal mammos.
• 17:17
  Dr. Komal Patil-Sisodia: We opted to try Roxane because she felt that it gave her peace of mind from a breast cancer risk reduction.
• 17:24
  Dr. Komal Patil-Sisodia: Point of view as well as helping her bones.
• 17:27
  Dr. Komal Patil-Sisodia: I did explain to her that hip fractures may not be prevented, but for now we're monitoring and we'll see how it all pans out.
• 17:35
  Dr. Komal Patil-Sisodia: So things that I want to review as we wrap this episode up.
• 17:41
  Dr. Komal Patil-Sisodia: Number one, the sequencing of the medications that you take, meaning the order in which you take it in, is very important.
• 17:48
  Dr. Komal Patil-Sisodia: So if somebody is very high risk at their initial presentation, I will start with an anabolic medication or romosozumab before switching them to something like a bisphosphonate or a denosumab, if they're high risk.
• 18:02
  Dr. Komal Patil-Sisodia: I will start bisphosphonates first and or switch to denosumab if they're not tolerating the bisphosphonates well, and you should never, ever combine osteoporosis drugs with the exception of calcium and vitamin D as supplements to help with therapy.
• 18:18
  Dr. Komal Patil-Sisodia: You should not be doing, bisphosphonate plus denosumab or a Bisphosphonate plus.
• 18:23
  Dr. Komal Patil-Sisodia: An anabolic or romosozumab at the same time.
• 18:26
  Dr. Komal Patil-Sisodia: There's no additive benefit that way.
• 18:28
  Dr. Komal Patil-Sisodia: Foundational stuff for everybody is making sure you're getting calcium a thousand to 1200 milligrams per day.
• 18:35
  Dr. Komal Patil-Sisodia: Calcium citrate absorbs better than calcium carbonate.
• 18:38
  Dr. Komal Patil-Sisodia: Calcium from your diet actually absorbs better than any supplemental cal.
• 18:43
  Dr. Komal Patil-Sisodia: And then vitamin D three, I generally recommend at least a thousand to 2000 international units per day.
• 18:50
  Dr. Komal Patil-Sisodia: Most people are vitamin D deficient, so we err on the side of 2000.
• 18:55
  Dr. Komal Patil-Sisodia: The other things that you can do lifestyle wise are make sure that you're getting in resistance and balance training, cutback, smoking, limit your alcohol, and.
• 19:06
  Dr. Komal Patil-Sisodia: Make sure that your environment is safe.
• 19:08
  Dr. Komal Patil-Sisodia: I know I talked about that in the last episode.
• 19:10
  Dr. Komal Patil-Sisodia: And then for monitoring, I will generally get a baseline bone density scan and then follow up scans every one to two years to make sure that we're seeing that effect.
• 19:19
  Dr. Komal Patil-Sisodia: It's really important to know that doing a bone density scan more frequently than every year.
• 19:25
  Dr. Komal Patil-Sisodia: Is not helpful.
• 19:26
  Dr. Komal Patil-Sisodia: You will not see the change in your bone in six months.
• 19:29
  Dr. Komal Patil-Sisodia: You need to give it that amount of time, and it's hard to wrap your brain around that because I think everybody wants to be able to see a change almost immediately.
• 19:39
  Dr. Komal Patil-Sisodia: And then we need to make sure that people are being consistent with their therapy.
• 19:43
  Dr. Komal Patil-Sisodia: I've had patients who started medications like.
• 19:48
  Dr. Komal Patil-Sisodia: A vide or teriparatide and they, despite counseling decided to just randomly stop and then they would end up with fractures and not be able to figure out why.
• 19:57
  Dr. Komal Patil-Sisodia: If you are just starting and stopping medications, that can actually be worse for your bones.
• 20:01
  Dr. Komal Patil-Sisodia: So please make sure you're telling your doctors if you are planning to make a therapy change just so that they're aware and they can give you some guidance and maybe lead you down a different path.
• 20:12
  Dr. Komal Patil-Sisodia: And then we need to make sure that we're planning transitions between medications, right?
• 20:17
  Dr. Komal Patil-Sisodia: So if we're taking a drug holiday or a break, if we are, switching from one medication to another, that all needs to be done under the supervision of your physician who knows how to use these meds.
• 20:28
  Dr. Komal Patil-Sisodia: So my final takeaway for this episode is for you all to remember that osteoporosis medications aren't just about bone density numbers.
• 20:35
  Dr. Komal Patil-Sisodia: They are really about keeping you strong enough to keep living life on your own terms, whether that is hiking with your friends.
• 20:44
  Dr. Komal Patil-Sisodia: Carrying your own groceries, being able to lift your grandkids, or just simply walking around confidently without a fear of a fall.
• 20:51
  Dr. Komal Patil-Sisodia: So if you have questions about your bone health, talk to your healthcare provider.
• 20:55
  Dr. Komal Patil-Sisodia: Feel free to send me a fan mail link if you need clarification on any part of this episode.
• 21:01
  Dr. Komal Patil-Sisodia: Please include your name and email address, so we can reply to you directly Thank you all for being here today.
• 21:07
  Dr. Komal Patil-Sisodia: I'll see you on the next episode.
• 21:11
  Dr. Komal Patil-Sisodia: Hey there.
• 21:12
  Dr. Komal Patil-Sisodia: Quick announcement before you go.
• 21:14
  Dr. Komal Patil-Sisodia: I've officially opened my own practice.
• 21:16
  Dr. Komal Patil-Sisodia: It's called Eastside Menopause and Metabolism based right here in Redmond, Washington.
• 21:20
  Dr. Komal Patil-Sisodia: I'm so grateful to be helping women navigate perimenopause, menopause, and metabolic health.
• 21:25
  Dr. Komal Patil-Sisodia: It's truly some of the most fulfilling work I've ever done.
• 21:28
  Dr. Komal Patil-Sisodia: If you're interested in working with me, head over to eastside mm.com.
• 21:32
  Dr. Komal Patil-Sisodia: You can book a consultation and stay tuned.
• 21:35
  Dr. Komal Patil-Sisodia: I'll be launching a membership program as well as an online course for those of you outside of Washington.
• 21:40
  Dr. Komal Patil-Sisodia: Lots more to come, so keep listening and thank you for being here.