WEBVTT

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Well, howdy, y 'all. Welcome back to another

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episode of You're a Mom on Drugs. My name is

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Josh, and I am the son. And I'm Jenny, and I'm

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the mom. And if you're new to this podcast, we

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are a mother and son combo. My name's Josh and

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I got a degree in biology and a master's in public

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health from the University of Texas at Austin.

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And my ostensibly intelligent, wonderful mother.

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Was educated in the great state of Virginia,

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as well as you also did your, you did your. So

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I got a BS in pharmacy in Virginia back when

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you got BS's in pharmacy. They don't do that

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anymore. BS stands for bachelor's in science.

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Bachelor's in science. Not the other BS. And

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then I wanted to pursue additional education.

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So I came to Texas and got my doctorate pharmacy

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degree. So now everybody who comes out of pharmacy

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school has a PharmD degree. Oh, really? Oh, I

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did not know that. Yeah, there's no BS in pharmacy

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anymore. Okay, so you're a rare breed. Yeah,

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us older people, yes. And you also studied at

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Duke as well, right? I did a residency at Duke.

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I did a pharmacy residency at Duke. Can you explain

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to folks out there, what is a residency? So back

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when you would get a BS, well, before the PharmD

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degree was the only degree you got. After you

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graduated from pharmacy school, you could go

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do what they called a general pharmacy residency.

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And so that's what I did. And they were offered

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at different places all over the country. And

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so Duke was just one of the places since I had

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grown up in Virginia, wasn't that far away from

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home. So I went to Duke for a year. And what

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you do in a residency is you get exposure to

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a bunch of different areas of pharmacy practice,

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because I think a lot of people don't realize

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that pharmacists, similar to physicians, there's

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different areas in which they can practice. And

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so you got exposed to that as you did this residency.

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And you also, because I was already a licensed

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pharmacist, we also had to serve as a staff pharmacist

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once a week as well, which meant that you were

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working in a satellite pharmacy in a hospital

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once a week and stuff. But then after that, they

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encouraged me to go get my doctor of pharmacy

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degree. And so I came to Texas and did that.

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Because you're so smart. And then I did another

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residency after that, which was a more specialized

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residency. Because now you can also do specialized

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residencies in pharmacy as well, too. So all

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this beautiful information, all the specialization

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has led you to this moment to becoming a podcaster

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with your son. Only because you asked. I did.

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Yeah. Well, you know, I didn't want, you know,

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a lot of times people when they retire, their

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brains just turn to mush. And so I didn't want

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that to happen to you. And luckily the whole

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world benefits from that. Oh, brother. But speaking

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of other things that you've experienced, we're

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going to do an episode that's kind of near and

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deep in your bones, as they say. we're going

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to be talking about osteoporosis today. So I

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don't know if you just kind of want to kick us

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off and kind of take us down the path of how

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we normally start episodes and kind of doing

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overviews, and then we'll get into kind of the

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things that you can do to either treat it or

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prevent it. So why don't you give us an overview,

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Dr. Seltzer? Okay, well, so as Josh mentioned,

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we're going to be talking about osteoporosis

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today, which is... actually a major non -communicable

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disease, which blew my mind. I was like, I never

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even knew it was classified like that. And it's

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the most common bone disease. And osteoporosis

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is defined as a bone disorder that's characterized

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by low bone density, impaired bone architecture,

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and compromised bone strength. So you are predisposed

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then. to an increased fracture risk. So a fracture

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being a broken bone. Okay. It's a public health

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epidemic and it can affect all ages, genders,

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races, and cultures. It's not specific to any

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one particular patient group, although it is

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more common in older people, specifically older

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women. And we'll get to that a little bit later.

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It's actually considered a silent disease as

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that there are really not a lot of symptoms until

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you break a bone. And it is the major cause of

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fractures in postmenopausal women and older men.

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So you're like, well, are you serious? Really?

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It's a major non -communicable disease? Well,

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it affects one out of three women and one out

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of five men over 50 years of age. And it's guesstimated

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that approximately 50 % of people 50 years and

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older are expected to develop this disease. Right

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now, approximately 10 million people in the United

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States have osteoporosis, with a prevalence in

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women of 16 .5%. And about 43 million people

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in the United States are estimated to have low

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bone density, so they're at risk for developing

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osteoporosis. And you can actually, interestingly,

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it's been broken down into based on race. And

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so actually non -Hispanic white women have a

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higher risk of developing osteoporosis. And then

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I believe that Mexican -Americans are next. No,

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that's not true. Asians are higher and then Mexican

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-Americans and then African -Americans. So it

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can be differentiated both in men and women.

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Yeah, as well as by your race. Right. It definitely

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increases with age. There is a 7 % incidence

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in women 50 to 59%. I'm sorry, I'm really misspeaking

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today. There's a 7 % incidence in women 50 to

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59 years of age, and it goes up to 35 % in women

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80 years of age and older. And then in men, it's

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about 3%. between 50 and 59 years of age, and

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it goes up to 11 % in men 80 years and older.

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And we'll talk about that a little bit more.

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Those who are over, I'm sorry, over 80 % of older

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adults who suffer fractures are never tested

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or treated for osteoporosis. So they can have

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a spontaneous fracture and they think of it.

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For whatever reason, they don't think of osteoporosis.

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It's like, I just have hip pain or my back's

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hurting. Or I just broke it because I'm old or

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something instead of looking for some other underlying

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reason. And over 90 % of patients who fail to

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receive a bone density scan or start treatment

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a year after a fragility fracture, which means

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that a fragility fracture is one that... Your

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bones are weaker and you do something just not

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that stressful and your bone breaks and stuff.

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And then nearly 70 % of people with actual osteoporosis

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go undiagnosed. Wow. So, yeah. It's an economic

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health burden as well, too, which you can imagine.

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It costs the United States $22 to $25 billion

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annually, and it's projected to increase to $95

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billion by the year 2040. And most of that cost

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is due to hip fractures. They account for about

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72 % of the cost of osteoporosis because a hip

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fracture is no bueno. There's a lot of other

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things that happen after you have a hip fracture.

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In addition, there's surgery. You may have to

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be put in a rehab or a nursing home facility.

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And so that all adds to the cost of it as well

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too. And the cost of osteoporosis can exceed

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the cost that is associated with breast cancer,

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heart attacks. So it's a big deal. Yeah, it's

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one of the, I remember, so I looked into some

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of the more, like one of the greatest predictors

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of mortality for folks kind of after heart disease

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and cancer is falling. Because I think we just

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don't think about it as like. It's crazy. There's

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a mortality figure from 2010. If you're a 90

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-year -old man and you fall and break your...

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And if you have a fracture, either in your hip

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or your femur, you have a 40 % mortality rate.

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That means that if 10 90 -year -olds fall, four

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of those 90 -year -olds are going to be dead

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within a year, which is insane. And when you

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think about it, it makes a lot of sense for anybody

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who's... kind of a bit younger like myself, it's

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like, okay, you break a leg or you break something,

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you sit on a while and you heal. And we're going

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to get into the biology of bones a little bit

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later on in this podcast. But like, just think

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about all the things that you can't do when you

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have a fracture. Like you can't walk. And maybe

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if you're 90, you don't have a lot of people

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there taking care of you. So like, how do you

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go to the bathroom by yourself? Like, how do

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you feed yourself? Like, how do you socialize?

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And so it's not really the The fall doesn't really

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kill you. It's kind of all these other things

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that can add up that over time, the mortality

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just kind of tends to creep up on you. So your

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quality of life just really diminishes. And then

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especially if you're older, getting that bone

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to actually heal itself might not even be possible.

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And so you unfortunately get a lot of people

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who pass away from that. A lot of this episode

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today is going to be about preventive measures

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because like mom said, it's one of those silent

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killers, very similar to like a heart attack

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or a mitochondrial infarction where you get plaque

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built up over time and then all of a sudden you

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have a cardiac event. There's not really a lot

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of signs before that that you're going to have

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it. So we're hopefully going to give you the

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tools and things today that can help you be informed

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so that you can basically start building bone

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early, no matter what age you are. And, or to

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delay the degradation of it. But I just thought

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that we'll put some of these graphs in our, we

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have like Instagram posts so that people can

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kind of see some of these mortality figures.

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But this should be one of those higher priorities

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than probably we give it credit for. The last

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thing I'll say in this and we'll move on is like,

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if you look at the hazard ratio for falls. And

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a hazard ratio is essentially like how dangerous

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is this activity in terms of engaging in it?

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And so a hazard ratio of one is essentially saying

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like, you're fine going either way, basically.

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Like if I drink water, my hazard ratio is one.

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It's essentially, it's not, hopefully you don't

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drown in a glass of water. Too much water, maybe

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not, but yes. But if you have a hazard ratio

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of two, that means like you're twice as likely

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to succumb to mortality than. than the control,

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like just drinking water. So smoking has a hazard

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ratio of around two. So essentially, you're twice

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as likely to die from something from smoking

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a cigarette over time than not smoking. Falling

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and hip fractures from osteoporosis has a hazard

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ratio of 2 .63 in people over 75. So it even

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has a higher hazard ratio than smoking. And the

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thing about all the messaging that we go to give

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towards people don't smoke because it's going

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to cause problems down the road. So this one

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even has a higher risk as it for older people,

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especially as they get older. So just wanted

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to kind of set the stage at this. I know it sounds

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like breaking bones. You're getting older. What's

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the big deal, but it really can be a big deal

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late, especially later in life. Yeah. Okay. So

00:11:52.919 --> 00:11:56.049
let's just talk a little bit about. kind of the

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mechanics or what a bone is. And so why on earth

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do they break to begin with? What is a bone?

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So the main components of a bone are collagen,

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which gives the bone flexibility and energy absorbing

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capabilities because our bones have to absorb

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a lot of energy for us to walk and move around.

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It also then is consists, the bone consists of

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minerals, primarily calcium and phosphorus, which

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makes up 50 to 70 % of our bone mass. And this

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gives our bones stiffness and strength. And so

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this collagen and mineral composition of a bone

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are created in a correct balance so that the

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bone can deal with stress and strain and resist

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fractures. And so if you've got imbalance in

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these areas with the collagen or with the calcium

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and phosphorus, then that increases the risk

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for a fracture because you're going to impair

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bone quality and bone strength. Yeah, it's kind

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of like having a shock absorber, like when you're

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riding a bike or a car. It's like, so when you're

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hitting that big bump as you're riding your bike,

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all of that energy then, the bump doesn't go

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directly to you and the bike. It goes into that

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shock absorber so it can be dispersed throughout.

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That is correct. So there are two different bone

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types. The first is cortical bone. And it's found

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mainly in your long bones, like your femur, which

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is in the long bone at the top of your leg, or

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your humerus, which is the top long bone in your

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arm. And they make up 80 % of our skeleton, the

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cortical bone does. And then we've got trabecular

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bone, which is found mainly in our vertebrae.

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Our vertebrae are the bones that are in our spinal

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column. and the ends of our long bones. So you

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know how bone is solid, but that the end of them

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looks a little bit different. Well, in that end

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of a bone, it's made of trabecular bone and it's,

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that bone is more, is more active. It's got a

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higher turnover rate and it's got a larger surface

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area. So if you spread it out, it would cover

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more space and it's got a honeycomb like appearance.

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So that's kind of how that bone looks. So bone

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strength integrates or it's a composite of bone

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mass strength and quality. And bone mass peaks

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at ages between the ages of 18 to 25 years of

00:14:20.980 --> 00:14:24.220
age. So when you're in that young, you know,

00:14:24.240 --> 00:14:27.259
you don't even know that you're reaching your

00:14:27.259 --> 00:14:28.879
peak with your bone. You probably don't think

00:14:28.879 --> 00:14:31.090
about that a whole lot and stuff. Well, that's

00:14:31.090 --> 00:14:32.629
kind of good to know. So anybody who has kids

00:14:32.629 --> 00:14:35.509
out there, if you want your kids to reach peak

00:14:35.509 --> 00:14:38.590
bone mineral density, it's probably good to give

00:14:38.590 --> 00:14:41.909
them calcium and some activity -based things

00:14:41.909 --> 00:14:45.450
to load those bones. Because after that, you're

00:14:45.450 --> 00:14:47.190
just going to kind of lose over time, correct?

00:14:47.389 --> 00:14:50.789
That's right. There are different factors that

00:14:50.789 --> 00:14:53.549
can influence bone mass. Genetic factors is certainly

00:14:53.549 --> 00:14:55.509
one of them. It's actually a large part of it.

00:14:55.549 --> 00:14:58.250
It's 60 to 80 % as far as, you know, what kind

00:14:58.250 --> 00:15:02.549
of bone structure and risks associated with your

00:15:02.549 --> 00:15:04.490
bone you're going to have. But other things can

00:15:04.490 --> 00:15:07.370
also impact your bone mass, and that includes

00:15:07.370 --> 00:15:10.690
nutritional intake, exercise, like Josh just

00:15:10.690 --> 00:15:14.570
mentioned, adverse lifestyle practices like smoking

00:15:14.570 --> 00:15:17.190
is not good for your bones. And then there's

00:15:17.190 --> 00:15:20.389
also some diseases and medications that you may

00:15:20.389 --> 00:15:23.090
have to take or you have been diagnosed with

00:15:23.090 --> 00:15:25.090
that you really can't do anything about that

00:15:25.090 --> 00:15:26.970
could also affect your bone strength as well

00:15:26.970 --> 00:15:29.070
to your bone mass as well. Okay. So if you're

00:15:29.070 --> 00:15:31.580
taking some of those medications. You might have

00:15:31.580 --> 00:15:33.580
to find a way to compensate for some of those

00:15:33.580 --> 00:15:36.500
side effects. Right. So one of the big medications

00:15:36.500 --> 00:15:40.159
that affects bone masses are glucocorticoids

00:15:40.159 --> 00:15:43.080
or steroids that a lot of patients with asthma

00:15:43.080 --> 00:15:47.340
or maybe, you know, maybe autoimmune diseases

00:15:47.340 --> 00:15:49.419
or people have to, you know, you're trying to

00:15:49.419 --> 00:15:53.080
suppress inflammation in your body. And glucocorticoids

00:15:53.080 --> 00:15:55.600
are really great anti -inflammatory agents, but

00:15:55.600 --> 00:15:58.620
they also have a whole slew of adverse effects

00:15:58.620 --> 00:16:01.360
and affects on bone is definitely one of them.

00:16:01.460 --> 00:16:05.220
Okay. That's good to know. And hormonal status

00:16:05.220 --> 00:16:07.279
is also another thing that affects bone mass,

00:16:07.519 --> 00:16:10.259
which we'll also talk about in a little bit,

00:16:10.419 --> 00:16:15.059
specifically with regard to women. Yeah. So why

00:16:15.059 --> 00:16:22.659
on earth does osteoporosis happen? tissue quality

00:16:22.659 --> 00:16:25.860
is directly related to the functional activity

00:16:25.860 --> 00:16:31.740
of what we call osteoblasts, osteoclasts, and

00:16:31.740 --> 00:16:35.539
osteocytes, and a bone matrix, as well as it

00:16:35.539 --> 00:16:38.879
also includes a whole slew of other things, cytokines,

00:16:38.919 --> 00:16:40.879
growth factors, and hormones. It's actually a

00:16:40.879 --> 00:16:43.120
very complicated process as far as how your bone

00:16:43.120 --> 00:16:45.179
grows. You think your bone is just one big, long

00:16:45.179 --> 00:16:47.379
piece of calcium, but it's a dynamic system.

00:16:47.379 --> 00:16:48.320
It's got a whole lot of things going on in it,

00:16:48.320 --> 00:16:50.100
and we're not going to focus in the whole...

00:16:50.519 --> 00:16:54.960
complicated mechanics of bone stability and bone

00:16:54.960 --> 00:16:59.019
growth. But just for the basics to understand

00:16:59.019 --> 00:17:01.279
osteoporosis, I wanted to talk about the fact

00:17:01.279 --> 00:17:05.240
that all these things are normally imbalanced.

00:17:05.259 --> 00:17:07.660
And so then your bone stays strong, your bone

00:17:07.660 --> 00:17:10.819
mass stays stable. But when you have an imbalance

00:17:10.819 --> 00:17:12.500
in it, that's when you start having problems.

00:17:13.339 --> 00:17:18.400
So osteoblasts, B osteoblasts, are the cells

00:17:18.400 --> 00:17:21.960
that will allow you to build bone or form bone.

00:17:22.339 --> 00:17:27.720
Whereas osteoclasts, with a C, class, will break

00:17:27.720 --> 00:17:31.400
down bone. And osteocytes are the cells that

00:17:31.400 --> 00:17:34.000
will differentiate into these different cells.

00:17:34.380 --> 00:17:37.299
Okay, so they're like the common denominator.

00:17:37.579 --> 00:17:39.980
Right, I think they primarily make osteoblasts.

00:17:39.980 --> 00:17:41.980
Yeah, they're going to choose who to be. So B.

00:17:42.559 --> 00:17:46.799
for building osteoblasts, C for clashing, like

00:17:46.799 --> 00:17:50.579
a cat. Chomping. Yeah, chomping. Tearing it down.

00:17:50.640 --> 00:17:57.019
So when you have osteoporosis, then your bone

00:17:57.019 --> 00:18:00.900
resorption, which is going to be led by your

00:18:00.900 --> 00:18:04.500
osteoclast, is greater than your bone formation.

00:18:05.000 --> 00:18:07.000
And that makes sense, doesn't it? So you're going

00:18:07.000 --> 00:18:09.019
to have more bone breakdown than you are going

00:18:09.019 --> 00:18:12.539
to have bone formation. And it will... Um, it'll

00:18:12.539 --> 00:18:14.700
happen in greater quantities and bone formation.

00:18:14.799 --> 00:18:18.400
And so it will make your, your, this bone remodeling,

00:18:18.400 --> 00:18:21.799
you know, is a, because it's not in balance and

00:18:21.799 --> 00:18:23.619
then you have, you're going to develop weaker

00:18:23.619 --> 00:18:26.460
bones. Um, I think one thing to say here is like

00:18:26.460 --> 00:18:28.240
one thing that I thought was really curious is

00:18:28.240 --> 00:18:30.079
like, why would you want to tear down your bone

00:18:30.079 --> 00:18:33.299
in the first place? You know, like why do osteoclasts

00:18:33.299 --> 00:18:37.059
exist in the first place? And I would, do you,

00:18:37.059 --> 00:18:40.339
do you have a, the only thing that I read that

00:18:40.339 --> 00:18:45.390
I. Correct me if I'm wrong, but I think somehow

00:18:45.390 --> 00:18:47.890
if you break down bone, then it stimulates the

00:18:47.890 --> 00:18:52.089
additional formation of the osteoblasts and new

00:18:52.089 --> 00:18:54.250
bone formation. I think the question is, why

00:18:54.250 --> 00:18:57.170
couldn't you just stimulate more osteoblasts

00:18:57.170 --> 00:19:00.170
to just grow? Why do you need to tear down to

00:19:00.170 --> 00:19:04.990
have osteoblasts? I think one of the things that,

00:19:05.089 --> 00:19:08.450
at least the reasoning that makes the most sense

00:19:08.450 --> 00:19:12.960
to me is that Bones are not just for structural

00:19:12.960 --> 00:19:15.680
integrity. They're actually a really good storage

00:19:15.680 --> 00:19:18.460
site for calcium. And if anybody knows anything

00:19:18.460 --> 00:19:20.859
about basic biology, calcium is a really good

00:19:20.859 --> 00:19:23.599
signaling molecule. So calcium especially is

00:19:23.599 --> 00:19:26.400
used in our neurons to essentially stimulate

00:19:26.400 --> 00:19:29.200
when a neuron is firing a signal from one area

00:19:29.200 --> 00:19:31.440
to the other. If anybody doesn't know anything

00:19:31.440 --> 00:19:33.960
about the central nervous system to communicate

00:19:33.960 --> 00:19:36.240
between your brain and your foot, for example,

00:19:36.319 --> 00:19:38.480
you use these specialized cells called nerve

00:19:38.480 --> 00:19:41.109
cells. And they relay messages like, hey, lift

00:19:41.109 --> 00:19:43.730
your big pinky toe, for example. Well, little

00:19:43.730 --> 00:19:45.589
pinky toe it would be. Well, they only have one

00:19:45.589 --> 00:19:48.549
pinky toe. So it's just true. Oh, true. Good

00:19:48.549 --> 00:19:55.109
point. So my left one. And because humans came

00:19:55.109 --> 00:19:57.529
out of it, we forget that we just evolved in

00:19:57.529 --> 00:19:59.630
a time of scarcity. There just wasn't a lot of

00:19:59.630 --> 00:20:01.670
stuff around. So a lot of times, a lot of these

00:20:01.670 --> 00:20:05.670
ancient measures of like, why do we store fat?

00:20:05.910 --> 00:20:08.759
Why do we store? a lot of these things inside

00:20:08.759 --> 00:20:12.920
of us when a lot of it, we forget that we came

00:20:12.920 --> 00:20:16.240
from a time of scarcity. So calcium just needed

00:20:16.240 --> 00:20:18.700
a place to be stored inside of the body because

00:20:18.700 --> 00:20:20.880
it eventually would need to be used. And so it

00:20:20.880 --> 00:20:23.160
kind of has this dual function. It's like, okay,

00:20:23.220 --> 00:20:26.019
not only are we going to give you skeletal stability,

00:20:26.319 --> 00:20:28.680
we're also going to give you a way to use some

00:20:28.680 --> 00:20:31.539
of that calcium in times where we need signaling

00:20:31.539 --> 00:20:33.779
so we can put it in your bloodstream and they

00:20:33.779 --> 00:20:37.730
can go to the appropriate spot. And so it's a

00:20:37.730 --> 00:20:41.049
great reservoir for calcium. But like mom said,

00:20:41.150 --> 00:20:43.569
that works great. Everything's in balance. But

00:20:43.569 --> 00:20:47.130
if you're tearing down more often than you're

00:20:47.130 --> 00:20:50.309
building, then you lose more calcium. You might

00:20:50.309 --> 00:20:52.430
need it for additional signaling, or maybe there's

00:20:52.430 --> 00:20:54.690
just something out of whack in that system. And

00:20:54.690 --> 00:20:56.650
that's when you can kind of lose some of the

00:20:56.650 --> 00:20:59.589
integrity of the bone. And obviously, even if

00:20:59.589 --> 00:21:01.250
you shave off a little bit of the building from

00:21:01.250 --> 00:21:03.009
your house, right? Like a little bit's great,

00:21:03.069 --> 00:21:05.730
but if you're not replacing it over time, then

00:21:05.730 --> 00:21:07.349
your house is going to be structurally unstable

00:21:07.349 --> 00:21:09.990
and you increase the risk of something, you know,

00:21:09.990 --> 00:21:12.849
collapsing and falling. So very similar to our

00:21:12.849 --> 00:21:15.329
skeletal architecture as well as general architecture.

00:21:15.490 --> 00:21:18.049
A little bit's fine if you're replacing it, but

00:21:18.049 --> 00:21:20.529
if you do that over time, you know, 20, 30, 40,

00:21:20.630 --> 00:21:23.950
50 years, that stuff adds up. And I think it's

00:21:23.950 --> 00:21:26.240
like, yeah, how can we... We know that it's going

00:21:26.240 --> 00:21:28.460
to happen based on what mom said is like when

00:21:28.460 --> 00:21:31.619
you're 18 or 25, you build basically all of the

00:21:31.619 --> 00:21:33.559
bone inside of your body. That's kind of your

00:21:33.559 --> 00:21:37.400
max bone density. And about 60 to 80 % is determined

00:21:37.400 --> 00:21:39.680
genetically, as you said, right? So a lot of

00:21:39.680 --> 00:21:41.539
it is just kind of predetermined by your parents.

00:21:42.000 --> 00:21:45.099
So if you've been dealt a good or bad hand, you

00:21:45.099 --> 00:21:47.059
kind of have to know what to do with that information.

00:21:47.279 --> 00:21:50.539
And so what can you do going forward to basically

00:21:50.539 --> 00:21:54.829
stave off the shaving of that bone? As we're

00:21:54.829 --> 00:21:57.490
moving forward. Do I have that correct? Yes.

00:21:57.609 --> 00:22:03.930
Okay. So, like Josh referred to, how the bone

00:22:03.930 --> 00:22:07.210
is made up and whether or not you've got stability

00:22:07.210 --> 00:22:11.400
between osteoblast, osteoclast. And how dense

00:22:11.400 --> 00:22:13.420
your bone is, it's called bone mineral density.

00:22:13.640 --> 00:22:17.420
No kidding. So anyway, and that's something that

00:22:17.420 --> 00:22:20.400
we measure, and we'll get into that a little

00:22:20.400 --> 00:22:22.759
bit later when we talk about how to actually

00:22:22.759 --> 00:22:25.039
assess whether or not you have osteoporosis or

00:22:25.039 --> 00:22:27.559
not. One other thing I wanted to talk about as

00:22:27.559 --> 00:22:30.880
far as just how osteoporosis develops, it has

00:22:30.880 --> 00:22:36.400
to do, because osteoporosis is seen more frequently

00:22:36.400 --> 00:22:40.309
in women of postmenopausal age, you're like,

00:22:40.369 --> 00:22:42.430
well, why on earth does that happen? And actually,

00:22:42.490 --> 00:22:45.130
it has to do with the fact that postmenopausal

00:22:45.130 --> 00:22:48.569
women lose a lot of their estrogen. And estrogen

00:22:48.569 --> 00:22:52.509
deficiency is associated with a significant amount

00:22:52.509 --> 00:22:56.210
of bone density loss, and it compromises the

00:22:56.210 --> 00:22:59.470
bone architecture because estrogen, interestingly,

00:23:00.509 --> 00:23:05.529
maintains normal bone resorption rates because

00:23:05.529 --> 00:23:09.859
it suppresses the... the growth and activity

00:23:09.859 --> 00:23:12.380
of osteoclasts, the chompers, you know, that

00:23:12.380 --> 00:23:14.720
break down the bone. And so it's going to decrease

00:23:14.720 --> 00:23:16.819
their development, and so it's going to help

00:23:16.819 --> 00:23:20.819
maintain good bone formation. But after menopause,

00:23:20.819 --> 00:23:24.660
as estrogen levels decline, then you don't have

00:23:24.660 --> 00:23:31.319
that... guard against the fact that osteoclasts

00:23:31.319 --> 00:23:33.420
want to break down your bone. And so then you're

00:23:33.420 --> 00:23:35.859
going to see more of that. And so then you end

00:23:35.859 --> 00:23:39.220
up having more osteoclast activity, which are

00:23:39.220 --> 00:23:40.680
the chompers that are going to break down your

00:23:40.680 --> 00:23:43.759
bone and less bone formation by the osteoblasts.

00:23:43.759 --> 00:23:46.920
And so you end up with an increased risk of developing

00:23:46.920 --> 00:23:50.819
osteoporosis. So interesting. Yeah. Yeah. And

00:23:50.819 --> 00:23:54.920
I also. remember reading that estrogen in women

00:23:54.920 --> 00:23:57.759
specifically when they're doing like resistance

00:23:57.759 --> 00:24:00.140
training or things with weights or just like

00:24:00.140 --> 00:24:02.180
body weights, even things like squats and pushups

00:24:02.180 --> 00:24:06.960
is also responsible for breaking down bone and

00:24:06.960 --> 00:24:10.079
muscle and things like that. So it's also involved

00:24:10.079 --> 00:24:13.180
in this osteoclast, osteoblast thing too. So

00:24:13.180 --> 00:24:15.920
men obviously have estrogen inside of us as well

00:24:15.920 --> 00:24:18.079
because it gets converted into testosterone.

00:24:18.440 --> 00:24:22.039
So it's amazing that this little molecule And

00:24:22.039 --> 00:24:24.000
obviously men don't lose estrogen because we

00:24:24.000 --> 00:24:25.579
don't go through menopause. So we kind of still

00:24:25.579 --> 00:24:27.680
have this molecule to help out with this process.

00:24:28.259 --> 00:24:30.779
Whereas women obviously lose a large portion

00:24:30.779 --> 00:24:33.200
of it when they go through menopause. So it's

00:24:33.200 --> 00:24:35.859
really interesting that it's also, it's a nifty

00:24:35.859 --> 00:24:38.140
little molecule that does a lot of things inside

00:24:38.140 --> 00:24:39.180
of the body. It does a lot more things than you

00:24:39.180 --> 00:24:44.099
thought it did. So also too, as you age. So you

00:24:44.099 --> 00:24:47.960
also have an increased chance of developing osteoporosis

00:24:47.960 --> 00:24:50.599
because when you get to be 60 years of age or

00:24:50.599 --> 00:24:53.539
older, then you will have an accelerated bone

00:24:53.539 --> 00:24:56.420
turnover rate and you have a reduction in your

00:24:56.420 --> 00:25:00.119
osteoblast bone formation. And so then that's

00:25:00.119 --> 00:25:03.500
going to also give you a greater tendency to

00:25:03.500 --> 00:25:06.220
develop osteoporosis as well too. So again, those

00:25:06.220 --> 00:25:09.519
osteoblasts are not working and growing as fast

00:25:09.519 --> 00:25:12.069
as you get older. And then one other term I just

00:25:12.069 --> 00:25:14.230
like to make people familiar with, and that's

00:25:14.230 --> 00:25:18.170
called osteopenia. So osteopenia is the stage

00:25:18.170 --> 00:25:21.950
that you get at between having no normal bone

00:25:21.950 --> 00:25:25.109
density, bone mineral density and osteoporosis.

00:25:25.210 --> 00:25:28.349
And so osteopenia is defined as reduced bone

00:25:28.349 --> 00:25:31.569
density and that bones have a lower mineral content

00:25:31.569 --> 00:25:34.250
and are weaker and that they're more susceptible

00:25:34.250 --> 00:25:37.049
to breakage and that it can progress to osteoporosis.

00:25:37.529 --> 00:25:41.609
Gotcha. So you have normal. osteopenia, and then

00:25:41.609 --> 00:25:45.430
osteoporosis. Yes. And it's just a gradual decline

00:25:45.430 --> 00:25:49.990
into basically more porosity of the bone because

00:25:49.990 --> 00:25:52.230
you're losing density. Right. So there's just

00:25:52.230 --> 00:25:54.990
more space in between, less compactness. Right.

00:25:55.049 --> 00:25:57.670
Okay. So again, remember, our bones are going

00:25:57.670 --> 00:26:06.349
to absorb energy and we step down, we run. you

00:26:06.349 --> 00:26:09.849
know whatever and so with that being it being

00:26:09.849 --> 00:26:14.250
not as strong it does then give us a propensity

00:26:14.250 --> 00:26:18.269
to potentially break a bone yeah my mom always

00:26:18.269 --> 00:26:20.930
uh especially during the holidays she always

00:26:20.930 --> 00:26:23.410
gets up on counters to reach things because she's

00:26:23.410 --> 00:26:26.880
basically she's as small as i am And it is freaks

00:26:26.880 --> 00:26:29.420
me out now because I know about this literature

00:26:29.420 --> 00:26:31.119
and it was like, she's going to fall one day

00:26:31.119 --> 00:26:34.480
reaching for some type of cup and, and, and it's

00:26:34.480 --> 00:26:37.160
going to be the end. So, uh, yeah, so far, so

00:26:37.160 --> 00:26:40.359
far, so good. I've got good balance so far. So,

00:26:40.400 --> 00:26:43.720
um, okay. So then people might say, okay, well

00:26:43.720 --> 00:26:45.980
then how do you even know if you've got osteoporosis?

00:26:46.000 --> 00:26:47.519
Yeah, that's a good question. So, and again,

00:26:47.559 --> 00:26:48.980
we talked about the fact that it's considered

00:26:48.980 --> 00:26:51.720
the silent disease because there's often no symptoms

00:26:51.720 --> 00:26:55.569
present in the early stages of bone loss. And

00:26:55.569 --> 00:26:58.690
the most common symptom is unfortunately a bone

00:26:58.690 --> 00:27:04.789
fracture or a bone break. And the kicker or the

00:27:04.789 --> 00:27:11.809
characteristics of the fall that may trigger

00:27:11.809 --> 00:27:16.200
a like. maybe i have osteoporosis is that it's

00:27:16.200 --> 00:27:20.240
a small fall or it's just a minor accident that

00:27:20.240 --> 00:27:22.579
in in normal it would never have done anything

00:27:22.579 --> 00:27:24.819
to you and now you ended up with a bone break

00:27:24.819 --> 00:27:27.160
and you're like what you know and so so that's

00:27:27.160 --> 00:27:29.720
kind of a bit of a trigger as to like maybe i

00:27:29.720 --> 00:27:32.680
should have this assessed yeah and also a reminder

00:27:32.680 --> 00:27:35.900
too that fractures come in very different sizes

00:27:35.900 --> 00:27:38.480
right like you get a hairline fracture or like

00:27:38.480 --> 00:27:41.279
a pure break like i think sometimes i even my

00:27:41.279 --> 00:27:44.319
my A needy thought is when you break a bone,

00:27:44.400 --> 00:27:46.680
it's like, you know, like breaking a twig, but

00:27:46.680 --> 00:27:48.779
you can definitely just get like a hairline fracture.

00:27:49.759 --> 00:27:52.420
That's just this really thin line that can cause

00:27:52.420 --> 00:27:55.720
pain and instability in somebody. And the areas

00:27:55.720 --> 00:27:59.559
in which fractures happen most commonly in osteoporosis

00:27:59.559 --> 00:28:01.920
are going to be in your vertebrae, which are

00:28:01.920 --> 00:28:05.279
those bones that are in your spine, your hip,

00:28:05.400 --> 00:28:10.930
your forearm, and your humerus. Can you cut that

00:28:10.930 --> 00:28:13.650
out? You're going to say uterus. Yeah, that was

00:28:13.650 --> 00:28:14.730
wrong. You don't want to have a fracture in your

00:28:14.730 --> 00:28:24.369
uterus. So remember, it's your hip, your vertebrae.

00:28:24.779 --> 00:28:26.900
Your forearm, because you're going to try to

00:28:26.900 --> 00:28:29.880
break your fall, and your humerus, which are

00:28:29.880 --> 00:28:31.799
the longer bones in your arm. Yeah, so not your

00:28:31.799 --> 00:28:34.500
femur. So that's usually not associated with

00:28:34.500 --> 00:28:36.599
that. That is not as much. I mean, you can, but

00:28:36.599 --> 00:28:38.819
it's primarily hips because of the way you fall.

00:28:39.059 --> 00:28:44.259
That makes sense. But if you don't break a bone,

00:28:44.400 --> 00:28:47.140
but you could have these kind of nonspecific

00:28:47.140 --> 00:28:49.799
symptoms that may make you think, maybe I should

00:28:49.799 --> 00:28:52.839
talk to my healthcare provider about this. If

00:28:52.839 --> 00:28:56.000
you lose an inch or more of your height, that's

00:28:56.000 --> 00:28:58.160
significant. And so that's really something to

00:28:58.160 --> 00:29:00.019
be taught. That's why your doctor's measuring

00:29:00.019 --> 00:29:01.859
you when you ever go to the doctor every time,

00:29:01.920 --> 00:29:03.920
like how high you are. I mean, especially how

00:29:03.920 --> 00:29:06.519
tall you are, especially as you get older, how

00:29:06.519 --> 00:29:08.640
high you are. That's a different conversation.

00:29:09.079 --> 00:29:10.700
Yeah, there you go. Check our episode on CBD.

00:29:11.119 --> 00:29:13.940
Oh, brother. If you have changes in your natural

00:29:13.940 --> 00:29:17.029
posture. So if you start stooping more or bending

00:29:17.029 --> 00:29:18.910
over, you know, and stuff, that's going to be

00:29:18.910 --> 00:29:21.390
kind of a red flag. Like maybe there's something

00:29:21.390 --> 00:29:24.630
else going on. If you have shortness of breath,

00:29:24.750 --> 00:29:29.029
because if some of the discs in your vertebrae

00:29:29.029 --> 00:29:33.349
break, it can somehow impact the whole diaphragm

00:29:33.349 --> 00:29:36.230
and your lung and your breathing capacity. And

00:29:36.230 --> 00:29:38.750
so you can have shortness of breath. Interesting.

00:29:38.890 --> 00:29:43.309
And then also if you have some unidentified or

00:29:44.250 --> 00:29:48.509
new or just unaware of low back pain, you know,

00:29:48.549 --> 00:29:51.029
like you're not sure why you're having this low

00:29:51.029 --> 00:29:53.750
back pain. That also could potentially be a signal

00:29:53.750 --> 00:29:56.710
for the fact that you might have osteoporosis.

00:29:57.269 --> 00:30:00.569
Another little fun fact, or actually two, Josh

00:30:00.569 --> 00:30:02.049
has actually kind of already mentioned this.

00:30:02.289 --> 00:30:05.829
So hip fractures cause the greatest morbidity

00:30:05.829 --> 00:30:08.509
and mortality in patients with osteoporosis.

00:30:09.180 --> 00:30:13.099
The mortality rate can be up to 36 % in the year

00:30:13.099 --> 00:30:16.619
following a hip fracture because they become

00:30:16.619 --> 00:30:20.420
immobile. A lot of times it's older people. They

00:30:20.420 --> 00:30:22.759
can have a predisposition to developing pneumonia.

00:30:23.059 --> 00:30:25.279
A lot of times they have to be put in a nursing

00:30:25.279 --> 00:30:27.640
home because maybe family doesn't live nearby

00:30:27.640 --> 00:30:30.779
and they can't care for themselves anymore. So

00:30:30.779 --> 00:30:34.319
it's a big, big deal. The other thing too is

00:30:34.319 --> 00:30:37.400
that Once you have what we call a low trauma

00:30:37.400 --> 00:30:40.440
fracture, so one of those that you're like, I

00:30:40.440 --> 00:30:42.759
didn't do anything. Why on earth am I, why did

00:30:42.759 --> 00:30:45.960
this break? Once you have one of those, then

00:30:45.960 --> 00:30:48.500
the risk for a subsequent fracture increases.

00:30:48.920 --> 00:30:52.400
So having a fracture with osteoporosis is something

00:30:52.400 --> 00:30:56.519
we really want to try to prevent. Okay. So who

00:30:56.519 --> 00:31:00.420
is more prone to developing osteoporosis? We've

00:31:00.420 --> 00:31:02.400
kind of given you a little taste of maybe some

00:31:02.400 --> 00:31:07.720
of that. But here's kind of a longer list. So

00:31:07.720 --> 00:31:10.279
if you're over 50 years of age, you're going

00:31:10.279 --> 00:31:12.359
to be more prone to developing osteoporosis.

00:31:12.380 --> 00:31:14.779
And if you're female, and especially if you're

00:31:14.779 --> 00:31:17.599
postmenopausal, that just goes with the territory.

00:31:18.779 --> 00:31:21.279
White and Asian women, we mentioned this already,

00:31:21.420 --> 00:31:24.839
are at higher risk. If you have a biological

00:31:24.839 --> 00:31:29.150
family history of osteoporosis. If you're naturally

00:31:29.150 --> 00:31:33.369
thin or have a smaller frame, that seems counterintuitive

00:31:33.369 --> 00:31:36.849
to me, but that's the deal. Somehow, I think

00:31:36.849 --> 00:31:40.250
if you're taller and have bigger bones, that

00:31:40.250 --> 00:31:43.549
you would be more likely to have osteoporosis.

00:31:43.809 --> 00:31:46.009
I actually think the opposite because I think

00:31:46.009 --> 00:31:48.509
if you start off with less bone, then you're

00:31:48.509 --> 00:31:51.210
going to lose. What you lose is going to be even

00:31:51.210 --> 00:31:52.730
more substantial. And that's exactly what happens.

00:31:53.839 --> 00:31:56.720
If you smoke or use tobacco products, that increases

00:31:56.720 --> 00:31:58.720
your risk of osteoporosis. Just don't do it,

00:31:58.759 --> 00:32:01.259
kids. Just don't do it. Or if you have a diet

00:32:01.259 --> 00:32:04.180
that's low or deficient in vitamin D or calcium.

00:32:05.059 --> 00:32:08.720
Because you need calcium and vitamin D working

00:32:08.720 --> 00:32:10.619
together. Yeah, we're going to talk about that

00:32:10.619 --> 00:32:12.440
later when we talk about treatments and stuff.

00:32:12.799 --> 00:32:15.680
Yeah, the calcium and vitamin D is an interesting

00:32:15.680 --> 00:32:18.680
conversation of how much you need and things

00:32:18.680 --> 00:32:20.960
like that. And here's another reason why having

00:32:20.960 --> 00:32:24.930
a hip fracture can also just be, just increased

00:32:24.930 --> 00:32:27.829
morbidity, mortality. If you have low levels

00:32:27.829 --> 00:32:31.049
of physical activity or prolonged levels of physical

00:32:31.049 --> 00:32:34.230
inactivity, that's not good for your bones and

00:32:34.230 --> 00:32:36.730
stuff. And so, and it doesn't help you. It also

00:32:36.730 --> 00:32:38.809
doesn't help you get rid of stuff, you know,

00:32:38.809 --> 00:32:40.589
cough stuff out of your lungs and stuff like

00:32:40.589 --> 00:32:43.210
that. So it's not good. If you are a chronic

00:32:43.210 --> 00:32:46.890
drinker of alcohol, that also increases your

00:32:46.890 --> 00:32:50.190
risk of developing osteoporosis. And then there's

00:32:50.190 --> 00:32:52.589
a number of different drugs, medications that

00:32:52.589 --> 00:32:55.089
can cause or increase your risk of osteoporosis.

00:32:55.130 --> 00:32:58.119
We talked about glucocorticoids. There are some

00:32:58.119 --> 00:33:00.920
hormone therapies for cancer could potentially

00:33:00.920 --> 00:33:03.599
do that. Proton pump inhibitors have a relationship

00:33:03.599 --> 00:33:06.960
with developing osteoporosis. Things like Prilosec

00:33:06.960 --> 00:33:10.660
and Prevacid. Those are for gastrointestinal.

00:33:12.279 --> 00:33:17.339
Heartburn, gastroesophageal reflux disease, peptic

00:33:17.339 --> 00:33:19.500
ulcers, those types of things are used in those.

00:33:19.579 --> 00:33:21.500
Yeah, I think we did an episode on heartburn

00:33:21.500 --> 00:33:24.119
and indigestion very early on. So you can check

00:33:24.119 --> 00:33:25.940
out those episodes if you're interested or have

00:33:25.940 --> 00:33:28.289
a little bit of interest. And then there are

00:33:28.289 --> 00:33:31.650
other medical conditions that could also predispose

00:33:31.650 --> 00:33:33.589
you to developing osteoporosis. I thought this

00:33:33.589 --> 00:33:36.450
was interesting. Bariatric surgery. There's something

00:33:36.450 --> 00:33:39.230
about bariatric surgery that causes you to develop

00:33:39.230 --> 00:33:43.529
osteoporosis. Anorexia will do that as well.

00:33:43.910 --> 00:33:47.789
If you have thyroid disease or diabetes, it predisposes

00:33:47.789 --> 00:33:52.089
you. And then some cancer types and HIV and AIDS.

00:33:52.309 --> 00:33:54.589
I wonder with the bariatric surgery, if it's

00:33:54.589 --> 00:33:57.049
just because, and with anorexia, it's because

00:33:57.049 --> 00:34:00.150
you're not eating as much. And because when you're

00:34:00.150 --> 00:34:02.690
not eating as much, you're not getting maybe

00:34:02.690 --> 00:34:05.869
the calcium and just the daily caloric needs

00:34:05.869 --> 00:34:08.429
that you would need to build up bone, right?

00:34:08.489 --> 00:34:10.710
And so, I mean, at the end of the day, you need

00:34:10.710 --> 00:34:14.110
nutrients and energy to build things up. So that's

00:34:14.110 --> 00:34:16.130
kind of my best guess. I don't really have an

00:34:16.130 --> 00:34:19.199
idea why. Let me see if I can look that up really

00:34:19.199 --> 00:34:23.119
quickly. Oh, it's okay. Okay. We'll add that.

00:34:23.119 --> 00:34:25.159
I was just wondering. Yeah, because I did know

00:34:25.159 --> 00:34:28.059
and then I forgot. So, yeah. Because I know that

00:34:28.059 --> 00:34:31.119
sometimes people who go through weight loss also

00:34:31.119 --> 00:34:34.360
go through their bone mineral density decreasing

00:34:34.360 --> 00:34:36.480
as well, which makes a lot of sense because weight

00:34:36.480 --> 00:34:38.929
is weight. And one of the things that if you're

00:34:38.929 --> 00:34:40.690
going to, if you're going to go through weight

00:34:40.690 --> 00:34:43.469
loss journey, whether it be just from cutting

00:34:43.469 --> 00:34:45.610
calories or if you're going to do bariatric surgery,

00:34:45.789 --> 00:34:47.949
or if you're going to do things like GOP ones,

00:34:47.989 --> 00:34:50.349
one of the things that you should really supplement

00:34:50.349 --> 00:34:55.489
with is especially protein and also strength

00:34:55.489 --> 00:34:57.750
training. Like actually, because what you're

00:34:57.750 --> 00:34:59.409
trying to tell your body to do is like, even

00:34:59.409 --> 00:35:04.369
though I'm losing weight and fat, muscle and

00:35:04.369 --> 00:35:07.920
bone. I'm going to tell my body to, if you have

00:35:07.920 --> 00:35:11.059
to direct your resources to anywhere, then you

00:35:11.059 --> 00:35:13.019
should probably direct it towards building muscle.

00:35:13.119 --> 00:35:14.840
So if you're going to go on a weight loss journey,

00:35:15.079 --> 00:35:18.059
it is really good to supplement that with exercise

00:35:18.059 --> 00:35:21.079
so that you can essentially keep your muscle

00:35:21.079 --> 00:35:24.679
mass and your bone mineral density up while you're

00:35:24.679 --> 00:35:28.619
going through that. Yes. I can tell mom's on

00:35:28.619 --> 00:35:31.079
a mission right now. She really wants to find

00:35:31.079 --> 00:35:33.000
this answer. I know, because I'm like, I read

00:35:33.000 --> 00:35:37.239
it. Okay. So, but we'll put a pin in that for

00:35:37.239 --> 00:35:42.199
now. And so then, so if you are feeling like

00:35:42.199 --> 00:35:45.380
maybe you may be predisposed to osteoporosis

00:35:45.380 --> 00:35:48.579
or sometimes your healthcare provider will make

00:35:48.579 --> 00:35:52.719
an assessment as you become perimenopausal as

00:35:52.719 --> 00:35:55.039
a woman and stuff to give kind of a baseline.

00:35:55.789 --> 00:35:58.130
bone density scan to figure out where you are.

00:35:58.429 --> 00:36:01.789
So that's basically the kind of gold standard

00:36:01.789 --> 00:36:04.130
for determining whether or not - Are we going

00:36:04.130 --> 00:36:06.789
to go into diagnostic of like how someone - Yes.

00:36:06.849 --> 00:36:10.670
How do you know if you have osteopenia or osteoporosis?

00:36:10.690 --> 00:36:13.710
Because like you said, it's silent and there's

00:36:13.710 --> 00:36:16.730
no biomarkers for it, but we do have diagnostics

00:36:16.730 --> 00:36:18.630
that can tell you where you're at. Right. Okay.

00:36:19.150 --> 00:36:24.159
So the - The gold standard is called a DEXA scan,

00:36:24.320 --> 00:36:30.519
and it stands for dual energy x -ray absorptiometry

00:36:30.519 --> 00:36:34.960
scan. So it helps to determine your bone density.

00:36:35.260 --> 00:36:37.780
And there are three areas that are routinely

00:36:37.780 --> 00:36:40.840
assessed when you get a DEXA scan. Your lumbar

00:36:40.840 --> 00:36:45.329
spine. and both femurs, so both of the heads

00:36:45.329 --> 00:36:49.190
of your hip bones. Okay, so the trabecular areas

00:36:49.190 --> 00:36:52.010
between your hip and your femur. Right. Okay.

00:36:52.230 --> 00:36:58.650
And so your results of a bone density scan, you

00:36:58.650 --> 00:37:01.670
end up with a population, you compare it with

00:37:01.670 --> 00:37:04.969
a population reference standard, and it's presented

00:37:04.969 --> 00:37:08.110
as quantitative value of a bone mineral density

00:37:08.110 --> 00:37:13.599
and a T -score. And T -scores are used to compare

00:37:13.599 --> 00:37:18.099
to this population reference standard in postmenopausal

00:37:18.099 --> 00:37:21.219
women, perimenopausal women, and men over 50

00:37:21.219 --> 00:37:25.159
years of age. Or we use a Z -score to compare

00:37:25.159 --> 00:37:28.300
it in younger people or premenopausal women.

00:37:29.980 --> 00:37:32.199
Isn't it the other way around? Isn't T -score

00:37:32.199 --> 00:37:35.239
comparing to the younger ideal? No. T -score

00:37:35.239 --> 00:37:38.280
is for older. Z -score is for younger. What I

00:37:38.280 --> 00:37:40.239
mean is like, if they give you, because you're

00:37:40.239 --> 00:37:44.159
67. Yes. So if they give you a Z score, they're

00:37:44.159 --> 00:37:47.900
going to compare it to women your age. I don't

00:37:47.900 --> 00:37:51.219
get a, I don't get a Z score. Z scores are not

00:37:51.219 --> 00:37:54.599
used in people over 50 years of age. So you're

00:37:54.599 --> 00:37:56.739
only going to get a T score just because they're

00:37:56.739 --> 00:38:01.400
comparing you to the younger ideal. Right. But

00:38:01.400 --> 00:38:06.170
I mean, why wouldn't. I'm sorry, I don't, it's

00:38:06.170 --> 00:38:08.750
beyond my pay grade. I don't understand. I mean,

00:38:08.789 --> 00:38:10.369
I could go back and read more. Because all a

00:38:10.369 --> 00:38:12.809
Z -score is, is like, so we should maybe do a

00:38:12.809 --> 00:38:14.690
little basic statistics for folks out there.

00:38:14.789 --> 00:38:17.289
So like, I think sometimes when we talk about

00:38:17.289 --> 00:38:19.829
things like T -scores, Z -scores, we have to

00:38:19.829 --> 00:38:22.369
remember that you're comparing, basically you

00:38:22.369 --> 00:38:25.050
want to compare yourself to your peers and say,

00:38:25.090 --> 00:38:28.889
okay, my. Most of the time with the DEXA, I actually

00:38:28.889 --> 00:38:30.829
just got a DEXA scan a month or two ago with

00:38:30.829 --> 00:38:33.130
my lovely girlfriend because we wanted to know

00:38:33.130 --> 00:38:35.690
what our bone mineral density was. And it also

00:38:35.690 --> 00:38:38.329
is really cool because it measures your lean

00:38:38.329 --> 00:38:43.170
mass and your adipose tissue because these are

00:38:43.170 --> 00:38:47.230
specific x -rays. If you remember your electromagnetic

00:38:47.230 --> 00:38:52.599
spectrum, different rays come in. different wavelengths

00:38:52.599 --> 00:38:54.880
so like you have visible light right so you can

00:38:54.880 --> 00:38:57.119
go from like blue all the way to red and red

00:38:57.119 --> 00:39:01.039
has 400 nanometers blue is around or violet is

00:39:01.039 --> 00:39:03.099
around 700 nanometers so they're going to represent

00:39:03.099 --> 00:39:05.219
a certain color you can do the same thing with

00:39:05.219 --> 00:39:07.559
radio stations too like anytime i don't know

00:39:07.559 --> 00:39:09.860
if you all still listen to the radio but if you

00:39:09.860 --> 00:39:13.500
tune to 940 fm that's a specific wavelength on

00:39:13.500 --> 00:39:15.940
the fm radio station which is you know different

00:39:15.940 --> 00:39:20.050
than 1200 um You can do that with x -rays too.

00:39:20.150 --> 00:39:22.250
And different frequencies or different wavelengths

00:39:22.250 --> 00:39:24.650
of x -rays will interact with different portions

00:39:24.650 --> 00:39:28.050
of a tissue. And there's one type of x -ray that

00:39:28.050 --> 00:39:30.690
is able to basically go and take a look at your

00:39:30.690 --> 00:39:33.309
bones. And then there's one that is able to differentiate

00:39:33.309 --> 00:39:36.530
between adipose and muscle tissue, what we call

00:39:36.530 --> 00:39:40.809
lean mass. So a DEXA, like mom said, it's a dual

00:39:40.809 --> 00:39:43.769
x -ray, which basically means it uses these two

00:39:43.769 --> 00:39:47.210
wavelengths of x -ray to look at your body. So

00:39:47.210 --> 00:39:52.210
I got a bone mineral density score of 1 .34 grams

00:39:52.210 --> 00:39:55.670
per meter cubed or centimeter cubed, not cubed,

00:39:55.809 --> 00:39:58.389
squared, because they only compare by surface

00:39:58.389 --> 00:40:01.250
area, by two dimensions rather than three dimensions,

00:40:01.349 --> 00:40:02.929
because they're coming up with a two -dimensional

00:40:02.929 --> 00:40:06.070
scan rather than a three -dimensional scan. And

00:40:06.070 --> 00:40:11.329
my girlfriend was around 1 .06. And the question

00:40:11.329 --> 00:40:14.070
is, is like, okay, we have these numbers. What

00:40:14.070 --> 00:40:17.989
does that mean? So is it right for me to compare

00:40:17.989 --> 00:40:20.230
myself to my girlfriend and say, well, hey, my

00:40:20.230 --> 00:40:23.250
number's bigger. So therefore, my bones are better.

00:40:23.489 --> 00:40:26.190
Well, it's not a good comparison because she

00:40:26.190 --> 00:40:29.250
and I are in different demographics. She's a

00:40:29.250 --> 00:40:32.210
smaller, younger female, and I'm an older, grandpa

00:40:32.210 --> 00:40:36.190
-like man. That's really sick. I mean, you're

00:40:36.190 --> 00:40:38.329
not that different in age. It was called a joke.

00:40:41.849 --> 00:40:44.829
The idea is like, okay, so my understanding is

00:40:44.829 --> 00:40:46.829
in statistics, when you're comparing against

00:40:46.829 --> 00:40:49.650
a population, which usually if you've ever seen

00:40:49.650 --> 00:40:52.610
like a bell curve before, like I'm just going

00:40:52.610 --> 00:40:54.409
to think about it in terms of height, right?

00:40:54.510 --> 00:40:57.349
So the average height for a man is I think is

00:40:57.349 --> 00:41:02.230
around 5 '8 or 5 '9. So most of the men in the

00:41:02.230 --> 00:41:04.750
United States are going to basically hover around

00:41:04.750 --> 00:41:07.380
the middle. of that distribution, meaning they're

00:41:07.380 --> 00:41:09.219
going to be at the top of that bell. If you can

00:41:09.219 --> 00:41:11.460
picture basically a bell, the top of the bell

00:41:11.460 --> 00:41:13.699
is going to be where most men are, and you're

00:41:13.699 --> 00:41:15.260
going to have a lot more men who are 5 '8 and

00:41:15.260 --> 00:41:17.659
5 '9. But there are also going to be extremes,

00:41:17.840 --> 00:41:21.619
like the tail ends of those, basically the edges

00:41:21.619 --> 00:41:23.739
of those bell. They're going to have men like

00:41:23.739 --> 00:41:26.840
me, who are 5 '4 or 5 foot or a lot shorter,

00:41:26.960 --> 00:41:29.900
to the left of the top of that bell. And then

00:41:29.900 --> 00:41:32.119
you have men maybe to the right of that bell

00:41:32.119 --> 00:41:34.500
who might be six foot, seven foot. They're going

00:41:34.500 --> 00:41:37.219
to be at the tail end of that bell. And basically

00:41:37.219 --> 00:41:40.599
by how many deviations away from the middle,

00:41:40.719 --> 00:41:43.099
which we call the median or the mean, we call

00:41:43.099 --> 00:41:45.860
those standard deviations, meaning like how many

00:41:45.860 --> 00:41:49.840
deviations away are you away from that mean?

00:41:49.960 --> 00:41:53.719
And usually we usually deviate as one, two, or

00:41:53.719 --> 00:41:56.920
three. If you're a standard deviation of one,

00:41:56.980 --> 00:42:01.420
that means you're 82 % sorry, you're going to

00:42:01.420 --> 00:42:04.039
basically going to be in the top 18 % of people

00:42:04.039 --> 00:42:05.719
in that thing that you're being measured. So

00:42:05.719 --> 00:42:08.099
if you're in the plus one standard deviation

00:42:08.099 --> 00:42:10.920
for height, you're going to be taller than 82

00:42:10.920 --> 00:42:14.420
% of men. If you are two standard deviations

00:42:14.420 --> 00:42:17.840
away, I think you're around 95 or is it? Yeah,

00:42:17.840 --> 00:42:23.099
95. And then three is 97 .5 % taller than most

00:42:23.099 --> 00:42:27.340
men. But if you only had seven foot men in a

00:42:27.340 --> 00:42:30.920
population, Like if you had 7 .1 to 7 .7, for

00:42:30.920 --> 00:42:35.559
example, the median might be 7 .2, right? So

00:42:35.559 --> 00:42:38.679
even you could be in the middle of the bell curve

00:42:38.679 --> 00:42:42.639
of people who are only seven foot tall, even

00:42:42.639 --> 00:42:44.340
though you're really tall, you're comparing to

00:42:44.340 --> 00:42:46.360
this population that's only seven foot tall.

00:42:46.559 --> 00:42:50.619
So my point about Z scores and T scores is that

00:42:50.619 --> 00:42:53.079
my understanding, at least what I read, is that

00:42:53.079 --> 00:42:57.380
a Z score is essentially just comparing you within

00:42:57.840 --> 00:43:01.599
people in your age group or in your demographics.

00:43:01.679 --> 00:43:05.579
So if you're a woman who is 67, what is my bone

00:43:05.579 --> 00:43:08.519
mineral density compared to people who are in

00:43:08.519 --> 00:43:12.059
my age group? How well am I doing? And then the

00:43:12.059 --> 00:43:14.719
T -score, like you said, is saying like, okay,

00:43:14.780 --> 00:43:18.059
how far away am I from my ideal? Like how far

00:43:18.059 --> 00:43:22.159
away am I from my 30 to 25 -year -old self when

00:43:22.159 --> 00:43:25.750
I was at peak bone mineral density? Because that

00:43:25.750 --> 00:43:28.030
is going to show you progression over time, right?

00:43:28.670 --> 00:43:30.110
And that's going to be what they're going to

00:43:30.110 --> 00:43:32.070
be more interested in. I agree. But I'm just

00:43:32.070 --> 00:43:34.309
saying is like there are these two metrics. Because

00:43:34.309 --> 00:43:37.389
if I'm a 39 -year -old man. You're going to get

00:43:37.389 --> 00:43:38.969
a Z score. A T score is not going to be that

00:43:38.969 --> 00:43:42.250
interesting to me. But you can still get one.

00:43:42.329 --> 00:43:45.409
Because even though a T score might be interesting

00:43:45.409 --> 00:43:48.889
from where you've deviated from, how do you compare

00:43:48.889 --> 00:43:51.889
to your peers? Right. So like you said, the T

00:43:51.889 --> 00:43:56.010
score is. It's used for diagnosis, and it's a

00:43:56.010 --> 00:43:58.690
comparison of the patient's bone mineral density

00:43:58.690 --> 00:44:02.889
to the mean bone mineral density of a healthy,

00:44:03.050 --> 00:44:07.750
young, which is 20 to 29 -year -old, white female

00:44:07.750 --> 00:44:11.369
reference population. It's not adjusted for age,

00:44:11.530 --> 00:44:15.190
sex, race, or ethnicity. And the T -score is

00:44:15.190 --> 00:44:17.750
the number of standard deviations from the mean

00:44:17.750 --> 00:44:20.500
of that reference population. The Z -score is

00:44:20.500 --> 00:44:23.539
similar, but it compares the patient's bone mineral

00:44:23.539 --> 00:44:26.920
density to the mean bone mineral density for

00:44:26.920 --> 00:44:30.880
a healthy sex and age -matched population. You

00:44:30.880 --> 00:44:33.400
said it much more succinctly than I did. Yes.

00:44:33.519 --> 00:44:36.760
And if you've got race and ethnicity for your

00:44:36.760 --> 00:44:38.659
Z -score, that should also be included. Okay.

00:44:38.719 --> 00:44:42.400
So it's a lot more specific, but... The T -score

00:44:42.400 --> 00:44:46.679
is what is used for treatment and to assess a

00:44:46.679 --> 00:44:50.820
bone density scan for an older person. So you're

00:44:50.820 --> 00:44:52.500
going to see both use it. It just depends on

00:44:52.500 --> 00:44:55.840
which age group you fall in. Well, that's true.

00:44:56.059 --> 00:44:58.300
And I think sometimes, you know, the perfect

00:44:58.300 --> 00:45:00.920
can be the enemy of the good. So yeah, I think

00:45:00.920 --> 00:45:03.380
it's like if you're 67, you're never going to

00:45:03.380 --> 00:45:06.440
get back to that. But sometimes you're like,

00:45:06.539 --> 00:45:09.090
okay. compared to my peers, how well am I doing?

00:45:09.250 --> 00:45:12.369
Yeah. And I don't know, I have to go back now.

00:45:12.389 --> 00:45:14.130
And now that we've done this, I need to pull

00:45:14.130 --> 00:45:17.469
out all my, my lab results and see if they actually

00:45:17.469 --> 00:45:19.889
did a Z score and a T score, just a Z score.

00:45:19.909 --> 00:45:22.590
Yeah. Just as, so just to make this point more

00:45:22.590 --> 00:45:26.190
clear, like I got my bone mineral density and

00:45:26.190 --> 00:45:31.349
it was 1 .34. And I think I was in the, I think

00:45:31.349 --> 00:45:33.929
I was a standard deviation away. I think maybe

00:45:33.929 --> 00:45:37.050
0 .5 standard deviations away. So I was in good

00:45:37.050 --> 00:45:38.989
shape compared to most men in my demographic.

00:45:39.349 --> 00:45:42.250
But when I looked at other bone mineral density

00:45:42.250 --> 00:45:45.289
metrics in the literature comparing with other

00:45:45.289 --> 00:45:51.809
men my age, it was around like 1 .1. So like

00:45:51.809 --> 00:45:56.710
the metric that was, it really does depend on

00:45:56.710 --> 00:45:58.730
the population you're measuring against. So like

00:45:58.730 --> 00:46:02.949
if I'm people who go get DEXA scans. It might

00:46:02.949 --> 00:46:04.969
be something called a selection bias. So people

00:46:04.969 --> 00:46:07.550
who actually voluntarily go get DEXA scans might

00:46:07.550 --> 00:46:10.570
be, we call it a healthy user bias. So it's like

00:46:10.570 --> 00:46:13.250
people who are more conscious about their health

00:46:13.250 --> 00:46:16.070
might be healthier, have higher bone mineral

00:46:16.070 --> 00:46:19.269
density or higher lean mass tissue. So you can

00:46:19.269 --> 00:46:23.090
actually get a false sense of where you are or

00:46:23.090 --> 00:46:25.849
even an undersense of where you are if you're

00:46:25.849 --> 00:46:27.829
comparing yourself to a healthy population. So

00:46:27.829 --> 00:46:29.750
that's why it's really good to look at a... your

00:46:29.750 --> 00:46:31.949
sample is really important of how you're comparing

00:46:31.949 --> 00:46:34.210
yourself to. Because I did this for my girlfriend

00:46:34.210 --> 00:46:38.869
as well. And compared to the population she was

00:46:38.869 --> 00:46:41.469
comparing herself to, she was quite low. I think

00:46:41.469 --> 00:46:46.369
she was in the minus two to minus three standard

00:46:46.369 --> 00:46:48.769
deviations away from the mean within people who

00:46:48.769 --> 00:46:51.110
get DEXA scans. But when I looked at the literature

00:46:51.110 --> 00:46:53.070
in places like South Korea and even the general

00:46:53.070 --> 00:46:55.900
United States, She was actually above average.

00:46:56.099 --> 00:46:59.239
So it really does depend on the population. So

00:46:59.239 --> 00:47:02.179
if you get these numbers and you're comparing

00:47:02.179 --> 00:47:04.820
T scores and Z scores, depending on if you're

00:47:04.820 --> 00:47:07.179
older or younger, it is really important to know

00:47:07.179 --> 00:47:10.559
what population you're referencing against. Because

00:47:10.559 --> 00:47:13.320
like mom said, knowing how far, especially for

00:47:13.320 --> 00:47:17.360
a T score, how far under you are the ideal is

00:47:17.360 --> 00:47:19.420
going to really help you figure out like, okay,

00:47:19.539 --> 00:47:23.039
how much bone mineral density have I lost over

00:47:23.039 --> 00:47:25.849
time? Because if the average bone density for

00:47:25.849 --> 00:47:29.510
a woman at 25, or it's just the average. 20 to

00:47:29.510 --> 00:47:32.309
29, I think was that standard. And if that number

00:47:32.309 --> 00:47:36.590
is like 1 .25 and you're at a one, then you're

00:47:36.590 --> 00:47:39.050
pretty low. And that's going to be pretty worrying,

00:47:39.130 --> 00:47:43.429
you know, as you're going forward. So brief statistical

00:47:43.429 --> 00:47:47.400
lesson. Thank you. So in order to interpret your

00:47:47.400 --> 00:47:51.199
results, once you get a DEXA scan, it's based

00:47:51.199 --> 00:47:54.239
on these T -scores. And so if you have a T, so

00:47:54.239 --> 00:47:57.119
again, remember the T -score shows how much your

00:47:57.119 --> 00:48:00.599
bone mass differs from an average healthy young

00:48:00.599 --> 00:48:02.880
adult, and it's primarily a female young adult.

00:48:03.559 --> 00:48:08.400
And so if you have a T -score of minus one or

00:48:08.400 --> 00:48:12.380
higher, that's considered normal. If you have

00:48:12.380 --> 00:48:17.039
a T score between minus one and minus 2 .5, and

00:48:17.039 --> 00:48:19.480
these are measured as standard deviations. So

00:48:19.480 --> 00:48:22.920
it's minus one standard deviation or higher is

00:48:22.920 --> 00:48:26.260
normal. So if you have a T score of minus one

00:48:26.260 --> 00:48:29.960
standard deviation to minus 2 .5 standard deviations,

00:48:29.960 --> 00:48:33.420
this is what's defined as osteopenia, where you

00:48:33.420 --> 00:48:36.860
have low bone mass and low bone density. And

00:48:36.860 --> 00:48:39.619
if you have a T score of less than... negative

00:48:39.619 --> 00:48:44.280
2 .5 standard deviations, then you have osteoporosis.

00:48:44.739 --> 00:48:48.039
If you have a Z -score, if you're getting a Z

00:48:48.039 --> 00:48:51.219
-score, and remember Z -scores are used in children,

00:48:51.539 --> 00:48:57.139
premenopausal women and males under 50, premenopausal

00:48:57.139 --> 00:49:00.420
women and males under 50 years of age. And that,

00:49:00.500 --> 00:49:03.380
the number that you're looking for is to not

00:49:03.380 --> 00:49:07.219
be less than two. Yeah, that makes sense because

00:49:08.170 --> 00:49:10.050
I'm thinking about this now is like, yeah, a

00:49:10.050 --> 00:49:14.789
Z score when you're probably past menopause is

00:49:14.789 --> 00:49:17.230
not going to make sense because your hormone

00:49:17.230 --> 00:49:19.110
profile, especially as a woman, is going to be

00:49:19.110 --> 00:49:22.880
a lot different. And also. comparing within your

00:49:22.880 --> 00:49:25.539
population, assuming maybe a lot of people have

00:49:25.539 --> 00:49:28.059
osteopenia and osteoporosis, it's not going to

00:49:28.059 --> 00:49:30.320
do a great job of saying like what you should

00:49:30.320 --> 00:49:32.699
be. Right. Because that's a great point. Yeah.

00:49:32.699 --> 00:49:34.900
It's like, because it's like, uh, it's comparing

00:49:34.900 --> 00:49:37.440
two sick people. Yeah. Or it's like if everybody

00:49:37.440 --> 00:49:41.539
in the class failed the exam, like you, you wouldn't

00:49:41.539 --> 00:49:43.639
say like, well, the person who got the 58 got

00:49:43.639 --> 00:49:46.920
an A and the person who got a 28 got an F and

00:49:46.920 --> 00:49:48.719
it's like, no, you all got Fs compared to the

00:49:48.719 --> 00:49:52.409
standard that I set, which is A is an A grade

00:49:52.409 --> 00:49:55.530
is 90 to 100. So that makes a lot of sense that

00:49:55.530 --> 00:49:57.710
you would set it against an ideal rather than

00:49:57.710 --> 00:50:03.530
just a general population. If by chance you don't

00:50:03.530 --> 00:50:06.929
have access to, or you can't, or you choose not

00:50:06.929 --> 00:50:09.829
to have a DEXA scan, there is another risk assessment

00:50:09.829 --> 00:50:12.590
that's available. It's called FRAX, F -R -A -X.

00:50:13.050 --> 00:50:16.550
And it actually calculates an individual's percent

00:50:16.550 --> 00:50:22.470
probability of a major osteoporotic. osteoporotic

00:50:22.470 --> 00:50:25.610
fracture and hip fracture over a 10 -year time

00:50:25.610 --> 00:50:29.210
period. And it uses factors that significantly

00:50:29.210 --> 00:50:33.150
increase fracture risk, like age, gender, low

00:50:33.150 --> 00:50:36.369
body mass index, a previous fracture, hip fracture,

00:50:36.590 --> 00:50:39.889
in a parent, treatment with glucocorticoids,

00:50:39.969 --> 00:50:43.460
whether or not you smoke or drink alcohol. And

00:50:43.460 --> 00:50:46.480
the other causes of secondary osteoporosis. And

00:50:46.480 --> 00:50:48.380
so then you're going to get this assessment and

00:50:48.380 --> 00:50:51.239
it will tell you whether or not you are likely

00:50:51.239 --> 00:50:56.400
to develop an osteoporotic fracture. And it determines

00:50:56.400 --> 00:50:59.159
an overall risk, including your spine, your shoulder,

00:50:59.300 --> 00:51:04.619
your forearm, and your hip. The scores are percentages

00:51:04.619 --> 00:51:07.340
and they're typically interpreted if you have

00:51:07.340 --> 00:51:13.349
a... FRAX assessment of a percentage score of

00:51:13.349 --> 00:51:17.389
20 % or greater for a major fracture or greater

00:51:17.389 --> 00:51:21.250
than or equal to 3 % for a hip fracture, that's

00:51:21.250 --> 00:51:23.570
going to help you be guided as far as treatment

00:51:23.570 --> 00:51:25.610
for low bone density. So that's not good. If

00:51:25.610 --> 00:51:29.510
you have a greater than overall 20 % risk of

00:51:29.510 --> 00:51:32.210
fracture or greater than 3 % risk of hip fracture,

00:51:32.449 --> 00:51:36.949
then probably something needs to be done. OK,

00:51:37.110 --> 00:51:39.949
so we're going to focus on now prevention. Like

00:51:39.949 --> 00:51:41.969
what on earth can we do to keep this from happening

00:51:41.969 --> 00:51:45.849
or or at least make it happen far in the future

00:51:45.849 --> 00:51:48.869
or maybe not to the degree that. Yeah, if you

00:51:48.869 --> 00:51:51.610
if you picture the if you picture kind of bone

00:51:51.610 --> 00:51:54.030
mineral density, kind of like a downward slope,

00:51:54.190 --> 00:51:58.179
like a ski slope. Right. Like how do you. Make

00:51:58.179 --> 00:52:00.739
it go. Basically, how do you keep the slope nice

00:52:00.739 --> 00:52:03.380
and shallow rather than nice and deep? Because

00:52:03.380 --> 00:52:05.639
the unfortunate thing is that it's going to happen.

00:52:05.699 --> 00:52:07.599
Your bone mineral density is going to decrease

00:52:07.599 --> 00:52:11.679
over time. So how do you keep that thing shallow?

00:52:11.980 --> 00:52:15.050
Yes. Okay. Yes. How do you keep it shallow? So

00:52:15.050 --> 00:52:17.210
again, so prevention is really the primary goal

00:52:17.210 --> 00:52:19.969
for osteoporosis. And so the way to do that is

00:52:19.969 --> 00:52:23.309
what we call a bone healthy lifestyle. And you're

00:52:23.309 --> 00:52:25.969
like, what on earth is a bone healthy lifestyle?

00:52:26.090 --> 00:52:28.550
And actually this should begin at birth and continue

00:52:28.550 --> 00:52:31.690
throughout life. Well, if I'd only known with

00:52:31.690 --> 00:52:34.809
my kids. Well, luckily my bone health is pretty

00:52:34.809 --> 00:52:38.050
good at the moment. So, but you're right. I'm

00:52:38.050 --> 00:52:41.449
already born and I've gone through 39 years of

00:52:41.449 --> 00:52:44.369
this life. So what do I do? 39 yet. I'll be,

00:52:44.369 --> 00:52:47.969
oh yeah. So anyway, so you start out with a well

00:52:47.969 --> 00:52:49.889
-balanced diet. And so you want to make sure

00:52:49.889 --> 00:52:52.429
it has enough calcium and vitamin D and protein

00:52:52.429 --> 00:52:55.690
in it. And so we've got a lot, now that we've

00:52:55.690 --> 00:52:57.869
got labels that tell us what's in everything,

00:52:58.010 --> 00:53:00.909
that finding out what's calcium rich and protein

00:53:00.909 --> 00:53:03.369
rich is not as hard as it used to be. Yeah, the

00:53:03.369 --> 00:53:08.739
recommended dosage for calcium. um, for minimum

00:53:08.739 --> 00:53:11.559
dosage to get what you think is between a thousand

00:53:11.559 --> 00:53:15.380
to 1200 milligrams a day. Although I think with

00:53:15.380 --> 00:53:18.260
women and postmenopausal women, it's, it's 600

00:53:18.260 --> 00:53:22.800
milligrams a day. Um, I, and, um, I think, I

00:53:22.800 --> 00:53:25.980
think that you can take more, but taking an actual

00:53:25.980 --> 00:53:27.920
supplement because you get it in another, other

00:53:27.920 --> 00:53:31.739
things as well too. And interestingly, um, As

00:53:31.739 --> 00:53:36.639
the older you get, higher calcium may potentially

00:53:36.639 --> 00:53:39.679
increase like your calcium score in your arteries

00:53:39.679 --> 00:53:42.400
and potentially contribute to plat formation.

00:53:42.739 --> 00:53:44.880
So it's kind of a balance. So the recommendation

00:53:44.880 --> 00:53:47.960
is usually about 600 milligrams a day for a postmenopausal

00:53:47.960 --> 00:53:50.000
woman. Okay. So you kind of have to balance the

00:53:50.000 --> 00:53:52.079
trade -off with some calcium being deposited

00:53:52.079 --> 00:53:54.820
in your arteries as opposed to going to these

00:53:54.820 --> 00:53:56.719
osteoblasts that are going to be. When you're

00:53:56.719 --> 00:53:58.420
younger, you don't have to think about that quite

00:53:58.420 --> 00:54:01.219
as much and stuff. So, yeah. Okay. So, but if

00:54:01.219 --> 00:54:03.159
you're going to get, let's say, so between a

00:54:03.159 --> 00:54:05.480
thousand and 1200 for a normal person, and then

00:54:05.480 --> 00:54:07.920
maybe down to 600 for post -menopausal women.

00:54:08.019 --> 00:54:11.099
Great. And then also things like vitamin D, maybe

00:54:11.099 --> 00:54:14.000
we should go through that pathway of how, why

00:54:14.000 --> 00:54:19.400
vitamin D is important. Okay. Go ahead. So I

00:54:19.400 --> 00:54:21.840
think a lot of people hear about vitamin D. It's

00:54:21.840 --> 00:54:23.460
one of the, I feel like it's one of those things

00:54:23.460 --> 00:54:28.400
that's maybe inappropriately seen as a panacea.

00:54:29.760 --> 00:54:34.699
But vitamin D, in terms of this and this context,

00:54:35.159 --> 00:54:39.760
it is responsible for essentially taking calcium

00:54:39.760 --> 00:54:44.000
out of your gut and delivering it to your bone

00:54:44.000 --> 00:54:47.219
so that osteoblasts can use it to build up your

00:54:47.219 --> 00:54:51.679
bone. Mom's going to hopefully help correct me

00:54:51.679 --> 00:54:55.940
a lot of these things because it's... You can

00:54:55.940 --> 00:54:58.340
ingest it by a supplement, but I'm just going

00:54:58.340 --> 00:55:00.139
to talk about how it's naturally made first.

00:55:00.480 --> 00:55:03.159
It is made by something called your parathyroid,

00:55:03.300 --> 00:55:06.400
which is the thyroid is in your neck. If you

00:55:06.400 --> 00:55:09.340
kind of look up and you kind of look at a man's

00:55:09.340 --> 00:55:11.840
like an Adam's apple. And if you're from Texas,

00:55:12.059 --> 00:55:14.199
you can do the hook them sign unless you're an

00:55:14.199 --> 00:55:16.239
Aggie. And I apologize. But if you look at one

00:55:16.239 --> 00:55:18.840
of those obnoxious people from UT or the rock

00:55:18.840 --> 00:55:22.090
on signal. If you look at if you kind of do the

00:55:22.090 --> 00:55:24.469
like rock on, dude, if you do that with your

00:55:24.469 --> 00:55:28.550
hand, the parathyroids are at your pinky, your

00:55:28.550 --> 00:55:31.690
pointer finger and the bottom right and left

00:55:31.690 --> 00:55:35.329
of that rock on. So they're a portion of your

00:55:35.329 --> 00:55:38.610
thyroid gland. And those things are responsible

00:55:38.610 --> 00:55:44.170
for secreting vitamin D2, which then gets converted

00:55:44.170 --> 00:55:47.789
into its active form, which we call vitamin D3.

00:55:48.460 --> 00:55:51.420
And vitamin D3 is responsible for taking calcium

00:55:51.420 --> 00:55:54.059
out of your gut, which is usually you consume

00:55:54.059 --> 00:55:57.719
calcium by eating things, things like yogurts

00:55:57.719 --> 00:56:01.820
and milks and things like tofu. And then it takes

00:56:01.820 --> 00:56:05.980
that calcium and then will deliver it to the

00:56:05.980 --> 00:56:08.550
bone. And probably a lot of other complicated

00:56:08.550 --> 00:56:10.409
pathways that I'm not aware of that maybe you

00:56:10.409 --> 00:56:12.090
can fill in if you want. Yeah, so it's also used

00:56:12.090 --> 00:56:15.329
in the heart to make the heart beat pump as well

00:56:15.329 --> 00:56:17.650
too. Oh, because of those for the ion channels?

00:56:17.769 --> 00:56:20.449
Yeah. Yeah, okay. So calcium is important in

00:56:20.449 --> 00:56:24.769
a lot of things. And then it gets deposited there.

00:56:25.610 --> 00:56:28.570
And probably people have heard that you can get

00:56:28.570 --> 00:56:33.170
vitamin D produced by sunlight. And I think a

00:56:33.170 --> 00:56:35.760
lot of times people don't realize like... how

00:56:35.760 --> 00:56:38.579
little you need in order to make vitamin D3.

00:56:38.900 --> 00:56:41.539
Because the sunlight is actually there to activate

00:56:41.539 --> 00:56:44.480
to go from vitamin D2, which is the inactive

00:56:44.480 --> 00:56:47.320
form, to vitamin D3, which is the active form.

00:56:47.780 --> 00:56:50.659
And based on some of the literature I read, you

00:56:50.659 --> 00:56:54.619
only need about 10 to 20 % of your body uncovered.

00:56:54.800 --> 00:56:57.679
And that usually means your face, your arms,

00:56:57.780 --> 00:57:00.179
maybe a little bit of your legs and your midriff.

00:57:00.590 --> 00:57:02.309
If you're a woman who likes a little crop top,

00:57:02.489 --> 00:57:03.789
you know, you can show your belly a little bit.

00:57:03.869 --> 00:57:06.789
Mom's shaking her head. So modest. And I like

00:57:06.789 --> 00:57:11.329
it. And so, but you can only have to really expose

00:57:11.329 --> 00:57:15.210
that from midday, 10 a .m. to 4 p .m. when you

00:57:15.210 --> 00:57:20.030
get kind of maximum sun exposure. And about 24

00:57:20.030 --> 00:57:23.150
minutes will actually, 24 minutes of sunlight

00:57:23.150 --> 00:57:26.050
can stimulate the maximal production from D2

00:57:26.050 --> 00:57:28.650
to D3 of what you need inside of your body for

00:57:28.650 --> 00:57:32.219
the day. So usually vitamin D supplementation

00:57:32.219 --> 00:57:33.980
is mainly for people who just don't have a lot

00:57:33.980 --> 00:57:37.219
of access to sunlight or they're working a night

00:57:37.219 --> 00:57:39.260
shift and they're not just able to be out in

00:57:39.260 --> 00:57:43.400
the sun. So really a little goes a long way when

00:57:43.400 --> 00:57:46.599
you are getting that vitamin D2 to vitamin D3

00:57:46.599 --> 00:57:51.179
synthesis from sunlight. And if you do need a

00:57:51.179 --> 00:57:54.000
little bit of supplement, there are ways to do

00:57:54.000 --> 00:57:57.039
that. And you can maybe take, you know, what's

00:57:57.039 --> 00:57:59.690
the recommendation like? 1 ,000 international

00:57:59.690 --> 00:58:02.110
units, or maybe it's like 400 international units.

00:58:02.250 --> 00:58:04.889
I think it may be 600, but with postmenopausal

00:58:04.889 --> 00:58:07.590
women, it goes up to 2 ,000 a day. But also,

00:58:07.650 --> 00:58:10.389
too, the whole sunlight thing with vitamin D

00:58:10.389 --> 00:58:15.360
conversion, it's not as... It's not as much,

00:58:15.360 --> 00:58:17.380
it's not as concerning as it used to be because

00:58:17.380 --> 00:58:20.119
we've got so many foods that are fortified with

00:58:20.119 --> 00:58:24.400
vitamin D, our milks, our juices and cereals

00:58:24.400 --> 00:58:26.679
and stuff like that. So we're able to get it

00:58:26.679 --> 00:58:29.519
even if we don't get out. So even from a standard

00:58:29.519 --> 00:58:31.900
diet, a lot of that has been fortified with vitamin

00:58:31.900 --> 00:58:35.599
D. Yeah. Okay. Excellent. Yeah. That's wonderful.

00:58:35.860 --> 00:58:38.699
And they fortify with the active component, I

00:58:38.699 --> 00:58:42.090
imagine. Okay. So again, we've got that well

00:58:42.090 --> 00:58:45.769
-balanced diet as the first leg or arm or tentacle

00:58:45.769 --> 00:58:48.670
in our bone healthy lifestyle. The second is

00:58:48.670 --> 00:58:52.090
to minimize caffeine consumption because caffeine

00:58:52.090 --> 00:58:55.429
is associated with an increased calcium excretion.

00:58:55.429 --> 00:58:57.829
And so it's going to increase rates of bone loss

00:58:57.829 --> 00:59:00.110
and it can modestly increase your fracture risk.

00:59:00.269 --> 00:59:03.719
So you want to make sure, I believe it was. Oh,

00:59:03.739 --> 00:59:06.380
golly, two cups a day of coffee, you know, kind

00:59:06.380 --> 00:59:08.280
of the equivalent and stuff. That is the standard

00:59:08.280 --> 00:59:13.320
kind of safe dosage. Then the third part is to

00:59:13.320 --> 00:59:16.920
avoid or quit smoking because smoking can reduce

00:59:16.920 --> 00:59:20.239
calcium absorption. It lowers vitamin D concentrations

00:59:20.239 --> 00:59:23.920
and it can increase bone resorption. So it's

00:59:23.920 --> 00:59:26.599
not a good thing. Alcohol, we want to limit as

00:59:26.599 --> 00:59:29.440
well, too, because it also increases bone resorption

00:59:29.440 --> 00:59:32.809
and decreases bone formation. So we've got, so

00:59:32.809 --> 00:59:35.409
far, we've got a well -balanced diet. We want

00:59:35.409 --> 00:59:38.070
to minimize caffeine consumption. We want to

00:59:38.070 --> 00:59:41.190
avoid or quit smoking. We want to limit alcohol

00:59:41.190 --> 00:59:44.250
intake. The fifth one is to do weight -bearing

00:59:44.250 --> 00:59:48.570
or resistance exercises. So you're going to increase,

00:59:48.750 --> 00:59:51.070
I thought this was really fascinating. You increase

00:59:51.070 --> 00:59:53.949
bone strain, especially in your weaker bone,

00:59:54.150 --> 00:59:57.429
which then will stimulate osteocytes, which will

00:59:57.429 --> 01:00:00.780
then lead to bone resorption. which then increases

01:00:00.780 --> 01:00:04.519
stronger bone formation. Gotcha. So by stressing

01:00:04.519 --> 01:00:07.000
your bone, you kind of say - You break it down

01:00:07.000 --> 01:00:08.619
to build it back up again. Oh, that's really

01:00:08.619 --> 01:00:11.239
interesting. Yeah. Yeah, I have this great chart

01:00:11.239 --> 01:00:13.019
because I think a lot of times people will be

01:00:13.019 --> 01:00:16.320
like, well, what type of exercise is best to

01:00:16.320 --> 01:00:20.599
kind of build up muscle? And actually, if you

01:00:20.599 --> 01:00:25.579
look at individuals who have the highest T -score

01:00:25.579 --> 01:00:29.070
or the highest bone mineral density, um college

01:00:29.070 --> 01:00:31.949
football is actually goodness gracious but that

01:00:31.949 --> 01:00:33.829
comes with a lot of other risks and a lot of

01:00:33.829 --> 01:00:35.789
people aren't playing college football and this

01:00:35.789 --> 01:00:39.429
is this was a study done amongst uh athletes

01:00:39.429 --> 01:00:42.610
uh athletes who essentially are engaging in things

01:00:42.610 --> 01:00:45.829
non -professional okay um so all the way at the

01:00:45.829 --> 01:00:49.469
bottom was swimming okay so swimming has the

01:00:49.469 --> 01:00:52.570
least modest effect on bone mineral density score

01:00:53.150 --> 01:00:56.610
Um, and probably right in the middle, probably

01:00:56.610 --> 01:00:59.530
where most people are going to want to, uh, engage

01:00:59.530 --> 01:01:04.389
in, um, is something like, uh, uh, distance running

01:01:04.389 --> 01:01:07.730
or resistance training, resistance training,

01:01:07.809 --> 01:01:10.869
especially in females. So, uh, resistance training

01:01:10.869 --> 01:01:14.849
is essentially any like pull -ups, small weights,

01:01:15.070 --> 01:01:18.820
squats. And one of the things that you can do

01:01:18.820 --> 01:01:21.099
that if you're like, I don't want to do any of

01:01:21.099 --> 01:01:23.579
that because I just don't like, you know, vigorous

01:01:23.579 --> 01:01:26.360
exercise or going to a gym. There's this new

01:01:26.360 --> 01:01:30.059
kind of trend called rucking. It's R -U -C -K

01:01:30.059 --> 01:01:32.820
-I -N -G. And it's essentially just wearing a

01:01:32.820 --> 01:01:35.539
weighted vest. And by wearing a weighted vest,

01:01:35.639 --> 01:01:38.699
you add some, like mom said, you add some resistance

01:01:38.699 --> 01:01:41.789
onto your frame. That essentially causes your

01:01:41.789 --> 01:01:43.409
muscles to go, Ooh, there's some extra weight

01:01:43.409 --> 01:01:45.449
here. Like I'm going to signal this pathway,

01:01:45.550 --> 01:01:47.789
these osteocytes to break down and then build

01:01:47.789 --> 01:01:50.329
back up a little bit better. So if you like to

01:01:50.329 --> 01:01:52.130
go on a morning walk, if you're walking your

01:01:52.130 --> 01:01:55.010
dog and you want to just say, I want to just

01:01:55.010 --> 01:01:57.510
enjoy my walk in the morning and not kind of

01:01:57.510 --> 01:02:00.230
add any additional stress. Rucking is actually

01:02:00.230 --> 01:02:04.070
a great way to add some additional weight, especially

01:02:04.070 --> 01:02:06.690
if you're going to be up and down hills. Elevation

01:02:06.690 --> 01:02:08.730
is huge because that kind of forces your muscles

01:02:08.730 --> 01:02:12.619
to like either push more effort as you're going

01:02:12.619 --> 01:02:14.460
up the hill. And even going down the hill, you'll

01:02:14.460 --> 01:02:17.320
be bracing yourself, which can also help strengthen

01:02:17.320 --> 01:02:20.460
your bones and your hips, which a lot of times

01:02:20.460 --> 01:02:23.880
fractions can occur. And in your lumbar. And

01:02:23.880 --> 01:02:25.860
in your lumbar. So as you're getting older, it's

01:02:25.860 --> 01:02:27.980
like, okay, where is the risk going to be the

01:02:27.980 --> 01:02:31.940
greatest? And as we've talked about, the lumbar,

01:02:31.940 --> 01:02:36.480
the vertebrae, the forearms, the hips. Humerus.

01:02:36.519 --> 01:02:39.960
And the humerus, which is the bone in your arm.

01:02:40.119 --> 01:02:44.280
Between your shoulder and your forearm. Because

01:02:44.280 --> 01:02:46.280
a lot of times that's when you're bracing yourself

01:02:46.280 --> 01:02:49.420
for when you fall. Or falling on your shoulder

01:02:49.420 --> 01:02:51.719
kind of thing. So this is a great compromise

01:02:51.719 --> 01:02:53.940
for anybody who just wants to get a little extra

01:02:53.940 --> 01:02:57.199
exercise. And for all you men out there who feel

01:02:57.199 --> 01:03:00.900
like my bone mineral density score is fine. It

01:03:00.900 --> 01:03:03.429
also helps. raise your heart rate a little bit

01:03:03.429 --> 01:03:05.809
more, which is great because then you essentially

01:03:05.809 --> 01:03:09.130
are getting into something we call zone two cardio,

01:03:09.269 --> 01:03:11.969
which is also associated with decreasing mortality

01:03:11.969 --> 01:03:14.190
as you go on. Cause you're causing your heart

01:03:14.190 --> 01:03:16.230
to, to work a little bit harder, even with a

01:03:16.230 --> 01:03:21.789
basic exercise. Um, this, this, um, remind me

01:03:21.789 --> 01:03:24.829
that the term again, rucking, are they, are there

01:03:24.829 --> 01:03:27.829
different weight? Um, are there different weights

01:03:27.829 --> 01:03:30.269
for the wrecking vest? There are, you can get

01:03:30.269 --> 01:03:32.429
from, and it probably, it probably helps. Like,

01:03:32.429 --> 01:03:34.510
so you would probably need one lighter than me

01:03:34.510 --> 01:03:37.610
because there's like eight pounds, 12 pounds,

01:03:37.730 --> 01:03:40.590
16 pounds. So very similar when you're at a gym

01:03:40.590 --> 01:03:43.010
and you're like, okay, what do I want to lift?

01:03:43.170 --> 01:03:46.090
Do I, do I want to, do I want to lift 35 pound,

01:03:46.230 --> 01:03:49.510
uh, barbells or dumbbells, or do I want to do

01:03:49.510 --> 01:03:51.750
five pound? It's, it really does depend on what

01:03:51.750 --> 01:03:53.880
you're trying to accomplish. But I think the

01:03:53.880 --> 01:03:56.239
biggest thing is like, do I feel enough resistance

01:03:56.239 --> 01:04:00.920
so that I can walk and talk while not, while

01:04:00.920 --> 01:04:03.820
being maybe slightly out of breath, but not completely

01:04:03.820 --> 01:04:06.019
out of breath. Got it. And I think that is the

01:04:06.019 --> 01:04:09.360
best thing to shoot for when you're exercising,

01:04:09.519 --> 01:04:11.239
because that means that you're working your heart

01:04:11.239 --> 01:04:13.360
enough to give yourself a little bit of like

01:04:13.360 --> 01:04:16.199
metabolic boost, but not enough to like, that

01:04:16.199 --> 01:04:19.300
you need to like puff and puff. Yes. So getting

01:04:19.300 --> 01:04:21.500
kind of that, that zone two cardio sweet spot.

01:04:21.800 --> 01:04:23.300
Okay. That's a great recommendation. Thanks,

01:04:23.380 --> 01:04:26.300
Josh. Okay. So again, remember for this bone

01:04:26.300 --> 01:04:28.599
healthy lifestyle, we've got a well -balanced

01:04:28.599 --> 01:04:31.340
diet. We want to minimize caffeine consumption.

01:04:31.659 --> 01:04:34.860
We want to avoid or quit smoking. We want to

01:04:34.860 --> 01:04:37.869
limit alcohol intake. We want to do weight bearing

01:04:37.869 --> 01:04:41.010
or resistance exercises. And the last one is

01:04:41.010 --> 01:04:43.989
fall prevention, which is very important. So

01:04:43.989 --> 01:04:46.610
that you're looking, especially as people get

01:04:46.610 --> 01:04:48.070
older, you want to look at your environment.

01:04:48.269 --> 01:04:51.570
The big thing is like moving rugs, slider rugs

01:04:51.570 --> 01:04:54.630
out of the way, slippery type floors, things

01:04:54.630 --> 01:04:58.239
that you could trip over. And also... You want

01:04:58.239 --> 01:05:00.860
to make sure that medications that are prescribed

01:05:00.860 --> 01:05:04.380
don't cause you to get dizzy or lose balance

01:05:04.380 --> 01:05:06.500
because that can also increase your fall risk

01:05:06.500 --> 01:05:11.679
as well too. Okay. So thankfully, in this day

01:05:11.679 --> 01:05:14.980
and age, there are a lot of medications that

01:05:14.980 --> 01:05:23.800
can be used to manage osteoporosis. Pardon me.

01:05:27.719 --> 01:05:31.480
And all of these agents are used in concert with

01:05:31.480 --> 01:05:34.260
taking calcium and vitamin D because we need

01:05:34.260 --> 01:05:38.239
that for just our bone health. Usually when you're

01:05:38.239 --> 01:05:40.880
treating osteoporosis, you might start with what

01:05:40.880 --> 01:05:43.900
we call a bisphosphonate, which is... or alendronate

01:05:43.900 --> 01:05:46.159
or Fosamax. And I'm not going to go through all

01:05:46.159 --> 01:05:49.039
of the medications as far as all their dosages

01:05:49.039 --> 01:05:50.659
and all that. I'm going to give you some little

01:05:50.659 --> 01:05:54.500
nuances with each one of them. I did find a meta

01:05:54.500 --> 01:05:57.460
-analysis of a lot of these medications that

01:05:57.460 --> 01:06:01.739
were done and they gave this nice little, it

01:06:01.739 --> 01:06:05.320
wasn't a scatter plot. Forest plot? Yeah. And

01:06:05.320 --> 01:06:08.059
so essentially lined up of like, what were the

01:06:08.059 --> 01:06:13.280
odds ratios of decreasing? you know, osteoporosis

01:06:13.280 --> 01:06:14.960
over time. And they gave them with confidence

01:06:14.960 --> 01:06:16.599
intervals as well, which I thought was helpful.

01:06:16.719 --> 01:06:19.539
It was a good visual. Because especially for

01:06:19.539 --> 01:06:22.980
like a drug that says that, you know, it decreased,

01:06:23.159 --> 01:06:25.320
the odds ratio was like 42, but the confidence

01:06:25.320 --> 01:06:27.800
interval was like, you know, it's like, okay,

01:06:27.860 --> 01:06:29.860
this isn't going to be that significant. Yeah.

01:06:30.360 --> 01:06:33.360
So oral bisphosphonates or bisphosphonates, they

01:06:33.360 --> 01:06:36.380
work by inhibiting bone resorption. So again,

01:06:36.440 --> 01:06:39.300
they're going to help stop the bone from breaking

01:06:39.300 --> 01:06:44.539
down. And so they don't have great bioavailability

01:06:44.539 --> 01:06:46.559
with the oral ones. There are some injectable

01:06:46.559 --> 01:06:49.280
ones as well too, but the oral ones is kind of

01:06:49.280 --> 01:06:51.059
where a lot of people will start when they're

01:06:51.059 --> 01:06:53.820
going to treat osteoporosis. So one of the kickers

01:06:53.820 --> 01:06:56.760
is that when you take it, you have to get up

01:06:56.760 --> 01:07:00.320
and you have to take it 30 minutes before you

01:07:00.320 --> 01:07:02.239
take anything else with a small sip of water.

01:07:02.300 --> 01:07:05.000
And you have to stay upright for 30 minutes because

01:07:05.000 --> 01:07:07.559
if you lie down, it has some irritant properties

01:07:07.559 --> 01:07:11.079
in your gastrointestinal and your gastrointestinal

01:07:11.079 --> 01:07:15.260
tracts, your esophagus. And so you're going to

01:07:15.260 --> 01:07:18.280
avoid that. So that's, I've taken it in the past.

01:07:18.300 --> 01:07:20.400
It's not really a big deal. And you can take

01:07:20.400 --> 01:07:24.460
it once a week. And so that's a great, so you're

01:07:24.460 --> 01:07:26.420
not taking it every day, but once a week. And

01:07:26.420 --> 01:07:29.119
when you take, what the data have shown with

01:07:29.119 --> 01:07:33.739
bisphosphonates is that you can reduce your vertebral

01:07:33.739 --> 01:07:37.400
and hip fractures and your non -vertebral fractures

01:07:37.400 --> 01:07:40.719
by, you know, a variety of percentages you know

01:07:40.719 --> 01:07:44.980
from 40 from 20 to 50 percent and with your vertebral

01:07:44.980 --> 01:07:47.960
fracture it can decrease it by 70 percent wow

01:07:47.960 --> 01:07:50.400
so and you can have some changes in your bone

01:07:50.400 --> 01:07:53.300
mineral density anywhere from your spine up to

01:07:53.300 --> 01:07:56.440
six percent to your hip up to four percent you

01:07:56.440 --> 01:07:59.099
said increase it increase wow that's nice agents

01:07:59.099 --> 01:08:01.139
are are you know they're they've definitely you

01:08:01.139 --> 01:08:07.030
know found found some efficacy but If it stops

01:08:07.030 --> 01:08:10.409
working or you can't tolerate it for whatever

01:08:10.409 --> 01:08:12.889
reasons, and so there are other agents as well

01:08:12.889 --> 01:08:15.989
too. One of the ones that we've probably seen

01:08:15.989 --> 01:08:20.989
in the past commercials for is denosumab, which

01:08:20.989 --> 01:08:23.989
is also known as Prolia. It's an injectable.

01:08:24.069 --> 01:08:27.130
It's a subcutaneous injection that you get twice

01:08:27.130 --> 01:08:30.729
a year, and you have to go to get it from a healthcare

01:08:30.729 --> 01:08:40.930
provider. And again, it is an agent. It also

01:08:40.930 --> 01:08:44.529
slows bone breakdown. So it's going to decrease

01:08:44.529 --> 01:08:49.029
bone resorption. So it's going to work on those

01:08:49.029 --> 01:08:51.729
osteoclasts to keep them from acting. Does it

01:08:51.729 --> 01:08:54.510
have a different mechanism of action than the

01:08:54.510 --> 01:08:57.550
bisphosphonines? It does. And again, it's because

01:08:57.550 --> 01:09:01.100
of that whole complicated... Yeah, we will have

01:09:01.100 --> 01:09:03.039
to get into it. It's called a wrinkle inhibitor.

01:09:03.260 --> 01:09:07.880
So yeah, so it works on another pathway in the

01:09:07.880 --> 01:09:12.220
bone to help build it up. So again, it's pretty

01:09:12.220 --> 01:09:15.159
effective as well too. It will decrease vertebral

01:09:15.159 --> 01:09:19.840
fractures by 68%, non -vertebrals by 20, hip

01:09:19.840 --> 01:09:23.560
fractures by 40, and it can increase spine bone

01:09:23.560 --> 01:09:27.840
mineral density by 9%. hip bone mineral density

01:09:27.840 --> 01:09:31.140
by six. So it's a little bit better than a bisphosphonate.

01:09:31.720 --> 01:09:33.859
Then there are a variety of other things that

01:09:33.859 --> 01:09:37.960
can be used as well too. Let's see, what else

01:09:37.960 --> 01:09:42.800
can I pull out? One is called a tissue selective

01:09:42.800 --> 01:09:46.039
estrogen complex. It's a conjugated estrogen

01:09:46.039 --> 01:09:48.840
combined with something called basodoxivine.

01:09:49.199 --> 01:09:52.779
And so interestingly, this agent is primarily

01:09:52.779 --> 01:09:56.359
used In postmenopausal women, it's FDA approved

01:09:56.359 --> 01:10:00.220
for postmenopausal women that also have vasomotor

01:10:00.220 --> 01:10:02.579
symptoms associated with menopause, that estrogen

01:10:02.579 --> 01:10:05.640
part. So the estrogen is definitely going to

01:10:05.640 --> 01:10:08.539
help with the bone part, but we don't prescribe

01:10:08.539 --> 01:10:11.560
that as much as a single agent anymore to treat

01:10:11.560 --> 01:10:13.600
with osteoporosis. And we'll get to that in just

01:10:13.600 --> 01:10:16.520
a second. But this combination agent has been

01:10:16.520 --> 01:10:19.680
shown to be effective in managing osteoporosis.

01:10:19.899 --> 01:10:22.970
Okay, wonderful. Seems like we got a lot of pharmacological

01:10:22.970 --> 01:10:26.550
tools. Another one is called a parathyroid. This

01:10:26.550 --> 01:10:30.409
one is interesting. The parathyroid hormone analogs.

01:10:30.409 --> 01:10:33.430
There are two of them. There's a baloparotide,

01:10:33.489 --> 01:10:36.609
which is Tymlus, and teraparotide, which is Forteo.

01:10:36.970 --> 01:10:40.470
They actually work to increase bone formation.

01:10:41.439 --> 01:10:44.420
And it's the only one I believe that's affiliated

01:10:44.420 --> 01:10:46.760
with bone formation. But the interesting thing

01:10:46.760 --> 01:10:48.760
is that you can only use it for a maximum of

01:10:48.760 --> 01:10:51.739
two years because that effect will decrease over

01:10:51.739 --> 01:10:55.340
time. And there's also been some bone sarcomas

01:10:55.340 --> 01:10:59.520
shown in rats. So they cap the duration of this

01:10:59.520 --> 01:11:02.000
medication for two years because of that. Is

01:11:02.000 --> 01:11:04.520
a sarcoma the cancer of the bone? It is. Okay.

01:11:04.880 --> 01:11:07.340
And just to remind people of parathyroid, what

01:11:07.340 --> 01:11:10.060
we talked a little bit about earlier. Parathyroid

01:11:10.060 --> 01:11:14.079
is responsible for releasing hormones that stimulate

01:11:14.079 --> 01:11:18.720
vitamin D release and conversion from D2 to D3

01:11:18.720 --> 01:11:21.939
in the body, which then builds up bone. So it's

01:11:21.939 --> 01:11:24.840
probably acting upon that pathway. Yeah. These

01:11:24.840 --> 01:11:28.119
agents don't have as much impact on hip fractures

01:11:28.119 --> 01:11:30.060
as they do vertebral fractures. So that's another

01:11:30.060 --> 01:11:32.000
factor as well too. So yeah. So maybe if you're

01:11:32.000 --> 01:11:35.239
suffering from vertebral fractures rather than

01:11:35.239 --> 01:11:37.300
the others. Well, I guess. I guess how would

01:11:37.300 --> 01:11:38.939
you, I mean, you're essentially just trying to

01:11:38.939 --> 01:11:41.539
do prevention, right? Right. Because you wouldn't

01:11:41.539 --> 01:11:42.760
get it after you got a fracture. You may have

01:11:42.760 --> 01:11:45.739
had a DEXA scan already, you know? Yeah. Or maybe

01:11:45.739 --> 01:11:47.359
you're trying to prevent another one in the future.

01:11:47.380 --> 01:11:49.600
It's like, okay, how do I stop a vertebral fracture?

01:11:49.779 --> 01:11:53.439
In the osteopenia range and you see that your

01:11:53.439 --> 01:11:57.800
hip T -score is worse than your, I mean, I'm

01:11:57.800 --> 01:11:59.520
sorry, your vertebral hip score is worse than

01:11:59.520 --> 01:12:01.619
your hip score. Yeah, so how can I get my vertebrae

01:12:01.619 --> 01:12:04.430
similar to my hip? That makes sense. One agent

01:12:04.430 --> 01:12:09.430
that is newer is called Romasozumab, or it's

01:12:09.430 --> 01:12:12.909
known as Avenity. It's called a sclerostin inhibitor.

01:12:13.010 --> 01:12:23.500
And so what it does is... It is both an anti

01:12:23.500 --> 01:12:27.159
-resorptive agent, so it's going to stop the

01:12:27.159 --> 01:12:29.739
bone breakdown, but it also causes some buildup

01:12:29.739 --> 01:12:32.140
of bone formation as well too. Okay. That's nice.

01:12:32.260 --> 01:12:35.060
Double action. Yes. And it has to be, and again,

01:12:35.140 --> 01:12:37.600
this is something that if you have never gotten

01:12:37.600 --> 01:12:39.880
a DEXA scan and then you get it and you've got

01:12:39.880 --> 01:12:42.239
a really bad T -score, this might be something

01:12:42.239 --> 01:12:46.079
that your physician might go for first. first

01:12:46.079 --> 01:12:48.319
line because they're trying to keep you from

01:12:48.319 --> 01:12:52.859
having a bone fracture. Like I said, it inhibits

01:12:52.859 --> 01:12:56.340
both bone resorption and it stimulates bone formation.

01:12:56.720 --> 01:13:00.279
It's given as a monthly subcutaneous injection.

01:13:00.500 --> 01:13:02.880
So monthly subcutaneous injection, but you have

01:13:02.880 --> 01:13:05.500
to go to get it by a healthcare provider. And

01:13:05.500 --> 01:13:07.979
it's only 12 doses. So you only get it for a

01:13:07.979 --> 01:13:10.420
year. And then after that, you've got to then

01:13:11.500 --> 01:13:13.460
have continual therapy either with something

01:13:13.460 --> 01:13:16.560
like a bisphosphonate like a lindernate or like

01:13:16.560 --> 01:13:19.100
something like prolia okay so you get you take

01:13:19.100 --> 01:13:20.840
it for a year and then it's not like you're one

01:13:20.840 --> 01:13:23.399
and done you need to keep kick starts the system

01:13:23.399 --> 01:13:25.560
and then you got to maintain it absolutely so

01:13:25.560 --> 01:13:28.399
um the only other thing that i want to mention

01:13:28.399 --> 01:13:30.279
as far as treatment is concerned is estrogen

01:13:30.279 --> 01:13:33.319
replacement therapy and so in some women that

01:13:33.319 --> 01:13:35.699
might be used but it's not first -line therapy

01:13:36.350 --> 01:13:38.789
So estrogen, remember, it promotes the activity

01:13:38.789 --> 01:13:41.510
of osteoblasts. So it's going to help build your

01:13:41.510 --> 01:13:44.390
bone back up and it helps to make it stronger.

01:13:45.310 --> 01:13:48.789
And so, and it's going to help reduce bone loss.

01:13:49.369 --> 01:13:51.770
But there have been some risks associated with

01:13:51.770 --> 01:13:54.090
estrogen therapy, especially if you don't take

01:13:54.090 --> 01:13:57.050
it with a progesterone. So you can increase your

01:13:57.050 --> 01:14:01.529
risk of endometrial hyperplasias or cancers in

01:14:01.529 --> 01:14:04.869
your uterus. There has been an associated with

01:14:04.869 --> 01:14:08.489
breast cancer, heart attacks, blood clots and

01:14:08.489 --> 01:14:12.489
strokes. But I think just recently they have

01:14:12.489 --> 01:14:16.760
modified the... package labeling for estrogens

01:14:16.760 --> 01:14:18.880
because I think they've learned how to make the

01:14:18.880 --> 01:14:22.239
dosages lower and they still work so that in

01:14:22.239 --> 01:14:25.479
a particular circumstance, your physician might

01:14:25.479 --> 01:14:28.920
be able to give you one, especially too, if you're

01:14:28.920 --> 01:14:31.779
having menopausal symptoms as well. Also that

01:14:31.779 --> 01:14:35.680
the study that information came from was called

01:14:35.680 --> 01:14:38.220
the Women's Health Initiative, which was, I believe,

01:14:38.260 --> 01:14:41.039
done back in the 2000s or the 90s. I think it's

01:14:41.039 --> 01:14:47.050
about 25 years old, yes. It was interpreted incredibly

01:14:47.050 --> 01:14:50.569
cautiously, meaning that if you looked at the

01:14:50.569 --> 01:14:54.130
control arm versus the experimental arm where

01:14:54.130 --> 01:14:57.470
the women got hormone replacement therapy, the

01:14:57.470 --> 01:15:02.590
number of cancers that the experimental arm got

01:15:02.590 --> 01:15:06.829
was four. Women who got a cancer diagnosis and

01:15:06.829 --> 01:15:09.210
died from cancer, the control arm was three.

01:15:09.449 --> 01:15:13.640
Wow. They reported a 25 % increase, which is

01:15:13.640 --> 01:15:17.060
true, but it's literally just one more person.

01:15:17.319 --> 01:15:22.239
And just to show you that if you want to be overly

01:15:22.239 --> 01:15:24.520
cautious with certain data, you can definitely

01:15:24.520 --> 01:15:28.020
make a claim. It's like, well, 25 % more women

01:15:28.020 --> 01:15:32.100
got cancer, but it's such a low sample that I

01:15:32.100 --> 01:15:36.880
think it got overly interpreted and a lot more

01:15:36.880 --> 01:15:40.170
harm. It was caused by women not getting hormone

01:15:40.170 --> 01:15:42.250
replacement therapy after menopause. And so I

01:15:42.250 --> 01:15:47.250
think we're seeing a reversal from this FDA to

01:15:47.250 --> 01:15:51.770
basically say there might be a better road if

01:15:51.770 --> 01:15:54.989
women are able to more easily get hormone replacement

01:15:54.989 --> 01:15:58.789
therapy. If you've been having menopausal symptoms

01:15:58.789 --> 01:16:03.310
for... you know, a decade or more, then sometimes

01:16:03.310 --> 01:16:05.430
the estrogen replacement therapy doesn't work

01:16:05.430 --> 01:16:07.850
as well as when you first started menopause.

01:16:07.970 --> 01:16:09.869
So that has to be factored in as well. Yeah,

01:16:09.869 --> 01:16:10.829
there does seem to be a window. It may help with

01:16:10.829 --> 01:16:13.090
some of the symptoms, but not all of them. Yeah,

01:16:13.090 --> 01:16:14.729
it's going to be an interesting road to see this

01:16:14.729 --> 01:16:18.369
become more popular and just to see, yeah, like

01:16:18.369 --> 01:16:20.710
maybe some of these conditions like will bone

01:16:20.710 --> 01:16:23.590
mineral density get better on women who have

01:16:23.590 --> 01:16:25.149
hormone replacement therapy? Yeah, we'll have

01:16:25.149 --> 01:16:26.529
to look at that in a couple of decades, right?

01:16:26.670 --> 01:16:28.609
Yeah. You're definitely going to be around. Yeah.

01:16:30.270 --> 01:16:32.789
I would love that. We can do more episodes. There

01:16:32.789 --> 01:16:35.210
you go. There you go. Yeah, me, my 80 -year -old

01:16:35.210 --> 01:16:40.050
self. I think, so it seems like one of the easiest

01:16:40.050 --> 01:16:42.090
things that you can do, no matter how old you

01:16:42.090 --> 01:16:44.970
are, is to go get something like a DEXA scan

01:16:44.970 --> 01:16:48.369
or a bone mineral density scan. And I got one

01:16:48.369 --> 01:16:51.970
the other day for $60. These are, there are obviously

01:16:51.970 --> 01:16:53.850
machines that are better than others. Like if

01:16:53.850 --> 01:16:56.470
you really, from what I've read, you can get

01:16:56.470 --> 01:16:58.989
a more specialized bone mineral density scan.

01:16:59.500 --> 01:17:01.460
that will actually analyze your bone mineral

01:17:01.460 --> 01:17:03.500
density depending on the region of your body.

01:17:03.600 --> 01:17:06.600
So it'll separate between vertebral, femur, hip,

01:17:06.699 --> 01:17:09.220
et cetera. But if you just get, the one that

01:17:09.220 --> 01:17:11.399
I got was just a whole body and it just kind

01:17:11.399 --> 01:17:14.359
of gave you an overall bone mineral density scan.

01:17:15.060 --> 01:17:17.460
I think that's fine, especially if you're young,

01:17:17.560 --> 01:17:20.420
but if you're someone who is of like, if you're

01:17:20.420 --> 01:17:22.439
65 or older, especially if you're a woman who's

01:17:22.439 --> 01:17:25.220
passed menopause, it might be a good idea to

01:17:25.220 --> 01:17:27.420
get one of those more expensive bone mineral.

01:17:27.869 --> 01:17:30.810
bone mineral density scans so that you kind of

01:17:30.810 --> 01:17:33.229
know what you're working with. I think more data

01:17:33.229 --> 01:17:35.170
is better so that when you go to your primary

01:17:35.170 --> 01:17:39.689
health, primary care doctor, that you can essentially

01:17:39.689 --> 01:17:42.130
say, hey, these are my numbers. How would you

01:17:42.130 --> 01:17:44.810
go about treating this? And in order to get a

01:17:44.810 --> 01:17:48.289
bone mineral, a DEXA scan, you need orders. You

01:17:48.289 --> 01:17:51.449
need a prescription. So you can't just walk into

01:17:51.449 --> 01:17:55.630
a imaging center and just request a DEXA scan.

01:17:55.810 --> 01:17:58.760
That's not true. I didn't need an order. Oh,

01:17:58.800 --> 01:18:00.840
I always have to have an order. Oh, no. You can

01:18:00.840 --> 01:18:03.100
just go in and get a DEXA scan. Oh, well, that's

01:18:03.100 --> 01:18:05.060
news to me. Well, thank you for enlightening

01:18:05.060 --> 01:18:06.560
me. Do you want to go after this episode? No,

01:18:06.600 --> 01:18:09.460
I really don't. I've had enough. No, they're

01:18:09.460 --> 01:18:12.520
all over the place. So the one my girlfriend

01:18:12.520 --> 01:18:16.060
and I use is BodySpec. Okay. I went to an imaging

01:18:16.060 --> 01:18:18.340
center. Well, you could do that, but there are

01:18:18.340 --> 01:18:22.890
places that just offer DEXA scans. Okay. I'm

01:18:22.890 --> 01:18:25.289
going to do one every six months now because

01:18:25.289 --> 01:18:28.090
it's one where you essentially can kind of see

01:18:28.090 --> 01:18:31.010
your progress. I would not do it every six months

01:18:31.010 --> 01:18:33.750
personally. Well, it's not just for bone minerals.

01:18:33.869 --> 01:18:37.510
I'm talking about for lean mass and body fat

01:18:37.510 --> 01:18:40.050
percentage. You can also measure that. But we

01:18:40.050 --> 01:18:43.329
digress. We do. But the point is that this is

01:18:43.329 --> 01:18:46.010
a very affordable, very accessible technology.

01:18:46.510 --> 01:18:52.260
If you do not need a prescription. to get these

01:18:52.260 --> 01:18:56.739
scans. And they are a great tool to have, even

01:18:56.739 --> 01:18:59.880
just from your personal health. And even there

01:18:59.880 --> 01:19:02.359
are certain AI tools coming online now, like

01:19:02.359 --> 01:19:07.239
ChatGBT even has a health portion of their chat

01:19:07.239 --> 01:19:09.819
that is HIPAA compliant. There's also something

01:19:09.819 --> 01:19:12.279
called Open Evidence, which is also HIPAA compliant,

01:19:12.380 --> 01:19:15.439
that you can use these scans and type in and

01:19:15.439 --> 01:19:18.380
say, hey, this is my DEXA scan. What would you

01:19:18.380 --> 01:19:21.300
advise based on this scan? And it can give you

01:19:21.300 --> 01:19:24.439
some really good information that you can also

01:19:24.439 --> 01:19:28.500
use to take to your primary healthcare doctor

01:19:28.500 --> 01:19:31.760
as well. I just Googled, I'm so sorry. I just

01:19:31.760 --> 01:19:33.239
Googled whether or not you need a prescription

01:19:33.239 --> 01:19:36.779
for a DEXA scan and you do. You don't. I went

01:19:36.779 --> 01:19:38.640
and got a DEXA scan. But are you sure you got

01:19:38.640 --> 01:19:41.100
a DEXA scan? Yes. Okay. All right. Well, all

01:19:41.100 --> 01:19:43.100
right. That's fine. Okay. I don't know. I don't

01:19:43.100 --> 01:19:45.920
know what you're looking up. I said, do you need

01:19:45.920 --> 01:19:47.699
a prescription for a DEXA scan? And you just

01:19:47.699 --> 01:19:51.539
trust the first. It's AI. But it's like, no,

01:19:51.680 --> 01:19:56.939
I'm just, I guess my, I guess I'm, I guess, yeah,

01:19:57.239 --> 01:19:59.920
these body spec places, I don't know. They don't

01:19:59.920 --> 01:20:02.819
require a prescription. Correct. So, and I don't

01:20:02.819 --> 01:20:06.460
know if it's the same thing or not. This is good.

01:20:06.500 --> 01:20:08.579
This is healthy skepticism. Yes, it is. Right

01:20:08.579 --> 01:20:11.510
at the end of the podcast. Because it says, okay,

01:20:11.590 --> 01:20:13.250
oh, you know what it is? I know what the difference

01:20:13.250 --> 01:20:15.829
is. Tell me. You're getting, so I think we're

01:20:15.829 --> 01:20:20.010
both right. Okay. Yours is just like a informational

01:20:20.010 --> 01:20:24.170
wellness scan, but mine is a diagnostic scan.

01:20:24.329 --> 01:20:27.409
And so a diagnostic scan does require a prescription.

01:20:28.069 --> 01:20:30.189
So it's just how it's classified. Yes. Yeah.

01:20:30.229 --> 01:20:33.189
So I'm just getting information. Your DEXA scan

01:20:33.189 --> 01:20:35.130
is just saying this is an actual diagnostic.

01:20:35.590 --> 01:20:38.109
Right. Okay. Yes. And it's probably your, your

01:20:38.109 --> 01:20:39.989
machine is probably better. Like it's probably

01:20:39.989 --> 01:20:42.210
going to be more specific. Mine's probably not

01:20:42.210 --> 01:20:45.130
the, the waves being used are probably just very

01:20:45.130 --> 01:20:47.989
general. So I totally agree with that. So I think

01:20:47.989 --> 01:20:50.649
just if you're just basically curious, yeah,

01:20:50.729 --> 01:20:52.670
do the body spec one or something that is just

01:20:52.670 --> 01:20:55.430
commercially available. But yeah, I, even if

01:20:55.430 --> 01:20:56.869
you're doing something commercially available,

01:20:57.090 --> 01:20:59.510
you don't have to interpret it on your own. I

01:20:59.510 --> 01:21:02.069
think that the whole point is to say. I got these

01:21:02.069 --> 01:21:04.310
numbers. I got it from this place. Your physician

01:21:04.310 --> 01:21:06.329
or whoever you deal with is going to know how

01:21:06.329 --> 01:21:09.949
to interpret those numbers. Right. So let's talk

01:21:09.949 --> 01:21:11.789
a little bit about this. This will kind of help

01:21:11.789 --> 01:21:13.930
us review and summarize kind of what we've talked

01:21:13.930 --> 01:21:16.949
about over the last hour or so. So what are some

01:21:16.949 --> 01:21:19.609
common misunderstandings or myths related to

01:21:19.609 --> 01:21:22.710
osteoporosis? The first one is, and we've...

01:21:22.960 --> 01:21:25.300
pretty much dealt with this, that osteoporosis

01:21:25.300 --> 01:21:27.880
only affects elderly women and is not found in

01:21:27.880 --> 01:21:30.300
men. Well, this is not true. It actually can

01:21:30.300 --> 01:21:33.180
be found in all ages and genders, even though

01:21:33.180 --> 01:21:36.420
it is more common in older women. Men definitely

01:21:36.420 --> 01:21:39.539
develop osteoporosis at lower rates than women

01:21:39.539 --> 01:21:42.699
do. Women are four times more likely to develop

01:21:42.699 --> 01:21:46.500
osteoporosis because of the whole estrogen deficiency

01:21:46.500 --> 01:21:50.340
issue that happens. And it can happen in younger

01:21:50.340 --> 01:21:52.220
individuals, especially if they've got some underlying

01:21:52.220 --> 01:21:55.220
medical conditions that will contribute to that.

01:21:59.800 --> 01:22:02.920
About 54 million Americans have osteoporosis

01:22:02.920 --> 01:22:06.640
and low bone mass. And it is suggested that one

01:22:06.640 --> 01:22:09.579
in two women and up to one in four men 50 years

01:22:09.579 --> 01:22:11.939
and older will break a bone due to osteoporosis.

01:22:12.020 --> 01:22:15.000
So it's not something to just kind of brush off.

01:22:16.470 --> 01:22:19.189
The second myth is osteoporosis is inevitable

01:22:19.189 --> 01:22:23.489
as people age. It's not an inevitable consequence

01:22:23.489 --> 01:22:26.329
of aging, but there are some factors like we've

01:22:26.329 --> 01:22:28.250
talked about that can contribute to a greater

01:22:28.250 --> 01:22:31.170
risk of developing it. But if you do adopt a

01:22:31.170 --> 01:22:33.109
healthy lifestyle that we talked about, remember

01:22:33.109 --> 01:22:37.090
the good diet, exercise, avoiding smoking and

01:22:37.090 --> 01:22:42.750
alcohol, preventing falls, that will help reduce

01:22:42.750 --> 01:22:47.470
your chance or help. slow that angle that Josh

01:22:47.470 --> 01:22:49.409
talked about as far as bone loss is concerned

01:22:49.409 --> 01:22:52.270
and help prolong the time before you might have

01:22:52.270 --> 01:22:56.369
some issues with osteoporosis. This might be

01:22:56.369 --> 01:22:58.510
kind of redundant, but only frail individuals

01:22:58.510 --> 01:23:01.649
develop osteoporosis, and that's not true. You

01:23:01.649 --> 01:23:04.760
can have a, I mean... I was not frail when I

01:23:04.760 --> 01:23:07.159
was diagnosed with osteoporosis and stuff. So

01:23:07.159 --> 01:23:09.779
it's like it just can happen. Again, remember,

01:23:09.899 --> 01:23:12.159
we've got all those factors that can contribute

01:23:12.159 --> 01:23:14.539
to it. How old were you when you got diagnosed?

01:23:14.600 --> 01:23:19.619
I was in my late 40s when I was diagnosed with

01:23:19.619 --> 01:23:22.420
osteopenia, and then it just kept getting worse.

01:23:23.239 --> 01:23:26.539
Had you gone through menopause? I was perimenopausal

01:23:26.539 --> 01:23:32.130
at that time. Okay. Yeah. The fourth myth is

01:23:32.130 --> 01:23:34.949
osteoporosis doesn't cause symptoms until a fracture

01:23:34.949 --> 01:23:39.289
occurs. And while that's generally true, remember

01:23:39.289 --> 01:23:41.470
there's some things that might be happening in

01:23:41.470 --> 01:23:44.050
your body if you're starting to have some more

01:23:44.050 --> 01:23:46.609
severe osteoporosis. Remember we talked about

01:23:46.609 --> 01:23:49.770
you could have lower back pain or you could lose

01:23:49.770 --> 01:23:58.289
height or you can have a curvature of your spine.

01:23:58.470 --> 01:24:00.579
So those could be things that you're like. Why

01:24:00.579 --> 01:24:02.760
am I hunched over all of a sudden, you know,

01:24:02.760 --> 01:24:04.420
and stuff? So, yeah, so that's just something

01:24:04.420 --> 01:24:10.060
to be considered. The fifth myth, the fifth myth,

01:24:10.460 --> 01:24:14.399
drinking milk alone is sufficient for preventing

01:24:14.399 --> 01:24:17.560
osteoporosis. And as we've kind of talked about,

01:24:17.600 --> 01:24:19.779
that's not true because you don't just need calcium

01:24:19.779 --> 01:24:23.600
to prevent osteoporosis, but you need vitamin

01:24:23.600 --> 01:24:26.579
D as well as protein and then also resistance

01:24:26.579 --> 01:24:28.500
training and some other things to help prevent

01:24:28.500 --> 01:24:31.180
osteoporosis. Yeah, because, I mean, calcium

01:24:31.180 --> 01:24:34.520
also needs to be absorbed from the gut. And also

01:24:34.520 --> 01:24:36.880
it goes to a lot of other places as well. I know

01:24:36.880 --> 01:24:38.779
that magnesium is also important. Right, that

01:24:38.779 --> 01:24:40.479
magnesium is another one, phosphorus, vitamin

01:24:40.479 --> 01:24:44.060
K. Yeah, so a lot of these can be really important

01:24:44.060 --> 01:24:46.720
for, because mom says this, like bone is not

01:24:46.720 --> 01:24:49.479
this simple just repository. For calcium, it's

01:24:49.479 --> 01:24:51.720
this whole matrix composed of a lot of things.

01:24:51.800 --> 01:24:54.060
It's actually a living kind of organism kind

01:24:54.060 --> 01:24:56.140
of thing. I mean, obviously it's inside of us,

01:24:56.159 --> 01:24:59.260
but it's quite fascinating. Yeah, it really is.

01:24:59.740 --> 01:25:04.399
Especially those trabecular areas where it's

01:25:04.399 --> 01:25:08.560
kind of the more where your joints are. And that

01:25:08.560 --> 01:25:12.000
is kind of the area, especially as women go through

01:25:12.000 --> 01:25:13.920
menopause, that is the area of bone mineral density

01:25:13.920 --> 01:25:16.260
that really falls off. There's this great graph

01:25:16.260 --> 01:25:17.939
where it's like men and women in the cortical

01:25:17.939 --> 01:25:20.640
areas, like the long shaft of your bone, fall

01:25:20.640 --> 01:25:23.239
about the same rate. But the trabecular areas

01:25:23.239 --> 01:25:26.020
where women, especially peri and post menopause,

01:25:26.079 --> 01:25:29.520
really fall off. So it is really important. For

01:25:29.520 --> 01:25:31.739
that area, because that's usually where those

01:25:31.739 --> 01:25:34.479
hip joints and the vertebral joints are where

01:25:34.479 --> 01:25:36.699
a lot of those fractures can occur. Right. Because

01:25:36.699 --> 01:25:39.840
if you fall, you may fall right on that area.

01:25:39.939 --> 01:25:45.659
Correct. Okay. The sixth myth. Osteoporosis is

01:25:45.659 --> 01:25:48.520
untreatable once it's diagnosed. And although

01:25:48.520 --> 01:25:52.340
it can't be cured, we've just identified there's

01:25:52.340 --> 01:25:55.140
a variety of things to do to treat osteoporosis.

01:25:55.199 --> 01:25:57.399
We've got so many things available now that we

01:25:57.399 --> 01:26:00.619
didn't have. even 10 years ago. So there's a

01:26:00.619 --> 01:26:02.500
lot of things that your healthcare provider can

01:26:02.500 --> 01:26:07.520
use to help you manage your osteoporosis. Next,

01:26:07.760 --> 01:26:11.880
osteoporosis risk. So I don't have any osteoporosis

01:26:11.880 --> 01:26:14.020
risk factors, so I don't need to be screened.

01:26:14.220 --> 01:26:19.140
And so you can think like that, but you might

01:26:19.140 --> 01:26:21.359
have some other underlying things that are happening

01:26:21.359 --> 01:26:23.680
or you remember you can't see what's going on.

01:26:24.159 --> 01:26:28.039
So I didn't think I had any other than drinking

01:26:28.039 --> 01:26:31.300
a lot of Diet Coke, which probably did contribute

01:26:31.300 --> 01:26:34.539
to it. But you think, oh, that's no big deal

01:26:34.539 --> 01:26:36.420
and stuff. And so then you end up with some issues

01:26:36.420 --> 01:26:39.039
and stuff. So it's not a bad thing to get screened,

01:26:39.039 --> 01:26:41.520
especially as you get older, especially as a

01:26:41.520 --> 01:26:43.720
woman, to just see where you stand and where

01:26:43.720 --> 01:26:45.159
your baseline is. I think you're referring to

01:26:45.159 --> 01:26:47.159
the caffeine and the Diet Coke, correct? Yes,

01:26:47.159 --> 01:26:48.720
I am. Yes, okay. Yeah, because a lot of people

01:26:48.720 --> 01:26:50.659
are scared of Diet Coke for other reasons that

01:26:50.659 --> 01:26:54.229
are unfounded. No, it's the caffeine. Yeah. Yeah.

01:26:54.449 --> 01:26:57.649
Okay. Here's a myth that's completely not true.

01:26:58.510 --> 01:27:00.970
Osteoporosis is a cancer of the bones. Absolutely

01:27:00.970 --> 01:27:04.289
not. It is a bone disease, but it is not a cancer.

01:27:04.689 --> 01:27:07.470
Again, it causes your bones, remember, to become

01:27:07.470 --> 01:27:12.130
thinner and weaker because of the whole osteoblast

01:27:12.130 --> 01:27:17.210
effects with getting less osteoblast building

01:27:17.210 --> 01:27:20.449
activity and greater osteoclast or breaking down

01:27:20.449 --> 01:27:26.390
activity. So here's the next myth. Screening

01:27:26.390 --> 01:27:29.369
for osteoporosis isn't easy, and there are high

01:27:29.369 --> 01:27:32.550
risks of exposure to radiation. This is not true.

01:27:32.670 --> 01:27:36.270
It's a really easy test. It takes about 20 minutes,

01:27:36.329 --> 01:27:39.750
maybe 30, depending on just what they're looking

01:27:39.750 --> 01:27:43.250
at. It's painless. It's performed on this thing

01:27:43.250 --> 01:27:45.930
called a bone densitometer machine, and it's

01:27:45.930 --> 01:27:49.140
very similar to having an x -ray. And you lie

01:27:49.140 --> 01:27:52.319
down while it's being done. And most of the time,

01:27:52.340 --> 01:27:55.539
you don't have to change into a gown. They just

01:27:55.539 --> 01:27:57.659
do it through your regular street clothes. So

01:27:57.659 --> 01:28:01.460
that's even an extra step. Radiation is involved

01:28:01.460 --> 01:28:04.000
in it, but it's typically less than the amount

01:28:04.000 --> 01:28:05.640
of radiation you get when you have a regular

01:28:05.640 --> 01:28:11.760
mammogram. So I think it's a safe way to assess

01:28:11.760 --> 01:28:15.020
osteoporosis. Correct. Yeah, and the dose makes

01:28:15.020 --> 01:28:16.880
the poison. You probably wouldn't want to get

01:28:16.880 --> 01:28:19.720
one every day, but compared to, like mom said,

01:28:19.800 --> 01:28:21.760
a mammogram or even just a regular x -ray that

01:28:21.760 --> 01:28:25.039
you're getting, it's very low. And as far as

01:28:25.039 --> 01:28:27.979
frequency of DEXA scans are concerned, we didn't

01:28:27.979 --> 01:28:32.119
talk about that, but typically I think that there's

01:28:32.119 --> 01:28:35.119
a variety of recommendations. Some healthcare

01:28:35.119 --> 01:28:38.960
providers may not give you another DEXA scan

01:28:38.960 --> 01:28:44.279
while you're taking a medication for it. My health

01:28:44.279 --> 01:28:46.880
care provider usually repeats my DEXA scan every

01:28:46.880 --> 01:28:49.380
two to three years just to make sure that I'm

01:28:49.380 --> 01:28:54.439
stable. If you are discontinued off of an agent

01:28:54.439 --> 01:28:58.140
for treating osteoporosis, usually they'll repeat

01:28:58.140 --> 01:29:00.460
it maybe in two to three years to see that you're

01:29:00.460 --> 01:29:03.380
stable. And if not, then you may need additional

01:29:03.380 --> 01:29:07.100
treatment as well, too. So if you have a negative

01:29:07.100 --> 01:29:09.739
scan, though, this is another myth, then you

01:29:09.739 --> 01:29:11.399
don't really need another one in the future.

01:29:11.840 --> 01:29:13.640
Well, we know that's not true because we keep

01:29:13.640 --> 01:29:16.560
changing and our bones do keep changing and maybe

01:29:16.560 --> 01:29:18.579
not for the better. They typically change for

01:29:18.579 --> 01:29:19.859
kind of a little bit for the worse, depending

01:29:19.859 --> 01:29:23.859
on, even though we're maybe doing good bone health

01:29:23.859 --> 01:29:26.979
and bone healthy lifestyle because of just aging

01:29:26.979 --> 01:29:30.039
and things like that. So it's a good idea every

01:29:30.039 --> 01:29:33.539
several years to get an update on it. And usually

01:29:33.539 --> 01:29:35.479
your healthcare provider will recommend that.

01:29:36.649 --> 01:29:39.090
And finally, the last one, but breaking a bone

01:29:39.090 --> 01:29:41.229
is not detrimental as it happens to everyone.

01:29:41.369 --> 01:29:43.210
And this is really not the case. And hopefully

01:29:43.210 --> 01:29:47.949
we've driven this point home, that breaking bones

01:29:47.949 --> 01:29:50.489
is really serious. They're physically painful.

01:29:50.609 --> 01:29:52.850
When you break a bone, it hurts, but it also

01:29:52.850 --> 01:29:55.909
can result in emotional and mental health challenges.

01:29:56.130 --> 01:29:59.529
And you can also have loss of mobility and independence.

01:30:00.279 --> 01:30:02.739
And like I said, sometimes it can cause an older

01:30:02.739 --> 01:30:05.300
person to have to be placed in a nursing home

01:30:05.300 --> 01:30:09.220
facility, which is not a great thing. And so

01:30:09.220 --> 01:30:12.159
recovery can sometimes take months. It can require

01:30:12.159 --> 01:30:15.659
surgery, weeks of therapy, and you have to change

01:30:15.659 --> 01:30:19.260
your whole lifestyle. So it's a huge deal, especially

01:30:19.260 --> 01:30:22.659
if you break a hip or you have a fracture in

01:30:22.659 --> 01:30:25.119
your lumbar area. So you want to try to minimize

01:30:25.119 --> 01:30:29.699
that. Osteoporosis fractures, remember, they

01:30:29.699 --> 01:30:32.119
don't have to be caused by trauma, but can happen

01:30:32.119 --> 01:30:35.399
simply. This is kind of the scary thing, especially

01:30:35.399 --> 01:30:37.500
if you don't know what your T -score is. They

01:30:37.500 --> 01:30:39.560
can happen simply by bumping into something.

01:30:39.720 --> 01:30:42.340
You could bend or lift something and just do

01:30:42.340 --> 01:30:44.060
it the wrong way and it can fracture something.

01:30:44.439 --> 01:30:47.640
Or you can have a minor fall or even coughing.

01:30:48.340 --> 01:30:51.159
So depending on how fragile your bones are. So

01:30:51.159 --> 01:30:54.399
bone fractures are a big deal. Or one of those

01:30:54.399 --> 01:30:56.479
big sneezes that you feel like are just going

01:30:56.479 --> 01:30:58.800
to destroy your life. Yeah, that's not good.

01:30:59.659 --> 01:31:02.819
So just to draw everything to a close, we want

01:31:02.819 --> 01:31:07.399
to remind you that osteoporosis affects primarily

01:31:07.399 --> 01:31:11.500
older women, but it can be seen in all ages and

01:31:11.500 --> 01:31:15.149
genders, races as well too. We want to encourage

01:31:15.149 --> 01:31:18.010
older people with a fragility fracture or anyone

01:31:18.010 --> 01:31:21.250
with osteoporosis symptoms to be screened for

01:31:21.250 --> 01:31:24.090
osteoporosis via either a DEXA scan or a FRAX

01:31:24.090 --> 01:31:27.069
assessment to just make sure where you are, to

01:31:27.069 --> 01:31:28.750
make sure that what's going on with you as far

01:31:28.750 --> 01:31:30.890
as these fractures are concerned, that there's

01:31:30.890 --> 01:31:33.470
not this underlying condition known as osteoporosis.

01:31:34.590 --> 01:31:37.949
Many medications are available that lower osteoporosis

01:31:37.949 --> 01:31:40.609
-associated hip, nonvertebral, and vertebral

01:31:40.609 --> 01:31:42.449
fractures, and we're really thankful for those.

01:31:43.180 --> 01:31:46.579
And finally, osteoporosis prevention begins at

01:31:46.579 --> 01:31:50.000
birth and continues throughout our life by practicing

01:31:50.000 --> 01:31:52.760
a bone healthy lifestyle. That's right. So refer

01:31:52.760 --> 01:31:55.300
back to our bone healthy lifestyle, which is

01:31:55.300 --> 01:31:58.680
have a good diet of calcium, vitamin D, magnesium.

01:31:59.739 --> 01:32:03.300
You should be exercising, especially in terms

01:32:03.300 --> 01:32:06.220
of things like resistance training, rucking,

01:32:06.340 --> 01:32:11.039
and sometimes even distance running. And avoid,

01:32:11.159 --> 01:32:16.220
minimize caffeine consumption, stop smoking and

01:32:16.220 --> 01:32:19.600
limit alcohol and, and fall prevention. Okay.

01:32:20.359 --> 01:32:22.859
Well, with that being said, I feel good all the

01:32:22.859 --> 01:32:27.840
way down to my bones, you know? Yeah. Yeah. I'm

01:32:27.840 --> 01:32:31.720
glad you do too. Well, we so hope that you learned

01:32:31.720 --> 01:32:34.239
a lot on this episode today. I know I did just

01:32:34.239 --> 01:32:36.960
like, I'm just be very grateful. I mean, one

01:32:36.960 --> 01:32:38.779
of the things that I, that I learned from my

01:32:38.779 --> 01:32:41.930
DEXA scan, is that when I looked at my skeleton

01:32:41.930 --> 01:32:45.149
and just all the meat that was around, I'm like,

01:32:45.170 --> 01:32:49.430
I'm so thankful for my bones. They really don't

01:32:49.430 --> 01:32:52.729
weigh a lot. And to look at your skeleton and

01:32:52.729 --> 01:32:56.310
how they carry your entire body is really wonderful.

01:32:56.510 --> 01:33:00.470
And not only that, but they also supply you with

01:33:00.470 --> 01:33:03.729
B cells and T cells from your bone marrow. And

01:33:03.729 --> 01:33:06.539
they're just wonderful little organs. You know,

01:33:06.579 --> 01:33:08.500
next time that you feel a pain in your bones,

01:33:08.699 --> 01:33:10.199
maybe cut them a little bit of slack because

01:33:10.199 --> 01:33:12.119
they've been carrying you around for a real long

01:33:12.119 --> 01:33:13.720
time. There you go. And I just looked up too,

01:33:13.819 --> 01:33:17.760
our average human skeleton weighs 22 to 26 pounds.

01:33:17.939 --> 01:33:21.560
Wow. So the rest of it is all the other stuff.

01:33:21.619 --> 01:33:24.840
So 24 pounds of my skeleton potentially is carrying

01:33:24.840 --> 01:33:27.939
the rest of the 140 pounds that's associated

01:33:27.939 --> 01:33:30.579
with me. That's amazing. There you go. Well,

01:33:30.600 --> 01:33:32.909
sweet. Well, until next time. We're going to

01:33:32.909 --> 01:33:35.449
talk about something else, but we hope that you

01:33:35.449 --> 01:33:37.829
learned a lot and we'll see you next time on

01:33:37.829 --> 01:33:39.909
another episode of Your Mom on Drugs. My name's

01:33:39.909 --> 01:33:42.609
Josh. And I'm Jenny. See ya. See ya.