Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today we're talking about bone health, and specifically osteoporosis. Joining me today is Kelsey Baxa. She's a family nurse practitioner at the Bone Health Clinic at Crete Area Medical Center.

Kelsey, thank you so much for joining us today. Tell us, what is osteoporosis? What is that term we hear, osteopenia? And what's the difference between the two?

Kelsey Baxa: Hi, Melanie. Thanks for having me. So, osteoporosis is something that can affect women and men. However, women are more likely to get osteoporosis just based on physiology. So, it's something I'm very passionate about explaining and educating my patients on.

Osteoporosis is a natural aging process. Our bone doesn't turn over as quickly as it did when we were younger, especially after we go through menopause, after we lose some of those estrogen hormones, mostly in our probably late 40s to early 50s.

So, I think a lot of us don't really think about how important it is to go ahead and start thinking about our bone health when we're young. But that's something that I try to teach my patients about. So, osteoporosis can be diagnosed three different ways. One, by a DEXA scan, which is by far the most common.

A DEXA scan is similar to an X-ray. We take pictures of your lumbar spine, your hip, and occasionally your forearm. And we measure your bone density based on something called T-scores. So, in my mind, T-scores are what our bone density looks like compared to an average 30-year-old that is our base or that's when our bone density actually peaks is at about age 30. And so, we're comparing our bone density now to our peak bone density to see how much it's changed or declined. Once we have your T-scores, I review those in detail or your provider can review those in detail with you. But osteoporosis is a T-score of -2.5 or lower. And at that point, I would consider prescription treatment.

Osteopenia is kind of "pre-osteoporosis end." we want to make sure that we're kind of looking into this and that we're trying to do something about it. Osteopenia is basically eventually going to transition to osteoporosis at some point. And so, it's not a bad idea to go ahead and get a DEXA scan and do that maybe before you're 50. Try to have a baseline scan at maybe age 40 or 45. And knowledge is power, right? So the more we know about what our T-scores are doing, the earlier we can start identifying those trends and treating.

Melanie Cole, MS: Well, thank you so much for that explanation of the difference between those two. So, tell us how common this is. You mentioned just a little bit about it in men and women, and it's more common in women. But what do we know about the prevalence between men and women?

Kelsey Baxa: We know that one in two women over age 50 are going to get osteoporosis and suffer some sort of a fracture. So, it's very prevalent. About one in four men over age 50 are going to sustain osteoporosis or a fracture at some point as well.

Melanie Cole, MS: Wow. Those are really interesting statistics. So complications, you just mentioned fracture. So, what does that mean? Tell us a little bit about those complications, the fractures, the posture, the things that happen to us if we develop osteoporosis.

Kelsey Baxa: So, if we develop osteoporosis, it doesn't only put us at risk for fracture, but it also affects our posture. And so, we can develop something called kyphosis, the hunched over look. And that actually has its own complications if it's bad enough. It can sure affect breathing. It could even affect swallowing.

But honestly, I think that the most important thing here is just understanding that there's other complications besides fractures. So, it can affect your quality of life. I really think it's important to think about how do you want to age. Do you want to age in your home or do you want to age, unfortunately, in a skilled facility? Some people don't make it back home after a hip fracture. So, lots of complications.

Melanie Cole, MS: Yes, that's true. We haven't really talked a little bit about causes. So, tell us how we get this.

Kelsey Baxa: So yeah, there's a lot of risk factors that we want to think about when we're one-on-one talking with patients about osteoporosis. But the most blatantly obvious for women is, actually when you go through menopause. If you needed to have a hysterectomy early, possibly because of anemia or chronic bleeding, that puts you at risk.

The general aging process, again, we're probably all at some point going to get some thinning. But family history is a huge one. So, if you have a first-degree relative with a hip fracture, that puts you at high risk for having osteoporosis. Being petite and not having a lot of body mass can put you at risk for osteoporosis, also for fracture.

And then, height, so height loss. If you are someone who's lost more than two inches, since your peak height, all of those things kind of put you at risk for the diagnosis of osteoporosis. Other things include hyperparathyroidism, more of a secondary cause. So, there's actually something going on where your calcium levels are not normal in the blood because of a hormonal condition. And some patients who have kidney stones or maybe high calcium in their urine also are at risk. So, those are things that I think it's important to look at when we're trying to diagnose osteoporosis.

Melanie Cole, MS: We're going to talk about treatment options from you. But what can we do as we're thinking about, you know, our futures? Maybe when we're younger and we can start doing some of these things, or as we get close to perimenopause and menopause, what are some things that we can do that can maybe slow the process down?

Kelsey Baxa: I think this is something that we can try to prevent or we can slow down. I think the most important nutritional items that we can do to kind of keep our bone health in check is vitamin D and calcium. I think of them as the nutrition of our bones. Almost all of us in the Midwest are going to be low in vitamin D. So, I typically order a vitamin D. And I would encourage patients to get a serum vitamin D level done and just see where that's at. Now, each dose for each person is going to be maybe a little different based on what your serum vitamin D is, but most of us in the Midwest are going to be considered low.

calcium is another really important item for bone health. I try to encourage my patients to get calcium through their diet if possible. Most women over 50 are going to need about 1,200 milligrams of calcium a day. You can only absorb 600 milligrams at a time though, so taking two calcium supplements at once is not usually helpful. It's not harmful, but you're not going to get everything out of that. So, dietary first and then supplement second.

Other items that have been like popular or are being studied right now are vitamin K, which helps the absorption of calcium. There's still studies being done. They're coming out with more information about how helpful that can be for bone health.

Melanie Cole, MS: Wow, that's really great information. That's cool to hear about some of the studies and what they're looking at for this because it is such a prevalent problem, as you said. So now, when you think of treatment options for us, we hear about these medications and things in the media and commercials. And tell us a little bit about some of the treatment options that you offer

Kelsey Baxa: Sure. So, I think it's really important to try to treat osteoporosis from not just a medication standpoint, but also make sure that we're utilizing other options that are non-pharmacological or not prescription. So, I really encourage my patients if they're willing, I think it's great to get into an exercise program. It doesn't have to be anything too crazy, but really just we want to use our bodies as resistance. So, things like Tai Chi, yoga, walking, swim. I also encourage my patients to go through a course of physical therapy to work on balance and gait training and just to make sure that they know what puts them at risk for fall. So, those are things that anybody can do. You know, you don't need to be on a prescription to do those things.

But in terms of prescription medicines, there's a couple of different classes of medicines. I would typically recommend someone in the pre-osteoporosis or osteopenia range, maybe we start with something more of like a tablet, like a Boniva or a Fosamax. And those medications have studies that show that they increase lumbar spine bone density, and they reduce your risk of a lumbar spine fractures.

So for patients though who have already suffered a fracture or are at high risk for osteoporosis, more studies are coming out saying that high-risk patients should be started on a medication in the anabolic class.

So, those medications are injections, but what they do is they help build our bone density up to as high as we can try to get it. And then, we want to keep those gains that we made with other medications,

Melanie Cole, MS: Well, you've given us so much great information. Kelsey, tell us a little bit about how you schedule with the bone clinic or to discuss all the things you've talked about here with us today, you know, to discuss that screening with your primary provider with you. Tell us a little bit about how we schedule and your best advice for people looking to learn more about osteoporosis.

Kelsey Baxa: You can schedule an appointment at the bone clinic at Crete Area Medical Center on your own. You can call and tell the schedulers you want to be scheduled for a bone clinic appointment. And at that point, you would see myself and we would view your DEXA in detail, view your history in detail, and I would educate you about what I think your best options were.

However, if you're trying to get scheduled or talk with your primary provider, I think it's just important to speak up and let them know that you're interested in talking about bone health. Oftentimes, we get so wrapped up in other items like blood pressure and diabetes that I feel like this gets missed. And so, it's okay to be your own advocate and ask your provider to go ahead and discuss this with you.

Melanie Cole, MS: That is such great advice, Kelsey. If we don't take care of ourselves, we can't take care of the ones that we love. So gosh, what great advice you gave us. Thank you so much. And I'd also like to thank our Bryan Foundation partner, Inpatient Physician Associates.

To listen to more podcasts from our experts, please visit bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.