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Scott Webb (Host): Osteoporosis is common in women especially, and my guest is here today to explain osteoporosis, how it's diagnosed and treated. I'm Scott Webb and I'm joined today by Tiffany Paul. She's a nurse practitioner with Carle.

Tiffany, it's nice to have you here today. We're going to talk about bone health, but specifically we're going to talk about osteoporosis, which I know affects a lot of Americans, a lot of people. And so, diagnosis, treatment, all important, you know, information to put out in the world. So, let's start there. What is osteoporosis? How is it diagnosed? You know, what are diagnosis criteria, if you will?

Tiffany Paul: So, osteoporosis is often related to sometimes people say brittle bone and it can be diagnosed two ways. One is through history of a fracture, and we call that a fragility fracture. Briefly, it would be a fracture that's not expected, so a low-trauma, low-energy fracture, sometimes a classic definition is a fall from standing height that results in a fracture.

The more diagnostic way to diagnose osteoporosis is through imaging called a bone density machine or x-ray. And that will actually image usually the lower spine, lumbar spine, and both hips, sometimes the forearm. And it'll give us numbers of which then we can place in a database. And then, what that number called a T score, identify which category of bone health they may be placed in, which can be normal or osteopenia, and then osteoporosis.

Host: Yeah. And I've heard that before, Tiffany, that it's those unexpected fractures, right? You just kind of bump into the doorframe or something as you're going into the bathroom or something and then you end up with a fracture, right? So, it's those like sort of unexpected, like that would be one of the signs for us, right?

Tiffany Paul: Yes. And often the more unexpected ones could be found in the spine. For instance, someone lifting up a box that usually is routine, but oh my goodness, they just had back pain. And then, it's found to have a fracture. Unfortunately, it also could happen by coughing, sometimes that can be found; making your bed, like turning that sort of thing; or even a fall directly on your bottom with immediate back pain, that can be usually spine related. But unlike a fall usually could lead to a femur or a hip fracture, which is more, you know, diagnosable because they're unable to get up.

Host: Yeah. Right. And we all saw those commercials when we were younger. I've fallen and I can't get up. But that's perhaps a different podcast. So, let's talk about the risk factors. When I think of osteoporosis, and maybe it's 'cause I'm remembering being a child and like my grandma had osteoporosis, so I always think of it as something that, you know, kind of affects older people. But I don't know that that's true, because I'm not the expert. You are. So, what are some of the risk factors? Who's at the highest risk?

Tiffany Paul: Yeah. I would say more diagnostic is through females. And one in two female, or women over the age of 50 will often experience an osteoporosis-related fracture. Current risk factors then would lead to age for females when they've had menopause; family history; body size, and then sometimes things we can't control and that would be medications we need to use for other medical issues. Dietary intake, specifically low calcium and vitamin D can also be a risk factor. Often there's like other disease processes, some modifiable risks that we can eliminate, but can lead to bone loss and osteoporosis, which would be activity level, smoking, as well as alcohol use.

Host: Yeah. Because I was going to ask you, you know, obviously there's things we can't outrun, age, family history, genetics, those kinds of things. But are there some behavior and lifestyle things that we can do to decrease our risk?

Tiffany Paul: Definitely. So, diet is a good one, that you would want to focus more on healthy eating in regards to vegetables, dairy, and other calcium-rich foods. Of course, like I mentioned, smoking, you know, there's not a oh-so-many pack years that would increase your risk just in general. Smoking is a risk factor. Alcohol usually is more related to three or more drinks a day can increase your risk of osteoporosis.

Host: All right. So, some of these things in moderation, smoking, never, right? Maybe drink more milk, get more Vitamin D. We want to have you talk about some of the basics of treatment. How do you treat osteoporosis?

Tiffany Paul: Yes. So even if someone is in the osteoporosis range as well as normal, I would want to make sure that they are taking enough calcium and vitamin D as indicated by maybe lab work. Activity level assessment is often a good one as well, because if someone's more sedentary, then we got to think that their muscle mass might be lower as well as maybe balance. So, assessing that is often good. Now, that can lead to maybe a physical therapy referral to have a formal evaluation. That way, fall risk is something to address and treatment-wise would then be to help that patient identify areas of their home, or even a physical therapy referral to lower that risk.

Now as far as medications, generally they're more led to the osteoporosis range, that can be diagnosed through the bone density test. But often, also a fragility fracture would indicate that that patient might be at a greater risk for additional fracture. And a lot of times one fracture would increase your risk by double for another fracture and medications, specifically to help build bone or even to prevent bone loss can then be addressed.

Host: Just give you a chance here at the end. Final thoughts, takeaways about osteoporosis? What do you want folks to know?

Tiffany Paul: What I would like them to know is screening is often painless through a bone density test or even screening of what potential risk factors they may have to be at a greater risk for osteoporosis. And like I said, for anyone who would be normal or even in that class, I would make sure that calcium, vitamin D is being addressed. Activity level, fall risk, then go forward and hopefully they can continue their life at an independent level where they want to be.

Host: Yeah, no doubt, right? We want to prevent those fractures, those falls, those types of things as much as possible. So, as you say, screening is really painless and really easy; diagnosis, treatment, all of that. So, thank you much for your time today. I really appreciate it.

Tiffany Paul: Thank you.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.