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Being Aware of Bone Health
Dr. Abhigyan Banka discusses the importance of bone health, and how to be aware of it.
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Learn more about Abhigyan Banka, MD
Abhigyan Banka, MD
Abhigyan Banka, MD, is a board-certified family physician practicing at Beech Grove Family Medicine. He has a special interest in preventive medicine, sports physicals, women's health, acute and chronic conditions, joint injections and skin biopsies. Dr. Banka completed externships in urology and surgical intensive care with highest honors at Harvard Medical School in Boston. He later completed a residency and served as chief resident of family medicine at Atlanta Medical Center in Georgia.Learn more about Abhigyan Banka, MD
Transcription:
Scott Webb: Osteoporosis is a chronic disease that causes bones to become weak and brittle so that a fall or even coughing can cause a fracture. These fractures commonly occur in the hip, wrist or spine. Bone is continually being broken down and replaced. And when the development of new bone doesn't keep pace with the loss of old bone, it is diagnosed as osteoporosis. Osteoporosis affects men and women of all races. White and Asian women, especially those who are past menopause are at the highest risk for developing osteoporosis.
Medications, a healthy diet and weight bearing exercises can prevent bone loss and strengthen weakened bones. A bone density test can help detect early bone loss and monitor the effectiveness of medications.
And joining me today to tell us all about osteoporosis is Dr. Abhi Banka. He's a board-certified family physician at Beech Grove Family Medicine, a Franciscan Physician Network practice.
This is the Franciscan Health Doc pod. I'm Scott Webb. So Dr. Banka, thanks so much for your time today. We're talking about bone health and bone health issues. So let's start up front here. Tell listeners exactly what is osteoporosis.
Dr. Abhi Banka: So osteoporosis is basically weak and brittle bones. We all think of bone as an inanimate object, you know, from what we see in Halloween costumes and growing up watching cartoons. Bone is actually living tissue. With age, that becomes weak. And when it's weak enough that it causes problems, that's when we classify it as osteoporosis. What osteoporosis translates to is porous bone, which means bones become weak and brittle.
Scott Webb: And doctor, I'm assuming so, but is osteoporosis a chronic disease?
Dr. Abhi Banka: Absolutely. Osteoporosis is a chronic disease. Chronic disease basically means something that we have to manage for more than several months. With osteoporosis, we're looking at years, if not decades.
The fascinating thing about bones is there's a balance between bone formation and bone reabsorption, which is living tissue versus dying tissue. We tend to make more new bones or tissues in the bone until we are at a younger age of say, 20 to 30. Once we are 30 and up, our body is not able to make new bones. So we basically start losing bone tissue once we hit that age. And come menopausal women or older age in men, the bones become weak enough that they cause fractures. And that's what we're trying to avoid with osteoporosis.
Scott Webb: Since we can't really see our bones, what are the symptoms of osteoporosis?
Dr. Abhi Banka: The funny thing about osteoporosis, most of the time, people may not have any symptoms, right? This is one of those things that gets you before it gets worse or the most common symptoms that people may complain of is a stooped posture, right? So people might take time getting out the bed. Their height might go shorter by a few inches as you become older. That's basically from the spine being compressed from being weak. Some people may have vague low back pain, but that's not really specific to osteoporosis. But by and large, osteoporosis does not really have symptoms unless you break a bone. Now, once you have a fracture or bone compression fracture, that's when you have pain, body aches and weakness.
Scott Webb: That's really interesting. I'm 52 and I used to be a full, like 6'4". I have definitely shrunk. My kids have noticed that dad's shrunk little bit. And, yeah, your explanation helps me to understand kind of what's happened. If there really are, for most people, really no symptoms, unless they break something or they've got pain, what are the causes of osteoporosis besides age, I guess?
Dr. Abhi Banka: When we look at the causes for osteoporosis, we have to look at who's at risk for osteoporosis. You know, by and large, women are four times at a higher risk than men for osteoporosis. And the reason for that is the hormone estrogen. We all know women, the estrogen level in them are higher than compared to men.
Once they hit menopause, the level of estrogen goes down. The estrogen is good for several things in the body, but one of the primary roles of estrogen is bone health. Some studies have shown that once you hit menopause, there's a 20% reduction in bone mass, even five to seven years of hitting menopause. So that's a significant amount of bone loss. So that's one of the risk factors.
The other risk factors are smoking. If you smoke, that generally is harmful for your bone and most living tissues. Alcohol consumption, if you have more than a couple of drinks a day a few times a week, that would put you at a higher risk for osteoporosis. Caucasians and Asians are at a higher risk of bone disease like osteoporosis than other races. If you are on the lighter side with body weight, if your weight is less than 120, 127 pounds, that puts you at a higher risk for osteoporosis. The older you are, as you mentioned, puts you at a higher risk for osteoporosis.
Lack of exercise, this is one thing that gets overlooked. If you don't exercise on a frequent basis, your bones become weaker, right? So if you have a weak of bones that would put you at a higher risk for osteoporosis. Now, these are the common ones. Now, there are certain other diseases or cancer or medications that can put you at a higher risk for osteoporosis.
For example, people who take oral steroids for whatever it might be, asthma or bronchitis, that can put them at a higher risk for osteoporosis. You know, some women going through treatment for breast cancer or men going for treatment for prostate cancer, if they get certain medicines that counteract those hormones, estrogen in women and testosterone in men, that can cause osteoporosis as well.
But by and large, you know, women, post-menopausal, Caucasian and Asian, if you don't exercise, if you smoke and if you drink a lot of alcohol, these are the people we're trying to keep a closer eye on when we screen them for osteoporosis.
Scott Webb: So what role does diet play when we talk about osteoporosis?
Dr. Abhi Banka: When we talk about diet, we mean three major things. We talk about calcium, we talk about vitamin D and we talk about protein in our diet. Bones are basically calcified living tissue, right? And the way that the calcium gets deposited on the bones is with the help of calcium that we eat and vitamin D that we eat or we make in our skin through sunlight.
If you're talking about how much calcium is required, so for most women before they hit menopause, about a 1000 milligrams of calcium a day is okay. That's what the recommended dose is. Now, post-menopausal or if you're above 50 for women and men if they're above 70, about 1200 milligrams of calcium a day is what is required and recommended.
When we talk about vitamin D, vitamin D is measured in something called International Units. Instead of milligrams and grams, it's International Units. So for younger women before menopause, the recommended dose is 600 International Units. And if you're menopausal, if you're above the age of 50, especially in women, about 800 units of vitamin D.
Now, when I say protein, I mean, any protein is good protein, you know, but I would recommend lean proteins. That's your eggs. You have chicken, you have white fish, shrimps, like that. For people who are vegan, legumes, nuts, tofu is a good source of protein as well. So well-balanced diet with calcium and vitamin D and protein is good for bone health.
Scott Webb: So if people are concerned or they've gotten to a certain age or they're within the risk factor, you know, zone, if you will, what is a bone density test? Is that how you identify or diagnose osteoporosis?
Dr. Abhi Banka: Yes. So osteoporosis is diagnosed with the help of a scan called a DEXA scan, which is a bone density scan. The good thing about the DEXA scan is it's easily available. It's painless. It's not like a CT scan or an MRI in which you have to go inside a tube. You basically lie flat on the bed and scanner goes through your body and scans your bones and it uses very low level of radiation. So it's a painless, you know, very easy to do tests and it doesn't take long to do. So that's one of the tools we have to check how dense or how strong your bones are.
Scott Webb: Yeah. And can we actually prevent osteoporosis or is it more of a situation where we're just kind of keeping it at bay, sort of keeping up with it as we age?
Dr. Abhi Banka: It's one of those things, you know, if you live long enough, your bones will become weakened, right? But if you lead a healthy lifestyle, again, I cannot emphasize how important exercise is on top of diet, right? So when I say exercise, I mean, something that you would do in your home. You don't have to have a personal trainer. You don't have to go to the gym. You know, exercise with a focus on balance and posture, but also strength and resistance training.
Like when I told those two words, people think, "Okay. It'll be fine. I have to go to the gym and, you know, lift dumbbells up." Not necessarily. Like you can have a can of soup in your arms and just build a little bit of strength with that bag of beans. And body weight strength and resistance training is all you need. The stronger you are, the better off you will be when it comes to bone health.
Scott Webb: What's real popular now because, you know, they're relatively small and they're easy to use at home is a lot of the resistance bands, those kinds of things. You don't have to go to the gym and pump iron, right?
Dr. Abhi Banka: That's exactly what I say. Yes.
Scott Webb: That the strength and resistance you're talking about is the kind of stuff that we can all do from home. And as you've mentioned here today, you've identified just how critical that is to kind of holding off osteoporosis as long as we can. You know, if we live long enough, osteoporosis might get us, but hopefully that's not until our 80s or 90s, right?
Dr. Abhi Banka: Yeah. That's what we're all hoping for, to push it as far ahead in the future as we can. The other thing I caution my patients about osteoporosis is I want to reduce the risk of falls, right? That's the one that I really am thinking about when I have my elderly patient visits, make sure they're not at risk for falls, right?
So some of the things that patients can do at home to prevent falls is to remove obstacles. So let's say, you take the same route through your bedroom, down to your living room and the kitchen and stuff, so make sure your house is not cluttered, right? Make sure your house is tidied up. You don't wear shoes inside or barefoot, wearing socks, especially if you have hardwood floor can put you at risk of slips and falls, right?
If you shower, make sure there's a non-slip mat down on the bed. Make sure you use guardrails and canes. Make sure you don't have no free cords lying around the house that you could trip over and fall. If you're a little careful about how you live around your surroundings, you will decrease the risk of falls and fractures.
Scott Webb: Doctor, as we wrap up here, anything else you want to tell people about osteoporosis, causes symptoms, but mainly how do we kind of hold it at bay? How can we hold off osteoporosis as long as possible?
Dr. Abhi Banka: After a certain age, it might be a little harder to get calcium and vitamin D and the amounts required to maintain bone health. So taking a calcium vitamin D pill, like a supplement pill over-the-counter is not a bad idea. Just to give you an idea, about an eight ounce of milk has 300 milligrams of calcium, right? So if you need close to a 1000 to 1200 milligrams of calcium a day, we're looking at at least two cups of milk, right? On top of that, again, just reading the labels of the food that you eat to see if it's got enough calcium and vitamin D. And if you feel like, "I'm eating well, I don't have a lot of appetite to eat four cups of milk a day" or maybe your cholesterol is high and you want to back off on the milk and cheese or the cod liver oil for vitamin D, what do I do? Please take a calcium and vitamin D pill over-the-counter, especially after you hit menopause for women or after the age of 70 for men. And exercise, please exercise the more strength training you have, the more balance you have, the stronger your bones will be.
Scott Webb: Yeah, absolutely. And great takeaways today. Doctor, thanks so much for your time and your expertise and you stay well.
Dr. Abhi Banka: You bet, Scott. You too.
Scott Webb: To schedule a bone density test visit FranciscanHealth.org and search bone density. And we hope you find this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.
Scott Webb: Osteoporosis is a chronic disease that causes bones to become weak and brittle so that a fall or even coughing can cause a fracture. These fractures commonly occur in the hip, wrist or spine. Bone is continually being broken down and replaced. And when the development of new bone doesn't keep pace with the loss of old bone, it is diagnosed as osteoporosis. Osteoporosis affects men and women of all races. White and Asian women, especially those who are past menopause are at the highest risk for developing osteoporosis.
Medications, a healthy diet and weight bearing exercises can prevent bone loss and strengthen weakened bones. A bone density test can help detect early bone loss and monitor the effectiveness of medications.
And joining me today to tell us all about osteoporosis is Dr. Abhi Banka. He's a board-certified family physician at Beech Grove Family Medicine, a Franciscan Physician Network practice.
This is the Franciscan Health Doc pod. I'm Scott Webb. So Dr. Banka, thanks so much for your time today. We're talking about bone health and bone health issues. So let's start up front here. Tell listeners exactly what is osteoporosis.
Dr. Abhi Banka: So osteoporosis is basically weak and brittle bones. We all think of bone as an inanimate object, you know, from what we see in Halloween costumes and growing up watching cartoons. Bone is actually living tissue. With age, that becomes weak. And when it's weak enough that it causes problems, that's when we classify it as osteoporosis. What osteoporosis translates to is porous bone, which means bones become weak and brittle.
Scott Webb: And doctor, I'm assuming so, but is osteoporosis a chronic disease?
Dr. Abhi Banka: Absolutely. Osteoporosis is a chronic disease. Chronic disease basically means something that we have to manage for more than several months. With osteoporosis, we're looking at years, if not decades.
The fascinating thing about bones is there's a balance between bone formation and bone reabsorption, which is living tissue versus dying tissue. We tend to make more new bones or tissues in the bone until we are at a younger age of say, 20 to 30. Once we are 30 and up, our body is not able to make new bones. So we basically start losing bone tissue once we hit that age. And come menopausal women or older age in men, the bones become weak enough that they cause fractures. And that's what we're trying to avoid with osteoporosis.
Scott Webb: Since we can't really see our bones, what are the symptoms of osteoporosis?
Dr. Abhi Banka: The funny thing about osteoporosis, most of the time, people may not have any symptoms, right? This is one of those things that gets you before it gets worse or the most common symptoms that people may complain of is a stooped posture, right? So people might take time getting out the bed. Their height might go shorter by a few inches as you become older. That's basically from the spine being compressed from being weak. Some people may have vague low back pain, but that's not really specific to osteoporosis. But by and large, osteoporosis does not really have symptoms unless you break a bone. Now, once you have a fracture or bone compression fracture, that's when you have pain, body aches and weakness.
Scott Webb: That's really interesting. I'm 52 and I used to be a full, like 6'4". I have definitely shrunk. My kids have noticed that dad's shrunk little bit. And, yeah, your explanation helps me to understand kind of what's happened. If there really are, for most people, really no symptoms, unless they break something or they've got pain, what are the causes of osteoporosis besides age, I guess?
Dr. Abhi Banka: When we look at the causes for osteoporosis, we have to look at who's at risk for osteoporosis. You know, by and large, women are four times at a higher risk than men for osteoporosis. And the reason for that is the hormone estrogen. We all know women, the estrogen level in them are higher than compared to men.
Once they hit menopause, the level of estrogen goes down. The estrogen is good for several things in the body, but one of the primary roles of estrogen is bone health. Some studies have shown that once you hit menopause, there's a 20% reduction in bone mass, even five to seven years of hitting menopause. So that's a significant amount of bone loss. So that's one of the risk factors.
The other risk factors are smoking. If you smoke, that generally is harmful for your bone and most living tissues. Alcohol consumption, if you have more than a couple of drinks a day a few times a week, that would put you at a higher risk for osteoporosis. Caucasians and Asians are at a higher risk of bone disease like osteoporosis than other races. If you are on the lighter side with body weight, if your weight is less than 120, 127 pounds, that puts you at a higher risk for osteoporosis. The older you are, as you mentioned, puts you at a higher risk for osteoporosis.
Lack of exercise, this is one thing that gets overlooked. If you don't exercise on a frequent basis, your bones become weaker, right? So if you have a weak of bones that would put you at a higher risk for osteoporosis. Now, these are the common ones. Now, there are certain other diseases or cancer or medications that can put you at a higher risk for osteoporosis.
For example, people who take oral steroids for whatever it might be, asthma or bronchitis, that can put them at a higher risk for osteoporosis. You know, some women going through treatment for breast cancer or men going for treatment for prostate cancer, if they get certain medicines that counteract those hormones, estrogen in women and testosterone in men, that can cause osteoporosis as well.
But by and large, you know, women, post-menopausal, Caucasian and Asian, if you don't exercise, if you smoke and if you drink a lot of alcohol, these are the people we're trying to keep a closer eye on when we screen them for osteoporosis.
Scott Webb: So what role does diet play when we talk about osteoporosis?
Dr. Abhi Banka: When we talk about diet, we mean three major things. We talk about calcium, we talk about vitamin D and we talk about protein in our diet. Bones are basically calcified living tissue, right? And the way that the calcium gets deposited on the bones is with the help of calcium that we eat and vitamin D that we eat or we make in our skin through sunlight.
If you're talking about how much calcium is required, so for most women before they hit menopause, about a 1000 milligrams of calcium a day is okay. That's what the recommended dose is. Now, post-menopausal or if you're above 50 for women and men if they're above 70, about 1200 milligrams of calcium a day is what is required and recommended.
When we talk about vitamin D, vitamin D is measured in something called International Units. Instead of milligrams and grams, it's International Units. So for younger women before menopause, the recommended dose is 600 International Units. And if you're menopausal, if you're above the age of 50, especially in women, about 800 units of vitamin D.
Now, when I say protein, I mean, any protein is good protein, you know, but I would recommend lean proteins. That's your eggs. You have chicken, you have white fish, shrimps, like that. For people who are vegan, legumes, nuts, tofu is a good source of protein as well. So well-balanced diet with calcium and vitamin D and protein is good for bone health.
Scott Webb: So if people are concerned or they've gotten to a certain age or they're within the risk factor, you know, zone, if you will, what is a bone density test? Is that how you identify or diagnose osteoporosis?
Dr. Abhi Banka: Yes. So osteoporosis is diagnosed with the help of a scan called a DEXA scan, which is a bone density scan. The good thing about the DEXA scan is it's easily available. It's painless. It's not like a CT scan or an MRI in which you have to go inside a tube. You basically lie flat on the bed and scanner goes through your body and scans your bones and it uses very low level of radiation. So it's a painless, you know, very easy to do tests and it doesn't take long to do. So that's one of the tools we have to check how dense or how strong your bones are.
Scott Webb: Yeah. And can we actually prevent osteoporosis or is it more of a situation where we're just kind of keeping it at bay, sort of keeping up with it as we age?
Dr. Abhi Banka: It's one of those things, you know, if you live long enough, your bones will become weakened, right? But if you lead a healthy lifestyle, again, I cannot emphasize how important exercise is on top of diet, right? So when I say exercise, I mean, something that you would do in your home. You don't have to have a personal trainer. You don't have to go to the gym. You know, exercise with a focus on balance and posture, but also strength and resistance training.
Like when I told those two words, people think, "Okay. It'll be fine. I have to go to the gym and, you know, lift dumbbells up." Not necessarily. Like you can have a can of soup in your arms and just build a little bit of strength with that bag of beans. And body weight strength and resistance training is all you need. The stronger you are, the better off you will be when it comes to bone health.
Scott Webb: What's real popular now because, you know, they're relatively small and they're easy to use at home is a lot of the resistance bands, those kinds of things. You don't have to go to the gym and pump iron, right?
Dr. Abhi Banka: That's exactly what I say. Yes.
Scott Webb: That the strength and resistance you're talking about is the kind of stuff that we can all do from home. And as you've mentioned here today, you've identified just how critical that is to kind of holding off osteoporosis as long as we can. You know, if we live long enough, osteoporosis might get us, but hopefully that's not until our 80s or 90s, right?
Dr. Abhi Banka: Yeah. That's what we're all hoping for, to push it as far ahead in the future as we can. The other thing I caution my patients about osteoporosis is I want to reduce the risk of falls, right? That's the one that I really am thinking about when I have my elderly patient visits, make sure they're not at risk for falls, right?
So some of the things that patients can do at home to prevent falls is to remove obstacles. So let's say, you take the same route through your bedroom, down to your living room and the kitchen and stuff, so make sure your house is not cluttered, right? Make sure your house is tidied up. You don't wear shoes inside or barefoot, wearing socks, especially if you have hardwood floor can put you at risk of slips and falls, right?
If you shower, make sure there's a non-slip mat down on the bed. Make sure you use guardrails and canes. Make sure you don't have no free cords lying around the house that you could trip over and fall. If you're a little careful about how you live around your surroundings, you will decrease the risk of falls and fractures.
Scott Webb: Doctor, as we wrap up here, anything else you want to tell people about osteoporosis, causes symptoms, but mainly how do we kind of hold it at bay? How can we hold off osteoporosis as long as possible?
Dr. Abhi Banka: After a certain age, it might be a little harder to get calcium and vitamin D and the amounts required to maintain bone health. So taking a calcium vitamin D pill, like a supplement pill over-the-counter is not a bad idea. Just to give you an idea, about an eight ounce of milk has 300 milligrams of calcium, right? So if you need close to a 1000 to 1200 milligrams of calcium a day, we're looking at at least two cups of milk, right? On top of that, again, just reading the labels of the food that you eat to see if it's got enough calcium and vitamin D. And if you feel like, "I'm eating well, I don't have a lot of appetite to eat four cups of milk a day" or maybe your cholesterol is high and you want to back off on the milk and cheese or the cod liver oil for vitamin D, what do I do? Please take a calcium and vitamin D pill over-the-counter, especially after you hit menopause for women or after the age of 70 for men. And exercise, please exercise the more strength training you have, the more balance you have, the stronger your bones will be.
Scott Webb: Yeah, absolutely. And great takeaways today. Doctor, thanks so much for your time and your expertise and you stay well.
Dr. Abhi Banka: You bet, Scott. You too.
Scott Webb: To schedule a bone density test visit FranciscanHealth.org and search bone density. And we hope you find this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.