Scott Webb (Host): Osteoporosis is common in women after menopause, and there are lots of things women can do to prevent and help in the treatment of osteoporosis, like taking calcium supplements and vitamin D. And I'm joined today by Dr. Tufail Ijaz, he's the Medical Director of Endocrinology Services at Genesis, and he's here to explain osteoporosis, how it's diagnosed and treated.

Host: This is Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. I'm Scott Webb. So, doctor, it's so nice to have you here today. We're going to talk about osteoporosis. And I think osteoporosis is one of those things that those of us who suffer from it, or we've known someone who suffers from it, we sort of have a, you know, pretty good idea of what it is. But for everybody else, great to have your expertise today. And let's just start there. What is osteoporosis?

Dr. Tufail Ijaz: Well, thank you for inviting me for this podcast. So osteoporosis basically means weak bones. So, microarchitecture of the bones is decreased. And when that happens, basically patients are more prone to breaking their bones or getting fractures.

Host: Yeah. And so let's talk about that. You know, I used to think when I was younger that just everybody who got to be a certain age, maybe especially women, they all ended up with osteoporosis, but that may or may not be true. And I know there's been a lot of advances in recent years, but let's talk about, you know, either who's at the highest risk and or/can folks prevent osteoporosis before it starts?

Dr. Tufail Ijaz: So, women after menopause are at the highest risk of osteoporosis. Other risk factors for osteoporosis include cigarette smoking, alcohol use, women have had premature menopause at an earlier age, either due to surgery or something else, or patients have vitamin D deficiency, or if they use certain medicines such as steroids or if they have hyperthyroidism, diabetes, certain cancers like multiple myeloma or some problems with their parathyroid glands like hyperparathyroidism or chronic kidney disease. So, all those various conditions will increase the risk of osteoporosis and fractures.

Your second question was, is osteoporosis preventable? Yes. If we take both calcium and vitamin D throughout our lives, that can prevent osteoporosis. If we try to avoid those medicines that will cause osteoporosis, then those are very helpful. Exercises, especially weight-bearing exercises, significantly decrease the risk of osteoporosis. And vitamin D, as we know, it's in the sunlight, so getting a good sunlight or taking vitamin D supplements, an adequate amount will, will prevent osteoporosis. And we should try to avoid cigarette smoking or alcohol use. But if somebody is already smoking or is using alcohol heavily, we should try to stop it or decrease it. That way, we can prevent osteoporosis.

Host: Yeah. So obviously, patient history, medical history, behavior, lifestyle, maybe some genetics mixed in there. We can never outrun, you know, our family history and genetics, but obviously some things we can do to try to slow it down or prevent it. So, let's talk then about the best and safest treatment options for osteoporosis.

Dr. Tufail Ijaz: Yeah. So we have several treatment options for osteoporosis. There is a test called DEXA scan, which basically gives us a measure of osteoporosis to see if they have just mild osteoporosis or severe osteoporosis, and then we look at the history of fractures and patient's tolerability and other medical conditions. So, all those play a role in choosing the appropriate treatment option. The easiest and the initial treatment option is typically a class of medicines called bisphosphonates. Those medicines are available weekly pills, monthly pills, or once a year IV injections.

The most commonly used medicine is called alendronate. The brand name for that would be Fosamax. It's a once-a-week pill, which patients take half an hour before breakfast. Now, if somebody has stomach problems, acid reflux or esophageal problems, then typically they cannot tolerate, then we use other medicines like the IV version of the same medicine, which is called Reclast.

Then if somebody has more severe osteoporosis, if their T scores are very low-- T scores is basically a measure of bone density. If T score is low, it means they have less bone density. So if their T scores are very low, like less than -3 or -3.5, or if they have history of breaking their bones, fragility bones, like without any trauma, then we use anabolic agents. There are two or three of them, Forteo or Tymlos. And these medicines, they are used typically for one to two years. They build your bones very fast and much more than any other agent, and they are just used once in your lifetime. So, those medicines are spared for patients with more severe osteoporosis and fractures. And there is also a once every six months subcutaneous injection called Prolia, which could be used for moderate osteoporosis. And it also depends on the patient's preference to see which treatment option they prefer.

Host: Yeah. And it's always good to hear that there are treatment options. I certainly like that, you know, take a pill once and never have to take it again, but that may not be appropriate for all patients, as you're saying. Wondering if there's exercises we can do, either to help prevent osteoporosis or sort of manage it once we've been diagnosed, is there anything we can do and do it safely?

Dr. Tufail Ijaz: Yes. If somebody has osteoporosis, then, of course, they should prevent falls, so they should be very careful. But weight-bearing exercises are always good to prevent osteoporosis or, once they get it, to treat osteoporosis. So, we always recommend weight-bearing exercises. But at the same time, they should be very careful to avoid falls because these patients are more prone to fracture. So if they fell and compared to a person who does not have osteoporosis, they'll have a greater chance of breaking their bones.

Host: Yeah. And kind of along those lines, you mentioned calcium and vitamin D and some other sort of, you know, vitamins and supplements and things earlier. Do you recommend calcium supplements? Do you recommend that as a course of either preventing osteoporosis and/or helping to treat and manage osteoporosis?

Dr. Tufail Ijaz: Yes. So before starting osteoporosis treatment, we always check their calcium and vitamin D levels. And we make it normal before starting any treatment. But generally, 1200 milligram of calcium either from their dietary sources or calcium pills is recommended, 1200 milligram a day. And at the same time, they should also at least take 800 units of vitamin D. So if somebody is taking dairy products, they can calculate their calcium amount in those, but taking calcium pill is fine. So, sure, we do recommend calcium, either for prevention of osteoporosis. And then once we start treatment for osteoporosis, we will recommend calcium and vitamin D in addition to specific treatment for osteoporosis.

Host: Yeah, right. We can use it to help try to slow it down or prevent it and or treat it later once we've been diagnosed. Good stuff today, doctor, as always, when we have you on. I just want to give you a chance here at the end, you know, final thoughts and takeaways about folks who maybe think they have osteoporosis, have been sort of dragging their feet about diagnosis. What would be your words of wisdom?

Dr. Tufail Ijaz: So, osteoporosis is very common, especially in postmenopausal women. So in women in that age group, they should be very careful. They should take calcium and vitamin D. And then, we recommend like a screening DEXA scan, which is a test for osteoporosis. So, they can ask their primary care doctor to have a DEXA scan done after menopause. And especially if they have family history of osteoporosis, then they are at higher risk of osteoporosis. At the same time, avoid cigarette smoking, alcohol use, have good exercise, have good dietary habits, and so in that way we can prevent osteoporosis.

Host: Yeah, that's the goal, right? So, great advice from an expert today. Always great to have you on. Thanks so much. You stay well.

Dr. Tufail Ijaz: Thank you very much for inviting me.

Host: And for more information on osteoporosis, go to genesishcs.org/services-search/endocrinology. I'm Scott Webb. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. Thanks so much for listening.