Transcription:
Bone Health

Scott Webb (Host): Falls and fractures are more common as we get older and there are a variety of ways to prevent them and assess our bone density, including DEXA scans. And joining me today to discuss all things, falls and fractures is Angeline Williams. She's a Certified Registered Nurse Practitioner and Head of the Own The Bone Program at the Centers for Advanced Orthopedics Orthopedic Associates of Central Maryland, in practice for over 50 years.

Hi, I'm Scott Webb and I've Got a Bone to Fix With You. Angheline, it so great to have you on. We're going to talk all things falls and fractures today. And as we get rolling here, who's at the highest risk for fractures?

Angeline Williams, CRNP (Guest): The highest risk is actually related to age and gender. Women are far more likely to have a fracture than men. In fact, one in two women over the age of 50 will have a fracture in their lifetime.

Host: Okay, so good to know. So age, gender, those are definitely factors. When we think about falls, in particular, some falls may be can be prevented, some can't, but what would be your best advice for folks, especially in the older age group on preventing falls.

Angeline: The best thing older people can do to help prevent falls is moving obstacles in their home, such as, rugs, things that they can slip on like toys. And unfortunately, a lot of people also trip over their pets. I know it's a little harder to move the pets out the way, but we've got to try to be more observant and to try to, I guess the word would be to get out of their way so that we won't fall and risk having fractures.

Host: You know, I was just thinking that as you started to answer, I started to think about pets, right? Our cats in particular, just have a unique sort of knack for just being in the way. They're always under my feet. Everywhere I turn, there's a cat rubbing against my leg and I'm sure for older folks who are already at higher risk, I can see how it would be tricky because you don't want to hurt your pets, but you also don't want to hurt yourself. Right?

Angeline: Correct. I have a lot of patients who said, oh, I just tripped over the dog. Or a lot of people actually walk in the dark and unlike the animals, we can't see in the dark. And I always say, well, why didn't you just turn on a light? And then they think, I don't know. Or some people say, well, I didn't want to bother anyone else. So, just the fact of, you know, turn that light on so you can see where you're going.

Host: That's such a such great advice. Yes. Turn the light on. Don't worry about bothering other people. We need to be able to see, we can't see in the dark like animals can. So, as we work our way through this, what are some other things that can make people's bones weak? You know, that they may not realize it. Could it be something like past cancer treatments, things like that?

Angeline: Oh, absolutely. The treatments for chemo and things can actually weaken our bones, some of the medication that we take for certain diseases and as well as certain diseases. I see a lot of people who suffer from inflammatory bowel disease or Crohns Disease. And those are two of the main ones that can prevent absorption of those crucial vitamins, such as calcium and vitamin D.

Host: Yeah. I mean, that's what I want to move on to next here is really prevention, right? So, we've talked about how to prevent falls, right? Watch out for the pets, turn the lights on, things like that. Those rugs that get kind of bunched up. So that's all great advice. Now, when we think about in terms of preventing fractures, right? Even in the high risk group, what are some things that we can do? Let's talk first, maybe things that we can take right, on a daily basis, whether it's a vitamin D, calcium, that kind of stuff. So take us through that. What can we do in terms of prevention that we can take on a daily basis? Or we can absorb on a daily basis.

Angeline: One thing is real important is for everyone young and old to maintain an adequate intake of dietary calcium and vitamin D. Like most vitamins, if at all possible, we hope you get it from your diet, but not everyone can get these from their diets. So, we do support taking supplements especially calcium and vitamin D because both of them are very important to your bone health.

And I talk to a lot of patients who, you know, I used to eat really well, but I don't now, or they're dieting because they want to lose weight. And I said, I totally understand but we can always work in the proper way for you to get the calcium and vitamin D because it is so crucial to bone health, and most people want to know well, how much of this do I need to take? And when should I take it? And what type is the best type? And when it comes to calcium, it is a lot of things to consider. And what I tell most people, young people, those 50 and under, you're good with what we call it 100 nanograms or milligrams a day, but for especially women, but men too, over the age of 50, we want you to take in at least 1200 milligrams of calcium.

And I tell people is really not hard to get the calcium you need from your diet, if you eat fruit, vegetables, fortified fruits, fortified foods, milk. It is so easy. And I tell people without even trying, you always get at least half of what you need from your diet. So, then what I suggest is getting the other half from supplements.

Host: Yeah, that sounds good. The, the fortified fruits, veggies, just foods in general. And I think that's the tricky part is that when you say 1200 or just a big number like that, that would be a lot in terms of supplements. But as you say, if we eat right, if we eat healthy, we can cover about half of that. And then the rest of the way we can do with supplements which is maybe more doable for most folks,

Angeline: right?

Right. And the thing with calcium supplements, they can be constipating and I tell people that's because most of us, I think, try to take the 1200 milligrams in the supplement.

Host: Yeah.

Angeline: So when I say you can easily get 600 from your diet. So, let's work on getting 600 milligrams from your supplements. And what I tell people to do is I don't want you to take the whole 600 at once.

I want you to divide that into two where you take 300 and 300. The one reason is because we do want to help avoid the constipation, but your body can only absorb around about 600 milligrams of calcium at a time. So, even if you're trying to take those big numbers all at once, your body is still not taking advantage of that because it can't absorb 1200 milligrams of calcium at once.

So if we do the 600 milligrams in supplements, take 300 in the morning, and I tell people most calcium is absorbed better with food. So, I tell them to take your morning dose with your breakfast and then take another 300 with your meals. And that way we can assure we're trying to avoid the constipation, but you're getting what you need for that bone health.

Host: So 600 from supplements and then the other 600, we split up 300 in the morning, 300 later with a meal to avoid constipation and better absorption. That's awesome. Great advice. Now I'm going to let you say the full name. I'm going to abbreviate it, we're just going to call it a DEXA scan. You're going to tell folks what that is exactly. But what are DEXA scans and what role do they play in terms of bone density, fragility, fractures, and so on?

Angeline: Your DEXA scan is basically an x-ray of your bones and the DEXA stands for dual-energy X-ray absorptiometry, which is why we all say DEXA, because it can be a tongue twister. And what they do, the results of the scan are compared to normal bone mineral density values based on your age, gender. And they determine if you are at high, normal or have low bone density.

And we use this information so we can determine your risk factors for having a fracture. And then once we determine what your risk factors are, then we can determine the best treatment, whether it be weight-bearing exercises, you need to increase your calcium or vitamin D or for those who are at severe risk of fractures; we recommend medications that are FDA approved. And these medications are ones that actually help improve the micro architecture of your bones, which helps prevent fractures.

Host: Yeah, thank you for carrying the heavy load there and spelling that out for folks, but yeah, DEXA scans, very useful, very helpful for folks. And when do you recommend that folks start maybe having these DEXA scans? Is it after the age of 50, 60, 70? When's it just a ballpark anyway, for folks, if they're at normal risk?

Angeline: Yeah, normal risk, we say have a DEXA scan, 65 and older, and you can have it every two years. And those exams are usually covered by Medicare or your insurance. Cause they consider it for your health. For younger folks, when we see women who are menopausal, meaning after 50 and going through menopause and they have risk factors in their history that put them in high risk, such as having a family history of osteoporosis. If you're one of those patients who have been taking medication or treatments, we know that weaken the density of your bone, we recommend those people performing DEXAs earlier and also every two years.

Host: Yeah, I think you're so right. We just can't get away from our family history and our genetics as much as we love our families. If you have a history of these things, obviously you may want to get started earlier than 65. So again, just more great advice. As we get close to wrapping up here Angeline, you know, some fractures make sense, right? You fall or you have an accident and you have a fracture, but that can also mean that that's a sign of bone fragility, right? Like, even though you can explain how the fracture happened, you may still have an issue and you may still have some things that you need to address through supplements or other medications. Right?

Angeline: Correct. What we call fragility fractures, are those ones that we worry about. And when people say, well, how do I know if I have a fragility fractures? Those are fractures we say that people have from a fall of a standing height that normally would not happen from a person who has normal bones. Let's say someone was just walking down the street and they tripped over their feet and they fell and they broke their leg, is not what we call a high impact fracture. It's low impact. And so those we want to investigate, and those are the ones we would consider also doing DEXA exams to determine their bone quality. Or if someone comes and say, they were in a car accident, a motor vehicle accident, and they received a fracture, well that's considered a high impact incident.

So those fractures do not, you know, bring up all the red flags that there may be something wrong with your bones. But the ones that are considered low fractures. I had a woman who had a fracture to her distal radius and she said she was just casually walking down the hall. And while she was swinging her arms, she hit it against the wall.

Well, under normal circumstances, hitting your arm against the wall, would not cause you to have a fracture, but in her case, she did. So that raised those flags. And we said she had what we consider a fragility fracture. And we definitely put her on treatment, but we also collected the information such as a DEXA to see where her bone density was. And in her case, she was considered to have osteoporosis.

Host: Yeah, I see what you mean. That's really helpful. The low versus high impact, as you say, right? In this example, just banging or bumping your arm against the wall, you shouldn't break your arm, but if you do, that can be a sign of fragility and then kick in some of the things that we've discussed here today, like a DEXA scan and so on.

Well, Angeline, this has been really helpful, really educational. Thanks so much for your time. You stay well.

Angeline: Alright, thank you.

Host: Go to MDbonedocs.com to schedule a bone screening with Angeline today. And please remember to share and subscribe to this podcast. And that's all for today. I'm Scott Webb and that Was a Bone That's Fixed.