Scott Webb (Host): Osteoporosis is common, but many of us don't know we're suffering from it until we experience an osteoporotic fracture. My guest today is here to explain osteoporosis and osteoporotic fractures and help us to know when to be screened and how to prevent injury. I'm joined today by Dr. Ebaad Malick. He's the Director of Osteoporosis with Orthopedic Associates of Central Maryland.

Welcome to A Bone to Fix from Orthopedic Associates of Central Maryland Division. I'm Scott Webb, and I've got A Bone to Fix with you.

Doctor, it's nice to have you on today. I know we're going to do a couple of podcasts together. Today, we're going to talk about osteoporotic fractures. So, what are they? What are osteoporotic fractures, and why are they often the first sign that someone has osteoporosis? And maybe which of these fractures, these hypothetical fractures, would be the most concerning?

Dr. Ebaad Malick: So, osteoporotic fractures are basically fractures that happen usually due to low impact in bone that has weakened over time. So, just to take a step back, osteoporosis is when either due to declining estrogen or as patients age, there's changes in the balance of bone building and bone breaking, to put it simply.

And either as we get older or for women after they go through menopause, their bones become more brittle because the rate of breaking down the bones and trying to release calcium in the bloodstream goes higher than the rate of rebuilding up the bone. So, what this does is make the bones less resistant to, you know, trauma or a fall, for instance.

So, osteoporotic fractures are fractures that happen in people that have osteoporosis. And frequently, unfortunately, osteoporotic fractures are the first sign that someone has osteoporosis, because we have a lot of patients walking around not knowing that they do have osteoporosis.

Host: Yeah. And it's good that we do things like this, podcasts like this to try to educate folks. And I guess it makes me wonder, Doctor, like what makes a fracture, let's say, caused by osteoporosis different than a typical fracture? And does that then affect the treatment and recovery because it's a little different?

Dr. Ebaad Malick: What makes a difference is, I think, the mechanism to start. If I have a fall and I'm in my 20s or 30s, I will probably, you know, might get bruised or it might hurt, but I won't end up with a broken bone. But in someone with osteoporosis, they're at significantly increased risk of having a broken hip or a broken leg, broken arm, or even a compression fracture in their spine.

And what this does is it puts them at risk of declining mobility, increased mortality, especially with hip fractures. And there's just a lot of other considerations when it's an osteoporotic fracture.

Host: Yeah, I see what you mean. And it makes me wonder then, like I'm in my mid to late 50s. We'll just leave it there. We'll be generic. Yeah, but who should be screened for osteoporosis? And maybe are there some warning signs that folks just might overlook before a fracture occurs?

Dr. Ebaad Malick: According to up-to-date guidelines, either the USPSTF or if you go by the Endocrine Society or various medical societies, I think there's a consensus that post-menopausal females above the age of 65 should be screened with a DEXA scan. Post-menopausal females under 65, that may have certain risk factors. And then, for men, the screening recommendations are to individualize the screening. It is important to note that men also can develop osteoporosis. And warning signs would be loss of height, stooped posture, wrist strength decline, as well as pain that wasn't present before. But unfortunately, you know, osteoporosis does fall into the category of what we call silent diseases, where you may not really have a lot of signs and symptoms.

Host: Right Yeah, my kids tease me that I've shrunk. I used to be like a full 6'4", and they say, "Hey, Dad, you've shrunk a little bit." So, that's maybe a separate podcast or just speak with my own provider. But are there some ways, Doctor, that we can strengthen bones, reduce our fracture risk, maybe through exercise, nutrition, lifestyle changes, those kinds of things?

Dr. Ebaad Malick: Yeah, absolutely. There are ways to prevent osteoporosis from either worsening or reduce the rate of it. It comes down to nutrition, resistance training, and vitamin supplementation. So for example, your calcium and vitamin D should be adequate to prevent osteoporosis from advancing or an osteoporotic fracture. And then, in terms of resistance training, it's been shown that even light resistance training a few times a week can reduce the rate of osteoporosis. And resistance training would basically be moving your skeleton against some type of resistance.

The most common form that we have nowadays is, you know, just going to the gym and lifting a few weights. Now, of course, you know, you shouldn't do anything that overstresses you, but you should focus on something that you can handle for maybe like eight to 12 reps and doing that in a couple sets a couple times a week to strengthen your bone.

And another important thing to note is that we actually build a strong foundation in our second and third decade of life where our bones reach a peak strength, if you will. And as we age, we slowly have reducing bone density. Now, osteoporosis is a little bit worse than just a little bit reduction of bone density it is a medical disease, but it's important to note that you can prepare for this even in your second and third decade of life by maintaining an active, healthy lifestyle. Of course, genetic and hereditary components exist too that you may not have as much control over, but there are a lot of ways of living a healthy life that can help reduce the rate of osteoporosis.

Host: Yeah, push that bill off a little bit longer, right, from coming due, right? So, we can help ourselves when we're younger. But certainly exercise, nutrition, lifestyle changes, some resistance training, all that good stuff. Give you a chance here, Doctor, just a little myth-busting, if you will. Like, are there some big misconceptions about osteoporosis and osteoporotic fractures that you wish more patients understood?

Dr. Ebaad Malick: Yeah. So, one of the biggest misconceptions is that osteoporosis is just a normal part of aging and nothing can be done about it. And what we just touched upon, that's not exactly true. While bone density naturally does decline as we get older, osteoporosis is a medical condition that can be diagnosed, treated, and often prevented from progressing.

Another misconception is that if you don't have pain, your bones must be healthy. And, you know, not having pain is always a great thing, but just because there's the absence of a symptom doesn't mean that there's not something brewing underneath the surface. We touched upon this earlier too, that osteoporosis is called a silent disease, because people usually don't know they have it until they experience a fracture, unfortunately. That's why screening is so important, especially for older adults and people with risk factors

Host: Yeah, you gave us a sense of who should probably be screened. And it was good stuff today, very educational, helpful for me at my age and other folks, I'm sure. I just want to give you a chance here at the end. Just tell us a little bit about yourself, your background, what you do for fun, all that good stuff.

Dr. Ebaad Malick: Yeah. So I'm a board-certified physician in family medicine. That's what I did my residency in. And then, I have additional board certification in obesity medicine too, which I found very interesting. But then, I went back to fellowship and did a chronic and interventional pain fellowship at UPMC where I got to train with some of the best physicians in the pain field.

And what I will be doing with Orthopedic Associates of Central Maryland is treating chronic pain from head to toe using therapies, medications, interventional procedures, minimally invasive procedures. But I'll also be directing their osteoporosis program where if we have a patient that comes to us due to a fracture, we do the appropriate follow-up and treat their underlying osteoporosis as well to improve their outcomes after surgery and prevent that second fracture.

Host: Yeah. Yeah, it's good stuff. As you say, many of us think that, well, you just get older and you get osteoporosis. What are you going to do? But you've given us a sense today that we can get started when we're younger, eating better, exercising, all of that, and we can know our risk factors, be diagnosed, be treated, all good stuff. Thank you so much.

Dr. Ebaad Malick: Thank you.

Host: Find out more about us online at mdbonedocs.com. 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.