Maggie McKay (Host): We hear a lot about osteoporosis, but how much do we really know? And why is it important? Joining us is Endocrinology nurse practitioner, Shellie Hafer, to tell us more.

Welcome to Wellness First, a St. Joseph Hospital podcast, where we hear and learn directly from the experts on all things health and wellness. I'm Maggie McKay. Thank you so much for being here today, Shellie. Would you please introduce yourself?

Shellie Hafer: Thank you for having me, Maggie. My name is Shellie Hafer. I'm a nurse practitioner. I've worked in Endocrinology for the last approximately 20 years and I've worked here at St. Jo's for the last eight.

Host: So, what is osteoporosis to start off?

Shellie Hafer: To start off with, osteoporosis is bone demineralization. So as we grow older in life, we actually put down bone and we have maximum bone density between ages 20 and 30. And then, we, just like a fine automobile, kind of go wear and tear through the bones, and you'll lose mineralization as you age.

Host: And what causes osteoporosis?

Shellie Hafer: So osteoporosis can be caused by a varying number of diseases. Age is one of them. But you can have hormonal imbalances like hyperparathyroidism or you can have testosterone deficiency. You can be on medications for cancer that can actually decrease hormones in the system for breast cancer, prostate cancer. There's also malabsorption issues like gastric bypass surgeries or Celiac disease or any type of GI stomach issue like ulcerative colitis.

Host: Shellie, who's most likely to develop osteoporosis?

Shellie Hafer: So, osteoporosis is primarily thought of as a female disease as one in two women will actually have a chance of developing osteoporosis in their lifetime. Unfortunately, we forget that men have bones too. And statistically, when you're looking at what goes on, approximately one in every four men will actually develop osteoporosis in their lifetime.

Host: Did you say one in two women will have it in their lifetime?

Shellie Hafer: Yes. One in two women, you have a higher chance of developing osteoporosis than you do of breast cancer and, in some cases, cardiovascular disease.

Host: So, how do you diagnose it?

Shellie Hafer: Generally, osteoporosis is diagnosed with a DEXA scan, which is a bone density scan that looks at the spine and the hips and the femoral neck. But often, this is not done in a timely enough manner. And so most times, osteoporosis is caught when somebody has either a vertebral fracture of their back or a hip fracture of one of the legs.

Host: And how do you treat osteoporosis?

Shellie Hafer: Osteoporosis can be treated in several different ways. But one of the most important things that we do tell a lot of our patients is to make sure you're getting adequate calcium and vitamin D, because those are two of the most important minerals that you can have to help promote bone density.

Then, depending upon how severe the bone density is, there are different types of drugs. You have the bisphosphonates, which have been out as the baseline treatment for several decades. And those would be things like either Reclast, which is an IV infusion, or alendronate, which is also known as Fosamax, and that's an oral tablet. Over the last 10 to 15 years, we've had some extra medications that have been designed, the monoclonal therapies, which include Prolia and Evenity. And then if you have a really severe case of osteoporosis, we can use an androgen-like Forteo or Tymlos, which actually help promote bone growth development.

Host: And what are some things that can be done to prevent osteoporosis development?

Shellie Hafer: Most important thing you can do to prevent is making sure that you're getting adequate nutrition. So, you want to make sure you get your calcium every single day. You don't have to take a calcium tablet. I do tell people that you want to get about three to four servings of calcium-rich foods per day. And then, depending upon where you live in the country, you may need anywhere between 800 units to as much as 4,000 units of vitamin D.

Additionally, we tell everybody walk and do bone strengthening exercises. So, putting pressure on the bones actually forces the bones to help promote bone growth and then do exercises that prevent you from losing your balance. So, anything for stability, yoga, tai chi, swimming, all of those things will actually help prevent you from tripping and falling so that you don't actually have an injury or bone fracture.

Host: So, it's all intertwined. No wonder my trainer always says, "You're not going to get osteoporosis if you keep coming and working out," or even working out on your own.

Shellie Hafer: Absolutely.

Host: Shellie, when should people be screened for osteoporosis? Like, how do you know?

Shellie Hafer: So, the National Bone and Osteoporotic Foundation recommends that everyone, men and women, get screened at least by the age of 65. However, if you have any type of fracture, whether it's a bone fracture or a spinal fracture, they do start recommending screening between the ages of 50 and 55 if there's been a fracture that's involved.

Host: This has been so informative. I've already learned so much in our short time together, Shellie. Is there anything else you'd like to add that we didn't cover?

Shellie Hafer: So, my biggest point that I want to add for people is that prevention is worth a pound of cure. So, try to keep yourself healthy and make sure you stay on top of your health so that we don't have fractures in the world.

Host: Thank you so much for sharing your expertise.

Shellie Hafer: Thank you.

Host: Again, that's Shellie Hafer. And to learn more, please visit stjosephhospital.com/services/endocrinology. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. This is Wellness First, a podcast presented by St. Joseph Hospital.