Amanda Wilde (Host): This is  Community Connect: presented by Tampa General Hospital. I'm Amanda Wilde. Joining me is Dr. Yevgeniya Kushchayeva, Medical Director of the USF Adult Osteoporosis Program. Join us as we explore the essential aspects of bone health. Dr. Kushchayeva, welcome.

Yevgeniya S. Kushchayeva, MD, PhD: Thank you so much. It's a great pleasure to be here. And thank you for your invitation.

Host: Well, this is something that is personal to me and many other women. When do we need to think about checking our bones?

Yevgeniya S. Kushchayeva, MD, PhD: The major US guidelines provide clear recommendations for osteoporosis screening initiation. The US Preventive Services Task Force usually recommends screening all women who are 65 and older using DEXA study or dual energy x-ray absorptiometry. So also, young women might need to be screened if they have risk factors for bone loss. And some of them, some select previous fracture, parents with hip fractures, low body mass index, smoking, chronic glucocorticoid therapy or other chronic disorders.

For men, it is a little bit different situation here. The US. Preventive Services Task Force states that current evidence is insufficient to recommend routine screening for men. But other organizations such as our National Bone Health and Osteoporosis Foundation and International Society for Clinical Densitometry suggest considering screening in men who are 70 years and older and even younger men with significant risk factors for bone loss. So in general, screening for bone loss is very important, and initiation of screening depends on age and risk factors that a person might have.

Host: Are there any clinical symptoms or signs of bone loss along with those risk factors? If there are symptoms, that would be something we need to consider.

Yevgeniya S. Kushchayeva, MD, PhD: This is usually a silent, asymptomatic disease until fracture occurs. Fracture is the initial presentation of osteoporosis. We call those fractures, fragility fractures because they can occur from minimal trauma, from falls from standing position even without trauma. And of course, symptoms will depend which bone has been fractured. But usually, it is pain.

However, sometimes with vertebral fractures, a patient might not have a classical clinical presentation. And up to two-thirds of vertebral fractures will be unrecognized by the patient due to really absence of symptoms like acute pain or misattribution to other chronic back conditions. So, just chronic back pain that many of us might have, especially with aging.

Host: It sounds like you diagnose bone loss due to fragility fractures, which might lead you to the screening with the DEXA. And the DEXA itself is a diagnosis tool, or do you have any other tools to diagnose bone loss?

Yevgeniya S. Kushchayeva, MD, PhD: Yes, absolutely. This is another great question. So, we have a couple of ways how to diagnose osteoporosis. First of all, this is based on bone mineral density when T-score is -2.5 or less in tje spine or hip, this is osteoporosis. Also, when patient had already fragility fracture regardless what DEXA shows, it's also osteoporosis already. And the third way how we can use this, we have a specific calculator that called FRAX. So, this calculator we use for patients with osteopenia, but this calculator has multiple questions about risk factors that can tell us the 10-year probability for fracture.

Host: You mentioned, aside from risk factors, that screening should apply to women 65 and older and men over 70. Those are the guidelines. But I'm wondering, I always hear about women and bone loss, is bone loss a women disease, or women and men both get this disease at the same rate?

Yevgeniya S. Kushchayeva, MD, PhD: Osteoporosis is not only a disease in women. Of course, the prevalence of osteoporosis in men is substantially lower than in women. It sounds like 4.4% versus close to 20%, but estimated number of men with osteoporosis, about one to two million in the United States. And it's interesting based on literature one in three women and one in five men over 50 will have osteoporotic fracture in their lifetime.

And the most important what we need to remember that men who experienced hip fracture have mortality rates approximately twice that of women. And let's say, if we are talking about hip fractures that happen in men and women, one-year mortality will be 37.5% in men compared to 28% in women.

Host: And you have described many conditions that can cause bone loss. So, that is something for us all to be aware of, and also aging.

Yevgeniya S. Kushchayeva, MD, PhD: Exactly, exactly. Osteoporosis is considered a disease of aging right now. Osteoporosis, I would say, became younger, and this is because of secondary osteoporosis. Because primary osteoporosis, it's usually in women because of estrogen deficiency. When we become menopausal, we lose our estrogens. That will accelerate bone resorption and reduce bone formation. So, we will be losing more bone than we can build.

Host: Now, medication is usually the go-to when people do have osteoporosis. What are some of the side effects of those osteoporosis medications and how do we minimize the risk?

Yevgeniya S. Kushchayeva, MD, PhD: Osteoporosis medications, as any other medications, can have side effects. But commonly, the prevalence of those side effects are exaggerated and sometimes even not supported by current literature. They are very rare. And the overall risk profile of those drugs is favorable compared to their benefits in fracture prevention.

Host: Dr. Kushchayeva, can you explain why treatment for osteoporosis is important?

Yevgeniya S. Kushchayeva, MD, PhD: Treatment for osteoporosis is important because it significantly reduces the risk of fractures, which are associated with substantial morbidity, mortality and loss of quality of life. And we are dealing mostly with elderly people. So, osteoporotic fractures, especially hip and spine, can lead to disability, increased risk for next fractures, even premature deaths. Hip fractures, for example, carry a one-year mortality risk of 21-24% in older people, and often result in long-term loss of independence.

And let me tell you even more, for hip fracture, studies consistently showed that 40-60% of patients will not recover their pre-fracture mobility or ability to perform a daily living activities for one-year after fracture. And I will tell you, only 26% in a year will continue living independently. So, the same for vertebral fracture. It's a chronic pain after vertebral fracture, it'll be a chronic pain, disability, limitation in function, limitation in daily living activities. So, that is why it is very important to prevent those fractures because consequences are quite devastating, especially for elderly people.

Host: After hearing this information, if someone wants to get screening, what's the first step they should take?

Yevgeniya S. Kushchayeva, MD, PhD: So, it's quite easy to do. So, the person can talk with their primary care physician or any specialist they are going to, to screen them for osteoporosis if they are eligible. It's very easy to do just with DEXA scan. DEXA scanners are widely available in almost all radiology departments. It is a simple x-ray-based test with very low radiation exposure.

But important to know that unlike other imaging modalities, the bone mineral density monitoring needs to be done on the same scanner since comparison results from different DEXA scanners is not recommended. So, it means you need to choose the DEXA scanner that is most convenient for you and go there on a regular basis for bone mineral density monitoring.

Host: Well, Dr. Kushchayeva, thank you so much for sharing your knowledge and this important information about a disease that really can affect any of us and really appreciate you also highlighting the risk factors.

Yevgeniya S. Kushchayeva, MD, PhD: Thank you so much for having me here. It was a pleasure.

Host: That was Dr. Yevgeniya Kushchayeva, Medical Director of the USF Adult Osteoporosis Program. For more information, please visit tgh.org/endo. If you enjoyed this episode, be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. This is  Community Connect: presented by Tampa General Hospital. Thanks for listening.