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Osteoporosis 101: What You Need to Know About Bone Health
Osteoporosis is a disease where the bones become brittle and weak, which makes them easier to break. Did you know there are ways to prevent weakening and increase bone strength? Dr. Natalie Chilaka, an osteoporosis expert who heads up the UM BWMC Osteoporosis Clinic, talks about who is most at risk for this disease, ways to prevent it and how you can improve your bone health.
Featured Speaker:
Natalie Chilaka, MD
Dr. Natalie Chilaka is an orthopaedic trauma surgeon who specializes in fracture care and osteoporosis treatment. She also runs the UM BWMC Osteoporosis Clinic. Dr. Chilaka earned her undergraduate degree from Cornell University and her medical degree from Weill Cornell Medical College. She completed her residency in orthopaedic surgery at the Harvard Combined Program in Boston, MA. She then completed a fellowship in orthopaedic trauma at Denver Health & Hospital Authority. Following training, Dr. Chilaka worked for several years at Yale New Haven Hospital, a busy level 1 trauma center in Connecticut. She joined the medical staff of UM BWMC in 2017. She started the UM BWMC Osteoporosis Clinic in 2019. Transcription:
Osteoporosis 101: What You Need to Know About Bone Health
Amanda Wilde (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
This podcast is sponsored by the UM Joint Network. Dr. Chilaka is an Orthopedic Surgeon specializing in orthopedic trauma. She's also the founder of the University of Maryland Baltimore Washington Medical Center, Osteoporosis Clinic. Dr. Chilaka, thank you for being here to talk about bone health. So, what exactly is osteoporosis and who is most effected by it?
Natalie Chilaka, MD (Guest): Thank you so much for having me here today. Osteoporosis is actually the most common bone disease. And if somebody has osteoporosis, it means that they have low bone mineral density or low bone mass, and that makes the bones weak and more likely to fracture or break. Osteoporosis can happen to anyone. It is most common in women, in part because of the hormone changes that women go through at menopause. It is also most common in people of Caucasian and Asian descent and people with certain medical problems, such as diabetes, kidney disease, rheumatoid arthritis, many cancer survivors who have had prior chemotherapy, persons who have had gastric bypass, and people who have strong family histories of osteoporosis, siblings who have osteoporosis, parents who have broken a hip fracture and similar.
Host: So what are the signs and symptoms that you may have osteoporosis?
Dr. Chilaka: So, osteoporosis is interesting and a little tricky in that osteoporosis in and of itself has no symptoms. A person has no idea that they have osteoporosis until they break a bone. And it is the breaking of the bone that is painful and requires treatment and alerts the provider that the patient might have osteoporosis.
The only way to diagnose osteoporosis before a person breaks a bone, is with a bone density test, also called a DEXA scan. And a DEXA scan is a quick painless test that uses a special x-ray technique to determine if the person has osteoporosis. And it also has a predictive model built into it, which can help predict the risk of future fractures for the individual.
Host: And how does that DEXA scan help you address the future for someone who is perhaps beginning the process or is the beginning of osteoporosis?
Dr. Chilaka: So, if there are people who are at higher risk for osteoporosis, but don't yet have it, they may have osteopenia or decreased bone mass on their bone mineral density test. And for those persons, it's an opportunity to recognize that they've started on this pathway. And if they have not yet broken a bone, it's a time to reinforce the lifestyle measures and health measures that they can take to help support their bone health.
Like maintaining an active, healthy lifestyle, regular exercise, walking, light weight bearing exercises like lightweights for the upper extremities, eating foods rich in calcium and vitamin D, like milk, cheese, leafy greens, fish, and also many fortified foods. And many people also take calcium and vitamin D supplements, not smoking, limiting alcohol and caffeine consuumption.
Host: If you do all those things, can you reverse osteoporosis? Can you turn the clock back on that? Or do you just stop it from advancing perhaps?
Dr. Chilaka: I think that you can help to stabilize your bone health, but it will not in and of itself stop osteoporosis. And one of the things that I always discuss with my patients is the process by which osteoporosis comes about. And so, while we don't think of it, often, our bone is actually living tissue and through a process of bone turnover, your body replaces it's skeleton throughout your lifetime. It takes an adult about 10 years to replace their skeleton. So, the skeleton that you have today is not the skeleton that you had 10 years ago. Your body has completely replaced it without changing its overall size and shape, which is pretty incredible. And it does that with some cells that eat up the bone and other cells that rebuild the bone.
And so this cycle is always in motion. As we get older, we keep eating up the bone and then some medical conditions that we mentioned, when women go through menopause, accelerates the eating up of the bone, but we're not as good at building the bone as we age. And so if you're always going through this cycle and you're eating up more bone than you're making, then, ultimately over time, you're losing your bone mass. And this process happens to every single person, men and women, healthy, not healthy. People achieve their peak bone mass in their late twenties. And then for the rest of your life, you're losing your bone mass. Because of this ongoing turnover cycle. And then the question of whether somebody actually loses so much bone that they become osteoporotic will depend on how much bone mass they ever achieved as a young adult.
And then also their other risk factors, genetics, medical conditions, lifestyle choices. So, this process happens to everyone. Every person is losing their bone mass. And so can you stop that process just with the best diet and exercise, you know, even the best diet and exercise in the world is not going to stop this process that's happening in your body, because this is happening in all of us.
Host: So osteoporosis really affects everyone at some point in your life.
Dr. Chilaka: Well, I think I would probably say that loss of bone mass as we age happens to everybody. And then the question is does any one individual lose enough bone mass that they get to the point that they actually have osteoporosis. Not everybody reaches that point where they've lost so much of their bone, that they actually have osteoporosis, but osteoporosis is incredibly common. So about one in two women will break a bone due to osteoporosis in their lifetime and up to one in four men.
Host: And you specialize in orthopedic trauma. So, how did that connect to the study of osteoporosis for you?
Dr. Chilaka: The majority of what I do as an orthopedic trauma surgeon is treat broken bones. They don't always require surgery. But, whether it be non-operative treatment with cast immobilization or surgery to properly align the bone for bone healing, that's would probably 90% of my practice is. For many of these patients, certain fractures, fragility fractures, meaning low energy fractures, a broken bone that somebody suffers from falling out of their chair, a fall from standing height, an injury mechanism where you wouldn't expect a young, healthy person to break a bone as opposed to high energy injuries, which we would define as something like a car accident, particularly a high-speed car accident, a fall from a height, such as a ladder or a second story window or higher, Those are mechanisms where anybody could break a bone regardless of the bone quality. But it's really these low energy fractures that are a red flag that this person needs to be evaluated for osteoporosis.
And usually patients are counseled or hopefully they're counseled that this is a red flag. You need to have a bone density test and see where you are. Some of these fractures in and of themselves define osteoporosis. So, if somebody suffers a low-energy hip fracture or a vertebral compression fracture, that person by definition has osteoporosis, even if you haven't done the bone density test yet. And that is somebody who is indicated to start targeted medication to improve their bone health. But many times that doesn't happen. And so the recommendation from the National Osteoporosis Foundation is that any man or woman over age 50 who breaks a bone should have a bone density test to screen for osteoporosis. On a national average, how many of these individuals over 50 breaking bones actually get these bone density tests to properly screen them and then initiate treatment as, as indicated for osteoporosis? It happens for only about one in 10 people who break a bone over age 50, which is. An incredibly lownumber and really a poor standard of care, but that's what's happening. And that is what was one of the major impetus for me to start the Osteoporosis Clinic. Because even when I was seeing these patients and counseling them about osteoporosis, you need to have this bone density test done. You should do this. And that many times it just doesn't happen. It gets lost in the wash because once people have recovered from their fracture, they're not having symptoms from osteoporosis anymore.
And screening and treating osteoporosis can often be the low item on the totem pole, depending what their other active health issues are. And then I would meet the same person again, a few months later, a year later with another fracture. And they're just going through this cycle of fracture to fracture without having the intervention to try to start improving the bone health and prevent future fractures. That's the goal of the treatment for osteoporosis.
Host: You mentioned all the kinds of exercise and foods you can eat to prevent osteoporosis. What are these medications you're referring to that you might use to treat when you've already discovered that a patient has osteoporosis?
Dr. Chilaka: For patients who are indicated to start targeted medication for osteoporosis, those medications work by influencing that bone turnover cycle that's already happening in your body. And so either you can take medications that slow down the cells that are eating up the bone so that the cells building bone can gain an advantage and over time increase the bone mass. Or there are more potent medications that actually work by speeding up the cells that are building bone. And so anytime we're treating osteoporosis, we're also kind of playing the long game because we have to influence this cycle that's already happening in your body. And so there are medications that work by slowing down cells that eat up bone that can be taken as a pill once a week or once a month.
They can also be given as a medication in the IV once a year or as a series of shots that somebody gets in the doctor's office every six months. And then the more potent medications that work by speeding up the cells that make bone can be given either as daily shots that the patient gives to themselves, or as monthly shots that they come into the office for.
Host: Are there any side effects from these medications?
Dr. Chilaka: The different medications have different potential side effects and risk profiles. Overwhelmingly the data for all of the medications is that balance of risk benefit for the medication almost always falls in favor of taking the medication because these medications are so effective in preventing future fractures and the fractures can be very debilitating for patients. And then which medication then kind of depends on what the side effects are. So, for the oral medications, one of the most common side effects is heartburn. And so if people already struggle with heartburn, then they might not be able to tolerate that medication.
But then they might take, you know, it in the IV or get the shots every six months, et cetera. Many people I have heard of something called Fosamax fractures quote-unquote and that had made people hesitant to start the treatment for osteoporosis. And a Fosamax fracture is a actually uncommon complication of the medications that slowed down the cells that are eating up the bone.
When these medications first came out, the first medications Fosamax came out in 1998, the medical community didn't know that you could get too much of a good thing. And there were a number of patients who were essentially overdosed on the medication and this process of bone turnover was disrupted too much.
And then those individuals developed a different type of femur fracture, fracture of the thigh bone that was a different pattern from the typical hip fractures that we see. But with proper medication management, that type of complication is very uncommon. I have encountered patients with atypical femur fractures, and they almost always have been on these medications for 10 years or longer. And so with these medications for all of the medications for osteoporosis, these are not medications that you start and stay on the rest of your life. These are medications that you start and stay on for a certain number of years, in the range of two to five, usually not more than seven years, following the bone density test periodically to see the response to medication, but then at some point the medication should be stopped and then go into a monitoring phase of the bone mass.
Host: Yeah. And I was going to say, as with all medications, you have to monitor closely with your doctor. Are there any other important tips our audience should take away from this conversation?
Dr. Chilaka: I think that one of the most important things that I try to discuss with my patients is that as we age, there are two things that people prize above all else. We prize our mental faculties and we prize our mobility and our independence. And when people suffer fractures related to osteoporosis, they are painful. They may require hospitalization or surgery. They have long recoveries. People can end up with permanent functional deficits after these types of injuries. And so they can really be life-changing events. And so maintaining bone health to prevent fractures is really one of the most important things that we can do as we age to help us stay mobile and independent.
Host: Thank you, Dr. Chilaka for your time for explaining osteoporosis and for your suggestions on how we can keep that skeleton working optimally.
Dr. Chilaka: Thank you very much for having me today.
Host: This episode of Live Greater is sponsored by the University of Maryland Joint Network. UM Joint Network surgeons are experts in total hip and knee replacements. Held to the highest standards of care, UM Joint Network Surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.
Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Osteoporosis 101: What You Need to Know About Bone Health
Amanda Wilde (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
This podcast is sponsored by the UM Joint Network. Dr. Chilaka is an Orthopedic Surgeon specializing in orthopedic trauma. She's also the founder of the University of Maryland Baltimore Washington Medical Center, Osteoporosis Clinic. Dr. Chilaka, thank you for being here to talk about bone health. So, what exactly is osteoporosis and who is most effected by it?
Natalie Chilaka, MD (Guest): Thank you so much for having me here today. Osteoporosis is actually the most common bone disease. And if somebody has osteoporosis, it means that they have low bone mineral density or low bone mass, and that makes the bones weak and more likely to fracture or break. Osteoporosis can happen to anyone. It is most common in women, in part because of the hormone changes that women go through at menopause. It is also most common in people of Caucasian and Asian descent and people with certain medical problems, such as diabetes, kidney disease, rheumatoid arthritis, many cancer survivors who have had prior chemotherapy, persons who have had gastric bypass, and people who have strong family histories of osteoporosis, siblings who have osteoporosis, parents who have broken a hip fracture and similar.
Host: So what are the signs and symptoms that you may have osteoporosis?
Dr. Chilaka: So, osteoporosis is interesting and a little tricky in that osteoporosis in and of itself has no symptoms. A person has no idea that they have osteoporosis until they break a bone. And it is the breaking of the bone that is painful and requires treatment and alerts the provider that the patient might have osteoporosis.
The only way to diagnose osteoporosis before a person breaks a bone, is with a bone density test, also called a DEXA scan. And a DEXA scan is a quick painless test that uses a special x-ray technique to determine if the person has osteoporosis. And it also has a predictive model built into it, which can help predict the risk of future fractures for the individual.
Host: And how does that DEXA scan help you address the future for someone who is perhaps beginning the process or is the beginning of osteoporosis?
Dr. Chilaka: So, if there are people who are at higher risk for osteoporosis, but don't yet have it, they may have osteopenia or decreased bone mass on their bone mineral density test. And for those persons, it's an opportunity to recognize that they've started on this pathway. And if they have not yet broken a bone, it's a time to reinforce the lifestyle measures and health measures that they can take to help support their bone health.
Like maintaining an active, healthy lifestyle, regular exercise, walking, light weight bearing exercises like lightweights for the upper extremities, eating foods rich in calcium and vitamin D, like milk, cheese, leafy greens, fish, and also many fortified foods. And many people also take calcium and vitamin D supplements, not smoking, limiting alcohol and caffeine consuumption.
Host: If you do all those things, can you reverse osteoporosis? Can you turn the clock back on that? Or do you just stop it from advancing perhaps?
Dr. Chilaka: I think that you can help to stabilize your bone health, but it will not in and of itself stop osteoporosis. And one of the things that I always discuss with my patients is the process by which osteoporosis comes about. And so, while we don't think of it, often, our bone is actually living tissue and through a process of bone turnover, your body replaces it's skeleton throughout your lifetime. It takes an adult about 10 years to replace their skeleton. So, the skeleton that you have today is not the skeleton that you had 10 years ago. Your body has completely replaced it without changing its overall size and shape, which is pretty incredible. And it does that with some cells that eat up the bone and other cells that rebuild the bone.
And so this cycle is always in motion. As we get older, we keep eating up the bone and then some medical conditions that we mentioned, when women go through menopause, accelerates the eating up of the bone, but we're not as good at building the bone as we age. And so if you're always going through this cycle and you're eating up more bone than you're making, then, ultimately over time, you're losing your bone mass. And this process happens to every single person, men and women, healthy, not healthy. People achieve their peak bone mass in their late twenties. And then for the rest of your life, you're losing your bone mass. Because of this ongoing turnover cycle. And then the question of whether somebody actually loses so much bone that they become osteoporotic will depend on how much bone mass they ever achieved as a young adult.
And then also their other risk factors, genetics, medical conditions, lifestyle choices. So, this process happens to everyone. Every person is losing their bone mass. And so can you stop that process just with the best diet and exercise, you know, even the best diet and exercise in the world is not going to stop this process that's happening in your body, because this is happening in all of us.
Host: So osteoporosis really affects everyone at some point in your life.
Dr. Chilaka: Well, I think I would probably say that loss of bone mass as we age happens to everybody. And then the question is does any one individual lose enough bone mass that they get to the point that they actually have osteoporosis. Not everybody reaches that point where they've lost so much of their bone, that they actually have osteoporosis, but osteoporosis is incredibly common. So about one in two women will break a bone due to osteoporosis in their lifetime and up to one in four men.
Host: And you specialize in orthopedic trauma. So, how did that connect to the study of osteoporosis for you?
Dr. Chilaka: The majority of what I do as an orthopedic trauma surgeon is treat broken bones. They don't always require surgery. But, whether it be non-operative treatment with cast immobilization or surgery to properly align the bone for bone healing, that's would probably 90% of my practice is. For many of these patients, certain fractures, fragility fractures, meaning low energy fractures, a broken bone that somebody suffers from falling out of their chair, a fall from standing height, an injury mechanism where you wouldn't expect a young, healthy person to break a bone as opposed to high energy injuries, which we would define as something like a car accident, particularly a high-speed car accident, a fall from a height, such as a ladder or a second story window or higher, Those are mechanisms where anybody could break a bone regardless of the bone quality. But it's really these low energy fractures that are a red flag that this person needs to be evaluated for osteoporosis.
And usually patients are counseled or hopefully they're counseled that this is a red flag. You need to have a bone density test and see where you are. Some of these fractures in and of themselves define osteoporosis. So, if somebody suffers a low-energy hip fracture or a vertebral compression fracture, that person by definition has osteoporosis, even if you haven't done the bone density test yet. And that is somebody who is indicated to start targeted medication to improve their bone health. But many times that doesn't happen. And so the recommendation from the National Osteoporosis Foundation is that any man or woman over age 50 who breaks a bone should have a bone density test to screen for osteoporosis. On a national average, how many of these individuals over 50 breaking bones actually get these bone density tests to properly screen them and then initiate treatment as, as indicated for osteoporosis? It happens for only about one in 10 people who break a bone over age 50, which is. An incredibly lownumber and really a poor standard of care, but that's what's happening. And that is what was one of the major impetus for me to start the Osteoporosis Clinic. Because even when I was seeing these patients and counseling them about osteoporosis, you need to have this bone density test done. You should do this. And that many times it just doesn't happen. It gets lost in the wash because once people have recovered from their fracture, they're not having symptoms from osteoporosis anymore.
And screening and treating osteoporosis can often be the low item on the totem pole, depending what their other active health issues are. And then I would meet the same person again, a few months later, a year later with another fracture. And they're just going through this cycle of fracture to fracture without having the intervention to try to start improving the bone health and prevent future fractures. That's the goal of the treatment for osteoporosis.
Host: You mentioned all the kinds of exercise and foods you can eat to prevent osteoporosis. What are these medications you're referring to that you might use to treat when you've already discovered that a patient has osteoporosis?
Dr. Chilaka: For patients who are indicated to start targeted medication for osteoporosis, those medications work by influencing that bone turnover cycle that's already happening in your body. And so either you can take medications that slow down the cells that are eating up the bone so that the cells building bone can gain an advantage and over time increase the bone mass. Or there are more potent medications that actually work by speeding up the cells that are building bone. And so anytime we're treating osteoporosis, we're also kind of playing the long game because we have to influence this cycle that's already happening in your body. And so there are medications that work by slowing down cells that eat up bone that can be taken as a pill once a week or once a month.
They can also be given as a medication in the IV once a year or as a series of shots that somebody gets in the doctor's office every six months. And then the more potent medications that work by speeding up the cells that make bone can be given either as daily shots that the patient gives to themselves, or as monthly shots that they come into the office for.
Host: Are there any side effects from these medications?
Dr. Chilaka: The different medications have different potential side effects and risk profiles. Overwhelmingly the data for all of the medications is that balance of risk benefit for the medication almost always falls in favor of taking the medication because these medications are so effective in preventing future fractures and the fractures can be very debilitating for patients. And then which medication then kind of depends on what the side effects are. So, for the oral medications, one of the most common side effects is heartburn. And so if people already struggle with heartburn, then they might not be able to tolerate that medication.
But then they might take, you know, it in the IV or get the shots every six months, et cetera. Many people I have heard of something called Fosamax fractures quote-unquote and that had made people hesitant to start the treatment for osteoporosis. And a Fosamax fracture is a actually uncommon complication of the medications that slowed down the cells that are eating up the bone.
When these medications first came out, the first medications Fosamax came out in 1998, the medical community didn't know that you could get too much of a good thing. And there were a number of patients who were essentially overdosed on the medication and this process of bone turnover was disrupted too much.
And then those individuals developed a different type of femur fracture, fracture of the thigh bone that was a different pattern from the typical hip fractures that we see. But with proper medication management, that type of complication is very uncommon. I have encountered patients with atypical femur fractures, and they almost always have been on these medications for 10 years or longer. And so with these medications for all of the medications for osteoporosis, these are not medications that you start and stay on the rest of your life. These are medications that you start and stay on for a certain number of years, in the range of two to five, usually not more than seven years, following the bone density test periodically to see the response to medication, but then at some point the medication should be stopped and then go into a monitoring phase of the bone mass.
Host: Yeah. And I was going to say, as with all medications, you have to monitor closely with your doctor. Are there any other important tips our audience should take away from this conversation?
Dr. Chilaka: I think that one of the most important things that I try to discuss with my patients is that as we age, there are two things that people prize above all else. We prize our mental faculties and we prize our mobility and our independence. And when people suffer fractures related to osteoporosis, they are painful. They may require hospitalization or surgery. They have long recoveries. People can end up with permanent functional deficits after these types of injuries. And so they can really be life-changing events. And so maintaining bone health to prevent fractures is really one of the most important things that we can do as we age to help us stay mobile and independent.
Host: Thank you, Dr. Chilaka for your time for explaining osteoporosis and for your suggestions on how we can keep that skeleton working optimally.
Dr. Chilaka: Thank you very much for having me today.
Host: This episode of Live Greater is sponsored by the University of Maryland Joint Network. UM Joint Network surgeons are experts in total hip and knee replacements. Held to the highest standards of care, UM Joint Network Surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.
Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.