Dr. Joshi tackles important topics such as what is osteoporosis? How will it affect me? How do I know I have it and how do I prevent it ?
Osteoporosis: The Silent Epidemic
Featuring:
Renu Joshi, MD
Renu Joshi, MD, chief of endocrinology and vice president, chronic disease population health management at UPMC Pinnacle, is a board-certified endocrinologist with years of experience in diabetes, metabolic and endocrine health. She completed training for her medical degree in India and did her fellowship training at the Penn State Milton S. Hershey Medical Center. Dr. Joshi has been instrumental in improving glucose control in the hospital and has published much data in the field. She is a two-time winner of Harrisburg Magazine's “Best Physician” award. Transcription:
Bill Klaproth: So what is osteoporosis? How do you know you have it? Can it be prevented in how about treatment? Well, let's find out what Dr. Renu Joshi, Vice President of chronic disease management, population health and division Chief of endocrinology at UPMC Pinnacle. This is Healthier You a podcast from UPMC Pinnacle I'm Bill Klaproth. Thank you so much for your time. Let's start here. What is osteoporosis?
Renu Joshi, MD: So osteoporosis has the name suggests, osteo means bones, but also this means holes. So you have holes in your bones. So the bones become weaker and the process happens because we are constantly laying new bones and losing the old bones.
So a time comes when you're not able to lay enough new bone, but you keep losing the old bone. And the difference between the two causes more holes. Which leads to osteoporosis. It's very different than osteoarthritis, which is the joint disease where you get pain in your joints. So these are two separate conditions.
Host: Okay. And when you have osteoporosis, that means your bones are more brittle and more prone to break. Is that right?
Dr.Joshi: Absolutely.
Bill Klaproth: So what is osteoporosis? How do you know you have it? Can it be prevented in how about treatment? Well, let's find out what Dr. Renu Joshi, Vice President of chronic disease management, population health and division Chief of endocrinology at UPMC Pinnacle. This is Healthier You a podcast from UPMC Pinnacle I'm Bill Klaproth. Thank you so much for your time. Let's start here. What is osteoporosis?
Renu Joshi, MD: So osteoporosis has the name suggests, osteo means bones, but also this means holes. So you have holes in your bones. So the bones become weaker and the process happens because we are constantly laying new bones and losing the old bones.
So a time comes when you're not able to lay enough new bone, but you keep losing the old bone. And the difference between the two causes more holes. Which leads to osteoporosis. It's very different than osteoarthritis, which is the joint disease where you get pain in your joints. So these are two separate conditions.
Host: Okay. And when you have osteoporosis, that means your bones are more brittle and more prone to break. Is that right?
Dr.Joshi: Absolutely.
Host: So that is dangerous then for people aging, if their bones become more brittle. Okay. So then how would someone know if this is affecting them?
Dr.Joshi: Yeah, so the reason it is very important to know is it's more of a condition for women. So if you're a woman, about 50 years of age, 50% of you will have either osteopenia or osteoporosis, which we'll discuss later. And if you are about 65 years of age, that number is close to 75 to 80%. So it's going to affect almost a significant number of female population. If you are a male above 70, you will also have the similar kind of risk for getting osteoporosis. And the biggest problem is that 50% of people who have osteoporosis will actually have a factor over lifetime. The same thing is true for men. 25% of men will have a factor in their lifetime.
Host: So how would someone know if they have this?
Dr.Joshi: Unfortunately, it's a silent disease. So you really don't know anything in the extreme or later stages, it will cause a fracture or a bony pain because of the factor. So the only way you find out that you have osteoporosis is by doing a test called as DEXA scans. So you can get a screening test done for Taxol, which can be done at any age. It's a free test done in any radiology department and it takes five minutes. And if the screening test is positive, then the insurance company will pay for a full DEXA scan. But the way you really find out is by the DEXA scan. So once you do a DEXA scan, there are guidelines which tells you by the T score. So in the DEXA scan, you look at a T score, which shows zero to minus one is normal bone density. It actually is measuring density of the bones. So zero to minus one is normal bone density, minus one to minus 2.5 is called osteopenia and below minus 2.5 T score is called osteoporosis. So if you look at your DEXA, scan yourself, you can find out and your doctors will actually tell you details about it.
Host: Do you recommend people over a certain age get this DEXA scan?
Dr.Joshi: Yeah, so it is actually approved by Medicare for anybody above age 65. But if you have a risk factors in person from 50 to 65 years of age, like an early menopause, if you have a height loss of one and a half inch, which means you have become shorter, if you had a fracture as an adult, which you didn't think it was due to trauma, or if you have conditions like you're on steroids, you take very little vitamin D you take no calcium. You have other conditions like overactive thyroid for a long time, then you have higher risk factors to develop osteoporosis and you can get the DEXA scan before. And if the first come towards, if the insurance company does not cover a DEXA scan, you can get a screening test first, which is free and then get an excess scan.
Host: So the next question is, is this preventable? Can you share any prevention tips with us?
Dr.Joshi: Yes. As I mentioned to you before, genetics play a big role. So if you're a Caucasian and you have a lower bone mass, like your BMI is less than 19, you have a very high risk for osteoporosis and you cannot prevent that at all because that's genes and that's your bodybuilder, but there are other factors which you actually can prevent.
And many of them are actually just your day to day routine, quit smoking, smoking is an independent risk factor for osteoporosis exercising, 20 to 30 minutes, five to seven days a week. I have caffeine or coffee, less than three cups a day because coffee again, after more than three cups of coffee is an independent risk factor for osteoporosis, especially if you do not take enough calcium with it.
Reducing alcohol and finally increasing calcium intake, which is the most important thing. So calcium requirements are very different, but for any adult, the requirement of calcium is 1000 milligram daily. After menopause, it is close to 1200. So somewhere between 800 to 1200 milligram daily is your calcium requirement.
So if you don't take that calcium, you're going to get osteoporosis and very simple fact about calcium. His daily products are your richest source. So one cup of milk or one and a half slice of cheese or one cup of yogurt gives you 300 milligrams of calcium, which is one third of your requirement. Good part is the skim milk has the same amount of calcium as regular milk.
So you can avoid the fat. But still get enough calcium broccoli, Chinese cabbage, canned fish seeds, nuts, very good sources of calcium. So if you can get your dietary calcium 1000 milligram, you do not need any supplements, but if your dietary intake is not enough, like you don't have all of these in your meals every day, then you have no choice, but to take calcium supplements to make up to the 1200 milligram daily.
The second equally important component, which you can do to prevent osteoporosis is vitamin D. So vitamin D not only makes the bone, but it also strengthens the bone. So lack of vitamin D will make your bones much weaker. So vitamin D normal levels from the, society of endocrinology should be more than 30.
Although some societies differ for this, but about 30 is an optimal level to prevent osteoporosis and we call it even better levels. If you're above 40. So if you have a level between 20 to 30, which is mildly deficient, if you have a level between 10 to 20, you have moderate deficiency. And if you have a level less than 10, you're severely deficient of vitamin D and a normal prevention requires somewhere between 800 to 1000 units of vitamin D daily.
800 is the ideal, but if you have deficiencies, you may need two thousand five thousand or 50,000 once a week to get that level. Above 30 to prevent osteopetrosis. I hope that answers your question.
Host: That answers my question wonderfully. In fact, I took notes. You can test me on my note taking ability. So some of the things we need to do quit smoking, make sure we exercise regularly. Watch our caffeine intake, reduce alcohol, increase calcium and good ways to do that is pay attention to milk, cheese and yogurt, and then broccoli, cabbage, or that you are sufficient in vitamin D as well. So kind of a quick summary then of what you said, is that correct Dr. Joshi?
Dr.Joshi: That's absolutely fine.
Host: So then if someone does get osteoporosis, how do you treat it?
Dr.Joshi: So, unfortunately, once you get osteoporosis, your calcium is vitamin D is just not going to cut it. You have to have certain other medications which will build your bones back up. So your risk of fracture decreases. And although depends a lot on how low the bone density. So somebody with a bone density of minus four, the score is a much higher risk for fracturing as opposed to somebody at minus 2.5. But nonetheless, there's a way about taking medications. The most common medicines we give is called bisphosphonates. And what they do is they decrease the bone loss, which is happening in your body. And there are many of them, and I can go into detail during this podcast, but like Actonel, the Fosamax. So there are many medications that are taken once a week, once a month. And once a year, by an IV injection, they really prevent osteoporosis. We also have some estrogen type compounds, the estrogen we don't use anymore, but there's some analogs of estrogen which can be used to prevent and treat osteoporosis. There's also medications which are bone building medicines. So these are injectable medications, which you inject every day in your body for one to two years. To build up new bones. These are all for tail. So again, I don't want to confuse people with the names because once you get osteoporosis, your biggest thing is you need to see a doctor. You need to see your primary care doctor. And if he wants to send you to a specialist who is an endocrinologist, they're specialist in treating osteoporosis, they will do the right approach for you and find the right medications for you, but it has to be treated.
Host: So then last question, Dr. Joshi for someone using these medicines. Is the hope to reverse osteoporosis? Can that happen or is this basically just to help someone manage osteoporosis over their lifetime?
Dr.Joshi: So, unfortunately it becomes a lifetime thing. There are some medications which can stay in your bones for more than three to five years. So after giving the Fosamax type of drug for seven years, we give a drug holiday, but we do follow every two to three years. And once we start to see the bone decline again, we may have to restart some of them or some of the newer medications. So one medicine I did not tell you before is Prolia, which is given every six months and it's a wonderful drug and has a safety data for up to 10 to 15 years. The other problem is that if you can't avoid the risk factors, so if somebody is taking prednisone or steroids for life because of kidney transplant, they will need to be on these medications for lifetime because they have a constant factor which is causing osteopetrosis all the time. So I think it really depends upon who the patients are. We try to give drug holidays, but can I say that once you treat for seven to 10 years, you can completely reverse it back to normal and nothing would happen. Unfortunately, not true.
Host: At least with the medication, people have the tools to manage this over the course of their life. Dr. Joshi, thank you so much for your time. This has really been informative.
Dr.Joshi: Thank you. Thank you for having me.
Host: That's Dr. Renu Joshi and for more information, please visit UPMC pinnacle.com/endo. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMCs Pinnacle. I'm Bill Klaproth, thanks for listening.
Dr.Joshi: Yeah, so the reason it is very important to know is it's more of a condition for women. So if you're a woman, about 50 years of age, 50% of you will have either osteopenia or osteoporosis, which we'll discuss later. And if you are about 65 years of age, that number is close to 75 to 80%. So it's going to affect almost a significant number of female population. If you are a male above 70, you will also have the similar kind of risk for getting osteoporosis. And the biggest problem is that 50% of people who have osteoporosis will actually have a factor over lifetime. The same thing is true for men. 25% of men will have a factor in their lifetime.
Host: So how would someone know if they have this?
Dr.Joshi: Unfortunately, it's a silent disease. So you really don't know anything in the extreme or later stages, it will cause a fracture or a bony pain because of the factor. So the only way you find out that you have osteoporosis is by doing a test called as DEXA scans. So you can get a screening test done for Taxol, which can be done at any age. It's a free test done in any radiology department and it takes five minutes. And if the screening test is positive, then the insurance company will pay for a full DEXA scan. But the way you really find out is by the DEXA scan. So once you do a DEXA scan, there are guidelines which tells you by the T score. So in the DEXA scan, you look at a T score, which shows zero to minus one is normal bone density. It actually is measuring density of the bones. So zero to minus one is normal bone density, minus one to minus 2.5 is called osteopenia and below minus 2.5 T score is called osteoporosis. So if you look at your DEXA, scan yourself, you can find out and your doctors will actually tell you details about it.
Host: Do you recommend people over a certain age get this DEXA scan?
Dr.Joshi: Yeah, so it is actually approved by Medicare for anybody above age 65. But if you have a risk factors in person from 50 to 65 years of age, like an early menopause, if you have a height loss of one and a half inch, which means you have become shorter, if you had a fracture as an adult, which you didn't think it was due to trauma, or if you have conditions like you're on steroids, you take very little vitamin D you take no calcium. You have other conditions like overactive thyroid for a long time, then you have higher risk factors to develop osteoporosis and you can get the DEXA scan before. And if the first come towards, if the insurance company does not cover a DEXA scan, you can get a screening test first, which is free and then get an excess scan.
Host: So the next question is, is this preventable? Can you share any prevention tips with us?
Dr.Joshi: Yes. As I mentioned to you before, genetics play a big role. So if you're a Caucasian and you have a lower bone mass, like your BMI is less than 19, you have a very high risk for osteoporosis and you cannot prevent that at all because that's genes and that's your bodybuilder, but there are other factors which you actually can prevent.
And many of them are actually just your day to day routine, quit smoking, smoking is an independent risk factor for osteoporosis exercising, 20 to 30 minutes, five to seven days a week. I have caffeine or coffee, less than three cups a day because coffee again, after more than three cups of coffee is an independent risk factor for osteoporosis, especially if you do not take enough calcium with it.
Reducing alcohol and finally increasing calcium intake, which is the most important thing. So calcium requirements are very different, but for any adult, the requirement of calcium is 1000 milligram daily. After menopause, it is close to 1200. So somewhere between 800 to 1200 milligram daily is your calcium requirement.
So if you don't take that calcium, you're going to get osteoporosis and very simple fact about calcium. His daily products are your richest source. So one cup of milk or one and a half slice of cheese or one cup of yogurt gives you 300 milligrams of calcium, which is one third of your requirement. Good part is the skim milk has the same amount of calcium as regular milk.
So you can avoid the fat. But still get enough calcium broccoli, Chinese cabbage, canned fish seeds, nuts, very good sources of calcium. So if you can get your dietary calcium 1000 milligram, you do not need any supplements, but if your dietary intake is not enough, like you don't have all of these in your meals every day, then you have no choice, but to take calcium supplements to make up to the 1200 milligram daily.
The second equally important component, which you can do to prevent osteoporosis is vitamin D. So vitamin D not only makes the bone, but it also strengthens the bone. So lack of vitamin D will make your bones much weaker. So vitamin D normal levels from the, society of endocrinology should be more than 30.
Although some societies differ for this, but about 30 is an optimal level to prevent osteoporosis and we call it even better levels. If you're above 40. So if you have a level between 20 to 30, which is mildly deficient, if you have a level between 10 to 20, you have moderate deficiency. And if you have a level less than 10, you're severely deficient of vitamin D and a normal prevention requires somewhere between 800 to 1000 units of vitamin D daily.
800 is the ideal, but if you have deficiencies, you may need two thousand five thousand or 50,000 once a week to get that level. Above 30 to prevent osteopetrosis. I hope that answers your question.
Host: That answers my question wonderfully. In fact, I took notes. You can test me on my note taking ability. So some of the things we need to do quit smoking, make sure we exercise regularly. Watch our caffeine intake, reduce alcohol, increase calcium and good ways to do that is pay attention to milk, cheese and yogurt, and then broccoli, cabbage, or that you are sufficient in vitamin D as well. So kind of a quick summary then of what you said, is that correct Dr. Joshi?
Dr.Joshi: That's absolutely fine.
Host: So then if someone does get osteoporosis, how do you treat it?
Dr.Joshi: So, unfortunately, once you get osteoporosis, your calcium is vitamin D is just not going to cut it. You have to have certain other medications which will build your bones back up. So your risk of fracture decreases. And although depends a lot on how low the bone density. So somebody with a bone density of minus four, the score is a much higher risk for fracturing as opposed to somebody at minus 2.5. But nonetheless, there's a way about taking medications. The most common medicines we give is called bisphosphonates. And what they do is they decrease the bone loss, which is happening in your body. And there are many of them, and I can go into detail during this podcast, but like Actonel, the Fosamax. So there are many medications that are taken once a week, once a month. And once a year, by an IV injection, they really prevent osteoporosis. We also have some estrogen type compounds, the estrogen we don't use anymore, but there's some analogs of estrogen which can be used to prevent and treat osteoporosis. There's also medications which are bone building medicines. So these are injectable medications, which you inject every day in your body for one to two years. To build up new bones. These are all for tail. So again, I don't want to confuse people with the names because once you get osteoporosis, your biggest thing is you need to see a doctor. You need to see your primary care doctor. And if he wants to send you to a specialist who is an endocrinologist, they're specialist in treating osteoporosis, they will do the right approach for you and find the right medications for you, but it has to be treated.
Host: So then last question, Dr. Joshi for someone using these medicines. Is the hope to reverse osteoporosis? Can that happen or is this basically just to help someone manage osteoporosis over their lifetime?
Dr.Joshi: So, unfortunately it becomes a lifetime thing. There are some medications which can stay in your bones for more than three to five years. So after giving the Fosamax type of drug for seven years, we give a drug holiday, but we do follow every two to three years. And once we start to see the bone decline again, we may have to restart some of them or some of the newer medications. So one medicine I did not tell you before is Prolia, which is given every six months and it's a wonderful drug and has a safety data for up to 10 to 15 years. The other problem is that if you can't avoid the risk factors, so if somebody is taking prednisone or steroids for life because of kidney transplant, they will need to be on these medications for lifetime because they have a constant factor which is causing osteopetrosis all the time. So I think it really depends upon who the patients are. We try to give drug holidays, but can I say that once you treat for seven to 10 years, you can completely reverse it back to normal and nothing would happen. Unfortunately, not true.
Host: At least with the medication, people have the tools to manage this over the course of their life. Dr. Joshi, thank you so much for your time. This has really been informative.
Dr.Joshi: Thank you. Thank you for having me.
Host: That's Dr. Renu Joshi and for more information, please visit UPMC pinnacle.com/endo. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMCs Pinnacle. I'm Bill Klaproth, thanks for listening.