How to Keep Your Bones Healthy for Life

Osteoporosis. Do you have it? Do you care about it? And can you prevent it? We'll do a little update. We've done some videos about this before, but stick around to learn the A to Z about osteoporosis. I'm Dr. Brad Wehning. Welcome to Talking with Docs. I'm Dr. Paul Zalza. And as you know, Talking with Docs, we love to talk with docs. So we have another specialist here on osteoporosis. Dr. Jay Minju, thanks for joining us this morning. Hey guys. So maybe, I know you have a clinic that helps manage people with osteoporosis. Yes. And you kind of work down the road from us. Yep. By the way, thanks for organizing those regional rounds. Oh yeah. Yeah, thanks for coming, Brad. Dr. Minju always coordinates, not quite monthly, every three or four months where a bunch of scientific articles are reviewed. People have dinner, maybe a glass of wine, chat about the research, their clinical practices, and share. But because I live further away, I don't attend very many of them. That's one way of saying it. One way of saying it, you can never attend any of them. Okay, that's it. It's on my list. It's on my list for next year. That's right. I'm coming to one. Okay. Can you sort of tell us a bit about your philosophy on osteoporosis? Yeah. So, you know, as your view is probably, you know, osteoporosis is this insidious disease where the bone gets weaker, fragile. You know, as orthopedic surgeons, we see the bone shifting from the consistency of like a firm oak to something similar to like chalk, or worst case, papier-mâché, right? And so you're at risk of fractures from relatively low energy trauma. Can I interrupt you? Yeah. In terms of osteoporosis, like I have a colleague who swears, says, no, osteoporosis is just a natural part of aging. Like, is it like a spectrum of bone loss, or is it just, no, everyone's going to get osteoporosis as you age? It's just aging, or osteoporosis is its own disease? How do you sort of put that in? My answer to your question is yes. Okay. Fair enough. So, osteoporosis, without any intervention, I think there is the body's natural tendency to lose bone mass, and some of that, especially in women, is hormone-mediated loss of the estrogen influence. But I don't think it's something that we should be like, we're going to become osteoporotic, right? Okay. I think that when you look at patients that have healthy, active lifestyles from like a younger age, well into their older ages, then you don't see that level of osteoporosis. And I don't see it, like you probably don't see it, like when you're in the OR, right? When you see these like muscular fit patients come in, like they've got bone that's hard, right? It's true. And I think that's the first take of that. It is not an inevitability. That's right. Obviously, there's a genetic component that we can't alter in us, like whatever genes you get, you get. Choose your parents. But yes, lifestyle has changed. We live longer than we used to, so that probably increases the amount of osteoporosis that we see. We live more sedentary lifestyles, which has contributed. We eat more poorly. We have more stress. We probably drink more alcohol. So, there are a lot of things that are contributing to this, but it is not inevitable. So, don't just throw up your hands and say, okay, I'm going to get osteoporosis. We're going to try to give you some strategies so that you can deal with it before it happens, and then if you have it, to try to deal with it after it happens. Okay. So, we've started an osteoporosis clinic in Burlington called Burlington Bone Health Clinic, and our goal is to treat osteoporosis ideally before it happens, right? Because it's easier, as we know, to prevent than it is to treat, right? The data shows that after your first osteoporotic fracture, there's a one in five chance that in the next two years, you're going to get another osteoporotic fracture. And so, in the past, we've been kind of focused on preventing that second fracture, but what I see, like in my practice, and I'm sure you guys see in your practice, is that after the first fracture, patients just generally don't go back to where they were. That's a new baseline. It's a new baseline. It's like that ball that bounces, and then it only bounces like three quarters, and then eventually, this doesn't bounce. Exactly, right? And so, there's this huge hit to patients' lifestyles, right? Which, you know, 30, 40 years ago, you know, if you were like 60, you weren't doing that much, so it wouldn't be a significant amount of difference, but now, at 60 years old, people are very vibrant. At 80 years old, people are very vibrant, and so, you know, I have patients that come in, they fracture their hip, they fracture their ankle, they're like, when can I go back to playing pickleball, you know? I'm like, well, were you able to play before? Classic. How's your neck game? Classic, classic. So, people have like higher expectations from their lifestyle, right? And these fractures, like they negatively impact that, so I think to stop the first fracture, I think is the best, you know, the best way to approach it. And I would say, when I'm going to the waiting room after fixing hip fracture, like the hardest part of the conversation is like, hey, surgery went fine, but I need you to know that this is a really serious kind of inflection point in your parents' or your loved one's life. It often has a really negative downturn, so if we can do anything to prevent it, and I think kids, like adult kids, see their parents, and they almost know that it's going to happen, and they feel like it's like a runaway train, like, my dad looks less mobile, he's more unsteady, he kind of had a little fall at home, but he didn't break anything. Like, the pattern is kind of predictable, and we need to kind of, I'm with you, we need to get in front of it and stop it before it happens. And it's a bigger deal than you think, it's not just a broken bone, like if you break your hip, it's not just a broken bone, because there is a mortality, a significant mortality associated, can you talk about, speak to that for a minute, just the mortality associated with a hip fracture, and the significance of that. Yeah, so, you know, like when we see patients in the emergency room, you know, we say to them, look, regardless of how sick you are, we need to fix this fracture. I'm with you. It's a trope, right, there's an internet trope, she has a fracture, we have to fix it, but there's a reason behind that trope, right, the risk of death after hip fracture within the first three months is 50 percent if you don't fix it, right, and we tell people that, but what we don't talk about is that even with fixation, even with healing, the risk of death within the first year is about 25 percent. And these people aren't dying in the operating room, they're not dying in the recovery room, they're dying once they're home. Right. And that's a stratified risk, right, certainly if you're 95 years old, the risk is higher than if you're 65 years old. It's a scary risk. Yeah, it is a significant risk of death, which is comparable, you mentioned previously, to like a myocardial infarction, like a heart attack. Yeah, right, the difference being is that after your first heart attack, 80 percent of people are put on adequate treatment. Sure, you get meds, you get a stent, you go to cardiac rehab, everyone's there, right? After your first hip fracture, only about 25 percent of people will get adequately treated. Like people are falling through the cracks. Yeah, you know, literally. Cracks in the bone. The sidewalk. Actually, what they showed like 10 years ago was that only 14 out of 20 patients are being adequately treated for osteoporosis. After a fracture, that goes up to 15, right? So I think it's... Sorry, 14 percent? So 14 out of 20 people. 14 out of 20, okay. I probably should have worked out what percentage that was. Okay, so 70. 70? Yeah. Sure, it sounds about right. And so I think it is a very undertreated, silent disease. Yeah. You know, like there's so many people walking around that have it, you don't even know it because it starts so slowly and it starts early, right? Even with women, like perimenopausal, like in their 50s, you know, just because like these stream levels are kind of coming down and so the osteoporosis is kind of slowly creeping in and that's actually like a great window to start. Okay. Before it starts treating. So what is your... So at the Burlington Bone Health Clinic, the BBHC. Yeah. You couldn't just be the Burlington Bone Clinic because that'd be the BBC. That's right. That'd be confusing. That'd be very confusing. The layers would be on you. Right? Yeah. So what's your philosophy? Like what can our viewers do so they don't have to come to your clinic and just watch this video? What can they do to mitigate these, the effects of the almost natural aging effect of osteoporosis? Yeah. Yeah. So what we do is we try to get patients to come in before they have the osteoporosis. Okay. We screen them. We get the blood work. We look at their past medical history, their family history. They get stratified based on all that information. We generate a FRAC score. The FRAC score determines what treatment you need. We have a video about it. We made the FRAC score. It's a fracking great score. It's a fracking score. That's fracking free to do really. But what we want to do is, and then, so treatment could be, you know, any number of medication, but ideally we want to start treatment before you need medication. Okay. And that would involve diet, exercise, lifestyle modifications. We actually have one of our staff will, after they meet with the specialist, we'll spend a chunk of time talking to them about what are the things you can do diet-wise, exercise-wise, lifestyle-wise. Lay it on us. I was going to say, so short answer for the diet we're talking about, whole foods, getting rid of the processed foods, adequate calcium, adequate protein. Yeah. Loading up on vitamin D. I think, and especially in North American societies, we're more than we would think hypovitaminic. Totally agree. So you might get it from fortified foods, but specifically supplementation. Supplementation. Yes. Okay. So you're going to be, if you're living in a place where you're not out there getting a ton of sunlight, you're taking vitamin D supplements. Yeah. And higher, I think it should be higher than we've been recommending, to be honest. Totally agree. We actually just had one of our ID docs talk about one of his top three ways to prevent infection. He takes 3000 a day. And I think more evidence shows it's probably in the two to 3000 international units. Actually, there are a couple of comments that are like, what? My thing says 75. You're talking about 3000. They're talking about micrograms versus IU. So I answered your comment. Now, you know, but yeah, probably in the two to 3000 I use, as opposed to the four to 800. Yeah. Not to be the party pooper though, but there has been some stuff in the news about vitamin D toxicity, because it is a fat soluble that gets stored. It's stored in your fat. So you can actually overdo it. But these are people that are usually taking 10 to 50,000 per week. Like these people are. Yeah. So you don't need to go that high. But I know typically to 2000, 3000. Have you guys been using it for patients that are like slow to heal fractures? Yeah. I do recommend it for patients, especially if someone says, well, what can I do to help? I'll say, well, there's some evidence to support taking vitamin D when you actually had a fracture. Yeah. Okay. So diet, something. Yeah. See what we did there. Right. I'm going to use the brain today. I have to operate later on. Just make sure that I get it. I'm just going to go home and lie down then. All right. And then, so exercise, what are we talking about with exercise? Am I like benching 300 to get the osteoporosis out of the system? So any, anything that loads the bone. So like you guys know about like Wolff's law, right? Yeah. Oh man. You're talking Paul's language now. Like how excited he is. That's fine. I'm it says that bone gets laid down, uh, as a result of the force going through it. Right. So the more of force going through the bone, the more of the body lays down calcified tissue, calcified bone, increases the strength of the bone. So you're talking, um, weight training for sure. Um, walking, running, anything that kind of loads that loads that bone, right. It's going to increase your skeletal mass. Um, and again with the diet protein. Yep. Yep. Okay. So literally the oldest use it or lose it kind of philosophy, right? That's why astronauts, we always say when they go in zero gravity environments, they lose so much bone stock. So avoid zero gravity environments. If you can, if you can't, no, that's hard. Cancel the space X trip. Don't sign up for the Mars trip. Okay. So diet, exercise, combination of weight bearing exercise and resistance training. Okay. What's number three. So say, so you're doing those two at the clinic, you're like, seems like you're still kind of sliding. Yeah. So, I mean, you can, you can start kind of looking at adjusting like hormonal issues. Okay. So specifically is perimenopausal or postmenopausal. Right. We're talking about hormone replacement therapy. I think you can actually change the name from HRT. Yeah. It escapes me right now, but leave a comment. There's, there's the new term for it, but yeah. So potentially replacing estrogen losses. Yeah. We didn't know that testosterone as well. Yeah. Less common, but still a very real issue directly impacts our bone density. And we know that we learned that unfortunately, because there have been decades of everyone being really afraid of estrogen supplements that it has a negative effect on our bones. Okay. I suspect the next one you mentioned, you're going to be walking through some landmines with our viewers when we start talking about other interventions you can do. Um, so, you know, the other thing would be medication. Okay. So now there's going to be a lot of viewers that are going to be like, ah, big pharma, this big part of that. Yeah. But I mean, we're not going to mention any specific, but just in general, there's basically two types. There's the answer sorts of, and then there's the anabolics, right? So the answer sorts of, um, decrease the bone, um, the breakdown of the bone that happens, right. And the anabolics actually build it up. Right. So, um, you know, there's been some, like some concerns that with the answer sort of, it decreases the bones, but it doesn't restore the modulus of elasticity. Okay. So the bones are, of course, these are thicker, but they're, they're stiffer. Right. So you can sometimes get like these, um, uh, a typical practice, right. It doesn't happen very often, but we do see it. Yeah. Right. Whereas we don't see that as much for the anabolics. And I think is what the average person may not understand, or maybe our viewers are pretty smart. So they probably do, but our bones are active and living, and they're constantly building up and taking away. And that's, we're trying to tip the scales back in your favor of growing more bone. And what you're saying is some of these medications are good at that, but it doesn't create normal bone per se. And there's an inherent irony in that anti-resorptive when you mentioned the atypical fracture, cause you're taking this to minimize fracture. One of the risks of taking this medication is causing a fracture. Yeah. So that's kind of, uh, you know, frustrating for some people. Um, and I know one of our colleagues in the czar is just probably freaking out right now. Cause we're talking to Dr. Zapf. Yeah. We're talking about medication for osteoporosis. Um, but yeah, so that's an option too. So of course we always start with lifestyle modifications. Those are the exercises, the diet, and then we get into a little bit of medicine, science-y stuff with the hormone management. And then we're like full fledged pharma. When you're talking about taking some medication to help mitigate, mitigate your risk of fracture. Yeah. And I, I think that it kind of depends on how high your risk is, right? Like if, if your risk is not that high and you just want to like keep things, um, keep things going, you want to decrease that risk. And I think the activity modification diet, those things are very valid to stop you getting to that point. But once you're at that point, I think the risk of fracture and the impact of the fracture is, I think it's worth doing at least considering the medication. And that's it. That's the spectrum of options you have available from least invasive to most invasive, like just about everything we do. You know, and I think the other critical thing is if you're young, work on your bone density when you're young, you know, that your muscle mass and your bone density all peak around 30. Thankfully, Paul and I are in our late twenties, so we're still on that. So Dr. Menji is a little bit older, so he's kind of on the side. So there were, you're peaking at three. Can we wrap this up? I have a dinner at four o'clock. That's right. Yeah. But, but do what you can. So eat well. Unfortunately with, um, certain diets for younger people, they have bad diets that don't adequately feed their bodies and exercise. Honestly, it is so critical. Get off your phone and do something. One thing that I, I wanted to say is that like when you hit like that 40 year old mark, right? Like you really need to switch from like the cardio stuff to just like almost focusing entirely on muscle. I would say if you had to pick, I would totally agree. Yeah. I think you can do both, but I'd totally, if you have two workouts a week, the, the X, the lifting weights is probably going to pay more dividend than, than three hours on the treadmill. The cardiologist will disagree. Yeah, sure. But Hey, no, I think, I think you should do both. You're right. You're right. You're right. But I, but I'd agree for your bones and for your muscles running is not going to do it for you. I would agree with that. 100%. All right. Here you have it folks. Osteoporosis little update, the philosophy we have here on a certain approach. Yeah. If you want to see Dr. Mangi, we'll put his coordinates in the description. Absolutely. And if you like this video, please like it, subscribe to our channel, share it with someone that you think could benefit and leave a comment on your experience with your bone density. And remember you are in charge of your own health. Thanks for joining us. Thanks for having me. We'll see you next time.