Transcription:

Melanie Cole (Host): In the United States, low bone mass and brittle bone disease – otherwise known as osteoporosis are currently considered major public health threats. Worldwide, osteoporosis causes more than 8 million fractures annually. That’s one fracture every three seconds. My guest today is Sandy Hoogland. She’s a Family Medicine Certified Physician Assistant at Aspirus Health System. Welcome to the show, Sandy. First, let’s talk about osteoporosis and bone mineral density, and who is most at risk for this?

Sandy Hoogland (Guest): Postmenopausal females are probably the group that we think of as the most at risk, but things that also increase your risk are being a smoker -- actually being underweight or petite is also a risk factor. Those under 120 pounds are also at increased risk -- those that drink heavily, more than two drinks a day are at increased risk. Everyone should think about considering a bone density once they go through menopause. Now, not all insurance companies will cover that, but every woman at 65 should be screened with a bone density, and that is covered by Medicare. Men over the age of 70 should also be screened, and we don’t always think about men having osteoporosis. They’re not as high a risk, but definitely, it is an issue. I know personally, for myself, my parents – both my mother and my father – have osteoporosis, and my father has it to a greater degree than my mother.

Melanie: So, 65 years old is the age at which Medicare will pay for it, but is there a certain age that you think that people should get a baseline? In their 50s, or even possibly self-pay to get this and get your baseline?

Sandy: If you have those risk factors, I would say it’s worthwhile self-paying to get a baseline. If you eat a well-rounded diet, fairly high in calcium-rich foods, like your dairy products, deep green, leafy vegetables, taking a Vitamin D supplement would be good especially if you live in the northern climates, and if you’re active, then I would say it’s probably perfectly fine to wait until the age of 65. Unless you went through menopause early for some reason, or let’s say you had a hysterectomy with your ovaries out at an early age, then you definitely should be scanned at least by age 50, I would say.

Melanie: Tell us about the bone density scan or the DEXA scan. Where is the place that people should look to getting them -- because now you see them at some walk-in clinics, you see them at even health clubs – where do you think is the best place? And then tell us about the scan itself, what’s involved?

Sandy: People think there’s just one type of bone density. There’s a heal densitometry, and that’s what – it’s just a very rough screening tool. It doesn’t correlate real well with sometimes that bone density in your hip or in your low spine. Those bone density heel screenings, they’re offered at health fairs for free, and I’m assuming that’s what you would probably see in a health club, that type of thing. I don’t think any walk-in clinics would have a regular DEXA machine either because it is a large dedicated unit. Any larger health systems have them in-house. Sometimes in smaller clinics, it might be a mobile, traveling unit.

It’s basically like an X-ray table. You lay down on it. You don’t even have to get undressed for the exam unless you have metal snaps or something like that that would interfere. There’s just a little C-arm or an X-ray arm that goes over the hip and the low spine. It’s a very low-dose of radiation, no more than a dental X-ray, and it takes just a few moments. It’s a very simple test. It’s probably one of the simplest and fairly painless tests that you’ll ever have.

Melanie: Now, let’s talk about the results. Who interprets the results, and what do they mean for the patient?

Sandy: Okay, it is a certified radiologist that interprets them, and it will give you a T-Score, which is your comparison to young normals. When your T-Score falls down to negative 2.5, that’s the point of osteoporosis. Now, if it is less than normal, but is not to that negative 2.5, that’s called osteopenia, which is bone loss, which can be fairly normal. Anybody after the age of – after menopause starts to lose bone. Whether or not that’s a problem and will increase your fracture risk, that is determined by other factors. I know here, in our system – and I personally use the World Health Organization’s tool. It’s called the FRAX calculator. It figures in your age, your family history, your risk factors, and that all comes down into a recommendation whether or not you would benefit from medication to improve your bone density.

Everyone can take the steps of getting plenty of weight-bearing exercises, taking a Vitamin D supplement, at least 1000mg every day, and getting at least 1200mg of Calcium, either by diet or by a supplement. It’s preferable to get it by diet, but if, for some reason, you don’t like dairy products, or you are intolerant of them then you can get it by a supplement. Calcium Citrate is probably the best-absorbed form of calcium supplement.

Melanie: If somebody doesn’t have a great diet and you want them to supplement, there’s so many on the market. Do you like the chewables? Do you care if they’re a tab—? Is one just like the other?

Sandy: Well, it doesn’t matter so much if it’s a chewable or a tablet, but I would look for the form. Calcium Carbonate is probably the most common one that you’ll find. If you absorb things well, you’ll probably do fine with that. They come in chewable, and plenty of tablet forms too. Calcium Citrate is a little better absorbed. One name brand that is most common is called Citracal. Now, there’s also some chewable forms like Viactiv that – it tastes like a little Starburst almost. It’s a little chew. People actually look forward to taking those, so whatever way you can get it in. If you’re older or you have any absorption problems, then you should go with the Citracal.

Melanie: So if someone is told that they have osteopenia or full-blown osteoporosis, what do you tell them? What is the best advice for what they should do? Because there’s Boniva, and there's all these things on the market, and then they hear about leafy greens, and good diet, and exercise. Where do all of these things fit in together?

Sandy: They all work in combination. If you have been determined to be at a great enough risk that you would benefit from one of the prescription medications, that’s when we start talking about the medications like Fosamax, Boniva, and those type. That would be in addition to all of the other things that you’re doing as far as prevention because that’s where you depart from just prevention and adding on actual treatment. The treatment is in oral form like those medications that we just mentioned, but not everybody can take those. If you have heartburn, you are not a good candidate for those medications because it can irritate the esophagus. Then you would be a candidate for an IV injection that you would – IV infusion that you would use once a year would be the alternative to that.

Melanie: And then how long? Is this something that then you have to deal with the rest of your life?

Sandy: No, we do not recommend that. As a general rule, you would take it anywhere from two to five years, and then, generally, if your numbers are good you would take a drug holiday. There are some people that even recommend that after you’ve taken it for five years, you may not need to take it again in your lifetime, but that’s a little controversial at this point. It depends on what your numbers are. A lot of people will take it for a couple of years, get another repeat bone density. After two years have passed if things are looking great, they might want to consider taking a drug holiday once again, for, say a year or two and using it intermittently as well.

Melanie: Wrap it up for us, Sandy, because it’s really good information, and so important for people to hear about when to get these and the importance of keeping that good bone health. Wrap it up with your best advice for us.

Sandy: All right. Living a healthy lifestyle is by far the most important. If you’re a smoker, stop smoking. If you drink to excess, definitely cut that down. Ideally, that’s one drink or less a day for women, two drinks or less a day for men. Make sure that you get screened, and that would be everyone – all women at age 65, men at age 70, and anybody that is at increased risk talk to you doctor about your risk and whether you should be screened early.

Melanie: Thank you, so much Sandy, for being with us today. You’re listening to Aspirus Health Talk, and for more information, you can go to Aspirus.org, that’s Aspirus.org. This is Melanie Cole. Thanks, so much for listening.