Your Checkup: Health Education Podcast
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Education Podcast
84: Osteoporosis Explained: How to Keep Your Bones Strong
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We break down osteopenia and osteoporosis with clear steps to protect independence: how bones weaken, how DEXA scoring works, and which daily habits reduce fracture risk. We share nutrition, exercise, lifestyle changes, and home safety that make a measurable difference.
• key stats on fracture risk in women and men over 50
• definitions of osteopenia and osteoporosis using T-scores
• hip, spine and wrist as common fracture sites
• why bone loss accelerates after menopause
• risk factors including family history, smoking and low weight
• DEXA scan basics and when to ask for screening
• calcium and vitamin D targets and food sources
• Mediterranean diet, protein and supportive micronutrients
• weight-bearing, resistance and balance training essentials
• Tai Chi and fall risk reduction
• home safety changes that prevent falls
• when medications like bisphosphonates or denosumab help
• practical questions to ask your clinician
References
1. Osteoporosis: Common Questions and Answers. Harris K, Zagar CA, Lawrence KV. American Family Physician. 2023;107(3):238-246.
2. Postmenopausal Osteoporosis. Walker MD, Shane E. The New England Journal of Medicine. 2023;389(21):1979-1991. doi:10.1056/NEJMcp2307353.
3. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Camacho PM, Petak SM, Binkley N, et al. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2020;26(Suppl 1):1-46. doi:10.4158/GL-2020-0524SUPPL.
4. Global, Regional Prevalence, and Risk Factors of Osteoporosis According to the World Health Organization Diagnostic Criteria: A Systematic Review and Meta-Analysis. Xiao PL, Cui AY, Hsu CJ, et al. Osteoporosis International : A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2022;33(10):2137-2153. doi:10.1007/s00198-022-06454-3.
5. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. Curry SJ, Krist AH, Owens DK, et al. JAMA. 2018;319(24):2521-2531. doi:10.1001/jama.2018.7498.
6. The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017. Tatangelo G, Watts J, Lim K, et al. Journal of Bone and Mineral Research : The Official Journal of the American Society for Bone and Mineral Research. 2019;34(4):616-625. doi:10.1002/jbmr.3640.
7. The Prevalence and Treatment Rate Trends of Osteoporosis in Postmenopausal Women. Zhang X, Wang Z, Zhang D, et al. PloS One. 2023;18(9):e0290289. doi:10.1371/journal.pone.0290289.
8. Osteopenia: A Key Target for Fracture Prevention. Reid IR, McClung MR. The Lancet. Diabetes & Endocrinology. 2024;12(11):856-864. doi:10.1016/S2213-8587(24)00225-0.
9. Effectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-Analysis for the American College of Physicians. Ayers C, Kansagara D, Lazur B, et al. Annals of Internal Medicine. 2023;176(2):182-195. doi:10.7326/M22-0684.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area.
SPEAKER_00:And I'm Nicole Rufo. I'm a nurse.
SPEAKER_02:And we are so excited you were happy. Wow. And we are so excited you were able to join us here again today. Um, you're being a really good sport about this and not holding you against your will at all. You kind of willingly sat down. I did. No, you don't forget it. I certainly won't. Um tell the good people what we are immediately coming off of that we can discuss in the banter section.
SPEAKER_00:Oh my God. Well, I think it was like a solid hour and a half of us in the bathroom trying to irrigate the wax out of your ears.
SPEAKER_02:I'm a waxy boy.
SPEAKER_00:You are a waxy. You're like a crazy old man who can't hear because his ears are clogged with wax.
SPEAKER_02:Yeah, you know, I can still hear, um, which is good. I I was concerned that you know, every time I try to do this, that it like gets gets clogged, but you really bought the right materials. This is not something anyone should try at home. You should only do this. We only do this.
SPEAKER_00:We probably shouldn't even be doing this at home. Probably not. I got um I bought one of those cameras. Did you really? With the thing at the end. It's coming tomorrow. It's coming tomorrow.
SPEAKER_02:Oh man. I mean, I'm excited. I I am curious to see what's going on in there. Um, ears are tough. Ears are tough for everyone. It's tough to describe what's going on in an ear. It's tough to see what's going on in an ear. Shout out to the ears, nose, and throat doctors. Um, what did you feel in this experience?
SPEAKER_00:Uh what did I feel? Well, I think a lot of it came out with the peroxide, like the clumps. So a little bit of it. Like I wanted it to be more satisfying. Like I wanted to scrape out a huge chunk of wax from your ear, but I think it got turned into bubbles and then went down the drain.
SPEAKER_02:Yeah. I think that's what happened too. Um, parts of it were uncomfortable, but you were so gracious. And we we did we were like teamwork makes the dream work with placing the syringe and then you give me the right thing. You were so nice. I mean, this is like, you know, it's not written in the vows, but it's part of your wifely duties.
SPEAKER_00:Wifely duties. Like the you need to do this like monthly.
SPEAKER_02:Yeah, well, I think at least I mean, so the left one's still a little weird. So I think we're gonna do Yeah, I was scraped.
SPEAKER_00:That was got a little angry. So tad bit bloody.
SPEAKER_02:So maybe we'll give it like a we'll give it like a day. Yeah, um, and then maybe we'll go back in there with the uh the peroxide again. Um, so that's most recently. Um, we went to Wegman's today. We went to grow grocery shopping. Um God, I love that brie.
SPEAKER_00:Triple cream brie. Oh my god, I forgot we got that.
unknown:Oh yes.
SPEAKER_02:Yeah, we might have to.
SPEAKER_00:That is the best. And I'm not even so much like a big brie person, just like Brie, plain. Not, I mean, when I make like a baked brie with like good stuff on it, then I like love it.
SPEAKER_02:Do you like brie?
SPEAKER_00:I hope Alex is listening. I hope he is. But like the triple the triple cream brie from Wegman specifically is so good. I love it.
SPEAKER_02:Yeah, Jillian didn't like it. We gave it to her and she was a little freaked out.
SPEAKER_00:Well, her palette isn't mature yet.
SPEAKER_02:Yeah, she's still working on that.
SPEAKER_00:I don't know that I liked Brie when I was her age. Good point. Maybe I did. I don't know.
SPEAKER_02:I don't think I knew what Brie was.
SPEAKER_00:Really?
SPEAKER_02:Yeah. I only knew people named Brie. Alex. I know.
SPEAKER_00:Alex, how's Brie?
SPEAKER_02:No, he's not. Yeah, we can keep his first name, his last name out of it to save his, to spare him. Um what happened this time?
SPEAKER_00:Alex, how's Gina?
SPEAKER_02:Oh, geez. Wow, that's fun. Well, um, what did I do? I went to, so I'm in a fantasy uh basketball league, dynasty basketball. It's like year-round activity. And there, I know one of the guys, well, two of the guys from college. One of them was my sweetmate, and then he like graduated, went to high school with a bunch of these guys, and they had an outing for his birthday, um, which was in August, um, to a 76ers game, and then went to my other friend Dan. Um, people who have listened to the podcast know about Dan, or if you see my inst my Instagram reels, you know that he was the one wearing ice during Halloween.
SPEAKER_00:Dan and his ice.
SPEAKER_02:Yeah. Um, Dan is also a physician, and we got to spend some time yesterday hanging out, celebrating his 30th birthday. The other guy's birthday was his name is Joe. He was 29th birthday. We were celebrating from back in August.
SPEAKER_00:Um, it's November. Wait, it wasn't his birthday this weekend?
SPEAKER_02:No, I did, I did bust in there, arms wide open, and I was like, Joe, happy birthday. And he's like, Thanks. And then he has a tattoo of his birthday on his arm. Also for Kobe.
SPEAKER_00:In case he forgets.
SPEAKER_02:And that's what I asked him, genuinely. I was like, Joe, do you do this because you like might forget? Or he's like, well, no, it's for the Mamba mentality because he like wants to wake up and be as motivated as Kobe was and like describe to people.
SPEAKER_00:Did Kobe have his birthday tattooed on him?
SPEAKER_02:No, but like Kobe's two numbers were eight and twenty-four when he was with the Lakers.
SPEAKER_00:Oh, and his birthday is August 24th. Correct. Wait.
SPEAKER_02:Kobe's birthday is August 23rd.
SPEAKER_00:When did you guys meet?
SPEAKER_02:Me and Joe Packer?
SPEAKER_00:No, for when did you guys all meet for the uh fantasy thing when you went uh what's it called? When you went to Top Golf. We was that around his birthday?
SPEAKER_02:Oh god. Um that was no, that was in June. I think that was in June or July. Yeah, that was a fun thing. We went to Top Golf, but we used their conference room and did nothing related to golf.
SPEAKER_00:I was so hoping that he was gonna organize this thing at a Sixers game. And then you guys were just in a conference room at what is it called now? It's not Will's Fargo anymore, right?
SPEAKER_02:It's called Xfinity Mobile Arena. That's dumb. I gotta say, they um the seats are different. No, it's still tight up there for a guy with wide shoulders like me, but it's um it's they're cushier. It's a little more comfortable sit. Oh, that's nice. Yeah, it was good. Um I like the artist formerly known as Wills Fargo Arena. I've been to Brooklyn. Um it's like two vertical the Brooklyn Stadium. I've been like once, I think.
SPEAKER_00:Who'd you go with? What's her name?
SPEAKER_02:I think I went with AJ and Frank.
unknown:Wow.
SPEAKER_02:Yeah.
SPEAKER_00:Figures. I know, right?
SPEAKER_02:Come after me. So we did that. Um, and then I'm gonna make Crab Cavitelli because we're coming up on well, when this episode comes out, it'll be like officially like a month that we've been married, but at the same time, like Friday was our four weeks, and we realized that this is like a weird thing.
SPEAKER_00:This is a weird thing. Like, I know like months have different days and like blah, blah, blah. But on Friday we were married for four weeks, which like four weeks is a month, but Friday was the seventh. How are there three days in between?
SPEAKER_02:I'm not sure.
SPEAKER_00:But then the 10th, we got married on October 10th, so tomorrow's November 10th. So then, like, that's also a month, right? But there's three days in between.
SPEAKER_02:It does feel like we're missing a feels like we're missing a day or three.
SPEAKER_00:Yeah.
SPEAKER_02:In there somewhere. I'm not entirely sure. But we're having crab cavatelli tonight, or Pollock Cavatelli. Um, classic dish on the show. We love Pollock. We love Pollock, we love uh Mr. Pollock, Dr. Pollock? Yeah, my pediatrician. Pediatrician, Dr. Pollock. Um, anything to do with Pollock. I asked Nikki today because like we were picking a tasty meal, and I was like, you know, normally like you make the excellent food. I like sub in every once in a while. And I was like, oh, it was like, are there any dishes that you want that you think will be extra tasty with our plans on Sunday night? And you're like, oh no, I want the I want the crab cavatelli.
SPEAKER_00:It's so good.
SPEAKER_02:But then I asked, I was like, do you want it with the crab this time to be like for it to be special?
SPEAKER_00:And you said No, I like it with the pollock.
unknown:Yeah.
SPEAKER_00:I've never had imitation crab unless it's in like a sushi roll, which I feel like then you can't like tell. You know, sometimes when you get like uh like spicy crab, and it's like that.
SPEAKER_02:It's not crab no. Whoa, whoa, whoa, whoa.
SPEAKER_00:Like the one we get from down the street?
SPEAKER_02:Yeah.
SPEAKER_00:No.
SPEAKER_02:Oh man. Whatever. I don't care. It's tasty.
SPEAKER_00:But it's tasty. What was I saying? Oh, yeah. I like never really had it in any other context until you started making this. And I'm so happy about it.
SPEAKER_02:I know, it's such a fun dish. Um, I hope I don't mess it up. Um, but I did one time and I like didn't make the roux right, and I was upset. But I found the right recipe.
SPEAKER_00:I'm proud of you for making a roux.
SPEAKER_02:Thank you. Oh, there was another dish I made that I was proud of that came out really good. Um, the coconut curry chicken.
SPEAKER_00:Oh, yeah, that was delicious.
SPEAKER_02:Yeah, gotta follow a recipe though, because I neglected to put sugar in there because I'm like, why would you put sugar in a savory dish? And then I sprinkled in the brown sugar at the end and discovered that it was so much better with me actually following the recipe.
SPEAKER_00:Using that biochem degree.
SPEAKER_02:Look, it's that's all it is. It's all it is. I'm happy about it. I have a biochem degree.
SPEAKER_00:It's so funny. You've been holding out on all of this good food, and it's really funny that in Karthik's speech about you at our wedding, he like a part of it was like talking about how we like make each other like better or whatever, and then it was all basically how your cooking has significantly improved since we've been together.
SPEAKER_02:I think it has. It has. I've also think I've become, yeah, no doubt about that. I um I get more creative in the kitchen and I take more, I'm more proactive. Look, like you do a lot. You take care of dinners like several days out of the week. If I can just pitch in a couple, I know who's gonna be listening to this right now, and they're gonna know who you are. They're gonna be getting an earful. And I'm like, I wish, I wish someone would step up and I wish someone would make me dinner. This person will remain nameless.
SPEAKER_00:You can come over and Eddie will make you dinner.
SPEAKER_02:So there's some of that. Um what else happened? I made. Oh, we went to the there's just a candlelight concert. You were I was pitching this as like a 65-minute date experience that I came up with that I needed you to, I guess when I take you out on a date.
SPEAKER_00:Yeah, he kept saying, He's like, We're like, I have a date plan for us Friday. Wouldn't tell me what it was. He's like, Oh, just like dress nice, like if we're going to dinner. So I'm like, all right, like are we going to dinner? He's like, no, like we we're just like gonna have dinner at home, but dress nice. But I'm like, dress nice how? Like, can I wear jeans to this theoretical dinner? Do I need to have like a cuter outfit? Are we going rock climbing? Like what?
SPEAKER_02:So this part irritated you.
SPEAKER_00:Uh well, I wouldn't say it irritated me. I just wanted to know what we were doing. And then you like, you know, and like you're like not supposed to like tell a toddler or something way ahead of time because they're gonna like get upset about it. You just like tell them, don't give them time to like perseverate on it or like cry or get upset. I feel like that's how I was because I thought about it for like a week and a half. I'm like, what could we be doing? And then I'm at work on Friday.
SPEAKER_02:I'm telling all your friends.
SPEAKER_00:I'm talking to my friend, like, what are you doing this weekend? I'm like, I don't know. Eddie has this 65-minute date experience plan. He's probably gonna make me go do something weird. But it wasn't, it was very nice. Yeah, so I should have trusted you more.
SPEAKER_02:I so I was served on Instagram this concert, and the idea behind this like candlelight concert is to make like, I don't know, like entertainment, like live entertainment from artists more accessible. So it was at the down near the waterfront, they had a museum and the concert hall. Um, I got my my buddy right here on my right hand, like I'm a villain and I'm petting. So cute. Um and yeah, it was this like these two or three violinists and a cellist, and they were all very well musically trained. They were excellent. And if you haven't, if you don't know me, I love Han Zimmer music and all the Christopher Nolan movies that go along with it. And I was like, oh, huh. They're doing Han Zimmer. So the date was like more for me than it was for you, but I figured it was something nice for us to do for 65 minutes on a Friday night.
SPEAKER_00:It was, it was nice. I liked it a lot. It was fun. I'm so so mad that we couldn't go see him when he was here.
SPEAKER_02:Oh, so what was the hang-up? He was in Tennessee. Oh, I had to work.
SPEAKER_00:Yeah, yeah, I had that. Once again, residency was ruining our life.
SPEAKER_02:Yes, and that was supposed to be in Tennessee, right?
SPEAKER_00:Yeah, he was gonna be in, so he was here. He was in New York for a little while, bopped around to another places at the or like other places in the country, stopped, added three more shows in like Brooklyn, Baltimore, and Nashville. Brooklyn and Baltimore were like during the week and like very expensive.
SPEAKER_01:Wow.
SPEAKER_00:So I'm like, all right, we can't make this work. And then the Nashville show was on a Sunday, and then you still had a day. Cause remember, I was like, can you use one of your like floating holidays on this Monday? I like found a flight, found the hotel we were gonna stay at. It was like right off Broadway, close to like Broadway, and I forgot what the venue was. And then I was gonna, because I think it was in February. So then I was going to either for Christmas or your birthday gift you a weekend in Nashville, which probably would have seemed random, but you would have gone along with it. And then we for sure we were gonna like go to dinner or something on Sunday, like our last night. And then I was gonna tell you we were gonna go see Han Zimmer. And I had this whole thing planned out. I would have pooped my pants, and I was so mad because they uh they do other, it's um like world of Han Zimmer. I think I think they're like in Philly too, but it's like not him, it's just like people playing his music. Like I want him on the piano playing the cornfield chase.
SPEAKER_02:Oh man, I and I got that. It was like so thoughtful of you. That's like you're almost gift-giving.
SPEAKER_00:I tried. So we're just gonna have to like go to London or Barcelona or like Switzerland or something to see him. That's where he is. Yeah, he's like in Europe bopping around.
SPEAKER_02:Oh, really?
SPEAKER_00:Yeah.
SPEAKER_02:Oh, I had no idea. Yeah, I guess artists like tour all the time. Like I was seeing Demi Lovato has a tour and she's gonna be at the extended mobile. Yeah, it's uh what's it called? It isn't that deep or it ain't that deep tour.
SPEAKER_00:Oh my god.
SPEAKER_02:Um, so yeah, she's on tour.
SPEAKER_00:Do you remember when it yeah, she sang at um this is so niche. She sang that song that was like something something, I think I'd have a heart attack. You know what that song is?
SPEAKER_02:Barney?
SPEAKER_00:No, it's a Demi Lovato song. And it's like, if I ever, how does that go? It's like here.
SPEAKER_02:It's not like I had the internet.
SPEAKER_00:If I ever did some, if I ever lost you, I think I'd have a heart attack or something, but she was singing it at like the American Heart Association thing with like all of these like heart attack survivors.
SPEAKER_02:Oh my god. I'd have a heart attack. Let's see.
SPEAKER_00:It might be called heart attack, but I also could be making that up.
SPEAKER_02:That sounds in poor taste. She does have a song named Heart Attack. Yeah. Yeah.
SPEAKER_00:It's that.
SPEAKER_02:And she sang that in front of people who survived heart attacks. Rock on. That's that's bold. Wow. No kidding. Demi Lovato. Yeah. So like she's touring a couple artists that I like, you know, I'm not cultured enough to know who they are. Cardi B's touring. I feel like these people just like pop up every like on Tuesdays and they're like, yep, here I am on Tuesday. And then you like meet that person on the street or at work who was like, Oh, yeah, I went to this concert on Tuesday. And I'm like, wow, so bold of you. I could not imagine us going outside on a school night to do an activity. I could barely imagine us going outside on a weekend to do an activity. It's exhausting.
SPEAKER_00:Honestly, it is.
SPEAKER_02:Wow. Okay.
SPEAKER_00:Well, we like to relax.
SPEAKER_02:We like we do like to relax. I also have a dinner to make.
SPEAKER_00:You do.
SPEAKER_02:And so wrap this up. Why don't we talk about bones? I know, wrap it up. We haven't even started yet. Um so we have our outline here. We are locked and loaded, ready to go. Our sources are in the show notes for anyone who is listening. Nikki, what are we talking about today?
SPEAKER_00:Today we're talking about osteoporosis.
SPEAKER_02:Yeah. Did you know that about half of women and maybe one in five men over the age of 50 will have a bone fracture in their lifetime? Wow. Did you know that?
SPEAKER_00:Uh, I feel like I did.
SPEAKER_02:Yeah, I had to triple check this because I was like, is that figure real? And the fracture can be something from as simple as a light fall or a bump. I was really disturbed. The the back of this episode is coming from a woman coming in to see me and she was like, Oh, hey, I got my DEXA scan and it says I have osteopenia. What do I do? And I was like, Oh, huh. What fodder for an episode of your checkup? The podcast where you try to bring health conversations from the doctor's office to your ears. Um let's keep let's keep moving and grooving. Um a lot of people don't realize how common it is. I, you know, in the doctor's office, we'd spend a lot of time talking about heart disease and a number one cause of death in the world. We talk about blood pressure, we talk about cholesterol, but I do tend to think that in certain spheres, bone health gets forgotten until something breaks.
SPEAKER_00:Anyway, so um, exactly like you said, um, people don't realize how important bone health is until you break something. So we're going to talk about how bones are getting weaker over time, what osteopenia and osteoporosis really mean, and what you can do to keep your bone strong with diet, exercise, and medication sometimes.
SPEAKER_02:We are going to describe what are osteopenia and osteoporosis. So definitions. Osteopenia means that your bones are weaker than normal, but not severely weak. That falls into a different definition of osteoporosis. And this is when the bones are fragile enough that even a small bump or a fall can cause a fracture.
SPEAKER_00:Where would you place um Heather Dubro?
SPEAKER_02:My God, I honestly think a strong gust of wind. She must. A strong gust of wind could probably unfortunately break that woman's hip. So these conditions are way more common than people think. Around one in five women and one in 20 men over the age of 50 have osteoporosis. But even more than that, and some estimates have that nearly half of women and men that are elderly have osteopenia. And the most surprising part is that most fractures happen in people who actually have osteopenia.
SPEAKER_00:The most common places that people are breaking bones are hips, which that's a bummer, spine, another bummer, and wrists, which feels more of an inconvenience than a bummer. Right. Um, hip fractures can be very serious. About one in five people need long-term care after a hip fracture, and the risk of dying within the year actually doubles after breaking your hip.
SPEAKER_02:Yeah, that's terrifying. That's why people are always so afraid of that when we talk about falls in LOL's little old ladies at home. So once someone has a fracture, their chance of having another goes way, way, way up. And especially in the first year after that initial break. So essentially what we're trying to get at here is that we're not, it's not just about names, it's not about definitions, it's not about like whether a bone breaks or not. This becomes way more about independence and long-term health and being able to do the things that you want to do. Like one's life and mobility completely changes if they have a fractured spine or a fracture in their hip. So getting a gauge of this and trying to prevent it is all the more valuable. And all of this costs a lot too. Um, osteoporosis-related fractures cost the U.S. around 57 billion every year. And if you didn't know, we have a lovely aging population, and that number is expected to jump to 95 billion by 2040, which is pretty much right around the corner. But, you know, money is fake. So, Nikki, let's jump into the second segment. Can you intro the second segment for us?
SPEAKER_00:All right, Eddie. Tell us why our bones weaken.
SPEAKER_02:So bones themselves are living tissue. They constantly, if you didn't know, they are they're not static. They are constantly being built up and broken down. And when we're young, the building outweighs the breaking down. But starting in our 30s, hooray for us, uh, that balance starts to tip the other way.
SPEAKER_00:I'm so confused.
SPEAKER_02:Oh, I got it here. And then for women, that loss of bone really speeds up after menopause. And that's when estrogen drops out of the picture. Something that we're going to be talking about in a few weeks. And that is one of the main reasons that osteoporosis and osteopenia is more common in women based on those figures that we described to you earlier. There are also other risk factors to keep in mind that make someone more prone to having osteoporosis. A family history of having osteoporosis matters. Low body weight matters. Smoking cigarettes matters. Heavy alcohol use matters. And certain long-term medications, like several long-term bouts of medicines like steroids, can increase risk of osteoporosis, though not like one bout of steroids. So that's something that is important to say out loud.
SPEAKER_00:And a big player is physical inactivity. So our bones respond to stress, um, like a fit the physical load of stress. So if you're not moving enough, if you're not exercising enough, your bones will get the message essentially that they don't need to stay strong. And I feel like that's kind of like the definition of if you don't use it, you lose it.
SPEAKER_02:Yeah. You know? Exactly that.
SPEAKER_00:Like your bones are gonna be like, I'm just being a loaf on the couch.
SPEAKER_02:I don't need to be strong.
SPEAKER_00:I don't need to be strong. I'm not going anywhere.
SPEAKER_02:Not going anywhere.
SPEAKER_00:I'm not doing anything. And then you stand up and you break your hip. Bang. Then you're in a nursing home.
SPEAKER_02:There that's it. Boom. Bang. Men aren't immune either. Their risk sharply rises after age 70. So also worthwhile to pay attention there.
SPEAKER_00:Um now that we know why our bones weaken, how would someone be diagnosed with either osteopenia or osteoporosis?
SPEAKER_02:Yep. So it's a special test. It's a special type of x-ray called a DEXA scan, D E X A. And it's a special type of x-ray that measures your bone density. And it gets into a little bit of statistics, um, which I will not bore you too much of, but it's based on a T-score, which takes like uh the average population of a person and it gives you a number to reflect like where you fall in that average population. So you get scores. And if your score is between like minus one and minus 2.4, it's more likely you have osteopenia and a score of minus 2.5 or lower is considered osteoporosis. There's also other calculators and risk scores that are incorporated into this, but that's more for your doctor to think about than for you to worry about. Even if your T score, as it were, isn't super low, having a fracture from a simple fall or something like that, something that wouldn't normally break a bone, can also mean that you have osteoporosis. So one of the scores or a fracture in a setting that you really don't think it would can be diagnostic of osteoporosis. And so thinking about this offers a great time to ask your doctor, when should I get screened? The average for women is starting at age 65. Um, and then the men guideline is a little wishy-washy. But you can ask, when should I get screened? Reasonable question to ask your clinician who's taking care of you. And what's my fracture risk compared to other people my age? And that's pretty much getting at the T-score. Nikki, I think this is a great one for you because that was a little uh boring statistical stuff, but that's kind of to pull back the curtain. Can you tell us little everyday habits that can help protect your bones?
SPEAKER_00:So there's actually a lot you can do to keep your bones strong no matter what your age is. Um, first starting with nutrition for strong bones. So calcium, which we all know is a big one. Um, I think milk for the longest time was marketed as like giving you strong bones. Um so adults over 50 need about 1,000 to 1200 milligrams of calcium a day, but most people will fall short. Um how well I don't know if you want to keep this in. How much calcium does like a person under 50 need?
SPEAKER_02:So the American Academy of Family Physicians recommends that people under the age of 50 years old consume about 1,000 milligrams of calcium daily.
SPEAKER_00:Okay. Uh for calcium, you can get calcium from a lot of our food. So dairy, obviously, is probably the biggest one. And then um, if you're not drinking dairy or eating dairy for some fortified plant milks, tofu has a lot of calcium, leafy greens, so like spinach, and then a weird one is canned salmon with the bones in. Um, apparently has a lot of calcium in there.
SPEAKER_02:Yeah. Apparently.
SPEAKER_00:But also keep in mind that calcium is very key, but if we're having too much of it, so more than about 1500 milligrams per day, it can um increase your risk of getting kidney stones.
SPEAKER_02:Yes, it can.
SPEAKER_00:Um, I've never had one of them, but they don't feel fun.
SPEAKER_02:I like had a run of people I was seeing like a week or two ago who just had like a kidney stone after kidney stone after kidney stone, and like a history of it or back pain and a history of kidney stone. I'm like, oh wow, we definitely have to think about this. So it's a real thing out there. Um, many people say it's like the most painful thing you can have.
SPEAKER_00:Yeah, that's what people say.
SPEAKER_02:I think some men like to pride themselves saying, like, some woman told me once that it's worse, like who had a child and they had a kidney stone, and they said that like the kidney stone was more painful.
SPEAKER_00:Yeah, I still work with the girl. She had an unmedicated birth. And whatever, then at whatever point had a kidney stone, and she said that she would have preferred the birth over the kidney stone.
SPEAKER_02:That's crazy. Um, so this next part I'll take. So then that comes in the conversation of vitamin D. Vitamin D is a vitamin, if you will, um, that can help the body absorb calcium. So there are different age brackets to this. Um, there's a New England Journal of Medicine invited review. And to break this down across the ages, so for infants under 12 months, for an example, we're talking like 400 international units. For people aged one to 70, I'll say that again, one to 70. It's 600 international units per day. And that can happen in your diet too. For those aged 70 and older, 71 and older, then the recommendation goes up to 800 international units. Which you'll probably notice that many, many, many people are vitamin D deficient, probably inviting a whole episode, but it is intimately related to osteoporosis and osteopenia because calcium goes through. Directly into bone, and if you can't absorb the calcium because you don't have the vitamin D to help with the whole process, like this is a whole medical school lecture and physiology lecture that many people probably got, but it's complicated. Nikki, can you tell us a little bit more about where you can get vitamin D from?
SPEAKER_00:Well, our favorite place to get it is from the sun. And then other diet um or diet food items would be again fortified milk. Eggs are high in vitamin D, and um fatty fish. But a lot of people still have low levels of vitamin D. And about half of um people diagnosed with osteoporosis, are deficient in vitamin D.
SPEAKER_02:Yeah, these are all very high numbers. They all happen to be very common in these populations of people. Other things you can think about are improving the amount of protein in your diet, magnesium, vitamin K, and vitamin C may also play a role in vitamin D absorption. A Mediterranean diet, literally probably the cure for everything, is that is rich in fruits and vegetables and olive oil, have also been shown to reduce fracture risk as we step away from vitamin D a little bit. So that's the Mediterranean diet helping to reduce fracture risk. Um, in that way, we are sort of thinking that you should have five servings of fruits and veggies. I told that to someone out loud the other day, and they were like, holy crap, that's a lot. And I was like, yes, um, very different than the American diet. And three servings of whole grains a day are all great things you can do for your bone health. So you were talking earlier about if you don't use it, you lose it. Um, what can we do in terms of meaningful timelines and meaningful activities for exercise that can help strengthen bones?
SPEAKER_00:So exercise is very important in keeping your bones strong. Um, so first doing, even if it's just like 30 minutes a day of any weight-bearing activity, so like walking, hiking, dancing will all help to keep your bones dense. And then also resistance training. So using weights, using resistance bands, doing body weight exercises, um, they can also help build bone density. And then um balance and flexibility also really matter, especially as you get older, which I know we've talked about before. Um, I forget what episode, but basically we were just talking about like getting older and like how your balance is important because if you have balance issues, then you are at a higher risk to fall.
SPEAKER_02:Um might have been episode 10 exercise.
SPEAKER_00:Oh, maybe, yeah.
SPEAKER_02:Which is crazy now, 70 episodes later.
SPEAKER_00:I know. Um, and since most hip fractures come from falls, preventing those is a big bone, big bone, big part of bone protection.
SPEAKER_02:You mean could you say a big bone us?
SPEAKER_00:Again, we are here to tell you that it is important to exercise daily, ideally. If you don't want to fall, your core strength should stay strong for as long as you can. If you want to be able to like go grocery shopping and carry your groceries inside when you're 80, you should be exercising when like now. Yeah, if you want to be able to wipe your own butt when you're 80 and have that mobility, you should be stretching, doing mobility stuff, exercising. Do all of that now so that you don't end up in a nursing home.
SPEAKER_02:Yeah.
SPEAKER_00:Someone else is gonna be wiping your butt. No one wants that. You know?
SPEAKER_02:Well said, Nikki.
SPEAKER_00:I know. I'm so eloquent.
SPEAKER_02:You are.
SPEAKER_00:You just gotta get straight to the point, you know?
SPEAKER_02:I know, yeah, I know. Um, what I wanted to say is that Tai Chi, one of my favorite podcasts that teaches me a lot, is um, they had an episode about falls recently, and they spoke with a physical therapist and really went in deep on Tai Chi, reducing the risk of falls. And so there is a really solid recommendation out there for folks of a certain age, probably greater than 65, or at increased risk of falls and the complications thereafter. That Tai Chi is like really, really beneficial.
SPEAKER_00:There's a whole group of people that do that in the park. Older adults.
SPEAKER_02:Yeah.
SPEAKER_00:Have you seen them?
SPEAKER_02:Uh which park?
SPEAKER_00:Washington Square.
SPEAKER_02:Uh no.
SPEAKER_00:Maybe and like in the morning, on like weekend mornings.
SPEAKER_02:Oh.
SPEAKER_00:Yeah.
SPEAKER_02:Yeah, that's so great. Is it oh yeah.
SPEAKER_00:Kind of in the middle where in the spot where the fountain is.
SPEAKER_02:Yes. Okay. No, it's beautiful and it's so helpful. Um, you know, you can keep your bones strong with all these things and exercise, but like this has been proven to reduce fall risk. Um, some figures by up to 30%. And, you know, something we mentioned earlier, we talked about risk factors. So there are certain lifestyle modifications you can make. So if someone slaps you with a diagnosis of osteoporosis or osteopenia and you're like, what the heck can I do? That's not a medicine, you can avoid smoking. Uh smoking increases the risk of osteoporosis. So it's a good excuse to contemplate cutting back. You can limit alcohol, probably to the degree of no more than two drinks per day. Um some would say, and I probably would say that like even drinking every day is probably too frequent. Um in Europe their recommendation is none, I think. Here in the United States, are for some reason we tolerate higher amounts and aiming for a healthy weight, which is something we talk ad nauseum about on this podcast. Um, but being underweight, rather, because that can increase the fall risk. So then something we won't spend a ton of time talking about, but just to highlight and say that this exists is when someone is really high risk for fractures and osteoporosis, that is when medicine might be able to help. And the most common medicines are called bisphosphonates. Um, you can take the time and read about them yourselves from reputable sources, but um, a common one is alendrinate. And what this does is slow down the bone breakdown. There are also medicines that go by different names, and like, you know, in this day and age, by the time you listen to this episode, new medicines come out every day, new information comes out every day. So we try to keep it as generalizable as possible. And then there's a medicine called denosomab, but that blocks bone resorption and then there's anabolic medications that help build new bone. There are big, three big types of medicines that may be offered you. Um but truly one size does not fit at all. So this is a conversation between you and the person taking care of you. As we're getting close to wrapping up, we'll have a conversation about other things to prevent falls and questions to ask your doctor. Um, Nikki, can you tell us a couple things in the home that make big differences when it comes to preventing falls?
SPEAKER_00:Yeah. So a big one is um like area rugs and removing those because like the like corner can flip up or you can just trip over it. Um, keeping hallways well lit, installing grab bars in bathrooms if someone would need it, and then wearing supportive shoes around your house.
SPEAKER_02:Excellent point. Doing these things can has been shown to also reduce the risk of falls by about 30%. And then questions that your doctor will not mind asking and might be able to help you with. Do I need a bone density test? What's my personal fracture risk? How can I get enough calcium and vitamin D? Should I start or continue medication? These are all great starting points, and they open the door to preventing problems before they start. So, for today's episode, the big takeaway: osteopenia and osteoporosis are common but preventable. Healthy bones start with what you eat, how you move, and the habits you keep every day. And the sooner that you start, the sooner you'll be able to keep working on these things. Strong bones aren't built overnight, they start going away at the age of 30. So if you're listening to this, time might be of the essence. But the habits that you start today can help keep you standing tall and independent and living your own lifestyle for decades to come. Thank you for coming back to another episode of Your Checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. Check out our website, you can find us on Instagram as well. You can send us an email, your checkuppod at gmail.com. But most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky.
SPEAKER_00:I'm Nicole Ruth.
SPEAKER_02:Thank you, and goodbye.
SPEAKER_00:Bye.
SPEAKER_02:This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.
