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This article is a transcribed edited summary of a video Bob and Brad recorded in March
of 2021. For the original video go to https://www.youtube.com/watch?v=GlBJZfFl3YI&t=64s
Bob: Today we are going to talk about the signs you should have an osteoporosis screening. So, we're going to do this for both women and men, and for women, they are at a higher risk. So you're going to find out that we're a little more stringent on them.
Brad: And we'll explain it. There's a very, very good reason for it.
Bob: Alright, let's get started, Brad.
Brad: Let's find out about osteoporosis. So, osteoporosis it's about bone density?
Bob: Bone density, but also, I found out from Sarah Meeks, one of our experts, that the structure of the bone is just as important. So like the trabeculae and how they're put together, is almost more important than if your bone is soft, or not.
Brad: So, the trabeculae is that the outside of the bone?
Bob: No, the inside.
Brad: Oh!
Bob: It's like the engineering.
Brad: Oh, sure.
Bob: Does that make sense to you?
Brad: Yeah, the part of the bone that actually looks like a sponge, if you cut through it.
Bob: Right, right! Exactly. And if that's designed to be strong, you're less likely to break bones than if you have let's say, one that's designed weak, but you have strong bones. Does that make sense?
Brad: So, uh this is a genetic factor?
Bob: Yeah, I think so. I don't know there's much you can do for that. Maybe Wolff's law would work with that? That means the more stress you put on the bone, the more that it reacts to it.
Brad: Right, right, right. So your activity level.
Bob: Right, right. Alright well, we'll have another video that we're going to show you exercises to do. So number one, all women who are over 65, you should have a screening, just out right, do it.
Brad: Right.
Bob: If you're post-menopausal women 60 to 65 and you have one risk. So, if you're over 60, you're post-menopausal, plus you had a fracture after age 45, you've had a hip fracture in a parent because there is a genetic factor.
Brad: Oh yeah, the genetic component.
Bob: If you've abuse tobacco. You smoke.
Brad: Oh, so that's going to increase your risk?
Bob: Right.
Brad: Okay.
Bob: Always does. Unfortunately, tobacco's bad for everything. If your BMI, your body mass index…
Brad: So, if you're a little heavier?
Bob: No! If you're lighter.
Brad: Lighter?
Bob: Yeah. If you're less than 22 kilograms/
Brad: That's right, because your bones adapt to that weight so they're stronger in heavier people.
Bob: Can you do the calculation for me, Brad? It's less than 22 kilograms.
Brad: What? In pounds?
Bob: Yeah!
Brad: Yeah, I can do that. (scoffs) Where's my phone?
Bob: Yeah, yeah. Alright, if you've been using Prednisone for like three months... I had a patient, Brad. She was in her twenties, and she had really severe asthma and she had to be on Prednisone. We just take her for a walk, she'd break a bone. It was just, it was terrible. It actually ended up killing her.
Brad: Yeah, I had a patient similar, she was in her fifties and she was on Prednisone and it’s really hard on you. It's a long story, but yeah, you don't want to get on that for too long.
Bob: Well, she would die without it. You know, she couldn't breathe, so. Alright number three, if they found, if they found osteopenia when they did an x-ray on you, then you should have a screening for osteoporosis too, because that's the stage before osteoporosis.
Brad: So, the x-rays will show signs of a bone weakening.
Bob: Right. Thinness
Brad: Yeah, thinness.
Bob: Hypogonadism, that's a medical term that you'd know if you have it. Hyperparathyroidism, same thing. Here's the risk calculator, some other things that could be giving you trouble. For example, if you have heavy alcohol use, two or more drinks a day. If you're female. If you're white or Asian, you're at higher risk.
Brad: Oh, really?
Bob: Did you know that?
Brad: No, this is statistically shown.
Bob: Yes. If you're Black or Hispanic, you have lower risk.
Brad: Okay. They don't know why they just know the statistics reveals this?
Bob: Well, I think a lot of the Asians you see they are fine boned.
Brad: Sure.
Bob: Would you say that? Smaller as an overall rule of thumb. Okay, here we go, weight below 128 pounds.
Brad: Oh, so we have a number?
Bob: Yeah. We have a number. If you have kyphosis, if you're bent forward and your spine is rounded out.
Brad: And kyphosis is the mid-section of the back. Right between the shoulder blades, and that area is rounded. And you know, this is not uncommon with older people.
Bob: Yeah, if you're really sedentary, that's not good either. You want to be moving, and you just aren't doing any bone loading exercises.
Brad: Right.
Bob: You know where you're at least walking and trying to get some exercise. Number 8, you have a physical disability, you know, if you're in a wheelchair, you're not getting bone loading.
Brad: Right, it's again, an activity level with things that are putting weight through your bones.
Bob: Too much caffeine. If you're drinking more than 2.5 cups a day. Do you drink coffee; you don't do you?
Brad: Yeah, I do now! I just started in the last year or so, but yeah.
Bob: You're not drinking that much?
Brad: Well 3 or 4 cups. No, I'm just kidding. I just, I find that just in the morning, if I drink it after that, it doesn't taste good anymore, actually. So that's good. I'm glad I don't have to fight that off.
Bob: Low vitamin D, which we're in trouble for, because during the winter we just don't get much of that sun.
Brad: Yeah, yeah. You tried to the thing with that one guy that goes out and freezes himself.
Bob: Wim Hof.
Brad: Yeah, Wim Hof. But yeah, I'm not going to do that.
Bob: Okay, low calcium intake or absorption if you're not taking the calcium in very well. If you have diabetes, if you're diabetic, DM. Believe it or not, if you haven't had any children, you're at a higher risk.
Brad: Oh really?
Bob: They call it nulliparity. You're going to learn a new word. I think it's multiparity, if you have multiple children.
Brad: Oh, really?
Bob: This is kind a big indicator, if you lost over 1.5 inches of height. There's a reason for that. Since age 25, you should probably have that done. Sarah Meeks said, that the numbers are all over the place. And she said 1.5 wasn't necessarily true, but start thinking about it. That's for sure.
Brad: And if you don't know, Sarah Meeks is an expert that has spent great deal of her professional life dedicated to this topic.
Bob: And the last one if you do have what appears to be a spine deformity. You're rounded out. You may have already had a compression fracture.
Brad: Sure.
Bob: Sarah called it a silent fracture.
Brad: Oh, without symptoms?
Bob: She said very common. In fact, that was the most common fracture, actually is silent fractures.
Brad: Interesting.
Bob: Yeah, alright. So, men we have forgot about you either. So we'll talk about the men now. If you're over 70 for men you're supposed to have it done. Not 65 Like women.
Brad: Okay.
Bob: If you're over 50, and you've had any of the following, then you should have it a done. If you've had a non-traumatic fracture. So, it just fractured like a hip fracture or a vertebra, without a fall or obvious reason.
Brad: Just got a fracture.
Bob: Same thing, if they find osteopenia on an x-ray.
Brad: Evidence of bone, not decay, but thinning, yes.
Bob: Same thing about prednisone use. If you've taken more than five milligrams a day for three months, you're at higher risk.
Brad: Now, I don't know if we cleared this up with the women. Maybe there's some men wondering, well why do men in general have less chance? It's because of going through menopause.
Bob: I don't know what it all is, Brad. I think, men tend to have bigger builds maybe too, larger bones? I really don't know. I don't know the answer. We need Sarah Meeks on that one.
Brad: Yeah.
Bob: Same as women, hypogonadism, and hyperparathyroidism puts you at higher risk. And there's other risks that can you have. Again, if your parents had a history of a fracture. It’s interesting, isn't it?
Brad: So genetics.
Bob: Yep. If you've had the test in your femoral neck bone, a mineral density test, you know obviously you're a higher risk.
Brad: Yeah, we're talking about the hip there. That's where our common fractures are in older people.
Bob: Heavy alcohol use. Now for men, you can go up to four drinks a day.
Brad: That's probably because of generally they're larger, heavier and more muscle mass possibly.
Bob: BMI, or if they weigh less than 128 pounds. A slighter build. If they've had a prostate cancer, and they had an orchiectomy. Remember from anatomy what that was?
Brad: Orchiectomy? No, I do not.
Bob: Oh, well it's not something you want when you're a man. You're losing something vital, part of it anyway.
Brad: Say no more, Bob.
Bob: A loss of height also in men, 2.4 inches since age 25, is the one I read.
Brad: I've lost about an inch, so far.
Bob: I've lost about an inch I would say. And I had an inch to give.
Brad: Yeah, you know, proportionally, you're taller. So maybe you can go a little bit more than that. You're really good I figure.
Bob: Again, low calcium intake, low vitamin D intake. Again, we talked about that, the sun.
Brad: So, really those, if you're not in the sun, or just getting a good diet of leafy greens, and that kind of thing.
Bob: I do take a supplement, for vitamin D. Just during the winter.
Brad: Okay.
Bob: Again, if you're diabetic and again if you have high caffeine in takes. Greater than 2.5 cups. You know the thing is, it can be treated to some extent. You can't reverse it, but you can certainly stop it from getting worse.
Brad: Sure.
Bob: And, so it's better to know if you are osteoporotic, and they can put you on meds, or you can maybe become more active.
Brad: More active. Your diet. Get out in the sun. It really kind of boils down to a lot of the common things. As we get older, you have to clean up your act.
Bob: Yeah.
Brad: You know, treat yourself well.
Bob: And so finally though, let's remember Brad, we can fix just about anything.
Brad: Except for...
Bob: A broken heart.
Brad: Right, but by the time you're this age and you have a little more experience with it. Usually, they don't need as much help.
Bob: That's right.
Brad: I hope, I don't know, whatever
Bob: Take care.
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