CredentialsPositions
Board Certifications
Education and Training
- Clinical Professor, Department of Medicine at NYU Grossman School of Medicine
- Director, Diabetes Clinical Research
Board Certifications
- American Board of Internal Medicine (Endocrinology, Diabetes & Metabolism), 2020
- American Board of Internal Medicine - Internal Medicine, 2019
Education and Training
- Fellowship, University of Washington School of Medicine, Endocrinology, Diabetes & Metabolism, 1998
- MD from Rajiv Gandhi University of Hea, 1984
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Katz's Corner hereon wr iHeartRadio. So glad you
(00:43):
could join us this morning of avery interesting show a topic that I think
is relevant to both men and women, and that is the thinning of bones
and things that you can do tokeep your bones healthy. And the topic
is on osteoporosis, a condition andthat is well traditionally been thought to be
more common in women as women getolder and maybe after menopause, but is
(01:07):
also very common in men and canrelate can cause lots of skeletal related issues
and fractures of the bone. SoI've asked doctor Ramachandra Nayak to come on
the show. Doctor Nayak is aclinical professor of medicine. He's the director
of the Diabetes Clinical Research at theHome and Division of Endochronology, Diabetes and
(01:30):
Metabolism in the Department of Medicine atthe NYU Grossman School of Medicine and NYU
Land Going Health. Doctor Nayak,Ramachandra, thank you so much for joining
us this morning. We really appreciateyou coming on the show and educating us
about this really important topic. Thankyou. Thank you, Doctor Katz,
thanks for having me here, somy pleasure. And maybe we can just
(01:53):
start out by just telling the audienceand educating us all about what actually isoporosis.
Sure, Osteoporosis is a skeletal disorder, and we classify in endochronology as
the most common metabolic bone disease.And this is a disease characterized by,
(02:13):
as you rightly say it, alow bone mass and what we also refer
to as a micro architecture disruption ofthe bone that leads to increased fragility of
the bones. All these eventually wouldlead to decrease in the bone strength,
and most importantly, it increases therisk of fracture. So basically that's what
(02:34):
at a high level we can defineosteoporosis as yeah, and I mean does
this happen you know? Is thishappening in everyone as we get older?
It is a common Yes, Agingis certainly a major factor that plays a
role in development of osteoporosis, andespelessly, as you rightly pointed out,
it's more common in women than men. And this is actually consider today as
(03:00):
a public health problem given the frequencyand the incidence of this disease that's increasing
not only the United States but globally. Just to give some numbers, twenty
percent of women over the age offifty and four percent of men over the
age of fifty develop osteoporosis. Andcurrently, if you look at the statistics
(03:22):
in the United States, ten millionAmericans are affected by osteoporosis, of which
eight million are women and two millionairemen. And so this actually underscores how
severe and significant the problem is.And osteoporotic fracture risk is exponentially increasing globally,
and it's very important to identify andtreat it appropriately. To reduce the
(03:46):
risk of fracture. Now, nowbeyond just the differences in gender, as
you pointed out, which is youknow, you said it's more common in
women and men. Are there anyother risk factor, let's say, any
other disorders that people can have,or diet or medication or anything like that
(04:06):
that come to your mind. Iknow you're an expert in this field,
so you'll be able to tell usthese things. Oh. No, it's
an important question because the difference inthe gender is primarily driven by how the
hormonal melieu or in ornament changes inwomen and men. And as all the
audience will know very well, womenattain menopause around the age of fifty years
(04:29):
and there is a sudden drop inthe estrogen levels, so that's kind of
a time point where the osteoporosis processactually sort of begins. And then over
the next ten to fifteen years,there is a progressive decline in the bone
density that happens in women. Butunlike that in men, there is no
single age at which that a stateronelevels drop, and there is no comparable
(04:55):
landmark like menopause in women as inmen. Although there are some people who
refer to Andrew, but it isa gradual decline, so this is a
major difference why the osteoporosis is morecommon in women. It happens somewhat sooner
than in men. But that beingsaid, there are a long list of
conditions which are very common to bothmen and women which put the patients or
(05:17):
people at risk of osteoporosis. Forexample, it's an age related disease.
Advancing eight is a major risk factor. Any history of previous fracture is a
predictor of future fractures osteoporotic. Somebodytaking glucocotchoid therapy or a long term anti
sezure medications for a prolonged duration,or history of parental history of fracture,
(05:41):
or an extremely low body weight,current cigarette smoking, excessive alcohol consumption,
some of the rhumatologic conditions such asrheumatoid or fritis, or someone developing a
low sex harmone like testosterone or estrogenprematurely or mall aps option syndrome, chronic
kidney disease, live disease, orwhat we call an inflammatory Bobel disease.
(06:03):
So these are some of the conditionsthat come to mind and E are more
equally important. There is a conditioncalled hyperparatharoidism where four tiny glands located in
the neck behind the paroid gland ifthey show overactivity or an overactivity of the
paroid line. All these are riskfactors which are pretty common to both men
and women. Yeah, you know, it's really amazing when you say all
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these things and how they can affectthe bone and just what goes on in
the body, the chemistry in thebody and the blood and how that affects
the cement the bone, and howyou really need to maintain certain and we'll
get into the certain minerals and vitaminsthat are so key in your body to
(06:46):
keep that bone structure, because youknow, we all see people that are
elderly and they get they get shorter, their bones are getting weaker, right,
and then they of course, asyou mentioned, fractures and things like
that. But it's extraordinary to methat all of these reactions, these chemical
reactions that are going on in thebody, these hormones and vitamins and everything
that you mentioned, and how theyreally can affect bone health. And it's
(07:11):
remarkable. Yeah, absolutely right.Yeah, And so you know, beyond
all of those things, are therethings in the diet that people should know
about that if they're at risk forAs you mentioned, all these risk factors
for it and age are being probablythe most common. Are there things in
the diet that people can take inthat maybe they can slow the process or
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prevent the process from happening. Yeah. Absolutely, Whether you are looking at
preventing osteoporosis in people over the ageof fifty years or you are looking at
treating osteoporosis for that matter, thefoundation stone is maintaining what we call adequate
calcium intake and also the vitamin Dsufficiency. And the guidelines are more clearly
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laid out for women in a postmenopausal setting because that's the more common population
where this disease is seen. Whatwe recommend people is that they should be
taking at least one to twelve hundredmilligram of calcium every day postmenopasal women,
whether it is for prevention of ostoporosisor even treatment of ostroporosis. And what
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is important to note here is thatwhen I say calcium intake of one thousand
milligram per day, it need notnecessarily be in the form of a supplement.
If someone is eating a lot ofmilk, cheese and dairy products and
calcium rich food. They may notneed a supplement at all. I mean
it's a good idea. At leastperiodically, one could look at what their
(08:41):
daily consumption of food is and howmuch of calcium they're actually getting and if
they fall short of that. Somebodyis vegan and because of their dietary preference,
they could add a calcium supplement.But unlike this, vitamin D has
to be taken as a supplement forpreventing an treating osteoporosis, and what is
recommended currently is about eight hundred toone thousand international units of vitamin D.
(09:07):
So if somebody has severe vitamin Ddeficiency then obviously they require a much higher
dose of vitamin D. But peoplewho are what we refer to as in
medicine as vitamin D sufficient, peoplewho have enough levels of vitamin D as
assessed by the blood test, thousandinternational units of vitamin D is what is
recommended. There are a lot ofother minerals and supplement but the data that
(09:30):
is no controlled clinical trial data tosupport that intake of any of these in
any combinations would prevent or used inthe treatment of osteoporosis. But the most
important thing I harp around is calciumand vitamin D sufficiency. So should you
be getting and I hear you,and I've recommended honestly more than that in
(09:50):
the vitamin D up to five thousandfor some people and have not seen any
side effects. And I found thatthat's the level. That's the amount that
you need to take in order toget that blood BOOD test up to the
normal range. In my own experience. The calcium sometimes, I mean,
do you recommend that people get acalcium blood test first before they start taking
(10:13):
calcium, just to see where they'reat? Or is everybody over fifty needed?
No, I'm bring this mostly forwomen after the age of fifty,
but not for men. If theyhave a normal bond held, they don't
have to take the supplements of calcium. Yeah, yeah, but these are
general nutritional guidelines as far as howmuch of calcium would is required in a
(10:33):
postmen aphisal women. And I agreeto your earlier point what you said was
whitemin D. We do routinely recommendhigher those than eight hundred two one thousand
international units vitamin D. I mean, this is what are the guidelines driven
cutoffs, but clinical practice is veryvariable. Every patient's requirement are different.
I mean, I fully agree thatthere are patients who take two thousand international
(10:56):
units and there are people who takeup to five thousand international units daily without
any adverse events. And the waythe vitamin D is stored in the body,
in the fat tissues, in liver, and how the vitamin D is
metabolized varies from person to person.For example, if somebody is extremely overweight
or obese, they may require amuch higher dose of vitamin D compared to
(11:18):
somebody who've seen So there are alot of inter and intra individual variability in
the way the vitamin D is handledby the body, and they also depends
on how much of sunlight exposure theyhave and stuff like that. So yeah,
good point. Varies from person toperson. As long as we are
not overdosing them, and as assessedby the blood levels of calcium, I
(11:39):
think we should be fine. Yeah, a good point, you know.
I also, you know, I'ma urologist, so I see I see
personally just men in my practice.But I have been impressed by the number
of men that are over fifty thathave declining levels of testosterone, and I
do think that there should be newguidelines for men as well as you know,
(12:01):
as you mentioned this testosterone, themale hormone, which is which is
necessary for bone growth. We seeunfortunately men with advanced prostate cancer that we
need to take out the testosterone bygiving them hormonal therapy which lowers the testosterone.
And certainly those men are at asignificant risk for bone fracture and osteoporosis.
(12:22):
And I think you're right they shouldbe on a calcium and vitamin D
daily and proper exercise and diet.We're going to get into all of that
as well. If someone obviously you'renot going to feel anything necessarily if you're
developing osteoporosis. So or do you? I mean, are there any signs
or warning signs that people should know. Is there a test that they can
(12:45):
go forward to check if they haveosteoporosis? Yeah, this is an interesting
point because osteoporosis, by all saidand done, is a painless disease.
Because many a time people get alot of musculo skeletal disorder, be it
osteopyritica or spinal stenosis or pondelolystesis,or they have got a lot of pine
and back issues. People have rheumatologicalconditions like chromatoid athritis and many a times
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and osteothretic changes in the joints.People tend to mix up that the joint
and bone related symptoms are all dueto osteoporosis because they also happen to get
a bone density scan they find thatthey have osteoporosis. They attribute all the
eggs and pain they are getting isdue to osteoporosis, But actually osteoporosis or
(13:30):
osteopinia, which is a foreigner orprecursor of osteoporosis, is a painless disease
unless the person gets a fracture.So that's an important point to differentiate.
If somebody is having significant pain associatedwith osteoporosis with respect to their muscular skeletal
system, I think it is likelyto be due to an underlying non osteoporotic
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disease rather than due to osteoporosis.And you brought up a very important point
with respect to man's health in termsof risk of osteoporosis in men due to
multiple secondary causes. Absolutely agree thatpeople receiving androgen deprivation for say, prostetic
cancer, people who develop hypogonadism whoare frailed, or people with paratheroid or
(14:16):
hypertheroid kind of disorders. All thesemust be screened for osteoporosis, whether it
is men or women, because theguidelines say all women should be screened after
the page of sixty five unless thereare risk factors. But men with any
of the risk factor we talked about, or somebody picks up a radiologic osteopenia,
some porosity of the bones on aroutine xay done for something else,
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or somebody had a low trauma fractures, or somebody has lost more than one
point five inches of their height,they all imply that they possibly have osteoporosis
and they should be screened and treatedno matter what their age is. Yeah,
but and they're not. I meanmost of the men are not screened.
You know, I don't know ifpeople don't have the high index of
(15:00):
of vision, then that we misseda lot of these patients. Actually,
Yeah, absolutely right. And youknow, you think about the cost of
healthcare if we're not screening and we'renot trying to prevent it, and you're
winding up with hip fractures or otherfractures in the body. It's certainly at
health cost and let alone the qualityof life. If you're just turning into
(15:22):
the morning. Here on Catsus Corner, we're talking with doctor Ramachandra Nayak,
who's Clinical Professor of Medicine and theDirector of Diabetes Clinical Research at the NYU
Grossman School of Medicine at the NYUland Gone Health. He did give me
his office number if you are interestedin making an appointment, either you or
a loved one, you can certainlysee him or his team. The number
(15:43):
is and I'll give it again atthe end of the show. It's two
one two four eight one one threefive zero. That number again is two
one two four eight one thirteen fiftyAnd so I guess. So the answer
to the question of what tests youshould get yet, it's not just a
normal X ray. You need abone density scan. Is that right?
(16:04):
Is that right? That? Yeah? Absolutely? Of cats I think the
bone density is kind of considered ahallmark of making a diagnosis of osteoporosis.
X rays to show osteoporosis, oneneeds to lose significant amount of bone mass
before one X rays can show.So the earlier way to pick up is
(16:25):
doing a bone density scan, andthis has been a pretty standardized test across
the world, and we screen certainspecific locations. The usual screening locations are
spine and hip and the left femur, and these are the bone density assessment
or standardized for these locations, andwe actopolate the information from these sites and
apply it to the general skeleton tomake a diagnosis of osteoporosis. I see,
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So when you get the test'll it'lltell you different regions of your body
that have askedeoporosis, but will alsogive you an overall general picture. Is
that right? Or yeah, that'strue. That's pretty much true. We
look, we take it. Justto elaborate little more technicalities here, osteoporosis
scores are given in numbers, absolutenumbers with no specific units, and they
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call it as a T score TSin tom T scores. What it exactly
means is how once bone density compareswith somebody who is a twenty five year
old person. So obviously, asage advances, we all lose our bones.
But how we compare our bones witha twenty five year old healthy young
femalees bombs and how far apart weare That determines the definition, and we
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have certain cutoff limits to call somebodyhas osteoporosis, and the scores just for
those who are interested is minus twopoint five and less in a negative direction
is osteoporosis. Minus one to minustwo point four is called osteopenia, which
is basically a precursor or a fourrunner of osteoporosis. If we don't intervean
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or monitor, it is likely toprogress to osteoporosis. And anything more than
minus one and between plus one tominus one is considered as a normal bond
density. Yeah. Now, soyou're comparing this to a normal twenty five
year old? Is that? Isthat? What? Yeah? Abrect maybe
say it should give you a scorebased upon what a normal, healthy fifty
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five year old would be. Now, I mean, yea, how can
we how can we possible? Ifyou're fifty five, how can you can
you have the bones of a twentyfive year old? You know? Okay?
I think these criterias are defined andalso by WHO and other bone associations
across the world. But we dohave a score, by the way,
to your point, comparing with ageand sex match control. That is called
(18:42):
the scores. The score is whenyou compare your bond density with age and
sex match controls, but they becomesthe problem of Z score is everybody's bond
density is so different and variable becausethe one what we major at the age
of twenty five is a reflection ofwhat we call is a peak bone mass,
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because from the time one enters intopuberty, whether it is a boy
or a girl, from the timeof pubertal maturation till the age of twenty
five, there isn't a pool ofbone strength and bone mass, which is
what they get around twenty to twentyfive is called a peak bone mass.
People who achieve a higher peak bonemass, they are at a lesser risk
of developing osteoporosis compared to a peoplewith a low peak bone mass. They
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are at a risk of osteoporosis inthe future life. So it's kind of
much easier landmark or a parameter tocompare compared to age and sex match because
there are a lot of variations ofbone density from ethnicities and rays, all
these tactic family a lot of thingscome into place. Okay, but we
do use these courses in certain scenariostoo, all right, So it's standardized.
(19:51):
You get the number you get thetest back and if it's low less
than what is it two point ohyou said negatively minus two point five or
low two point five minus two pointeight minus three in that direction. Let's
say it's in a bad direction andit's osteoporosis. And the arcto Coos says,
yes, you have asteoporosis. Andlet's say you've been on the vitamin
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D and the calcium. Now whatI mean, are there medications I mean
that you can take for this condition. Yes, absolutely, because many a
time people believe that they would treattheir osteoporosis just with exercise. I'm not
undermining the importance of exercise, beingphysically active, maintaining the seaweight and calcium
and vitamin D all those. Unfortunately, it is a metabolic disease. It's
(20:36):
it's a disease that is progressive overlifetime and we need specific agents because to
treat this osteoporosis. Because bone isa dynamic structure, there is a new
born formation all the time happening.An old bone is getting removed. That
is called a process of resorption.And this dynamic process gets impacted as the
age advances and the architecture of boneget deteriorated, so it is to be
(21:00):
treated with specific medications. And broadlyspeaking, there are two groups of medication.
Either we prevent the bone destruction thatis called as an anti resolptive agent,
or we stimulate the new bone formation, which is osteoanabolic agents. And
there are some medication which can actuallydo both the things. So, depending
on how severe the osteoporosis is,the choice of medication varies. There are
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pills that can be used, thereare injections that can be used, There
are intravenous in fusions that are given. The regiments and the dosing varies from
medicine to medicine, and the durationof treatment varies. But the bottom line
is medications are required if the osteoporosisis established diagnosis and if it is progressive.
Now the easiest would be a pill, I guess, but you said
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that the injection is that like anevery month or every day an injection or
how does that work? Well?It depends. Just to give a few
examples, the pill is the easiestone. Obviously, the treditional pill have
been foss max or landroinate that weuse seventy milligram once a week or ibatronate
or residronate. There are different pills. They are safe and they are generally
given for a duration. These areall fall into anti resorptive pills and they
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are generally given for a duration ofabout five years. And but the only
catch is all these osteoporotic pills havean adverse effect on the esophagus or the
foot pipe. They have a tendencyto cause an erosion or alteration in the
esophagus. We need to take certainprecautions like taking it on an empty stomach,
drinking of water, be in anupright posture so that you reduce the
(22:33):
exposure to the foot pipe. Butpeople with a lot of acid reflux,
people with hightus hernias, and peoplewith esophagial disease, they're not the candidates
for the pills. And the samedrugs can be given as an intravenous in
fusion, but that's once a year. That's called soldronic acid. There are
injections called probe which can be givenonce a year. Yeah, solidronic acid
or reclass infusion. It's the sameclass of medication as the pills called bisphosphonates.
(23:00):
They are given once a year intravenouslyfor three or five years duration and
then we revisit the treatment decisions periodicallyno matter what the treatment is, and
are there side effects with that withit once a year injection. No,
Actually, once you get an infusion, they may get a flu like illness
and acute phase reaction. But keepingone hydrated and also taking some over the
(23:22):
counter tylanol should help them overcome thisside effect. But majority of the people
tolerate it well, and with theprogressive infusion year two, year three,
the side effect is minimal. Butmost importantly, people get really frightened by
what they read in the media.And if you i mean also this is
an FDA black box warning of someof these drugs. When they google and
(23:45):
search for osteoporosis drugs, people getfrightened that, oh they are going to
develop some osteonecrosis of the jay thefemale. These two things stand out.
People get worried that the side effectsare significant. But what is to understand
is a risk benefit assessment. Imean, you need to look into what
is this risk in the versus what'sthe fracture risk reduction? Just to give
(24:10):
you an example again, I'm goingback to the beginning. How common the
osteoporocess is. And if you lookat the number of osteoporotic fracture across the
world is nine million, and inthe United States we get two million fractures
every year. It's a huge number. And at fifty years, the lifetime
risk of fracture is one in twowomen and one in five men. So
given the magnitude of fracture which isgoing to be huge, and the burden
(24:33):
that it's going to put not onlyfor quality of life but on the socioeconomic
burden, and if you can reduceand prevent it, the benefits are far
far higher and outweigh the risk ofthe complication that I just mentioned. And
just to put the things in perspective, these complications are seen one in ten
thousand people. It's extremely rare.And we identify who are the people at
(24:56):
risk of this complications and what putsthe people at risk of these complications and
taking precautions to avoid those scenarios,I think that should be the most appropriate
option. Actually, yeah, andthat information needs to get out. You're
absolutely right, And you know,I'm just thinking about, you know,
the people that are have severe ostereoprocessalmost like the people that have super high
(25:18):
cholesterol levels. I mean of let'ssay three hundred or three fifty. You
can you can try diet and exercise, it's not gonna work. It's not
gonna work. And you need totake these medications to stat And let's say
to prevent a heart attack, wellhere, you know, which is obviously
very common in the United States.Here, you need to take the medication
if you get the bone density scanand you're severely ASTERO product, because it's
(25:41):
gonna prevent the bone fracture and it'sgonna and that can obviously have a major
effect on your overall quality of life. So I think that's a really important
message and I really appreciate that,uh Dot Nayak. Unfortunately that's the end
of the show. We do needto end here, but I want to
think, thank you. You gaveus lots of information. We probably need
(26:02):
to have you on again. Hisnumber again with his team at NYU is
two one two for eight one onethree five zero two one two four eight
one one three five zero. Ifyou or your loved one needs an evaluation
for for osteoporosis. It sounds likewomen over the age of a postman appausal
and certainly, I think we needto make a stronger emphasis for our men
in this country because clearly fracture riskis very high. Thank you very much,
(26:30):
Yes, under Detective, I thinkabsolutely. Thank you again and it's
been a pleasure of being on theshow, and thanks for having me again.
Well it's my pleasure. Thank you. We haven't really had a show
like this and we'll certainly have youon again. That's the end of the
show. Everyone. I want tothank you all for tuning in here on
Kats's Corner. We'll be back nextweek with a great guest. Tune in
every Sunday. This is doctor AaronKatz. You've been listening to Katzer's Corner.
(26:53):
Come back every week to hear morestraight talk on a wide range of
men's health topics advice on how tolive your healthiest life. The proceeding was
a paid podcast. iHeartRadio's hosting ofthis podcast constitutes neither an endorsement of the
products offered or the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatz. Well, good morning everyone,
and welcome again to Katz's Corner hereon wr iHeartRadio. So glad you
(00:43):
could join us this morning of avery interesting show a topic that I think
is relevant to both men and women, and that is the thinning of bones
and things that you can do tokeep your bones healthy. And the topic
is on osteoporosis, a condition andthat is well traditionally been thought to be
more common in women as women getolder and maybe after menopause, but is
(01:07):
also very common in men and canrelate can cause lots of skeletal related issues
and fractures of the bone. SoI've asked doctor Ramachandra Nayak to come on
the show. Doctor Nayak is aclinical professor of medicine. He's the director
of the Diabetes Clinical Research at theHome and Division of Endochronology, Diabetes and
(01:30):
Metabolism in the Department of Medicine atthe NYU Grossman School of Medicine and NYU
Land Going Health. Doctor Nayak,Ramachandra, thank you so much for joining
us this morning. We really appreciateyou coming on the show and educating us
about this really important topic. Thankyou. Thank you, Doctor Katz,
thanks for having me here, somy pleasure. And maybe we can just
(01:53):
start out by just telling the audienceand educating us all about what actually isoporosis.
Sure, Osteoporosis is a skeletal disorder, and we classify in endochronology as
the most common metabolic bone disease.And this is a disease characterized by,
(02:13):
as you rightly say it, alow bone mass and what we also refer
to as a micro architecture disruption ofthe bone that leads to increased fragility of
the bones. All these eventually wouldlead to decrease in the bone strength,
and most importantly, it increases therisk of fracture. So basically that's what
(02:34):
at a high level we can defineosteoporosis as yeah, and I mean does
this happen you know? Is thishappening in everyone as we get older?
It is a common Yes, Agingis certainly a major factor that plays a
role in development of osteoporosis, andespelessly, as you rightly pointed out,
it's more common in women than men. And this is actually consider today as
(03:00):
a public health problem given the frequencyand the incidence of this disease that's increasing
not only the United States but globally. Just to give some numbers, twenty
percent of women over the age offifty and four percent of men over the
age of fifty develop osteoporosis. Andcurrently, if you look at the statistics
(03:22):
in the United States, ten millionAmericans are affected by osteoporosis, of which
eight million are women and two millionairemen. And so this actually underscores how
severe and significant the problem is.And osteoporotic fracture risk is exponentially increasing globally,
and it's very important to identify andtreat it appropriately. To reduce the
(03:46):
risk of fracture. Now, nowbeyond just the differences in gender, as
you pointed out, which is youknow, you said it's more common in
women and men. Are there anyother risk factor, let's say, any
other disorders that people can have,or diet or medication or anything like that
(04:06):
that come to your mind. Iknow you're an expert in this field,
so you'll be able to tell usthese things. Oh. No, it's
an important question because the difference inthe gender is primarily driven by how the
hormonal melieu or in ornament changes inwomen and men. And as all the
audience will know very well, womenattain menopause around the age of fifty years
(04:29):
and there is a sudden drop inthe estrogen levels, so that's kind of
a time point where the osteoporosis processactually sort of begins. And then over
the next ten to fifteen years,there is a progressive decline in the bone
density that happens in women. Butunlike that in men, there is no
single age at which that a stateronelevels drop, and there is no comparable
(04:55):
landmark like menopause in women as inmen. Although there are some people who
refer to Andrew, but it isa gradual decline, so this is a
major difference why the osteoporosis is morecommon in women. It happens somewhat sooner
than in men. But that beingsaid, there are a long list of
conditions which are very common to bothmen and women which put the patients or
(05:17):
people at risk of osteoporosis. Forexample, it's an age related disease.
Advancing eight is a major risk factor. Any history of previous fracture is a
predictor of future fractures osteoporotic. Somebodytaking glucocotchoid therapy or a long term anti
sezure medications for a prolonged duration,or history of parental history of fracture,
(05:41):
or an extremely low body weight,current cigarette smoking, excessive alcohol consumption,
some of the rhumatologic conditions such asrheumatoid or fritis, or someone developing a
low sex harmone like testosterone or estrogenprematurely or mall aps option syndrome, chronic
kidney disease, live disease, orwhat we call an inflammatory Bobel disease.
(06:03):
So these are some of the conditionsthat come to mind and E are more
equally important. There is a conditioncalled hyperparatharoidism where four tiny glands located in
the neck behind the paroid gland ifthey show overactivity or an overactivity of the
paroid line. All these are riskfactors which are pretty common to both men
and women. Yeah, you know, it's really amazing when you say all
(06:25):
these things and how they can affectthe bone and just what goes on in
the body, the chemistry in thebody and the blood and how that affects
the cement the bone, and howyou really need to maintain certain and we'll
get into the certain minerals and vitaminsthat are so key in your body to
(06:46):
keep that bone structure, because youknow, we all see people that are
elderly and they get they get shorter, their bones are getting weaker, right,
and then they of course, asyou mentioned, fractures and things like
that. But it's extraordinary to methat all of these reactions, these chemical
reactions that are going on in thebody, these hormones and vitamins and everything
that you mentioned, and how theyreally can affect bone health. And it's
(07:11):
remarkable. Yeah, absolutely right.Yeah, And so you know, beyond
all of those things, are therethings in the diet that people should know
about that if they're at risk forAs you mentioned, all these risk factors
for it and age are being probablythe most common. Are there things in
the diet that people can take inthat maybe they can slow the process or
(07:34):
prevent the process from happening. Yeah. Absolutely, Whether you are looking at
preventing osteoporosis in people over the ageof fifty years or you are looking at
treating osteoporosis for that matter, thefoundation stone is maintaining what we call adequate
calcium intake and also the vitamin Dsufficiency. And the guidelines are more clearly
(07:57):
laid out for women in a postmenopausal setting because that's the more common population
where this disease is seen. Whatwe recommend people is that they should be
taking at least one to twelve hundredmilligram of calcium every day postmenopasal women,
whether it is for prevention of ostoporosisor even treatment of ostroporosis. And what
(08:18):
is important to note here is thatwhen I say calcium intake of one thousand
milligram per day, it need notnecessarily be in the form of a supplement.
If someone is eating a lot ofmilk, cheese and dairy products and
calcium rich food. They may notneed a supplement at all. I mean
it's a good idea. At leastperiodically, one could look at what their
(08:41):
daily consumption of food is and howmuch of calcium they're actually getting and if
they fall short of that. Somebodyis vegan and because of their dietary preference,
they could add a calcium supplement.But unlike this, vitamin D has
to be taken as a supplement forpreventing an treating osteoporosis, and what is
recommended currently is about eight hundred toone thousand international units of vitamin D.
(09:07):
So if somebody has severe vitamin Ddeficiency then obviously they require a much higher
dose of vitamin D. But peoplewho are what we refer to as in
medicine as vitamin D sufficient, peoplewho have enough levels of vitamin D as
assessed by the blood test, thousandinternational units of vitamin D is what is
recommended. There are a lot ofother minerals and supplement but the data that
(09:30):
is no controlled clinical trial data tosupport that intake of any of these in
any combinations would prevent or used inthe treatment of osteoporosis. But the most
important thing I harp around is calciumand vitamin D sufficiency. So should you
be getting and I hear you,and I've recommended honestly more than that in
(09:50):
the vitamin D up to five thousandfor some people and have not seen any
side effects. And I found thatthat's the level. That's the amount that
you need to take in order toget that blood BOOD test up to the
normal range. In my own experience. The calcium sometimes, I mean,
do you recommend that people get acalcium blood test first before they start taking
(10:13):
calcium, just to see where they'reat? Or is everybody over fifty needed?
No, I'm bring this mostly forwomen after the age of fifty,
but not for men. If theyhave a normal bond held, they don't
have to take the supplements of calcium. Yeah, yeah, but these are
general nutritional guidelines as far as howmuch of calcium would is required in a
(10:33):
postmen aphisal women. And I agreeto your earlier point what you said was
whitemin D. We do routinely recommendhigher those than eight hundred two one thousand
international units vitamin D. I mean, this is what are the guidelines driven
cutoffs, but clinical practice is veryvariable. Every patient's requirement are different.
I mean, I fully agree thatthere are patients who take two thousand international
(10:56):
units and there are people who takeup to five thousand international units daily without
any adverse events. And the waythe vitamin D is stored in the body,
in the fat tissues, in liver, and how the vitamin D is
metabolized varies from person to person.For example, if somebody is extremely overweight
or obese, they may require amuch higher dose of vitamin D compared to
(11:18):
somebody who've seen So there are alot of inter and intra individual variability in
the way the vitamin D is handledby the body, and they also depends
on how much of sunlight exposure theyhave and stuff like that. So yeah,
good point. Varies from person toperson. As long as we are
not overdosing them, and as assessedby the blood levels of calcium, I
(11:39):
think we should be fine. Yeah, a good point, you know.
I also, you know, I'ma urologist, so I see I see
personally just men in my practice.But I have been impressed by the number
of men that are over fifty thathave declining levels of testosterone, and I
do think that there should be newguidelines for men as well as you know,
(12:01):
as you mentioned this testosterone, themale hormone, which is which is
necessary for bone growth. We seeunfortunately men with advanced prostate cancer that we
need to take out the testosterone bygiving them hormonal therapy which lowers the testosterone.
And certainly those men are at asignificant risk for bone fracture and osteoporosis.
(12:22):
And I think you're right they shouldbe on a calcium and vitamin D
daily and proper exercise and diet.We're going to get into all of that
as well. If someone obviously you'renot going to feel anything necessarily if you're
developing osteoporosis. So or do you? I mean, are there any signs
or warning signs that people should know. Is there a test that they can
(12:45):
go forward to check if they haveosteoporosis? Yeah, this is an interesting
point because osteoporosis, by all saidand done, is a painless disease.
Because many a time people get alot of musculo skeletal disorder, be it
osteopyritica or spinal stenosis or pondelolystesis,or they have got a lot of pine
and back issues. People have rheumatologicalconditions like chromatoid athritis and many a times
(13:09):
and osteothretic changes in the joints.People tend to mix up that the joint
and bone related symptoms are all dueto osteoporosis because they also happen to get
a bone density scan they find thatthey have osteoporosis. They attribute all the
eggs and pain they are getting isdue to osteoporosis, But actually osteoporosis or
(13:30):
osteopinia, which is a foreigner orprecursor of osteoporosis, is a painless disease
unless the person gets a fracture.So that's an important point to differentiate.
If somebody is having significant pain associatedwith osteoporosis with respect to their muscular skeletal
system, I think it is likelyto be due to an underlying non osteoporotic
(13:52):
disease rather than due to osteoporosis.And you brought up a very important point
with respect to man's health in termsof risk of osteoporosis in men due to
multiple secondary causes. Absolutely agree thatpeople receiving androgen deprivation for say, prostetic
cancer, people who develop hypogonadism whoare frailed, or people with paratheroid or
(14:16):
hypertheroid kind of disorders. All thesemust be screened for osteoporosis, whether it
is men or women, because theguidelines say all women should be screened after
the page of sixty five unless thereare risk factors. But men with any
of the risk factor we talked about, or somebody picks up a radiologic osteopenia,
some porosity of the bones on aroutine xay done for something else,
(14:39):
or somebody had a low trauma fractures, or somebody has lost more than one
point five inches of their height,they all imply that they possibly have osteoporosis
and they should be screened and treatedno matter what their age is. Yeah,
but and they're not. I meanmost of the men are not screened.
You know, I don't know ifpeople don't have the high index of
(15:00):
of vision, then that we misseda lot of these patients. Actually,
Yeah, absolutely right. And youknow, you think about the cost of
healthcare if we're not screening and we'renot trying to prevent it, and you're
winding up with hip fractures or otherfractures in the body. It's certainly at
health cost and let alone the qualityof life. If you're just turning into
(15:22):
the morning. Here on Catsus Corner, we're talking with doctor Ramachandra Nayak,
who's Clinical Professor of Medicine and theDirector of Diabetes Clinical Research at the NYU
Grossman School of Medicine at the NYUland Gone Health. He did give me
his office number if you are interestedin making an appointment, either you or
a loved one, you can certainlysee him or his team. The number
(15:43):
is and I'll give it again atthe end of the show. It's two
one two four eight one one threefive zero. That number again is two
one two four eight one thirteen fiftyAnd so I guess. So the answer
to the question of what tests youshould get yet, it's not just a
normal X ray. You need abone density scan. Is that right?
(16:04):
Is that right? That? Yeah? Absolutely? Of cats I think the
bone density is kind of considered ahallmark of making a diagnosis of osteoporosis.
X rays to show osteoporosis, oneneeds to lose significant amount of bone mass
before one X rays can show.So the earlier way to pick up is
(16:25):
doing a bone density scan, andthis has been a pretty standardized test across
the world, and we screen certainspecific locations. The usual screening locations are
spine and hip and the left femur, and these are the bone density assessment
or standardized for these locations, andwe actopolate the information from these sites and
apply it to the general skeleton tomake a diagnosis of osteoporosis. I see,
(16:49):
So when you get the test'll it'lltell you different regions of your body
that have askedeoporosis, but will alsogive you an overall general picture. Is
that right? Or yeah, that'strue. That's pretty much true. We
look, we take it. Justto elaborate little more technicalities here, osteoporosis
scores are given in numbers, absolutenumbers with no specific units, and they
(17:14):
call it as a T score TSin tom T scores. What it exactly
means is how once bone density compareswith somebody who is a twenty five year
old person. So obviously, asage advances, we all lose our bones.
But how we compare our bones witha twenty five year old healthy young
femalees bombs and how far apart weare That determines the definition, and we
(17:38):
have certain cutoff limits to call somebodyhas osteoporosis, and the scores just for
those who are interested is minus twopoint five and less in a negative direction
is osteoporosis. Minus one to minustwo point four is called osteopenia, which
is basically a precursor or a fourrunner of osteoporosis. If we don't intervean
(18:00):
or monitor, it is likely toprogress to osteoporosis. And anything more than
minus one and between plus one tominus one is considered as a normal bond
density. Yeah. Now, soyou're comparing this to a normal twenty five
year old? Is that? Isthat? What? Yeah? Abrect maybe
say it should give you a scorebased upon what a normal, healthy fifty
(18:21):
five year old would be. Now, I mean, yea, how can
we how can we possible? Ifyou're fifty five, how can you can
you have the bones of a twentyfive year old? You know? Okay?
I think these criterias are defined andalso by WHO and other bone associations
across the world. But we dohave a score, by the way,
to your point, comparing with ageand sex match control. That is called
(18:42):
the scores. The score is whenyou compare your bond density with age and
sex match controls, but they becomesthe problem of Z score is everybody's bond
density is so different and variable becausethe one what we major at the age
of twenty five is a reflection ofwhat we call is a peak bone mass,
(19:03):
because from the time one enters intopuberty, whether it is a boy
or a girl, from the timeof pubertal maturation till the age of twenty
five, there isn't a pool ofbone strength and bone mass, which is
what they get around twenty to twentyfive is called a peak bone mass.
People who achieve a higher peak bonemass, they are at a lesser risk
of developing osteoporosis compared to a peoplewith a low peak bone mass. They
(19:27):
are at a risk of osteoporosis inthe future life. So it's kind of
much easier landmark or a parameter tocompare compared to age and sex match because
there are a lot of variations ofbone density from ethnicities and rays, all
these tactic family a lot of thingscome into place. Okay, but we
do use these courses in certain scenariostoo, all right, So it's standardized.
(19:51):
You get the number you get thetest back and if it's low less
than what is it two point ohyou said negatively minus two point five or
low two point five minus two pointeight minus three in that direction. Let's
say it's in a bad direction andit's osteoporosis. And the arcto Coos says,
yes, you have asteoporosis. Andlet's say you've been on the vitamin
(20:11):
D and the calcium. Now whatI mean, are there medications I mean
that you can take for this condition. Yes, absolutely, because many a
time people believe that they would treattheir osteoporosis just with exercise. I'm not
undermining the importance of exercise, beingphysically active, maintaining the seaweight and calcium
and vitamin D all those. Unfortunately, it is a metabolic disease. It's
(20:36):
it's a disease that is progressive overlifetime and we need specific agents because to
treat this osteoporosis. Because bone isa dynamic structure, there is a new
born formation all the time happening.An old bone is getting removed. That
is called a process of resorption.And this dynamic process gets impacted as the
age advances and the architecture of boneget deteriorated, so it is to be
(21:00):
treated with specific medications. And broadlyspeaking, there are two groups of medication.
Either we prevent the bone destruction thatis called as an anti resolptive agent,
or we stimulate the new bone formation, which is osteoanabolic agents. And
there are some medication which can actuallydo both the things. So, depending
on how severe the osteoporosis is,the choice of medication varies. There are
(21:26):
pills that can be used, thereare injections that can be used, There
are intravenous in fusions that are given. The regiments and the dosing varies from
medicine to medicine, and the durationof treatment varies. But the bottom line
is medications are required if the osteoporosisis established diagnosis and if it is progressive.
Now the easiest would be a pill, I guess, but you said
(21:48):
that the injection is that like anevery month or every day an injection or
how does that work? Well?It depends. Just to give a few
examples, the pill is the easiestone. Obviously, the treditional pill have
been foss max or landroinate that weuse seventy milligram once a week or ibatronate
or residronate. There are different pills. They are safe and they are generally
given for a duration. These areall fall into anti resorptive pills and they
(22:11):
are generally given for a duration ofabout five years. And but the only
catch is all these osteoporotic pills havean adverse effect on the esophagus or the
foot pipe. They have a tendencyto cause an erosion or alteration in the
esophagus. We need to take certainprecautions like taking it on an empty stomach,
drinking of water, be in anupright posture so that you reduce the
(22:33):
exposure to the foot pipe. Butpeople with a lot of acid reflux,
people with hightus hernias, and peoplewith esophagial disease, they're not the candidates
for the pills. And the samedrugs can be given as an intravenous in
fusion, but that's once a year. That's called soldronic acid. There are
injections called probe which can be givenonce a year. Yeah, solidronic acid
or reclass infusion. It's the sameclass of medication as the pills called bisphosphonates.
(23:00):
They are given once a year intravenouslyfor three or five years duration and
then we revisit the treatment decisions periodicallyno matter what the treatment is, and
are there side effects with that withit once a year injection. No,
Actually, once you get an infusion, they may get a flu like illness
and acute phase reaction. But keepingone hydrated and also taking some over the
(23:22):
counter tylanol should help them overcome thisside effect. But majority of the people
tolerate it well, and with theprogressive infusion year two, year three,
the side effect is minimal. Butmost importantly, people get really frightened by
what they read in the media.And if you i mean also this is
an FDA black box warning of someof these drugs. When they google and
(23:45):
search for osteoporosis drugs, people getfrightened that, oh they are going to
develop some osteonecrosis of the jay thefemale. These two things stand out.
People get worried that the side effectsare significant. But what is to understand
is a risk benefit assessment. Imean, you need to look into what
is this risk in the versus what'sthe fracture risk reduction? Just to give
(24:10):
you an example again, I'm goingback to the beginning. How common the
osteoporocess is. And if you lookat the number of osteoporotic fracture across the
world is nine million, and inthe United States we get two million fractures
every year. It's a huge number. And at fifty years, the lifetime
risk of fracture is one in twowomen and one in five men. So
given the magnitude of fracture which isgoing to be huge, and the burden
(24:33):
that it's going to put not onlyfor quality of life but on the socioeconomic
burden, and if you can reduceand prevent it, the benefits are far
far higher and outweigh the risk ofthe complication that I just mentioned. And
just to put the things in perspective, these complications are seen one in ten
thousand people. It's extremely rare.And we identify who are the people at
(24:56):
risk of this complications and what putsthe people at risk of these complications and
taking precautions to avoid those scenarios,I think that should be the most appropriate
option. Actually, yeah, andthat information needs to get out. You're
absolutely right, And you know,I'm just thinking about, you know,
the people that are have severe ostereoprocessalmost like the people that have super high
(25:18):
cholesterol levels. I mean of let'ssay three hundred or three fifty. You
can you can try diet and exercise, it's not gonna work. It's not
gonna work. And you need totake these medications to stat And let's say
to prevent a heart attack, wellhere, you know, which is obviously
very common in the United States.Here, you need to take the medication
if you get the bone density scanand you're severely ASTERO product, because it's
(25:41):
gonna prevent the bone fracture and it'sgonna and that can obviously have a major
effect on your overall quality of life. So I think that's a really important
message and I really appreciate that,uh Dot Nayak. Unfortunately that's the end
of the show. We do needto end here, but I want to
think, thank you. You gaveus lots of information. We probably need
(26:02):
to have you on again. Hisnumber again with his team at NYU is
two one two for eight one onethree five zero two one two four eight
one one three five zero. Ifyou or your loved one needs an evaluation
for for osteoporosis. It sounds likewomen over the age of a postman appausal
and certainly, I think we needto make a stronger emphasis for our men
in this country because clearly fracture riskis very high. Thank you very much,
(26:30):
Yes, under Detective, I thinkabsolutely. Thank you again and it's
been a pleasure of being on theshow, and thanks for having me again.
Well it's my pleasure. Thank you. We haven't really had a show
like this and we'll certainly have youon again. That's the end of the
show. Everyone. I want tothank you all for tuning in here on
Kats's Corner. We'll be back nextweek with a great guest. Tune in
every Sunday. This is doctor AaronKatz. You've been listening to Katzer's Corner.
(26:53):
Come back every week to hear morestraight talk on a wide range of
men's health topics advice on how tolive your healthiest life. The proceeding was
a paid podcast. iHeartRadio's hosting ofthis podcast constitutes neither an endorsement of the
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