November 10, 2025 • 40 mins
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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 an
Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
Vantage Design Works (Vanessa Jones)
Website: https://www.vantagedesignworks.com/
Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qr
Original Artwork Concept: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:07):
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:22):
And I'm Nicole Rufo.
I'm a nurse.
SPEAKER_02 (00:24):
And we are so excited you were happy.
Wow.
And we are so excited you wereable to join us here again
today.
Um, you're being a really goodsport 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.
(00:44):
Um tell the good people what weare immediately coming off of
that we can discuss in thebanter section.
SPEAKER_00 (00:52):
Oh my God.
Well, I think it was like asolid hour and a half of us in
the bathroom trying to irrigatethe wax out of your ears.
SPEAKER_02 (01:00):
I'm a waxy boy.
SPEAKER_00 (01:01):
You are a waxy.
You're like a crazy old man whocan't hear because his ears are
clogged with wax.
SPEAKER_02 (01:09):
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 anyoneshould try at home.
You should only do this.
We only do this.
SPEAKER_00 (01:22):
We probably shouldn't even be doing this at
home.
Probably not.
I got um I bought one of thosecameras.
Did you really?
With the thing at the end.
It's coming tomorrow.
It's coming tomorrow.
SPEAKER_02 (01:33):
Oh man.
I mean, I'm excited.
I I am curious to see what'sgoing on in there.
Um, ears are tough.
Ears are tough for everyone.
It's tough to describe what'sgoing on in an ear.
It's tough to see what's goingon in an ear.
Shout out to the ears, nose, andthroat doctors.
Um, what did you feel in thisexperience?
SPEAKER_00 (01:52):
Uh what did I feel?
Well, I think a lot of it cameout with the peroxide, like the
clumps.
So a little bit of it.
Like I wanted it to be moresatisfying.
Like I wanted to scrape out ahuge chunk of wax from your ear,
but I think it got turned intobubbles and then went down the
drain.
SPEAKER_02 (02:13):
Yeah.
I think that's what happenedtoo.
Um, parts of it wereuncomfortable, but you were so
gracious.
And we we did we were liketeamwork makes the dream work
with placing the syringe andthen 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 wifelyduties.
SPEAKER_00 (02:32):
Wifely duties.
Like the you need to do thislike monthly.
SPEAKER_02 (02:37):
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 (02:43):
That was got a little angry.
So tad bit bloody.
SPEAKER_02 (02:47):
So maybe we'll give it like a we'll give it like a
day.
Yeah, um, and then maybe we'llgo 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 groceryshopping.
Um God, I love that brie.
SPEAKER_00 (03:05):
Triple cream brie.
Oh my god, I forgot we got that.
unknown (03:09):
Oh yes.
SPEAKER_02 (03:10):
Yeah, we might have to.
SPEAKER_00 (03:11):
That is the best.
And I'm not even so much like abig brie person, just like Brie,
plain.
Not, I mean, when I make like abaked brie with like good stuff
on it, then I like love it.
SPEAKER_02 (03:24):
Do you like brie?
SPEAKER_00 (03:27):
I hope Alex is listening.
I hope he is.
But like the triple the triplecream brie from Wegman
specifically is so good.
I love it.
SPEAKER_02 (03:36):
Yeah, Jillian didn't like it.
We gave it to her and she was alittle freaked out.
SPEAKER_00 (03:39):
Well, her palette isn't mature yet.
SPEAKER_02 (03:42):
Yeah, she's still working on that.
SPEAKER_00 (03:43):
I don't know that I liked Brie when I was her age.
Good point.
Maybe I did.
I don't know.
SPEAKER_02 (03:47):
I don't think I knew what Brie was.
SPEAKER_00 (03:49):
Really?
SPEAKER_02 (03:50):
Yeah.
I only knew people named Brie.
Alex.
I know.
SPEAKER_00 (03:55):
Alex, how's Brie?
SPEAKER_02 (03:57):
No, he's not.
Yeah, we can keep his firstname, his last name out of it to
save his, to spare him.
Um what happened this time?
SPEAKER_00 (04:04):
Alex, how's Gina?
SPEAKER_02 (04:05):
Oh, geez.
Wow, that's fun.
Well, um, what did I do?
I went to, so I'm in a fantasyuh basketball league, dynasty
basketball.
It's like year-round activity.
And there, I know one of theguys, 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 ofthese guys, and they had an
(04:27):
outing for his birthday, um,which was in August, um, to a
76ers game, and then went to myother friend Dan.
Um, people who have listened tothe podcast know about Dan, or
if you see my inst my Instagramreels, you know that he was the
one wearing ice duringHalloween.
SPEAKER_00 (04:42):
Dan and his ice.
SPEAKER_02 (04:43):
Yeah.
Um, Dan is also a physician, andwe got to spend some time
yesterday hanging out,celebrating his 30th birthday.
The other guy's birthday was hisname is Joe.
He was 29th birthday.
We were celebrating from back inAugust.
SPEAKER_00 (04:57):
Um, it's November.
Wait, it wasn't his birthdaythis weekend?
SPEAKER_02 (05:02):
No, I did, I did bust in there, arms wide open,
and I was like, Joe, happybirthday.
And he's like, Thanks.
And then he has a tattoo of hisbirthday on his arm.
Also for Kobe.
SPEAKER_00 (05:12):
In case he forgets.
SPEAKER_02 (05:13):
And that's what I asked him, genuinely.
I was like, Joe, do you do thisbecause you like might forget?
Or he's like, well, no, it's forthe Mamba mentality because he
like wants to wake up and be asmotivated as Kobe was and like
describe to people.
SPEAKER_00 (05:24):
Did Kobe have his birthday tattooed on him?
SPEAKER_02 (05:27):
No, but like Kobe's two numbers were eight and
twenty-four when he was with theLakers.
SPEAKER_00 (05:31):
Oh, and his birthday is August 24th.
Correct.
Wait.
SPEAKER_02 (05:34):
Kobe's birthday is August 23rd.
SPEAKER_00 (05:37):
When did you guys meet?
SPEAKER_02 (05:43):
Me and Joe Packer?
SPEAKER_00 (05:44):
No, for when did you guys all meet for the uh fantasy
thing when you went uh what's itcalled?
When you went to Top Golf.
We was that around his birthday?
SPEAKER_02 (05:53):
Oh god.
Um that was no, that was inJune.
I think that was in June orJuly.
Yeah, that was a fun thing.
We went to Top Golf, but we usedtheir conference room and did
nothing related to golf.
SPEAKER_00 (06:05):
I was so hoping that he was gonna organize this thing
at a Sixers game.
And then you guys were just in aconference room at what is it
called now?
It's not Will's Fargo anymore,right?
SPEAKER_02 (06:15):
It's called Xfinity Mobile Arena.
That's dumb.
I gotta say, they um the seatsare different.
No, it's still tight up therefor a guy with wide shoulders
like me, but it's um it'sthey're cushier.
It's a little more comfortablesit.
Oh, that's nice.
Yeah, it was good.
Um I like the artist formerlyknown as Wills Fargo Arena.
(06:36):
I've been to Brooklyn.
Um it's like two vertical theBrooklyn Stadium.
I've been like once, I think.
SPEAKER_00 (06:45):
Who'd you go with?
What's her name?
SPEAKER_02 (06:48):
I think I went with AJ and Frank.
unknown (06:49):
Wow.
SPEAKER_02 (06:50):
Yeah.
SPEAKER_00 (06:51):
Figures.
I know, right?
SPEAKER_02 (06:53):
Come after me.
So we did that.
Um, and then I'm gonna make CrabCavitelli because we're coming
up on well, when this episodecomes out, it'll be like
officially like a month thatwe've been married, but at the
same time, like Friday was ourfour weeks, and we realized that
this is like a weird thing.
SPEAKER_00 (07:11):
This is a weird thing.
Like, I know like months havedifferent days and like blah,
blah, blah.
But on Friday we were marriedfor four weeks, which like four
weeks is a month, but Friday wasthe seventh.
How are there three days inbetween?
SPEAKER_02 (07:29):
I'm not sure.
SPEAKER_00 (07:30):
But then the 10th, we got married on October 10th,
so tomorrow's November 10th.
So then, like, that's also amonth, right?
But there's three days inbetween.
SPEAKER_02 (07:37):
It does feel like we're missing a feels like we're
missing a day or three.
SPEAKER_00 (07:44):
Yeah.
SPEAKER_02 (07:45):
In there somewhere.
I'm not entirely sure.
But we're having crab cavatellitonight, 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 likewe were picking a tasty meal,
(08:06):
and I was like, you know,normally like you make the
excellent food.
I like sub in every once in awhile.
And I was like, oh, it was like,are there any dishes that you
want that you think will beextra tasty with our plans on
Sunday night?
And you're like, oh no, I wantthe I want the crab cavatelli.
SPEAKER_00 (08:22):
It's so good.
SPEAKER_02 (08:23):
But then I asked, I was like, do you want it with
the crab this time to be likefor it to be special?
SPEAKER_00 (08:28):
And you said No, I like it with the pollock.
unknown (08:32):
Yeah.
SPEAKER_00 (08:33):
I've never had imitation crab unless it's in
like a sushi roll, which I feellike then you can't like tell.
You know, sometimes when you getlike uh like spicy crab, and
it's like that.
SPEAKER_02 (08:47):
It's not crab no.
Whoa, whoa, whoa, whoa.
SPEAKER_00 (08:52):
Like the one we get from down the street?
SPEAKER_02 (08:54):
Yeah.
SPEAKER_00 (08:55):
No.
SPEAKER_02 (08:55):
Oh man.
Whatever.
I don't care.
It's tasty.
SPEAKER_00 (09:00):
But it's tasty.
What was I saying?
Oh, yeah.
I like never really had it inany other context until you
started making this.
And I'm so happy about it.
SPEAKER_02 (09:09):
I know, it's such a fun dish.
Um, I hope I don't mess it up.
Um, but I did one time and Ilike didn't make the roux right,
and I was upset.
But I found the right recipe.
SPEAKER_00 (09:20):
I'm proud of you for making a roux.
SPEAKER_02 (09:24):
Thank you.
Oh, there was another dish Imade that I was proud of that
came out really good.
Um, the coconut curry chicken.
SPEAKER_00 (09:32):
Oh, yeah, that was delicious.
SPEAKER_02 (09:37):
Yeah, gotta follow a recipe though, because I
neglected to put sugar in therebecause I'm like, why would you
put sugar in a savory dish?
And then I sprinkled in thebrown sugar at the end and
discovered that it was so muchbetter with me actually
following the recipe.
SPEAKER_00 (09:52):
Using that biochem degree.
SPEAKER_02 (09:55):
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 (10:02):
It's so funny.
You've been holding out on allof this good food, and it's
really funny that in Karthik'sspeech about you at our wedding,
he like a part of it was liketalking about how we like make
each other like better orwhatever, and then it was all
(10:24):
basically how your cooking hassignificantly improved since
we've been together.
SPEAKER_02 (10:30):
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 thekitchen and I take more, I'm
more proactive.
Look, like you do a lot.
You take care of dinners likeseveral 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'regonna know who you are.
(10:52):
They're gonna be getting anearful.
And I'm like, I wish, I wishsomeone would step up and I wish
someone would make me dinner.
This person will remainnameless.
SPEAKER_00 (11:03):
You can come over and Eddie will make you dinner.
SPEAKER_02 (11:06):
So there's some of that.
Um what else happened?
I made.
Oh, we went to the there's justa candlelight concert.
You were I was pitching this aslike a 65-minute date experience
that I came up with that Ineeded you to, I guess when I
take you out on a date.
SPEAKER_00 (11:26):
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 dressnice, like if we're going to
dinner.
So I'm like, all right, like arewe going to dinner?
He's like, no, like we we'rejust like gonna have dinner at
home, but dress nice.
But I'm like, dress nice how?
Like, can I wear jeans to thistheoretical dinner?
(11:49):
Do I need to have like a cuteroutfit?
Are we going rock climbing?
Like what?
SPEAKER_02 (11:55):
So this part irritated you.
SPEAKER_00 (11:57):
Uh well, I wouldn't say it irritated me.
I just wanted to know what wewere doing.
And then you like, you know, andlike you're like not supposed to
like tell a toddler or somethingway ahead of time because
they're gonna like get upsetabout it.
You just like tell them, don'tgive them time to like
perseverate on it or like cry orget upset.
(12:18):
I feel like that's how I wasbecause I thought about it for
like a week and a half.
I'm like, what could we bedoing?
And then I'm at work on Friday.
SPEAKER_02 (12:24):
I'm telling all your friends.
SPEAKER_00 (12:25):
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 dateexperience plan.
He's probably gonna make me godo something weird.
But it wasn't, it was very nice.
Yeah, so I should have trustedyou more.
SPEAKER_02 (12:39):
I so I was served on Instagram this concert, and the
idea behind this likecandlelight concert is to make
like, I don't know, likeentertainment, like live
entertainment from artists moreaccessible.
So it was at the down near thewaterfront, they had a museum
and the concert hall.
(13:00):
Um, I got my my buddy right hereon my right hand, like I'm a
villain and I'm petting.
So cute.
Um and yeah, it was this likethese two or three violinists
and a cellist, and they were allvery well musically trained.
They were excellent.
And if you haven't, if you don'tknow me, I love Han Zimmer music
and all the Christopher Nolanmovies that go along with it.
(13:23):
And I was like, oh, huh.
They're doing Han Zimmer.
So the date was like more for methan it was for you, but I
figured it was something nicefor us to do for 65 minutes on a
Friday night.
SPEAKER_00 (13:34):
It was, it was nice.
I liked it a lot.
It was fun.
I'm so so mad that we couldn'tgo see him when he was here.
SPEAKER_02 (13:42):
Oh, so what was the hang-up?
He was in Tennessee.
Oh, I had to work.
SPEAKER_00 (13:46):
Yeah, yeah, I had that.
Once again, residency wasruining our life.
SPEAKER_02 (13:50):
Yes, and that was supposed to be in Tennessee,
right?
SPEAKER_00 (13:53):
Yeah, he was gonna be in, so he was here.
He was in New York for a littlewhile, bopped around to another
places at the or like otherplaces in the country, stopped,
added three more shows in likeBrooklyn, Baltimore, and
Nashville.
Brooklyn and Baltimore were likeduring the week and like very
expensive.
SPEAKER_01 (14:12):
Wow.
SPEAKER_00 (14:12):
So I'm like, all right, we can't make this work.
And then the Nashville show wason a Sunday, and then you still
had a day.
Cause remember, I was like, canyou use one of your like
floating holidays on thisMonday?
I like found a flight, found thehotel we were gonna stay at.
It was like right off Broadway,close to like Broadway, and I
forgot what the venue was.
(14:33):
And then I was gonna, because Ithink it was in February.
So then I was going to eitherfor Christmas or your birthday
gift you a weekend in Nashville,which probably would have seemed
random, but you would have gonealong with it.
And then we for sure we weregonna like go to dinner or
something on Sunday, like ourlast night.
And then I was gonna tell you wewere gonna go see Han Zimmer.
And I had this whole thingplanned out.
(14:54):
I would have pooped my pants,and I was so mad because they uh
they do other, it's um likeworld of Han Zimmer.
I think I think they're like inPhilly too, but it's like not
him, it's just like peopleplaying his music.
Like I want him on the pianoplaying the cornfield chase.
SPEAKER_02 (15:13):
Oh man, I and I got that.
It was like so thoughtful ofyou.
That's like you're almostgift-giving.
SPEAKER_00 (15:21):
I tried.
So we're just gonna have to likego to London or Barcelona or
like Switzerland or something tosee him.
That's where he is.
Yeah, he's like in Europebopping around.
SPEAKER_02 (15:31):
Oh, really?
SPEAKER_00 (15:32):
Yeah.
SPEAKER_02 (15:32):
Oh, I had no idea.
Yeah, I guess artists like tourall the time.
Like I was seeing Demi Lovatohas 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'tthat deep tour.
SPEAKER_00 (15:47):
Oh my god.
SPEAKER_02 (15:48):
Um, so yeah, she's on tour.
SPEAKER_00 (15:50):
Do you remember when it yeah, she sang at um this is
so niche.
She sang that song that was likesomething something, I think I'd
have a heart attack.
You know what that song is?
SPEAKER_02 (16:05):
Barney?
SPEAKER_00 (16:06):
No, it's a Demi Lovato song.
And it's like, if I ever, howdoes that go?
It's like here.
SPEAKER_02 (16:12):
It's not like I had the internet.
SPEAKER_00 (16:13):
If I ever did some, if I ever lost you, I think I'd
have a heart attack orsomething, but she was singing
it at like the American HeartAssociation thing with like all
of these like heart attacksurvivors.
SPEAKER_02 (16:22):
Oh my god.
I'd have a heart attack.
Let's see.
SPEAKER_00 (16:29):
It might be called heart attack, but I also could
be making that up.
SPEAKER_02 (16:32):
That sounds in poor taste.
She does have a song named HeartAttack.
Yeah.
Yeah.
SPEAKER_00 (16:36):
It's that.
SPEAKER_02 (16:36):
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 coupleartists that I like, you know,
I'm not cultured enough to knowwho they are.
Cardi B's touring.
I feel like these people justlike pop up every like on
(16:57):
Tuesdays and they're like, yep,here I am on Tuesday.
And then you like meet thatperson on the street or at work
who was like, Oh, yeah, I wentto this concert on Tuesday.
And I'm like, wow, so bold ofyou.
I could not imagine us goingoutside on a school night to do
an activity.
I could barely imagine us goingoutside on a weekend to do an
activity.
It's exhausting.
SPEAKER_00 (17:18):
Honestly, it is.
SPEAKER_02 (17:20):
Wow.
Okay.
SPEAKER_00 (17:22):
Well, we like to relax.
SPEAKER_02 (17:23):
We like we do like to relax.
I also have a dinner to make.
SPEAKER_00 (17:26):
You do.
SPEAKER_02 (17:27):
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, readyto go.
Our sources are in the shownotes for anyone who is
listening.
Nikki, what are we talking abouttoday?
SPEAKER_00 (17:46):
Today we're talking about osteoporosis.
SPEAKER_02 (17:50):
Yeah.
Did you know that about half ofwomen and maybe one in five men
over the age of 50 will have abone fracture in their lifetime?
Wow.
Did you know that?
SPEAKER_00 (18:00):
Uh, I feel like I did.
SPEAKER_02 (18:01):
Yeah, I had to triple check this because I was
like, is that figure real?
And the fracture can besomething from as simple as a
light fall or a bump.
I was really disturbed.
The the back of this episode iscoming from a woman coming in to
see me and she was like, Oh,hey, I got my DEXA scan and it
(18:22):
says I have osteopenia.
What do I do?
And I was like, Oh, huh.
What fodder for an episode ofyour checkup?
The podcast where you try tobring health conversations from
the doctor's office to yourears.
Um let's keep let's keep movingand grooving.
Um a lot of people don't realizehow common it is.
(18:43):
I, you know, in the doctor'soffice, we'd spend a lot of time
talking about heart disease anda number one cause of death in
the world.
We talk about blood pressure, wetalk about cholesterol, but I do
tend to think that in certainspheres, bone health gets
forgotten until somethingbreaks.
SPEAKER_00 (19:01):
Anyway, so um, exactly like you said, um,
people don't realize howimportant bone health is until
you break something.
So we're going to talk about howbones are getting weaker over
time, what osteopenia andosteoporosis really mean, and
what you can do to keep yourbone strong with diet, exercise,
(19:22):
and medication sometimes.
SPEAKER_02 (19:25):
We are going to describe what are osteopenia and
osteoporosis.
So definitions.
Osteopenia means that your bonesare weaker than normal, but not
severely weak.
That falls into a differentdefinition of osteoporosis.
And this is when the bones arefragile enough that even a small
(19:45):
bump or a fall can cause afracture.
SPEAKER_00 (19:51):
Where would you place um Heather Dubro?
SPEAKER_02 (19:54):
My God, I honestly think a strong gust of wind.
She must.
A strong gust of wind couldprobably unfortunately break
that woman's hip.
So these conditions are way morecommon than people think.
Around one in five women and onein 20 men over the age of 50
have osteoporosis.
(20:15):
But even more than that, andsome estimates have that nearly
half of women and men that areelderly have osteopenia.
And the most surprising part isthat most fractures happen in
people who actually haveosteopenia.
SPEAKER_00 (20:29):
The most common places that people are breaking
bones are hips, which that's abummer, spine, another bummer,
and wrists, which feels more ofan inconvenience than a bummer.
Right.
Um, hip fractures can be veryserious.
About one in five people needlong-term care after a hip
(20:53):
fracture, and the risk of dyingwithin the year actually doubles
after breaking your hip.
SPEAKER_02 (20:59):
Yeah, that's terrifying.
That's why people are always soafraid of that when we talk
about falls in LOL's little oldladies at home.
So once someone has a fracture,their chance of having another
goes way, way, way up.
And especially in the first yearafter that initial break.
So essentially what we're tryingto get at here is that we're
(21:20):
not, it's not just about names,it's not about definitions, it's
not about like whether a bonebreaks or not.
This becomes way more aboutindependence and long-term
health and being able to do thethings that you want to do.
Like one's life and mobilitycompletely changes if they have
a fractured spine or a fracturein their hip.
So getting a gauge of this andtrying to prevent it is all the
(21:44):
more valuable.
And all of this costs a lot too.
Um, osteoporosis-relatedfractures cost the U.S.
around 57 billion every year.
And if you didn't know, we havea lovely aging population, and
that number is expected to jumpto 95 billion by 2040, which is
pretty much right around thecorner.
(22:06):
But, you know, money is fake.
So, Nikki, let's jump into thesecond segment.
Can you intro the second segmentfor us?
SPEAKER_00 (22:15):
All right, Eddie.
Tell us why our bones weaken.
SPEAKER_02 (22:19):
So bones themselves are living tissue.
They constantly, if you didn'tknow, they are they're not
static.
They are constantly being builtup and broken down.
And when we're young, thebuilding outweighs the breaking
down.
But starting in our 30s, hoorayfor us, uh, that balance starts
to tip the other way.
SPEAKER_00 (22:39):
I'm so confused.
SPEAKER_02 (22:40):
Oh, I got it here.
And then for women, that loss ofbone really speeds up after
menopause.
And that's when estrogen dropsout of the picture.
Something that we're going to betalking about in a few weeks.
And that is one of the mainreasons that osteoporosis and
osteopenia is more common inwomen based on those figures
that we described to youearlier.
(23:02):
There are also other riskfactors to keep in mind that
make someone more prone tohaving osteoporosis.
A family history of havingosteoporosis matters.
Low body weight matters.
Smoking cigarettes matters.
Heavy alcohol use matters.
And certain long-termmedications, like several
(23:23):
long-term bouts of medicineslike steroids, can increase risk
of osteoporosis, though not likeone bout of steroids.
So that's something that isimportant to say out loud.
SPEAKER_00 (23:38):
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 messageessentially that they don't need
to stay strong.
And I feel like that's kind oflike the definition of if you
(24:02):
don't use it, you lose it.
SPEAKER_02 (24:03):
Yeah.
You know?
Exactly that.
SPEAKER_00 (24:04):
Like your bones are gonna be like, I'm just being a
loaf on the couch.
SPEAKER_02 (24:08):
I don't need to be strong.
SPEAKER_00 (24:10):
I don't need to be strong.
I'm not going anywhere.
SPEAKER_02 (24:12):
Not going anywhere.
SPEAKER_00 (24:12):
I'm not doing anything.
And then you stand up and youbreak your hip.
Bang.
Then you're in a nursing home.
SPEAKER_02 (24:18):
There that's it.
Boom.
Bang.
Men aren't immune either.
Their risk sharply rises afterage 70.
So also worthwhile to payattention there.
SPEAKER_00 (24:28):
Um now that we know why our bones weaken, how would
someone be diagnosed with eitherosteopenia or osteoporosis?
SPEAKER_02 (24:36):
Yep.
So it's a special test.
It's a special type of x-raycalled a DEXA scan, D E X A.
And it's a special type of x-raythat measures your bone density.
And it gets into a little bit ofstatistics, um, which I will not
bore you too much of, but it'sbased on a T-score, which takes
(24:57):
like uh the average populationof a person and it gives you a
number to reflect like where youfall in that average population.
So you get scores.
And if your score is betweenlike minus one and minus 2.4,
it's more likely you haveosteopenia and a score of minus
2.5 or lower is consideredosteoporosis.
(25:20):
There's also other calculatorsand risk scores that are
incorporated into this, butthat's more for your doctor to
think about than for you toworry about.
Even if your T score, as itwere, isn't super low, having a
fracture from a simple fall orsomething like that, something
that wouldn't normally break abone, can also mean that you
have osteoporosis.
(25:41):
So one of the scores or afracture in a setting that you
really don't think it would canbe diagnostic of osteoporosis.
And so thinking about thisoffers a great time to ask your
doctor, when should I getscreened?
The average for women isstarting at age 65.
Um, and then the men guidelineis a little wishy-washy.
(26:02):
But you can ask, when should Iget screened?
Reasonable question to ask yourclinician who's taking care of
you.
And what's my fracture riskcompared to other people my age?
And that's pretty much gettingat the T-score.
Nikki, I think this is a greatone for you because that was a
little uh boring statisticalstuff, but that's kind of to
(26:23):
pull back the curtain.
Can you tell us little everydayhabits that can help protect
your bones?
SPEAKER_00 (26:31):
So there's actually a lot you can do to keep your
bones strong no matter what yourage is.
Um, first starting withnutrition for strong bones.
So calcium, which we all know isa big one.
Um, I think milk for the longesttime was marketed as like giving
you strong bones.
(26:52):
Um so adults over 50 need about1,000 to 1200 milligrams of
calcium a day, but most peoplewill fall short.
Um how well I don't know if youwant to keep this in.
How much calcium does like aperson under 50 need?
SPEAKER_02 (27:08):
So the American Academy of Family Physicians
recommends that people under theage of 50 years old consume
about 1,000 milligrams ofcalcium daily.
SPEAKER_00 (27:17):
Okay.
Uh for calcium, you can getcalcium from a lot of our food.
So dairy, obviously, is probablythe biggest one.
And then um, if you're notdrinking dairy or eating dairy
for some fortified plant milks,tofu has a lot of calcium, leafy
greens, so like spinach, andthen a weird one is canned
(27:40):
salmon with the bones in.
Um, apparently has a lot ofcalcium in there.
SPEAKER_02 (27:44):
Yeah.
Apparently.
SPEAKER_00 (27:48):
But also keep in mind that calcium is very key,
but if we're having too much ofit, so more than about 1500
milligrams per day, it can umincrease your risk of getting
kidney stones.
SPEAKER_02 (28:02):
Yes, it can.
SPEAKER_00 (28:03):
Um, I've never had one of them, but they don't feel
fun.
SPEAKER_02 (28:06):
I like had a run of people I was seeing like a week
or two ago who just had like akidney stone after kidney stone
after kidney stone, and like ahistory of it or back pain and a
history of kidney stone.
I'm like, oh wow, we definitelyhave to think about this.
So it's a real thing out there.
Um, many people say it's likethe most painful thing you can
(28:27):
have.
SPEAKER_00 (28:28):
Yeah, that's what people say.
SPEAKER_02 (28:29):
I think some men like to pride themselves saying,
like, some woman told me oncethat it's worse, like who had a
child and they had a kidneystone, and they said that like
the kidney stone was morepainful.
SPEAKER_00 (28:40):
Yeah, I still work with the girl.
She had an unmedicated birth.
And whatever, then at whateverpoint had a kidney stone, and
she said that she would havepreferred the birth over the
kidney stone.
SPEAKER_02 (28:53):
That's crazy.
Um, so this next part I'll take.
So then that comes in theconversation of vitamin D.
Vitamin D is a vitamin, if youwill, um, that can help the body
absorb calcium.
So there are different agebrackets to this.
Um, there's a New EnglandJournal of Medicine invited
(29:17):
review.
And to break this down acrossthe ages, so for infants under
12 months, for an example, we'retalking like 400 international
units.
For people aged one to 70, I'llsay that again, one to 70.
It's 600 international units perday.
And that can happen in your diettoo.
(29:38):
For those aged 70 and older, 71and older, then the
recommendation goes up to 800international units.
Which you'll probably noticethat many, many, many people are
vitamin D deficient, probablyinviting a whole episode, but it
is intimately related toosteoporosis and osteopenia
because calcium goes through.
(30:00):
Directly into bone, and if youcan't absorb the calcium because
you don't have the vitamin D tohelp with the whole process,
like this is a whole medicalschool lecture and physiology
lecture that many peopleprobably got, but it's
complicated.
Nikki, can you tell us a littlebit more about where you can get
vitamin D from?
SPEAKER_00 (30:21):
Well, our favorite place to get it is from the sun.
And then other diet um or dietfood items would be again
fortified milk.
Eggs are high in vitamin D, andum fatty fish.
But a lot of people still havelow levels of vitamin D.
(30:43):
And about half of um peoplediagnosed with osteoporosis, are
deficient in vitamin D.
SPEAKER_02 (30:50):
Yeah, these are all very high numbers.
They all happen to be verycommon in these populations of
people.
Other things you can think aboutare improving the amount of
protein in your diet, magnesium,vitamin K, and vitamin C may
also play a role in vitamin Dabsorption.
A Mediterranean diet, literallyprobably the cure for
everything, is that is rich infruits and vegetables and olive
(31:11):
oil, have also been shown toreduce fracture risk as we step
away from vitamin D a littlebit.
So that's the Mediterranean diethelping to reduce fracture risk.
Um, in that way, we are sort ofthinking that you should have
five servings of fruits andveggies.
I told that to someone out loudthe other day, and they were
like, holy crap, that's a lot.
(31:32):
And I was like, yes, um, verydifferent than the American
diet.
And three servings of wholegrains a day are all great
things you can do for your bonehealth.
So you were talking earlierabout if you don't use it, you
lose it.
Um, what can we do in terms ofmeaningful timelines and
(31:54):
meaningful activities forexercise that can help
strengthen bones?
SPEAKER_00 (32:00):
So exercise is very important in keeping your bones
strong.
Um, so first doing, even if it'sjust like 30 minutes a day of
any weight-bearing activity, solike walking, hiking, dancing
will all help to keep your bonesdense.
And then also resistancetraining.
(32:21):
So using weights, usingresistance bands, doing body
weight exercises, um, they canalso help build bone density.
And then um balance andflexibility also really matter,
especially as you get older,which I know we've talked about
before.
(32:42):
Um, I forget what episode, butbasically we were just talking
about like getting older andlike how your balance is
important because if you havebalance issues, then you are at
a higher risk to fall.
SPEAKER_02 (32:58):
Um might have been episode 10 exercise.
SPEAKER_00 (33:01):
Oh, maybe, yeah.
SPEAKER_02 (33:02):
Which is crazy now, 70 episodes later.
SPEAKER_00 (33:05):
I know.
Um, and since most hip fracturescome from falls, preventing
those is a big bone, big bone,big part of bone protection.
SPEAKER_02 (33:13):
You mean could you say a big bone us?
SPEAKER_00 (33:16):
Again, we are here to tell you that it is important
to exercise daily, ideally.
If you don't want to fall, yourcore strength should stay strong
for as long as you can.
If you want to be able to likego grocery shopping and carry
(33:37):
your groceries inside whenyou're 80, you should be
exercising when like now.
Yeah, if you want to be able towipe your own butt when you're
80 and have that mobility, youshould be stretching, doing
mobility stuff, exercising.
Do all of that now so that youdon't end up in a nursing home.
SPEAKER_02 (34:01):
Yeah.
SPEAKER_00 (34:02):
Someone else is gonna be wiping your butt.
No one wants that.
You know?
SPEAKER_02 (34:07):
Well said, Nikki.
SPEAKER_00 (34:08):
I know.
I'm so eloquent.
SPEAKER_02 (34:10):
You are.
SPEAKER_00 (34:10):
You just gotta get straight to the point, you know?
SPEAKER_02 (34:12):
I know, yeah, I know.
Um, what I wanted to say is thatTai Chi, one of my favorite
podcasts that teaches me a lot,is um, they had an episode about
falls recently, and they spokewith a physical therapist and
really went in deep on Tai Chi,reducing the risk of falls.
And so there is a really solidrecommendation out there for
(34:34):
folks of a certain age, probablygreater than 65, or at increased
risk of falls and thecomplications thereafter.
That Tai Chi is like really,really beneficial.
SPEAKER_00 (34:45):
There's a whole group of people that do that in
the park.
Older adults.
SPEAKER_02 (34:51):
Yeah.
SPEAKER_00 (34:52):
Have you seen them?
SPEAKER_02 (34:53):
Uh which park?
SPEAKER_00 (34:55):
Washington Square.
SPEAKER_02 (34:56):
Uh no.
SPEAKER_00 (34:57):
Maybe and like in the morning, on like weekend
mornings.
SPEAKER_02 (35:00):
Oh.
SPEAKER_00 (35:01):
Yeah.
SPEAKER_02 (35:02):
Yeah, that's so great.
Is it oh yeah.
SPEAKER_00 (35:05):
Kind of in the middle where in the spot where
the fountain is.
SPEAKER_02 (35:08):
Yes.
Okay.
No, it's beautiful and it's sohelpful.
Um, you know, you can keep yourbones strong with all these
things and exercise, but likethis has been proven to reduce
fall risk.
Um, some figures by up to 30%.
And, you know, something wementioned earlier, we talked
about risk factors.
So there are certain lifestylemodifications you can make.
(35:30):
So if someone slaps you with adiagnosis of osteoporosis or
osteopenia and you're like, whatthe heck can I do?
That's not a medicine, you canavoid smoking.
Uh smoking increases the risk ofosteoporosis.
So it's a good excuse tocontemplate cutting back.
You can limit alcohol, probablyto the degree of no more than
two drinks per day.
(35:50):
Um some would say, and Iprobably would say that like
even drinking every day isprobably too frequent.
Um in Europe theirrecommendation is none, I think.
Here in the United States, arefor some reason we tolerate
higher amounts and aiming for ahealthy weight, which is
something we talk ad nauseumabout on this podcast.
(36:12):
Um, but being underweight,rather, because that can
increase the fall risk.
So then something we won't spenda ton of time talking about, but
just to highlight and say thatthis exists is when someone is
really high risk for fracturesand osteoporosis, that is when
medicine might be able to help.
(36:32):
And the most common medicinesare called bisphosphonates.
Um, you can take the time andread about them yourselves from
reputable sources, but um, acommon one is alendrinate.
And what this does is slow downthe bone breakdown.
There are also medicines that goby different names, and like,
you know, in this day and age,by the time you listen to this
episode, new medicines come outevery day, new information comes
(36:53):
out every day.
So we try to keep it asgeneralizable as possible.
And then there's a medicinecalled denosomab, but that
blocks bone resorption and thenthere's anabolic medications
that help build new bone.
There are big, three big typesof medicines that may be offered
you.
Um but truly one size does notfit at all.
(37:16):
So this is a conversationbetween you and the person
taking care of you.
As we're getting close towrapping up, we'll have a
conversation about other thingsto prevent falls and questions
to ask your doctor.
Um, Nikki, can you tell us acouple things in the home that
make big differences when itcomes to preventing falls?
SPEAKER_00 (37:37):
Yeah.
So a big one is um like arearugs and removing those because
like the like corner can flip upor you can just trip over it.
Um, keeping hallways well lit,installing grab bars in
bathrooms if someone would needit, and then wearing supportive
shoes around your house.
SPEAKER_02 (37:58):
Excellent point.
Doing these things can has beenshown to also reduce the risk of
falls by about 30%.
And then questions that yourdoctor will not mind asking and
might be able to help you with.
Do I need a bone density test?
What's my personal fracturerisk?
How can I get enough calcium andvitamin D?
Should I start or continuemedication?
(38:23):
These are all great startingpoints, and they open the door
to preventing problems beforethey start.
So, for today's episode, the bigtakeaway: osteopenia and
osteoporosis are common butpreventable.
Healthy bones start with whatyou eat, how you move, and the
habits you keep every day.
And the sooner that you start,the sooner you'll be able to
(38:44):
keep working on these things.
Strong bones aren't builtovernight, 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 starttoday can help keep you standing
tall and independent and livingyour own lifestyle for decades
to come.
(39:05):
Thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
Check out our website, you canfind us on Instagram as well.
You can send us an email, yourcheckuppod at gmail.com.
But most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_00 (39:24):
I'm Nicole Ruth.
SPEAKER_02 (39:26):
Thank you, and goodbye.
SPEAKER_00 (39:27):
Bye.
SPEAKER_02 (39:33):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(39:55):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider 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 yourown checkup with your own
personal doctor.
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:22):
And I'm Nicole Rufo.
I'm a nurse.
SPEAKER_02 (00:24):
And we are so excited you were happy.
Wow.
And we are so excited you wereable to join us here again
today.
Um, you're being a really goodsport 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.
(00:44):
Um tell the good people what weare immediately coming off of
that we can discuss in thebanter section.
SPEAKER_00 (00:52):
Oh my God.
Well, I think it was like asolid hour and a half of us in
the bathroom trying to irrigatethe wax out of your ears.
SPEAKER_02 (01:00):
I'm a waxy boy.
SPEAKER_00 (01:01):
You are a waxy.
You're like a crazy old man whocan't hear because his ears are
clogged with wax.
SPEAKER_02 (01:09):
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 anyoneshould try at home.
You should only do this.
We only do this.
SPEAKER_00 (01:22):
We probably shouldn't even be doing this at
home.
Probably not.
I got um I bought one of thosecameras.
Did you really?
With the thing at the end.
It's coming tomorrow.
It's coming tomorrow.
SPEAKER_02 (01:33):
Oh man.
I mean, I'm excited.
I I am curious to see what'sgoing on in there.
Um, ears are tough.
Ears are tough for everyone.
It's tough to describe what'sgoing on in an ear.
It's tough to see what's goingon in an ear.
Shout out to the ears, nose, andthroat doctors.
Um, what did you feel in thisexperience?
SPEAKER_00 (01:52):
Uh what did I feel?
Well, I think a lot of it cameout with the peroxide, like the
clumps.
So a little bit of it.
Like I wanted it to be moresatisfying.
Like I wanted to scrape out ahuge chunk of wax from your ear,
but I think it got turned intobubbles and then went down the
drain.
SPEAKER_02 (02:13):
Yeah.
I think that's what happenedtoo.
Um, parts of it wereuncomfortable, but you were so
gracious.
And we we did we were liketeamwork makes the dream work
with placing the syringe andthen 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 wifelyduties.
SPEAKER_00 (02:32):
Wifely duties.
Like the you need to do thislike monthly.
SPEAKER_02 (02:37):
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 (02:43):
That was got a little angry.
So tad bit bloody.
SPEAKER_02 (02:47):
So maybe we'll give it like a we'll give it like a
day.
Yeah, um, and then maybe we'llgo 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 groceryshopping.
Um God, I love that brie.
SPEAKER_00 (03:05):
Triple cream brie.
Oh my god, I forgot we got that.
unknown (03:09):
Oh yes.
SPEAKER_02 (03:10):
Yeah, we might have to.
SPEAKER_00 (03:11):
That is the best.
And I'm not even so much like abig brie person, just like Brie,
plain.
Not, I mean, when I make like abaked brie with like good stuff
on it, then I like love it.
SPEAKER_02 (03:24):
Do you like brie?
SPEAKER_00 (03:27):
I hope Alex is listening.
I hope he is.
But like the triple the triplecream brie from Wegman
specifically is so good.
I love it.
SPEAKER_02 (03:36):
Yeah, Jillian didn't like it.
We gave it to her and she was alittle freaked out.
SPEAKER_00 (03:39):
Well, her palette isn't mature yet.
SPEAKER_02 (03:42):
Yeah, she's still working on that.
SPEAKER_00 (03:43):
I don't know that I liked Brie when I was her age.
Good point.
Maybe I did.
I don't know.
SPEAKER_02 (03:47):
I don't think I knew what Brie was.
SPEAKER_00 (03:49):
Really?
SPEAKER_02 (03:50):
Yeah.
I only knew people named Brie.
Alex.
I know.
SPEAKER_00 (03:55):
Alex, how's Brie?
SPEAKER_02 (03:57):
No, he's not.
Yeah, we can keep his firstname, his last name out of it to
save his, to spare him.
Um what happened this time?
SPEAKER_00 (04:04):
Alex, how's Gina?
SPEAKER_02 (04:05):
Oh, geez.
Wow, that's fun.
Well, um, what did I do?
I went to, so I'm in a fantasyuh basketball league, dynasty
basketball.
It's like year-round activity.
And there, I know one of theguys, 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 ofthese guys, and they had an
(04:27):
outing for his birthday, um,which was in August, um, to a
76ers game, and then went to myother friend Dan.
Um, people who have listened tothe podcast know about Dan, or
if you see my inst my Instagramreels, you know that he was the
one wearing ice duringHalloween.
SPEAKER_00 (04:42):
Dan and his ice.
SPEAKER_02 (04:43):
Yeah.
Um, Dan is also a physician, andwe got to spend some time
yesterday hanging out,celebrating his 30th birthday.
The other guy's birthday was hisname is Joe.
He was 29th birthday.
We were celebrating from back inAugust.
SPEAKER_00 (04:57):
Um, it's November.
Wait, it wasn't his birthdaythis weekend?
SPEAKER_02 (05:02):
No, I did, I did bust in there, arms wide open,
and I was like, Joe, happybirthday.
And he's like, Thanks.
And then he has a tattoo of hisbirthday on his arm.
Also for Kobe.
SPEAKER_00 (05:12):
In case he forgets.
SPEAKER_02 (05:13):
And that's what I asked him, genuinely.
I was like, Joe, do you do thisbecause you like might forget?
Or he's like, well, no, it's forthe Mamba mentality because he
like wants to wake up and be asmotivated as Kobe was and like
describe to people.
SPEAKER_00 (05:24):
Did Kobe have his birthday tattooed on him?
SPEAKER_02 (05:27):
No, but like Kobe's two numbers were eight and
twenty-four when he was with theLakers.
SPEAKER_00 (05:31):
Oh, and his birthday is August 24th.
Correct.
Wait.
SPEAKER_02 (05:34):
Kobe's birthday is August 23rd.
SPEAKER_00 (05:37):
When did you guys meet?
SPEAKER_02 (05:43):
Me and Joe Packer?
SPEAKER_00 (05:44):
No, for when did you guys all meet for the uh fantasy
thing when you went uh what's itcalled?
When you went to Top Golf.
We was that around his birthday?
SPEAKER_02 (05:53):
Oh god.
Um that was no, that was inJune.
I think that was in June orJuly.
Yeah, that was a fun thing.
We went to Top Golf, but we usedtheir conference room and did
nothing related to golf.
SPEAKER_00 (06:05):
I was so hoping that he was gonna organize this thing
at a Sixers game.
And then you guys were just in aconference room at what is it
called now?
It's not Will's Fargo anymore,right?
SPEAKER_02 (06:15):
It's called Xfinity Mobile Arena.
That's dumb.
I gotta say, they um the seatsare different.
No, it's still tight up therefor a guy with wide shoulders
like me, but it's um it'sthey're cushier.
It's a little more comfortablesit.
Oh, that's nice.
Yeah, it was good.
Um I like the artist formerlyknown as Wills Fargo Arena.
(06:36):
I've been to Brooklyn.
Um it's like two vertical theBrooklyn Stadium.
I've been like once, I think.
SPEAKER_00 (06:45):
Who'd you go with?
What's her name?
SPEAKER_02 (06:48):
I think I went with AJ and Frank.
unknown (06:49):
Wow.
SPEAKER_02 (06:50):
Yeah.
SPEAKER_00 (06:51):
Figures.
I know, right?
SPEAKER_02 (06:53):
Come after me.
So we did that.
Um, and then I'm gonna make CrabCavitelli because we're coming
up on well, when this episodecomes out, it'll be like
officially like a month thatwe've been married, but at the
same time, like Friday was ourfour weeks, and we realized that
this is like a weird thing.
SPEAKER_00 (07:11):
This is a weird thing.
Like, I know like months havedifferent days and like blah,
blah, blah.
But on Friday we were marriedfor four weeks, which like four
weeks is a month, but Friday wasthe seventh.
How are there three days inbetween?
SPEAKER_02 (07:29):
I'm not sure.
SPEAKER_00 (07:30):
But then the 10th, we got married on October 10th,
so tomorrow's November 10th.
So then, like, that's also amonth, right?
But there's three days inbetween.
SPEAKER_02 (07:37):
It does feel like we're missing a feels like we're
missing a day or three.
SPEAKER_00 (07:44):
Yeah.
SPEAKER_02 (07:45):
In there somewhere.
I'm not entirely sure.
But we're having crab cavatellitonight, 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 likewe were picking a tasty meal,
(08:06):
and I was like, you know,normally like you make the
excellent food.
I like sub in every once in awhile.
And I was like, oh, it was like,are there any dishes that you
want that you think will beextra tasty with our plans on
Sunday night?
And you're like, oh no, I wantthe I want the crab cavatelli.
SPEAKER_00 (08:22):
It's so good.
SPEAKER_02 (08:23):
But then I asked, I was like, do you want it with
the crab this time to be likefor it to be special?
SPEAKER_00 (08:28):
And you said No, I like it with the pollock.
unknown (08:32):
Yeah.
SPEAKER_00 (08:33):
I've never had imitation crab unless it's in
like a sushi roll, which I feellike then you can't like tell.
You know, sometimes when you getlike uh like spicy crab, and
it's like that.
SPEAKER_02 (08:47):
It's not crab no.
Whoa, whoa, whoa, whoa.
SPEAKER_00 (08:52):
Like the one we get from down the street?
SPEAKER_02 (08:54):
Yeah.
SPEAKER_00 (08:55):
No.
SPEAKER_02 (08:55):
Oh man.
Whatever.
I don't care.
It's tasty.
SPEAKER_00 (09:00):
But it's tasty.
What was I saying?
Oh, yeah.
I like never really had it inany other context until you
started making this.
And I'm so happy about it.
SPEAKER_02 (09:09):
I know, it's such a fun dish.
Um, I hope I don't mess it up.
Um, but I did one time and Ilike didn't make the roux right,
and I was upset.
But I found the right recipe.
SPEAKER_00 (09:20):
I'm proud of you for making a roux.
SPEAKER_02 (09:24):
Thank you.
Oh, there was another dish Imade that I was proud of that
came out really good.
Um, the coconut curry chicken.
SPEAKER_00 (09:32):
Oh, yeah, that was delicious.
SPEAKER_02 (09:37):
Yeah, gotta follow a recipe though, because I
neglected to put sugar in therebecause I'm like, why would you
put sugar in a savory dish?
And then I sprinkled in thebrown sugar at the end and
discovered that it was so muchbetter with me actually
following the recipe.
SPEAKER_00 (09:52):
Using that biochem degree.
SPEAKER_02 (09:55):
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 (10:02):
It's so funny.
You've been holding out on allof this good food, and it's
really funny that in Karthik'sspeech about you at our wedding,
he like a part of it was liketalking about how we like make
each other like better orwhatever, and then it was all
(10:24):
basically how your cooking hassignificantly improved since
we've been together.
SPEAKER_02 (10:30):
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 thekitchen and I take more, I'm
more proactive.
Look, like you do a lot.
You take care of dinners likeseveral 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'regonna know who you are.
(10:52):
They're gonna be getting anearful.
And I'm like, I wish, I wishsomeone would step up and I wish
someone would make me dinner.
This person will remainnameless.
SPEAKER_00 (11:03):
You can come over and Eddie will make you dinner.
SPEAKER_02 (11:06):
So there's some of that.
Um what else happened?
I made.
Oh, we went to the there's justa candlelight concert.
You were I was pitching this aslike a 65-minute date experience
that I came up with that Ineeded you to, I guess when I
take you out on a date.
SPEAKER_00 (11:26):
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 dressnice, like if we're going to
dinner.
So I'm like, all right, like arewe going to dinner?
He's like, no, like we we'rejust like gonna have dinner at
home, but dress nice.
But I'm like, dress nice how?
Like, can I wear jeans to thistheoretical dinner?
(11:49):
Do I need to have like a cuteroutfit?
Are we going rock climbing?
Like what?
SPEAKER_02 (11:55):
So this part irritated you.
SPEAKER_00 (11:57):
Uh well, I wouldn't say it irritated me.
I just wanted to know what wewere doing.
And then you like, you know, andlike you're like not supposed to
like tell a toddler or somethingway ahead of time because
they're gonna like get upsetabout it.
You just like tell them, don'tgive them time to like
perseverate on it or like cry orget upset.
(12:18):
I feel like that's how I wasbecause I thought about it for
like a week and a half.
I'm like, what could we bedoing?
And then I'm at work on Friday.
SPEAKER_02 (12:24):
I'm telling all your friends.
SPEAKER_00 (12:25):
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 dateexperience plan.
He's probably gonna make me godo something weird.
But it wasn't, it was very nice.
Yeah, so I should have trustedyou more.
SPEAKER_02 (12:39):
I so I was served on Instagram this concert, and the
idea behind this likecandlelight concert is to make
like, I don't know, likeentertainment, like live
entertainment from artists moreaccessible.
So it was at the down near thewaterfront, they had a museum
and the concert hall.
(13:00):
Um, I got my my buddy right hereon my right hand, like I'm a
villain and I'm petting.
So cute.
Um and yeah, it was this likethese two or three violinists
and a cellist, and they were allvery well musically trained.
They were excellent.
And if you haven't, if you don'tknow me, I love Han Zimmer music
and all the Christopher Nolanmovies that go along with it.
(13:23):
And I was like, oh, huh.
They're doing Han Zimmer.
So the date was like more for methan it was for you, but I
figured it was something nicefor us to do for 65 minutes on a
Friday night.
SPEAKER_00 (13:34):
It was, it was nice.
I liked it a lot.
It was fun.
I'm so so mad that we couldn'tgo see him when he was here.
SPEAKER_02 (13:42):
Oh, so what was the hang-up?
He was in Tennessee.
Oh, I had to work.
SPEAKER_00 (13:46):
Yeah, yeah, I had that.
Once again, residency wasruining our life.
SPEAKER_02 (13:50):
Yes, and that was supposed to be in Tennessee,
right?
SPEAKER_00 (13:53):
Yeah, he was gonna be in, so he was here.
He was in New York for a littlewhile, bopped around to another
places at the or like otherplaces in the country, stopped,
added three more shows in likeBrooklyn, Baltimore, and
Nashville.
Brooklyn and Baltimore were likeduring the week and like very
expensive.
SPEAKER_01 (14:12):
Wow.
SPEAKER_00 (14:12):
So I'm like, all right, we can't make this work.
And then the Nashville show wason a Sunday, and then you still
had a day.
Cause remember, I was like, canyou use one of your like
floating holidays on thisMonday?
I like found a flight, found thehotel we were gonna stay at.
It was like right off Broadway,close to like Broadway, and I
forgot what the venue was.
(14:33):
And then I was gonna, because Ithink it was in February.
So then I was going to eitherfor Christmas or your birthday
gift you a weekend in Nashville,which probably would have seemed
random, but you would have gonealong with it.
And then we for sure we weregonna like go to dinner or
something on Sunday, like ourlast night.
And then I was gonna tell you wewere gonna go see Han Zimmer.
And I had this whole thingplanned out.
(14:54):
I would have pooped my pants,and I was so mad because they uh
they do other, it's um likeworld of Han Zimmer.
I think I think they're like inPhilly too, but it's like not
him, it's just like peopleplaying his music.
Like I want him on the pianoplaying the cornfield chase.
SPEAKER_02 (15:13):
Oh man, I and I got that.
It was like so thoughtful ofyou.
That's like you're almostgift-giving.
SPEAKER_00 (15:21):
I tried.
So we're just gonna have to likego to London or Barcelona or
like Switzerland or something tosee him.
That's where he is.
Yeah, he's like in Europebopping around.
SPEAKER_02 (15:31):
Oh, really?
SPEAKER_00 (15:32):
Yeah.
SPEAKER_02 (15:32):
Oh, I had no idea.
Yeah, I guess artists like tourall the time.
Like I was seeing Demi Lovatohas 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'tthat deep tour.
SPEAKER_00 (15:47):
Oh my god.
SPEAKER_02 (15:48):
Um, so yeah, she's on tour.
SPEAKER_00 (15:50):
Do you remember when it yeah, she sang at um this is
so niche.
She sang that song that was likesomething something, I think I'd
have a heart attack.
You know what that song is?
SPEAKER_02 (16:05):
Barney?
SPEAKER_00 (16:06):
No, it's a Demi Lovato song.
And it's like, if I ever, howdoes that go?
It's like here.
SPEAKER_02 (16:12):
It's not like I had the internet.
SPEAKER_00 (16:13):
If I ever did some, if I ever lost you, I think I'd
have a heart attack orsomething, but she was singing
it at like the American HeartAssociation thing with like all
of these like heart attacksurvivors.
SPEAKER_02 (16:22):
Oh my god.
I'd have a heart attack.
Let's see.
SPEAKER_00 (16:29):
It might be called heart attack, but I also could
be making that up.
SPEAKER_02 (16:32):
That sounds in poor taste.
She does have a song named HeartAttack.
Yeah.
Yeah.
SPEAKER_00 (16:36):
It's that.
SPEAKER_02 (16:36):
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 coupleartists that I like, you know,
I'm not cultured enough to knowwho they are.
Cardi B's touring.
I feel like these people justlike pop up every like on
(16:57):
Tuesdays and they're like, yep,here I am on Tuesday.
And then you like meet thatperson on the street or at work
who was like, Oh, yeah, I wentto this concert on Tuesday.
And I'm like, wow, so bold ofyou.
I could not imagine us goingoutside on a school night to do
an activity.
I could barely imagine us goingoutside on a weekend to do an
activity.
It's exhausting.
SPEAKER_00 (17:18):
Honestly, it is.
SPEAKER_02 (17:20):
Wow.
Okay.
SPEAKER_00 (17:22):
Well, we like to relax.
SPEAKER_02 (17:23):
We like we do like to relax.
I also have a dinner to make.
SPEAKER_00 (17:26):
You do.
SPEAKER_02 (17:27):
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, readyto go.
Our sources are in the shownotes for anyone who is
listening.
Nikki, what are we talking abouttoday?
SPEAKER_00 (17:46):
Today we're talking about osteoporosis.
SPEAKER_02 (17:50):
Yeah.
Did you know that about half ofwomen and maybe one in five men
over the age of 50 will have abone fracture in their lifetime?
Wow.
Did you know that?
SPEAKER_00 (18:00):
Uh, I feel like I did.
SPEAKER_02 (18:01):
Yeah, I had to triple check this because I was
like, is that figure real?
And the fracture can besomething from as simple as a
light fall or a bump.
I was really disturbed.
The the back of this episode iscoming from a woman coming in to
see me and she was like, Oh,hey, I got my DEXA scan and it
(18:22):
says I have osteopenia.
What do I do?
And I was like, Oh, huh.
What fodder for an episode ofyour checkup?
The podcast where you try tobring health conversations from
the doctor's office to yourears.
Um let's keep let's keep movingand grooving.
Um a lot of people don't realizehow common it is.
(18:43):
I, you know, in the doctor'soffice, we'd spend a lot of time
talking about heart disease anda number one cause of death in
the world.
We talk about blood pressure, wetalk about cholesterol, but I do
tend to think that in certainspheres, bone health gets
forgotten until somethingbreaks.
SPEAKER_00 (19:01):
Anyway, so um, exactly like you said, um,
people don't realize howimportant bone health is until
you break something.
So we're going to talk about howbones are getting weaker over
time, what osteopenia andosteoporosis really mean, and
what you can do to keep yourbone strong with diet, exercise,
(19:22):
and medication sometimes.
SPEAKER_02 (19:25):
We are going to describe what are osteopenia and
osteoporosis.
So definitions.
Osteopenia means that your bonesare weaker than normal, but not
severely weak.
That falls into a differentdefinition of osteoporosis.
And this is when the bones arefragile enough that even a small
(19:45):
bump or a fall can cause afracture.
SPEAKER_00 (19:51):
Where would you place um Heather Dubro?
SPEAKER_02 (19:54):
My God, I honestly think a strong gust of wind.
She must.
A strong gust of wind couldprobably unfortunately break
that woman's hip.
So these conditions are way morecommon than people think.
Around one in five women and onein 20 men over the age of 50
have osteoporosis.
(20:15):
But even more than that, andsome estimates have that nearly
half of women and men that areelderly have osteopenia.
And the most surprising part isthat most fractures happen in
people who actually haveosteopenia.
SPEAKER_00 (20:29):
The most common places that people are breaking
bones are hips, which that's abummer, spine, another bummer,
and wrists, which feels more ofan inconvenience than a bummer.
Right.
Um, hip fractures can be veryserious.
About one in five people needlong-term care after a hip
(20:53):
fracture, and the risk of dyingwithin the year actually doubles
after breaking your hip.
SPEAKER_02 (20:59):
Yeah, that's terrifying.
That's why people are always soafraid of that when we talk
about falls in LOL's little oldladies at home.
So once someone has a fracture,their chance of having another
goes way, way, way up.
And especially in the first yearafter that initial break.
So essentially what we're tryingto get at here is that we're
(21:20):
not, it's not just about names,it's not about definitions, it's
not about like whether a bonebreaks or not.
This becomes way more aboutindependence and long-term
health and being able to do thethings that you want to do.
Like one's life and mobilitycompletely changes if they have
a fractured spine or a fracturein their hip.
So getting a gauge of this andtrying to prevent it is all the
(21:44):
more valuable.
And all of this costs a lot too.
Um, osteoporosis-relatedfractures cost the U.S.
around 57 billion every year.
And if you didn't know, we havea lovely aging population, and
that number is expected to jumpto 95 billion by 2040, which is
pretty much right around thecorner.
(22:06):
But, you know, money is fake.
So, Nikki, let's jump into thesecond segment.
Can you intro the second segmentfor us?
SPEAKER_00 (22:15):
All right, Eddie.
Tell us why our bones weaken.
SPEAKER_02 (22:19):
So bones themselves are living tissue.
They constantly, if you didn'tknow, they are they're not
static.
They are constantly being builtup and broken down.
And when we're young, thebuilding outweighs the breaking
down.
But starting in our 30s, hoorayfor us, uh, that balance starts
to tip the other way.
SPEAKER_00 (22:39):
I'm so confused.
SPEAKER_02 (22:40):
Oh, I got it here.
And then for women, that loss ofbone really speeds up after
menopause.
And that's when estrogen dropsout of the picture.
Something that we're going to betalking about in a few weeks.
And that is one of the mainreasons that osteoporosis and
osteopenia is more common inwomen based on those figures
that we described to youearlier.
(23:02):
There are also other riskfactors to keep in mind that
make someone more prone tohaving osteoporosis.
A family history of havingosteoporosis matters.
Low body weight matters.
Smoking cigarettes matters.
Heavy alcohol use matters.
And certain long-termmedications, like several
(23:23):
long-term bouts of medicineslike steroids, can increase risk
of osteoporosis, though not likeone bout of steroids.
So that's something that isimportant to say out loud.
SPEAKER_00 (23:38):
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 messageessentially that they don't need
to stay strong.
And I feel like that's kind oflike the definition of if you
(24:02):
don't use it, you lose it.
SPEAKER_02 (24:03):
Yeah.
You know?
Exactly that.
SPEAKER_00 (24:04):
Like your bones are gonna be like, I'm just being a
loaf on the couch.
SPEAKER_02 (24:08):
I don't need to be strong.
SPEAKER_00 (24:10):
I don't need to be strong.
I'm not going anywhere.
SPEAKER_02 (24:12):
Not going anywhere.
SPEAKER_00 (24:12):
I'm not doing anything.
And then you stand up and youbreak your hip.
Bang.
Then you're in a nursing home.
SPEAKER_02 (24:18):
There that's it.
Boom.
Bang.
Men aren't immune either.
Their risk sharply rises afterage 70.
So also worthwhile to payattention there.
SPEAKER_00 (24:28):
Um now that we know why our bones weaken, how would
someone be diagnosed with eitherosteopenia or osteoporosis?
SPEAKER_02 (24:36):
Yep.
So it's a special test.
It's a special type of x-raycalled a DEXA scan, D E X A.
And it's a special type of x-raythat measures your bone density.
And it gets into a little bit ofstatistics, um, which I will not
bore you too much of, but it'sbased on a T-score, which takes
(24:57):
like uh the average populationof a person and it gives you a
number to reflect like where youfall in that average population.
So you get scores.
And if your score is betweenlike minus one and minus 2.4,
it's more likely you haveosteopenia and a score of minus
2.5 or lower is consideredosteoporosis.
(25:20):
There's also other calculatorsand risk scores that are
incorporated into this, butthat's more for your doctor to
think about than for you toworry about.
Even if your T score, as itwere, isn't super low, having a
fracture from a simple fall orsomething like that, something
that wouldn't normally break abone, can also mean that you
have osteoporosis.
(25:41):
So one of the scores or afracture in a setting that you
really don't think it would canbe diagnostic of osteoporosis.
And so thinking about thisoffers a great time to ask your
doctor, when should I getscreened?
The average for women isstarting at age 65.
Um, and then the men guidelineis a little wishy-washy.
(26:02):
But you can ask, when should Iget screened?
Reasonable question to ask yourclinician who's taking care of
you.
And what's my fracture riskcompared to other people my age?
And that's pretty much gettingat the T-score.
Nikki, I think this is a greatone for you because that was a
little uh boring statisticalstuff, but that's kind of to
(26:23):
pull back the curtain.
Can you tell us little everydayhabits that can help protect
your bones?
SPEAKER_00 (26:31):
So there's actually a lot you can do to keep your
bones strong no matter what yourage is.
Um, first starting withnutrition for strong bones.
So calcium, which we all know isa big one.
Um, I think milk for the longesttime was marketed as like giving
you strong bones.
(26:52):
Um so adults over 50 need about1,000 to 1200 milligrams of
calcium a day, but most peoplewill fall short.
Um how well I don't know if youwant to keep this in.
How much calcium does like aperson under 50 need?
SPEAKER_02 (27:08):
So the American Academy of Family Physicians
recommends that people under theage of 50 years old consume
about 1,000 milligrams ofcalcium daily.
SPEAKER_00 (27:17):
Okay.
Uh for calcium, you can getcalcium from a lot of our food.
So dairy, obviously, is probablythe biggest one.
And then um, if you're notdrinking dairy or eating dairy
for some fortified plant milks,tofu has a lot of calcium, leafy
greens, so like spinach, andthen a weird one is canned
(27:40):
salmon with the bones in.
Um, apparently has a lot ofcalcium in there.
SPEAKER_02 (27:44):
Yeah.
Apparently.
SPEAKER_00 (27:48):
But also keep in mind that calcium is very key,
but if we're having too much ofit, so more than about 1500
milligrams per day, it can umincrease your risk of getting
kidney stones.
SPEAKER_02 (28:02):
Yes, it can.
SPEAKER_00 (28:03):
Um, I've never had one of them, but they don't feel
fun.
SPEAKER_02 (28:06):
I like had a run of people I was seeing like a week
or two ago who just had like akidney stone after kidney stone
after kidney stone, and like ahistory of it or back pain and a
history of kidney stone.
I'm like, oh wow, we definitelyhave to think about this.
So it's a real thing out there.
Um, many people say it's likethe most painful thing you can
(28:27):
have.
SPEAKER_00 (28:28):
Yeah, that's what people say.
SPEAKER_02 (28:29):
I think some men like to pride themselves saying,
like, some woman told me oncethat it's worse, like who had a
child and they had a kidneystone, and they said that like
the kidney stone was morepainful.
SPEAKER_00 (28:40):
Yeah, I still work with the girl.
She had an unmedicated birth.
And whatever, then at whateverpoint had a kidney stone, and
she said that she would havepreferred the birth over the
kidney stone.
SPEAKER_02 (28:53):
That's crazy.
Um, so this next part I'll take.
So then that comes in theconversation of vitamin D.
Vitamin D is a vitamin, if youwill, um, that can help the body
absorb calcium.
So there are different agebrackets to this.
Um, there's a New EnglandJournal of Medicine invited
(29:17):
review.
And to break this down acrossthe ages, so for infants under
12 months, for an example, we'retalking like 400 international
units.
For people aged one to 70, I'llsay that again, one to 70.
It's 600 international units perday.
And that can happen in your diettoo.
(29:38):
For those aged 70 and older, 71and older, then the
recommendation goes up to 800international units.
Which you'll probably noticethat many, many, many people are
vitamin D deficient, probablyinviting a whole episode, but it
is intimately related toosteoporosis and osteopenia
because calcium goes through.
(30:00):
Directly into bone, and if youcan't absorb the calcium because
you don't have the vitamin D tohelp with the whole process,
like this is a whole medicalschool lecture and physiology
lecture that many peopleprobably got, but it's
complicated.
Nikki, can you tell us a littlebit more about where you can get
vitamin D from?
SPEAKER_00 (30:21):
Well, our favorite place to get it is from the sun.
And then other diet um or dietfood items would be again
fortified milk.
Eggs are high in vitamin D, andum fatty fish.
But a lot of people still havelow levels of vitamin D.
(30:43):
And about half of um peoplediagnosed with osteoporosis, are
deficient in vitamin D.
SPEAKER_02 (30:50):
Yeah, these are all very high numbers.
They all happen to be verycommon in these populations of
people.
Other things you can think aboutare improving the amount of
protein in your diet, magnesium,vitamin K, and vitamin C may
also play a role in vitamin Dabsorption.
A Mediterranean diet, literallyprobably the cure for
everything, is that is rich infruits and vegetables and olive
(31:11):
oil, have also been shown toreduce fracture risk as we step
away from vitamin D a littlebit.
So that's the Mediterranean diethelping to reduce fracture risk.
Um, in that way, we are sort ofthinking that you should have
five servings of fruits andveggies.
I told that to someone out loudthe other day, and they were
like, holy crap, that's a lot.
(31:32):
And I was like, yes, um, verydifferent than the American
diet.
And three servings of wholegrains a day are all great
things you can do for your bonehealth.
So you were talking earlierabout if you don't use it, you
lose it.
Um, what can we do in terms ofmeaningful timelines and
(31:54):
meaningful activities forexercise that can help
strengthen bones?
SPEAKER_00 (32:00):
So exercise is very important in keeping your bones
strong.
Um, so first doing, even if it'sjust like 30 minutes a day of
any weight-bearing activity, solike walking, hiking, dancing
will all help to keep your bonesdense.
And then also resistancetraining.
(32:21):
So using weights, usingresistance bands, doing body
weight exercises, um, they canalso help build bone density.
And then um balance andflexibility also really matter,
especially as you get older,which I know we've talked about
before.
(32:42):
Um, I forget what episode, butbasically we were just talking
about like getting older andlike how your balance is
important because if you havebalance issues, then you are at
a higher risk to fall.
SPEAKER_02 (32:58):
Um might have been episode 10 exercise.
SPEAKER_00 (33:01):
Oh, maybe, yeah.
SPEAKER_02 (33:02):
Which is crazy now, 70 episodes later.
SPEAKER_00 (33:05):
I know.
Um, and since most hip fracturescome from falls, preventing
those is a big bone, big bone,big part of bone protection.
SPEAKER_02 (33:13):
You mean could you say a big bone us?
SPEAKER_00 (33:16):
Again, we are here to tell you that it is important
to exercise daily, ideally.
If you don't want to fall, yourcore strength should stay strong
for as long as you can.
If you want to be able to likego grocery shopping and carry
(33:37):
your groceries inside whenyou're 80, you should be
exercising when like now.
Yeah, if you want to be able towipe your own butt when you're
80 and have that mobility, youshould be stretching, doing
mobility stuff, exercising.
Do all of that now so that youdon't end up in a nursing home.
SPEAKER_02 (34:01):
Yeah.
SPEAKER_00 (34:02):
Someone else is gonna be wiping your butt.
No one wants that.
You know?
SPEAKER_02 (34:07):
Well said, Nikki.
SPEAKER_00 (34:08):
I know.
I'm so eloquent.
SPEAKER_02 (34:10):
You are.
SPEAKER_00 (34:10):
You just gotta get straight to the point, you know?
SPEAKER_02 (34:12):
I know, yeah, I know.
Um, what I wanted to say is thatTai Chi, one of my favorite
podcasts that teaches me a lot,is um, they had an episode about
falls recently, and they spokewith a physical therapist and
really went in deep on Tai Chi,reducing the risk of falls.
And so there is a really solidrecommendation out there for
(34:34):
folks of a certain age, probablygreater than 65, or at increased
risk of falls and thecomplications thereafter.
That Tai Chi is like really,really beneficial.
SPEAKER_00 (34:45):
There's a whole group of people that do that in
the park.
Older adults.
SPEAKER_02 (34:51):
Yeah.
SPEAKER_00 (34:52):
Have you seen them?
SPEAKER_02 (34:53):
Uh which park?
SPEAKER_00 (34:55):
Washington Square.
SPEAKER_02 (34:56):
Uh no.
SPEAKER_00 (34:57):
Maybe and like in the morning, on like weekend
mornings.
SPEAKER_02 (35:00):
Oh.
SPEAKER_00 (35:01):
Yeah.
SPEAKER_02 (35:02):
Yeah, that's so great.
Is it oh yeah.
SPEAKER_00 (35:05):
Kind of in the middle where in the spot where
the fountain is.
SPEAKER_02 (35:08):
Yes.
Okay.
No, it's beautiful and it's sohelpful.
Um, you know, you can keep yourbones strong with all these
things and exercise, but likethis has been proven to reduce
fall risk.
Um, some figures by up to 30%.
And, you know, something wementioned earlier, we talked
about risk factors.
So there are certain lifestylemodifications you can make.
(35:30):
So if someone slaps you with adiagnosis of osteoporosis or
osteopenia and you're like, whatthe heck can I do?
That's not a medicine, you canavoid smoking.
Uh smoking increases the risk ofosteoporosis.
So it's a good excuse tocontemplate cutting back.
You can limit alcohol, probablyto the degree of no more than
two drinks per day.
(35:50):
Um some would say, and Iprobably would say that like
even drinking every day isprobably too frequent.
Um in Europe theirrecommendation is none, I think.
Here in the United States, arefor some reason we tolerate
higher amounts and aiming for ahealthy weight, which is
something we talk ad nauseumabout on this podcast.
(36:12):
Um, but being underweight,rather, because that can
increase the fall risk.
So then something we won't spenda ton of time talking about, but
just to highlight and say thatthis exists is when someone is
really high risk for fracturesand osteoporosis, that is when
medicine might be able to help.
(36:32):
And the most common medicinesare called bisphosphonates.
Um, you can take the time andread about them yourselves from
reputable sources, but um, acommon one is alendrinate.
And what this does is slow downthe bone breakdown.
There are also medicines that goby different names, and like,
you know, in this day and age,by the time you listen to this
episode, new medicines come outevery day, new information comes
(36:53):
out every day.
So we try to keep it asgeneralizable as possible.
And then there's a medicinecalled denosomab, but that
blocks bone resorption and thenthere's anabolic medications
that help build new bone.
There are big, three big typesof medicines that may be offered
you.
Um but truly one size does notfit at all.
(37:16):
So this is a conversationbetween you and the person
taking care of you.
As we're getting close towrapping up, we'll have a
conversation about other thingsto prevent falls and questions
to ask your doctor.
Um, Nikki, can you tell us acouple things in the home that
make big differences when itcomes to preventing falls?
SPEAKER_00 (37:37):
Yeah.
So a big one is um like arearugs and removing those because
like the like corner can flip upor you can just trip over it.
Um, keeping hallways well lit,installing grab bars in
bathrooms if someone would needit, and then wearing supportive
shoes around your house.
SPEAKER_02 (37:58):
Excellent point.
Doing these things can has beenshown to also reduce the risk of
falls by about 30%.
And then questions that yourdoctor will not mind asking and
might be able to help you with.
Do I need a bone density test?
What's my personal fracturerisk?
How can I get enough calcium andvitamin D?
Should I start or continuemedication?
(38:23):
These are all great startingpoints, and they open the door
to preventing problems beforethey start.
So, for today's episode, the bigtakeaway: osteopenia and
osteoporosis are common butpreventable.
Healthy bones start with whatyou eat, how you move, and the
habits you keep every day.
And the sooner that you start,the sooner you'll be able to
(38:44):
keep working on these things.
Strong bones aren't builtovernight, 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 starttoday can help keep you standing
tall and independent and livingyour own lifestyle for decades
to come.
(39:05):
Thank you for coming back toanother episode of Your Checkup.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
Check out our website, you canfind us on Instagram as well.
You can send us an email, yourcheckuppod at gmail.com.
But most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_00 (39:24):
I'm Nicole Ruth.
SPEAKER_02 (39:26):
Thank you, and goodbye.
SPEAKER_00 (39:27):
Bye.
SPEAKER_02 (39:33):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(39:55):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider 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 yourown checkup with your own
personal doctor.
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