Boost Your Bone and Joint Health

Amanda Newman (00:00:00):

Should you drink bone broth daily? How much calcium do you need? What lifestyle changes will lead to better joint and bone health over time? All that and more on this episode of The Healthiest You.

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While another birthday is a blessing, the aches and pains that can come along with growing a year older are not. But being proactive about your joint and bone health now can make a difference.

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We are focusing on women’s health and wellness on The Healthiest You podcast. Whether you’re on your way to work or enjoying a cup of coffee, take this time to focus on your health.

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Here to talk about joint and bone health are Dr. Marie O’Brien, rheumatologist with Lehigh Valley Health Network, and Dr. Scott Sexton, orthopedic surgeon with Lehigh Valley Orthopedic Institute.

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Dr. O’Brien and Dr. Sexton, welcome to the show.

Marie O’Brien, DO (00:00:57):

Thank you for having us.

Scott Sexton, MD (00:00:58):

Yes, thank you.

Amanda Newman (00:00:59):

So let’s start off by talking about bone broth. Many people are buying it at their local market, the grocery store, or some people are even making it at home. What are the health benefits of drinking bone broth?

Scott Sexton, MD (00:01:12):

So that’s an interesting question. We often learn as much from our patients as sometimes we teach them during our appointments. And diet is a big thing because there’s so many different diets out there, some gain in popularity, some lose popularity over time. But bone broth certainly makes sense. You can make it yourself at home, you can buy it at stores, and at the end of the day, it’s kind of breaking down the elements that ultimately help form bone and connective tissue and breaking them down to their basic components, your proteins, your amino acids. So they can be very helpful in helping us maintain our bone health and our soft-tissue health because not only does the bone broth contain the precursors of bone and amino acids, but also our collagens, which are important for our tendons and connective tissue.

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It also has been shown to promote abdominal or gut health, meaning for people who have irritable bowels or things like that, the bone broth actually has a protective component.

Amanda Newman (00:02:24):

Interesting. Do you drink bone broth?

Scott Sexton, MD (00:02:26):

I have not, but after reading and learning more about it from my patients and also for this podcast, I’d certainly be willing to give it a try.

Amanda Newman (00:02:35):

Definitely. I occasionally do and I enjoy it. I usually spice it up a little bit, throw some seasoning in there just to kind of make it a little more enjoyable, add some more flavor.

Scott Sexton, MD (00:02:46):

Sounds delicious.

Amanda Newman (00:02:48):

Is there anything you’d like to add Dr. O’Brien?

Marie O’Brien, DO (00:02:50):

Yeah, so interesting. The natural approach I think is where we are in the 2020s, focusing on, I think, a lot of patients are avoiding gluten or they’re avoiding high sugar or they want to eat healthier. So bone broth is, I think the newer fad. It is all natural. One thing to caution too is avoiding high salt in some patients who may have high blood pressure. So all these types of supplementations or healthy eating are important to take at an individual basis. So patients have risk factors for heart disease.

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But getting back to the question, I actually grew up with bone broth, European family, and my grandmother always made her soups using carcasses of the chicken, and it was the best soup and very healthy, very gut-friendly. And more and more literature is promoting it, not just for bone health, but I think for general health or patients that may have malabsorption issues, it can be very beneficial for them.

Amanda Newman (00:04:00):

That sounds delicious. Nothing like homemade soup. Have you carried on that tradition of making it?

Marie O’Brien, DO (00:04:04):

I have for chicken soup, yes.

Amanda Newman (00:04:06):

Oh, that’s nice.

Marie O’Brien, DO (00:04:08):

Yes, it’s very easy. It’s very easy. And all natural, and it’s very healthy.

Amanda Newman (00:04:14):

So there are 28 types of collagen in our body. Which ones are important for bone and joint health?

Marie O’Brien, DO (00:04:21):

So there are multiple types of collagen, and specifically type 1 collagen is more bone as well as ligaments, tendon and cartilage. And when the people are taking collagen supplements, whether they’re topicals or they’re oral, the purpose is to replenish. So when taking oral supplements and they’re like, “I want to take collagen, it helps strengthen my bones.” Unfortunately, there’s no FDA regulations to say this is how much you should be taking.

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So I think it’s important reading the ingredients. For aging properties, if people are taking collagen to help prevent wrinkles, those are more topical and maybe they are supplementing with orals. So there is, as mentioned with bone broth, these are building blocks of bone and structure.

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So we’re not sure how much they help overall results, but we know there’s a role. There’s a role. Because we make our own natural collagen, and as we age, we lose part of that, whether it’s in our ligaments, in our tendons, in our bone structure or in our skin. So we all want to be healthy and support that. So I think collagen is important. Just the question becomes, well, how much, how do I get it back?

Amanda Newman (00:05:34):

That’s what everyone always wants to ask. Well, how do I know how much is right? And too much, too little. But there’s not a clear-cut answer. It’s kind of individualized.

Marie O’Brien, DO (00:05:44):

Right. And body-part wise, people get collagen injections, and certainly they’ve been shown to be safe as well, and they can look very natural. And then it’s actually ingesting it and seeing is it helpful for me.

Amanda Newman (00:05:58):

And is there anything you’d like to add, Dr. Sexton?

Scott Sexton, MD (00:06:00):

Yeah, no, that was great, but I don’t want to date myself, but I guess I graduated medical school in 2000. I mean I’m sure there’s more types of collagen now than there was then, because science is great and we learn new things all the time. And breaking it down the simplest way is collagen has to serve so many functions, right? It’s in our skin, it’s in our muscles, tendons and bones. So the collagen in our skin, we want it to be more pliable and flexible. We don’t want tight fibrotic skin. We want it to be nice and smooth. Whereas our bones, we want them to be strong, so we need a stronger collagen there.

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I always remember in medical school, we all want to do well on our exams and they’ll always ask what type of collagen is where, and type 1 was in the bone, right? ‘Because one is O-N-E and bone is B-O-N-E. And from there, there’s multiple other kinds and they’re all important to maintain the structure of our skeleton, our soft-tissue envelope, and they all serve different roles and purposes and they heal in different ways too.

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My patients always ask me as a doctor who took care of a lot of fractures, “Is it as strong as new when it heals?” And the one great thing about being an orthopedic doctor is, believe it or not, I can tell them with relative confidence that the bone is actually the one thing in the human body which heals as good as it was before. Because if you have a cut on your skin, does it ever look like skin again? No. You have a big scar. If someone’s in a bad accident and has a cut in their brain, is it ever the same? No. Same thing. Even the cartilage of our joints, if you damage your joints, your hyaline cartilage never reforms. You get fibro or scar cartilage.

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Whereas through whatever evolution or whatever you want to call it, our bones have to heal as good as they were before or else we wouldn’t be able to get up and walk. We wouldn’t be able to get away from predators back when the dinosaur age or whatever. So our bones have to recover or else it would be kind of a death sentence.

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So the bone is actually the one thing in the human body, which because of the type 1 collagen and the other components, is actually as strong as it was before.

Amanda Newman (00:08:22):

Wow, that’s amazing. Well, we’ve definitely evolved a lot since the dinosaurs.

Scott Sexton, MD (00:08:26):

Exactly.

Amanda Newman (00:08:29):

As we age, collagen levels start to decline, which can damage our joint and bone health. What are the most effective ways to boost collagen, and do you recommend most women take a collagen supplement?

Marie O’Brien, DO (00:08:42):

The most important thing is exercise and healthy eating. I think that’s imperative. Collagen is also in natural food. So whether in protein, egg whites and certainly hydration is key, and exercise for keeping the muscles strong around those bones and keep the ligaments stretched, tendons strong. So a combination of good healthy diet and exercise is key.

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As far as supplementing, many multivitamins and there are individual collagen supplements that you can take. There’s no recommended amount as far as like we say, calcium and vitamin D, which we’ll allude to later. There are guidelines, we don’t necessarily have that yet through evidence-based studies to say you need this amount of milligrams or units of collagen. But certainly the exercise to keep the muscles strong will help prevent further deterioration of those joints and ligaments.

Scott Sexton, MD (00:09:47):

Yeah, I would agree with everything Marie said. And Marie and I treat a lot of people with osteoporosis, and there’s 65-, 75-year-old patients and it’s never too early to start thinking about this. The problem is that if we wait till everything’s declining and worsening, it’s harder to restore that.

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My daughter just asked me about, she … lives in Chicago and has a job now and asked me about saving money. So I kind of showed her if you start saving money when you’re 22 and you get compounding and the growth, it’s a lot better than if you start saving when you’re 60. It’s the same thing with building your bone and collagen, right? If you build your peak mass and your stores by being healthy, participating in sports or other activities as a kid, eating healthy as a kid, not smoking, doing all those things, if we’re starting way up here in our collagen mass and bone mass, then it takes a lot longer to get into those warning zones or danger zones. So everything Marie said about getting your supplements, but starting early is the key.

Marie O’Brien, DO (00:11:06):

So I think it’s important too to also focus on prevention. So smoking, as Scott alluded to, avoiding smoking, alcohol, and one thing that’s really critical with collagen is sleep. And as we age, we seem to get less and less sleep and that is really critical to preserve collagen and getting enough rest. Also too, our muscles can regenerate, our bones can heal. So that’s really critical too, to focus on.

Amanda Newman (00:11:36):

We should be aiming for what, eight to nine hours?

Marie O’Brien, DO (00:11:39):

Ideally yes.

Amanda Newman (00:11:40):

OK.

Marie O’Brien, DO (00:11:40):

In a real world, not maybe real.

Amanda Newman (00:11:43):

I’m lucky if I get seven. I really would like eight or nine though.

Marie O’Brien, DO (00:11:46):

Yeah, yeah.

Scott Sexton, MD (00:11:47):

That sounds great. I’m going on vacation next week, so hopefully I’ll store up some extra hours.

Amanda Newman (00:11:52):

There you go. You can catch up on all the missed sleep that you have.

Scott Sexton, MD (00:11:54):

Exactly. But I think to your one question, should everyone take a collagen supplement? I mean eventually it becomes hard, right? There’s so many different supplements and we’re going to talk about even more later, how many can you take? And I think Marie alluded to it earlier with the medications we prescribe, I mean, they’re all carefully monitored, researched and studied. Whereas a lot of the supplements and dietary aids have a little less – they’re not monitored by the FDA.

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So do you have to take a collagen supplement? I mean, it’s probably not going to hurt. But at the end of the day, if you’re staying active, eating healthy, getting a lot of proteins, the egg whites, the fish, the meats that Marie mentioned, that’s the initial building block you want to start with.

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If you’re found to be collagen deficient or having issues with your connective tissue or skin, then certainly it’s totally reasonable to take a supplement with the understanding that your body doesn’t actually absorb collagen. What it’s absorbing is the amino acids and the basic building blocks, and then your body has to regenerate and re-create the collagen to start all over again.

Amanda Newman (00:13:16):

Interesting. Well, thank you both for breaking that down and explaining it because I feel like there’s a lot of people that have questions all about collagen. And I just think it’s really just essential that we understand how it works, that it is a building block, and focus on getting those whole foods that are rich in collagen and then if necessary maybe consider a supplement, but we can only have so many supplements too at the same time, so.

Scott Sexton, MD (00:13:39):

For sure.

Amanda Newman (00:13:43):

Another thing you had mentioned was the importance of exercise. So that can boost collagen production and strengthen bones. I’m curious, what are the best workouts to keep your bones and joints healthy?

Scott Sexton, MD (00:13:55):

I think that certainly changes as we age. When we’re younger, obviously we’re a little more fearless and reckless. It’s important to participate in sports, be part of a team, kind of regular aerobic exercise, as well as strengthening exercise.

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The population Marie and I take care of for the most part are older individuals who suffer from osteoporosis or osteopenia, which is kind of thin bone, and exercise is incredibly important for this age group. And what we like to recommend is walking or what we call weight-bearing exercise, meaning we want to be striking our heels because that our body somehow has the miraculous ability to sense that weight-bearing load and realize how important it is to keep our bones strong and healthy.

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So walking five times a week or some other weight-bearing equivalent such as a StairMaster or going up and down stairs or even going to a dance class with your loved one. Or if you don’t love him, you can still go dance, right? It’s fun.

Amanda Newman (00:15:04):

I go to dance class with my husband. We take ballroom.

Scott Sexton, MD (00:15:10):

Impressive, yes. The American College of Endocrinology guidelines would suggest you do walking or weight-bearing exercises five times a week for 20 to 30 minutes a day and then add on strength or resistance training two times a week. So that can again vary. Someone who’s older may just have one-pound dumbbells or bands, whereas someone who’s younger is still going to the gym and using the weight rack or you got to do what’s best for you.

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For the most part, we like to think exercise is safe, but if we’re getting older and our bones are getting a little more frail or weak, or we have osteoporosis, there are risks too. People who have severe osteoporosis, you have to be really careful leaning forward or being forward flex because that places a lot of pressure on your spinal column and vertebral bodies.

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So we actually have therapy programs where you can have an exercise prescription and learn important things to do and not to do, but you got to do something really. But that’s what we like to tell our patients.

Amanda Newman (00:16:16):

Definitely. And it’s so important to start now, like 20s, 30s, 40s, 50s, like get that exercise regimen in place because your bones might thank you later in life.

Scott Sexton, MD (00:16:28):

Yeah, for sure.

Marie O’Brien, DO (00:16:30):

I think what’s important too is finding what you love. And I think that’s the hard part. If somebody doesn’t exercise, they’re going to look maybe to social media or what their friend is doing, and that may not be a program that’s for them. The key is being consistent and to be consistent, you got to like it. And the hardest part is just getting off the sofa and getting started.

Amanda Newman (00:16:52):

Indeed.

Marie O’Brien, DO (00:16:53):

So whether it’s going with a loved one to a class or walking with a neighbor or spouse or your kid or  bike riding, finding something that you like, and then being consistent. Everyone’s different. Yoga may be perfect for one person, running for the next person.

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But also important is to change your styles. You don’t want to be running seven days a week. You want to be balancing cardio with strength training. There has to be some form of weight bearing. You really have to work on core -- whatever you do – because core helps strengthen your low back. If you have osteoporosis, the low back is a target. Vertebral fractures are very common. So if you have a strong core, that lowers that risk of fragility fractures in that area.

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And then balance. So even simple walking every day can help reduce risk of falling by helping your balance. If you’re older and just have issues ambulating, tai chi, chair yoga. So there’s all flavors of exercise, wall Pilates that everyone can exercise in some way or form, but understanding that it’s not one-size-fits-all. It’s finding what works for you and tailored to your body and what you’re passionate about.

Amanda Newman (00:18:10):

That’s important, to find something that you enjoy doing that still challenges you, but something that you can be consistent with because that is so important.

Marie O’Brien, DO (00:18:19):

Yeah.

Amanda Newman (00:18:19):

I’m curious. What are your favorite exercises, both of you?

Scott Sexton, MD (00:18:24):

I’ll let you go first.

Marie O’Brien, DO (00:18:26):

I’m a runner and that was instilled. My dad was a runner. He still runs, not as much at his age. But seventh grade he would make us get out there, and I hated it as a kid. But now I’ve learned it is my antidepressant. And when I’m not running, I don’t feel well, I’m bummed out. When I get in a routine … overall it just makes my day better.

Amanda Newman (00:18:53):

It’s those endorphins.

Marie O’Brien, DO (00:18:55):

And I bring people to run with me.

Amanda Newman (00:18:56):

Yeah, a running buddy.

Marie O’Brien, DO (00:18:58):

Yes.

Amanda Newman (00:18:58):

Love that.

Marie O’Brien, DO (00:18:59):

Yes.

Scott Sexton, MD (00:19:00):

So I played basketball growing up, so that was my thing. And then as you get older, you kind of phase out. I remember I was still playing up to like 42 or 43 and then ...

Amanda Newman (00:19:11):

That’s great.

Scott Sexton, MD (00:19:12):

And then one night – they always give the young kids the best times in the gyms. We were playing at 9 p.m. at night and I’m like, “Forget this man. It’s time to retire.”

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I like running. I’ve done some 5Ks and half-marathons. I also did use to enjoy doing yoga, stretching your joints. Probably feel better after doing that than anything else. Unfortunately, I actually have my own orthopedic condition and a bad elbow, so it makes a lot of the poses and weight-bearing things difficult. But I guess if I had to give an answer, it’d probably be running. Although my partner Dr. [Yury] Bykov doesn’t call what I do running because I go too slow. So I guess jogging. I guess jogging is what I do.

Amanda Newman (00:19:58):

Now what is running too slow?

Scott Sexton, MD (00:20:00):

I once ran a half-marathon with him and I told him I did nine-and-a-half minute miles and he laughed since he does six-minute miles. And he finished 130th out of 13,000 people, but I couldn’t believe it when he blew past me in the park, but it was quite an experience. So I’ll stick to jogging for now.

Amanda Newman (00:20:20):

I just had a flashback to high school when we had to run a mile, and I was always so disappointed because I was always the student that did not get the best time. I’m more of a walker, I’m not a runner, but I try to get my steps in each day as far as exercise. And I really enjoy strength training. It’s something my husband and I have been doing. We have a bench set up, we have a barbell, we have some dumbbells. And it’s just, it’s good for my mind. It feels good on my body. Maybe not so much the day after, but if you don’t feel a little sore, is it really doing what it’s supposed to do?

Marie O’Brien, DO (00:20:55):

Exactly. Yeah.

Scott Sexton, MD (00:20:56):

Exactly.

Amanda Newman (00:20:57):

So the phrase “milk builds strong bones” has been a phrase many have heard since childhood. Some studies show that milk does not lower a woman’s risk of fractures later in life. Is milk really not necessary for most women?

Marie O’Brien, DO (00:21:12):

I think certainly dairy was heavily pushed years ago, and the pendulum has now swung in the opposite direction that we focus on dairy because of calcium, bone building. But certainly we can get calcium in other sources because dairy can also be bad for our cardiovascular health due to high fat content, increased atherosclerosis with high levels of dairy, and there are other healthier ways to get calcium like in almond milk or coconut milk. And then there’s that patient population that doesn’t tolerate dairy, causes a lot of GI upset or they have lactose intolerance.

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So a feel that the palate is changed, that we’re not focused as heavily on dairy. Now in the pediatric population that is different. Kids are growing and we want them to have foods rich in protein, and milk can be – if tolerated – milk obviously is recommended for those growing bones. But in the adult population, certainly looking at calories, fat content and making sure you’re getting well-balanced and you can get proteins in other areas other than dairy products.

Amanda Newman (00:22:30):

I personally opt for the low-fat milk just because I think it has a little healthier edge to it. And I love putting milk in my smoothies. I also really love matcha right now. There’s a strawberry matcha trend going on. I don’t know if either of you enjoy matcha, but so good. So I like to think that I’m getting a bit of calcium but not overindulging.

Marie O’Brien, DO (00:22:52):

Yes, yes.

Scott Sexton, MD (00:22:53):

I think the big thing you said at the end was not overindulging. I think no matter what, as we go through time and here, all different fad diets, all different trends. I think at the end of the day, everything in moderation is probably OK and probably has benefits. So certainly some dairy, some milk is probably still important.

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But again, there’s multiple other food sources and supplements where we can get our vitamin D and calcium. And typically that’s a common part of our evaluations at the Bone Health Center [LVPG Bone Health–Hausman Road]. We go over foods rich in vitamin D and calcium and often hand out pamphlets with that information, as well as point the avid computer user to Google because certainly you can find that information on any important search.

Amanda Newman (00:23:44):

So as we’re talking about calcium, it brings me to my next question of: Do most women need a calcium supplement in addition to eating calcium-rich foods?

Marie O’Brien, DO (00:23:54):

Absolutely. I think it depends mostly on the age of the female patient. So we typically don’t recommend calcium supplements to kids and we promote healthy eating and getting calcium naturally. Nearing menopause, or say you have an underlying health condition that you’re not able to get calcium through your food, then supplements are recommended. And at menopause, we do have guidelines through National Osteoporosis Foundation, American College of Rheumatology that we typically say 1,000 milligrams of calcium is recommended under the age of 50. Over the age of 50, we say about 1,200.

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So this is where it gets a little confusing for a lot of people out there because what’s on the shelves is not 1,000 milligrams, and how much you ingest in one sitting is critical. So your kidneys can only handle 600 milligrams at one time. So if the recommendation’s 1,200 milligrams calcium and you’re a 65-year-old female, that means you’re going to have to take 600 milligrams in the morning and 600 milligrams later in the day or evening. Really important.

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And then what other meds are you taking? There are some meds that calcium won’t get absorbed if you’re taking Synthroid. Synthroid has to be taken by itself, which is a thyroid replacement, and then you take your calcium later. So definitely important to review with your family doctor based on your other health conditions, what other medications you’re on, when you’re taking your calcium.

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And then a whole separate topic is the importance of vitamin D, which is just as critical as calcium. But rule of thumb, we say on average for the patients that we see in rheumatology I see age 16 and older, the orthopedic populations, certainly the osteoporosis patients, mostly post-menopausal women, our target is like 1,000 to 1,200 milligrams of calcium. Naturally, green leafy vegetables, dairy products, orange juice, so fruits and vegetables, you certainly can get some calcium supplementation. And the green leafy vegetables are very high in calcium, spinach as well.

Amanda Newman (00:26:04):

Excellent information. Thank you so much for sharing all of that. And is there something else that you’d like to add, Dr. Sexton?

Scott Sexton, MD (00:26:11):

Yeah, I’ll go back to my savings in the bank analogy because that’s what I tell my patients when they come. When we get our blood level checked, the calcium is almost always normal because we’re measuring what’s in our blood. And if it’s not, you probably have another underlying problem, a parathyroid hormone problem, a kidney problem, because everyone thinks calcium in bones, but calcium is so important for everything else. It makes our muscles contract, and our heart’s a muscle. It makes our nerves work. So it’s making our brain function.

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So sadly, as an orthopedic surgeon, I realized that the bones aren’t our body’s number one priority, right? Probably heart is and our brain is. So our body’s always going to steal calcium from bones because our bones serve as the calcium storage bank to keep it normal in the blood to make our heart work, to make our brain work.

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So that’s why we have to make sure we maintain our calcium stores and our calcium supplements and daily intake. Because you may say it’s normal in my blood, every test is normal, but I mean your body’s going to fight to keep it normal because it wants your heart to beat, it needs it to contract and pump blood, it wants your brain to work. But people don’t realize that it’s stealing it from the bone the whole time. And that’s where, as an orthopedic doctor, we get to be important again, by helping people understand maintaining their bone health by keeping our bones strong. So again, like Marie said, it’s important to get your supplements, but also through the diet as well.

Amanda Newman (00:27:40):

And most importantly, talking with your physician and getting their recommendation and really partnering with them to figure out what is best based on your needs.

Scott Sexton, MD (00:27:51):

Exactly.

Amanda Newman (00:27:51):

I have a very serious question. Why is it called the funny bone when it’s not even a bone? We all know it’s not exactly humorous when you accidentally whack it against something. What’s the scoop?

Scott Sexton, MD (00:28:07):

That’s a quite interesting question, and it has touched my life in a certain dramatic way. Number one, taking care of my patients. We do see a lot of patients who’ve had humerus fractures, and I almost stole your line there. I say, you broke your bone. It’s not that humorous, but it is your humerus. And then unfortunately for myself, I actually have what’s called cubital tunnel syndrome, which is the condition why it’s called the funny bone, because your ulnar nerve runs right behind your humerus bone and can get pinched, trapped, compressed. And what happens is then every time it gets pressure or hit, your whole arm gets tingly, particularly down into your fourth and fifth fingers. So I’ve kind of developed numbness in my hand and kind of a contracture of my finger. So unfortunately I no longer operate as an orthopedic surgeon.

(00:29:04):

And so that’s kind of part of why I’ve kind of shared interest with Marie and taking care of people with osteoporosis and thin bone as I have ended my operative career. And now have realized that over the past 15 years I saw a lot of people with fractures and then over the next year or two, saw them back with another fracture. So that’s prompted Marie and I and the rest of the orthopedic division to start a Bone Health Center [LVPG Bone Health–Hausman Road] to treat people who get osteoporosis and have fractures to make sure they don’t get a second fracture.

Amanda Newman (00:29:40):

So what is your best bone joke or was that the best one you got?

Scott Sexton, MD (00:29:43):

I was texting my PAs [physician assistants] all this morning and they were trying to come up with jokes, and I have to tell you, there are a lot of skeleton jokes on the internet and not many of them are good. And I’ve never been a good storyteller or joke teller and always hated hearing my voice on these type of things because I thought I was very monotone. And my one for the kids was always, “Why did the chocolate chip cookie go to the hospital? Because he felt crummy.” But I’m not really sure that applied here.

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So I did spend a day realizing that I’m not a good joke teller, and I think I got that from my father. He would always tell the same story over and over again to the point where no one was listening and maybe only my mother was laughing, and I guess probably she was the only one laughing at mine and his jokes. I mean I guess it’s good now, because she’s like 75 and has osteoporosis and she’s always cracking up.

Amanda Newman (00:30:45):

That was good.

Scott Sexton, MD (00:30:46):

I tried. It took all morning.

Marie O’Brien, DO (00:30:49):

I can’t top it. I can’t. I can’t. I am a horrible, my husband, can vouch. I give away the punchline as I’m telling it. I’m the worst joke teller.

Amanda Newman (00:30:59):

Well, at least our husbands can laugh at our jokes.

Marie O’Brien, DO (00:31:03):

I am all about hearing them, but I can’t tell them. I can’t.

Amanda Newman (00:31:07):

Well, thank you for that. That was really fun. I enjoyed that and I’m sure our listeners will too.

Scott Sexton, MD (00:31:12):

I tried my best.

Amanda Newman (00:31:15):

So how do bones change with age and when do women start to lose bone mass?

Marie O’Brien, DO (00:31:21):

So actually bones start to change for women starting at age 30. So we reach peak bone mass essentially in our 20s. At puberty is when we start seeing major hormonal changes and then peak bone mass [in our] 20s. And then starting in our 30s, we start to lose some estrogen.

(00:31:42):

When estrogen is lost, whether naturally or surgically, so say in women who have a hysterectomy, removal of the uterus and the ovaries, that absence of that critical hormone really accelerates the bone loss process. So in some women osteoporosis can occur much younger. Other women, they may not hit menopause until later in their 50s, and so they will have that added protection of estrogen.

(00:32:17):

In addition to the estrogen component, we also lose water out of our joint spaces. So our cushions that are filled with water when we’re younger, they start to desiccate. So you lose that water. We shrink. The spaces between our vertebrae and our spine get smaller and leads to arthritis, as well as you lose the bone mass, which can increase your risk for fracture. So the actual age itself is not set in stone for everyone. And in men, testosterone is key. So men typically lose their bone mass later than women.

Amanda Newman (00:32:59):

So earlier we were talking a lot about different foods and supplements that can improve your bone and joint health, but something that we didn’t touch on is prunes. We know that eating prunes to keep things regular is not new information. But what about their impact on bone health? Researchers say they may slow down age-related bone loss and even reduce risk of fractures. They recommend eating five to six prunes a day. What is your take?

Scott Sexton, MD (00:33:32):

That’s certainly an interesting question and really if you try to keep up with every study and the literature out there – it’s like I have journals all over my house that my wife gets angry about. There’s just so much out there, prunes, everyone loves them, doesn’t love them, keeps things moving and grooving.

(00:33:56):

But when it comes to bones, someone actually did do a study, believe it or not, to see if this can strengthen our bones. They took patients and put them into three groups, people who ate no prunes, people who ate a moderate amount of prunes, five to six a day, and people who ate a lot of prunes.

(00:34:14):

So after a year they looked at the difference in bone density and bone quality, and they found that the people who ate no prunes actually had decidedly lower or less bone mass in their tibia compared to the other two groups. So their conclusion was that some prunes are probably good. You don’t have to go crazy and eat 12 or 20 prunes a day, but eating that moderate amount of five or six a day may actually prove to be beneficial to helping maintain our bone health and bone strength.

Amanda Newman (00:34:48):

Might as well keep the bowels and the bones healthy and happy, right?

Scott Sexton, MD (00:34:53):

The killer Bs, the bowels and the bones.

Amanda Newman (00:34:58):

So half the population is considered magnesium deficient. So how do low magnesium levels affect your bones? Is a supplement important to consider?

Marie O’Brien, DO (00:35:10):

So magnesium is important for bone health. I truly feel it doesn’t get the attention it deserves. It’s not something that’s commonly on a basic panel your family doctor orders. Magnesium plays a critical role with calcium. So if there is an underlying condition that you have issues absorbing vitamins like calcium, magnesium is probably low as well.

(00:35:36):

So it’s important that that is checked routinely. It is on our panel for osteoporosis when we’re checking patients to make sure not just magnesium but vitamin D and calcium are in line, and if they’re deficient, we certainly replace it.

(00:35:51):

Also important too, that the patient has healthy functioning kidneys because that can affect all your electrolyte levels. So a replacement of magnesium for someone that has normal kidneys may be different. The amount may be different if the kidneys are not functioning as well, as well as what other medications they’re taking commonly like water pills or diuretics, they can deplete your electrolytes including magnesium. So everything’s related. So typically wouldn’t isolate one electrolyte alone; we’re checking multiple electrolytes to see if they’re all in line. But magnesium being low is a common thing.

Amanda Newman (00:36:33):

I actually take an element [LMNT] packet. I don’t know. Do you recommend those at all to patients? They’re like electrolyte packets.

Marie O’Brien, DO (00:36:42):

Again, depends on what their levels are. My philosophy has always been less is best and also to enhance compliance. So certainly if it’s warranted, I recommend it, but if their levels are normal, I don’t push extra.

Amanda Newman (00:36:56):

Sure, that makes sense.

(00:36:58):

So now what about vitamin D and potassium?

Marie O’Brien, DO (00:37:02):

So vitamin D is huge. I’m a huge fan of checking vitamin D levels in all my patients regardless of their existing bone health because vitamin D is critical, not just for bones, but muscle, memory, sleep. We see a lot of deficiency based on our zip code here in PA, we don’t see the sun much. Our winters are long. Or I see college students and their vitamin D levels are critically low because they’re just not out getting the natural sunshine or their diet is poor in vitamin D. So certainly it is a key vitamin that I check routinely. You can get your vitamin D checked, your levels checked twice a year, and most insurance plans cover that.

(00:37:46):

Potassium kind of goes along with the magnesium. So that’s part of your basic chemistry panel that’s checked by your family doctor. If magnesium is low, potassium certainly may be low as well, but I don’t routinely replace potassium, especially if they’re on other medications that can impact those levels. But the vitamin D repletion levels above 30 are normal. Yet you don’t want to be too high. Levels above 80 may be associated with kidney stones. So important that if someone is low, they’re getting the right repletion and they’re getting follow-up that those levels are being checked to make sure that they’re maintaining, not that they’re just left on a high dose and then continue and their levels are going too high, or they only take it for eight weeks and then they go back to what their levels were previously.

(00:38:34):

And there’s all different flavors of vitamin D. The key is vitamin D3. That has been shown to be better absorbed than the D2 supplements.

Amanda Newman (00:38:44):

How often would you recommend someone getting their vitamin D level and their magnesium levels checked?

Marie O’Brien, DO (00:38:49):

So basic. So again, based on the health of the patient, if they’re a younger patient, their annual blood work, I think vitamin D should be incorporated with that in their chemistries. If they’re routinely low, getting them checked twice a year to make sure they’re maintaining. Plus, if you’re being treated for osteoporosis, those medications are, they work better if your vitamin D levels are normal. If you’re deficient, you have to fix the vitamin D before going on osteoporosis therapy.

Amanda Newman (00:39:18):

Well that brings me to my next question about osteoporosis. Women are four times more likely to develop osteoporosis than men. So why do women have a higher risk?

Marie O’Brien, DO (00:39:30):

The risk is higher in women because of the estrogen loss. So as estrogen declines, so starting in our 30s, we start to lose those levels and then when we hit menopause, estrogen’s gone. And then there’s a rapid decline in bone loss. And that can occur over a period of three to five years. And as far as the rate of change of bone loss, it can be different in each individual, but based on the amount of estrogen you have in your body or other medications you’re on or your physical health or other medical conditions that you have, that can further accelerate bone loss.

(00:40:04):

As a rheumatologist, I see rheumatoid arthritis, I see lupus, psoriatic arthritis, other autoimmune diseases that certainly can affect their gut health or they’re taking steroids which rips the calcium out of bone and causes rapid bone loss. So it’s important that we adequately screen appropriately for osteoporosis in women. We certainly, we say the age of 65 women should have a DEXA scan, but even younger women who have risk factors should be screened earlier, especially if they hit menopause at an earlier age.

Amanda Newman (00:40:37):

OK. Interesting. I think a misconception about osteoporosis is it something that we worry about later in life, but it’s never too early, as you both mentioned earlier, to start thinking about ways to prevent it now. So what things should women avoid and start doing in their 20s, their 30s, 40s, to lower their risk of osteoporosis?

Scott Sexton, MD (00:41:03):

Yeah, I mean I think we’ve talked about that earlier in the podcast about obtaining a peak bone mass when we’re younger. So you want to avoid a sedentary lifestyle, you want to stay active, exercise, weight-bearing exercise, whether walking or running. We want to optimize our diet including all the things we just ran through, your vitamin D, your magnesium, your calcium, your proteins and amino acids for building blocks of bone and collagen and soft tissue. I mean the bone is like everything else in the body, right? Things are going to be bad for it too. We talked about all the good things you can do for it.

(00:41:41):

What’s bad? So bad is everything always comes back to smoking, right? Smoking’s bad for everything. So smoking’s bad for your bone health too. We see it in osteoporotic patients, as well as in our patients who have fractures when they’re younger or any time, if you smoke, there’s almost two times a chance of the bone not healing or being very slow to heal. So when patients ask what they can do, that’s always one of the big things. Do everything in moderation, don’t smoke, stay active and eat a healthy diet.

Amanda Newman (00:42:14):

And how about the whole phrase that sitting is the new smoking. And a lot of us have very sedentary lifestyles, especially if we’re in front of the computer or if we’re a student, we’re not moving around as much as we used to.

Scott Sexton, MD (00:42:28):

Right. I mean, I’ll admit that I do have a 4-year-old and she loves to go on her tablet and watch YouTube or Lingokids, which is a game or Netflix. And it’s important to know you make sure you’re getting your kids even at a young age out and participating. Even if it’s running around the yard or gymnastics or soccer or whatever, but you just can’t sit at a screen eight hours a day, unless that’s your occupation and job. But at home you can’t be doing that all day long and not stressing our body, getting our exercise and participation in activities. Those things are just so important.

Amanda Newman (00:43:09):

Now what about the trend of grounding or earthing? Can this lower your risk for osteoporosis?

Scott Sexton, MD (00:43:16):

Interesting question. And I actually, in getting the syllabus for this talk, did some research myself and it kind of hit close to home. Because I actually went to Costa Rica this winter and was walking through the rainforest and our tour guide gave us information that they’ve actually done studies when you’re out in nature, when you’re especially in a rainforest, if they’ve measured levels of immune cells in your lungs and tissues, they’ll actually stay significantly elevated for two weeks after being in a rainforest.

Amanda Newman (00:43:51):

Two weeks?

Scott Sexton, MD (00:43:52):

Two weeks.

Amanda Newman (00:43:52):

Amazing.

Scott Sexton, MD (00:43:53):

So the theory behind the grounding or earthing is that if we’re walking barefoot, if we’re touching the soil, the grass, especially water, so the beach, the sand, that there is an inherent electric current within our body and there is a thought or theory that that is good for essentially everything, right? Our muscles, our nerves, our connective tissues, including the bone. So I know your mom said don’t run outside on the concrete, you’ll cut your foot if you don’t have your shoes on, but apparently there’s some science that suggests that maybe walking in your backyard or grass or at the beach may actually in fact be helpful.

Amanda Newman (00:44:36):

Well, I do water my garden barefoot. I try to do that. So maybe that can help, maybe lower the risk maybe for later things in life.

Scott Sexton, MD (00:44:49):

Yeah, I know Marie said earlier that she’s always been a runner. There are books that suggest people who run barefoot actually [it] has dramatic benefits.

Amanda Newman (00:44:58):

Interesting. I don’t know if I’d run barefoot. I think I’d be afraid I’d get something in my foot. Yeah, don’t want to go see the podiatrist for that.

(00:45:09):

Now going back to osteoporosis, what are the most common symptoms to watch for and when do you know when it’s time to reach out to a physician?

Marie O’Brien, DO (00:45:20):

That is a great question. Osteoporosis is silent until you fracture, and that’s why it typically gets the backburner. I feel like in most well visits when you see your family doctor or your primary care physician, it’s what are the issues of the moment? What’s bothering you? And osteoporosis is prevention, and that requires screening.

(00:45:42):

So in your 10-, 15-, maybe 20-minute visit with your doctor, there’s not a lot of time to check all the boxes when talking about wellness. You’re trying to cut out smoking and stop drinking, all the risk factors related to poor bone health. But when it comes down to actually screening, the test is simple, it’s an X-ray of your spine and hip, and appropriate to be screened if you have the risk factors for osteoporosis.

(00:46:10):

So identifying if that patient is post-menopausal, female patient post-menopausal more than a year after menopause should be screened, especially if it has risk factors. Males should be screened for as Dr. Sexton alluded to. The baby boomer generation, we are seeing more men with osteoporosis and many times they are not screened. So certainly if it’s a male patient that maybe has a seizure disorder or on blood thinners, those are medicines that can accelerate bone loss too, not just prednisone. So important that men typically we say over the age of 70 should start getting screened with a DEXA scan. And women, we focus on that post-menopausal period when they no longer have estrogen to have their screening test.

Amanda Newman (00:46:59):

So it goes back to how critical screening is.

Marie O’Brien, DO (00:47:01):

Correct.

Amanda Newman (00:47:02):

For catching it as early as possible.

Marie O’Brien, DO (00:47:04):

Many of the patients, well, Dr. Sexton will see the fractured patients. They already have osteo. Once you have the fragility fracture, you have osteoporosis by definition, regardless of your DEXA scan.

(00:47:14):

We’ll see patients that are being referred for osteopenia, which is a step before osteoporosis, or we’re actively screening our patient population because we’re giving them medicines that are accelerating their bone loss. So we’ll screen them earlier maybe than they would get screened with their family physician. So bone health is critical. It should always be addressed as part of someone’s well visit, especially if you have risk factors for osteoporosis.

Amanda Newman (00:47:41):

So let’s say you find out a family member or yourself has osteoporosis. What are the treatment options that are available?

Marie O’Brien, DO (00:47:49):

So there are a variety, and certainly treatment is individual based, just like any other chronic condition. And it’s important to have that shared decision making with the patient to kind of see where they’re coming from. If it’s a patient that doesn’t like oral medications or maybe already knows that they’re not going to be compliant taking medicine once a week. So we have oral therapies, we have injectable therapies, we have infusions, we have drugs that target the cells that chew bone, and we have drugs that target the cells that build bone.

(00:48:22):

So depending on what is the cause of their osteoporosis, [it] can also help us tailor what treatment is best for them. If it’s a patient that is extremely high risk, their DEXA scan shows severe osteoporosis, they’ve already had a fragility fracture, which by definition a fragility fracture is a fracture not from trauma. Standing position, patient steps off the curb and their hip shatters, whether they lifted a box and they had a vertebral fracture. So a car accident is a traumatic fracture. You’re standing on a 10-foot ladder and you fall, that’s a traumatic fracture. That’s not an osteoporotic-related fracture.

(00:49:02):

So we tailor our treatments for our patients based on their conditions, based on their underlying health, based on their insurance.

Amanda Newman (00:49:11):

So there’s a lot of factors that go into it.

Marie O’Brien, DO (00:49:13):

Yes.

Amanda Newman (00:49:14):

Now as we’re continuing to talk about osteoporosis, what is the difference between osteoarthritis and osteoporosis?

Marie O’Brien, DO (00:49:23):

So definitely they’re different. Osteoarthritis and osteoporosis, two totally different concepts, and many times patients will not be clear on the understanding of what they are. Osteoporosis does not cause pain until you fracture. So osteoporosis is thinning of the bone, fragile bones. Osteoarthritis is essentially arthritis or inflammation of the bone or wear and tear of the bone, loss [from] the aging process. Our cartilage, our cushions around our joints get thinner, get softer, get worn out, leading to the joint spaces getting more narrow and that causes inflammation and pain.

(00:50:05):

So pain with use, whether it’s your back, and arthritis, osteoarthritis can occur in multiple joints throughout the body. And the treatments are anti-inflammatories, joint injections, joint replacements, physical therapy to help keep those joints moving, which is a key component of treatment for osteoarthritis.

Amanda Newman (00:50:27):

Well, thank you for explaining the difference between osteoporosis and osteoarthritis.

(00:50:32):

And Dr. Sexton, is there anything you would like to add to that?

Scott Sexton, MD (00:50:35):

Yeah, I mean everything Marie said was spot on, but that certainly is a question that patients ask almost on a daily basis. I heard of osteoarthritis or osteoporosis. What’s the difference? But again, osteoporosis doesn’t cause pain, whereas if people are coming to the office with pain in their joints, they’re creaking, they’re grinding, that is osteoarthritis. So even though osteo means bone and arthritis means kind of inflammation, osteoarthritis is usually more a joint problem, meaning your knee doesn’t bend as good as before. It’s painful. It’s swollen. There’s grinding. Whereas osteoporosis is more of the bone itself just gradually becoming weak and unfortunately ultimately predisposing you to a fracture.

(00:51:20):

So as someone who used to do orthopedic surgery, ultimately at the end of the line for bad arthritis would be a joint replacement, but there’s multiple other treatments short of that for the person who hurts once a month or something. Obviously we’re not going to tell you to have a major operation. There’s over-the-counter pain gels and creams, there’s over-the-counter medications, as well as some prescriptions that are gentler on your stomach. But certainly for those aches and pains, it’s important to discuss with your primary care doctor and get referred to an orthopedist or rheumatologist as needed.

Amanda Newman (00:52:01):

So research suggests that a creatine supplement, and we’ve been covering lots of supplements in this episode, but that it may improve osteoarthritis symptoms. Is it worth trying or do you recommend any other vitamins or supplements that may help with osteoarthritis?

Scott Sexton, MD (00:52:19):

Well, there’s certainly a lot of different creatine supplements out there, and hopefully it’s important not to get them mixed or confused because some supplements can have bad effects. Creatine for the most part is harmless. But if you’re someone who’s older or dehydrated and don’t drink a lot of fluids, it can have harmful effects on your muscles and kidneys as well. So certainly it can keep our joints strong and stable, so it may be of some benefit, but certainly you got to make sure you read all the warnings and everything else associated with these supplements.

Amanda Newman (00:53:01):

And discuss with your doctor as well.

Scott Sexton, MD (00:53:04):

That’s important.

Amanda Newman (00:53:05):

So how do hormone fluctuations affect joint pain in women? We know women go through so many different things throughout life and hormones fluctuate. So how does that affect joint pain?

Marie O’Brien, DO (00:53:18):

So certainly hormones are involved in a lot of things related to the joints, so whether arthritis or osteoporosis as we discussed earlier. So we definitely see a pattern that women will have flare of their arthritis around the time of their period each month or say they notice that they’re going through menopause and having all the wonderful symptoms that go with being postmenopausal, hot flashes, poor sleep. So those factors can also, if you’re not sleeping right, if you’re constantly tossing and turning and then they’re wondering why their back is sore, they’re having more joint pain maybe related to that transition period. So certainly they play a role.

(00:54:03):

With arthritis pain, we don’t treat arthritis pain with hormone supplements. Many times if we feel there’s a hormonal connection, it’s: OK, is there something going on? Are they in menopause or another hormone? Maybe it is a thyroid problem or a parathyroid which regulates calcium. So it’s evaluating other hormone levels in the body to see if that may be contributing to their current joint pain or if it’s a mobility problem or they have muscle weakness. Definitely a change in their general health. We don’t just focus on reproductive hormones like testosterone or estrogen or progesterone, but we’ll also look at other hormone levels in the body to see if there’s an imbalance.

Amanda Newman (00:54:47):

So it’s a multifaceted approach to figure it out. OK.

(00:54:51):

What are the best ways to alleviate joint pain? I know there’s a lot of topical creams, there’s Biofreeze, Arnicare. I’m curious what you both think.

Scott Sexton, MD (00:55:00):

Well, certainly, I always recommend starting with the simplest. By the time they come to an orthopedic surgeon, most of them have had X-rays. So sometimes you can tell if it’s mild, moderate or really severe arthritis. But no matter what it is, we always start with the simplest things. The things you mentioned are great. Those are things I commonly say, the Biofreeze, the Arnica, Voltaren gel is an NSAID [non-steroidal anti-inflammatory drug], kind of like Motrin. So as long as you don’t have any kidney or stomach problems, that’s a good topical cream.

(00:55:34):

Same for the medications. There’s a lot of over-the-counter formulations of Tylenol Arthritis, Aleve Arthritis. Some people talk about the nutritional supplements, things like glucosamine and chondroitin that help rebuild the basic building blocks of our joint fluid and improved viscosity and lubrication of our joints.

(00:55:56):

Now, once you get to the office, we do kind of offer other alternatives such as things like injections, cortisone injections, other things people have always called the chicken shots, which are …

Amanda Newman (00:56:13):

The chicken shots. That’s something new I have not heard of.

Scott Sexton, MD (00:56:13):

Well, the technical term is viscose supplementation or gel shots, which is basically to restore the lubrication and viscosity of your joint. But there’s one formulation that was grown in the embryos of chicken eggs. So people have caught on. Chicken shots sounds much more fun than gel shots or viscose supplementation. These are things that can be done every three months, six months, as long as they’re helpful.

(00:56:38):

So we always say start with the simplest things and always you have to treat two things. You have to treat the patient and the X-ray. So if someone has terrible arthritis, but it bothers them once every few weeks where they do a lot of yard work, then there’s no reason to say you have to rush into a joint replacement. Same thing if you have mild to moderate arthritis and you’re in agony and the gels, the shots, the pain medicines haven’t worked, then you may be a good candidate to get a joint replacement. And total hip replacement is the number one surgery in the world for patient satisfaction. And I believe total knee is, I think up to number two. So people typically do very well after joint replacement surgery.

Amanda Newman (00:57:24):

So there’s a lot of options that we can look at …

Scott Sexton, MD (00:57:25):

A lot of options.

Amanda Newman (00:57:25):

... for alleviating joint pain.

Scott Sexton, MD (00:57:30):

Always start small, and the joint replacement is always there to hopefully alleviate your pain at the end of the day if it gets to that point.

Amanda Newman (00:57:38):

So while we’re talking about joints, how bad is it to crack your joints?

Marie O’Brien, DO (00:57:45):

If a patient is complaining that they have, for example, hand pain or neck pain and they’re like, “Well, when I crack my joints, that alleviates them.” And then the follow-up question will be, “Well, how often do you crack your joints?” And if it becomes a pattern or it’s their stress relief to pop or crack, certainly we’ll discourage that pattern and try and replace that pattern with something else. Repetitive motion can be a bad thing too much.

(00:58:20):

So if it’s my daughter, it’s a habit of hers to crack her knuckles, and replacing that with a fidget has become very effective for her. There’s all kinds. We didn’t have these things when I was growing up, the old fidget spinners and whatever else that she could have that she can play with to not go to cracking, which is not healthy.

(00:58:43):

Now people don’t break their fingers from repetitive cracking. It doesn’t predispose them to earlier osteoporosis, but it’s wearing out the joint because you’re constantly moving it. And the same with the cervical spine or the neck area. If they’re constantly twisting their neck because it feels better, I would rather send that patient to physical therapy and have actual exercises or maybe they’re having traction or soft-tissue massage instead of them doing the cracking maneuver.

Amanda Newman (00:59:13):

Sounds like I have a bad habit to break.

Marie O’Brien, DO (00:59:15):

It is a habit. Yes.

Amanda Newman (00:59:17):

I crack my hips all the time. I sound so creaky. Even just working out this morning, I was like, “Oh my goodness.” I’m doing these reverse lunges and creak, creak, creak. But I also just do it out of habit too. It’s that …

Marie O’Brien, DO (00:59:30):

It feels better?

Amanda Newman (00:59:32):

Yes. It’s like I’m relieving something and it, yeah, feels better.

Marie O’Brien, DO (00:59:35):

So the cracking could also be if the ligaments are tight. So focusing on a program that can help stretch those hip flexors and extensors so that they’re not the cracking, or the popping is not as frequent or not as audible.

Amanda Newman (00:59:52):

Yeah, honestly, it’s like an instrument.

Marie O’Brien, DO (00:59:54):

Yes.

Amanda Newman (00:59:54):

It’s not cute.

(00:59:58):

Well, to wrap up today’s episode, what are your top five tips for maintaining strong bones and healthy joints?

Scott Sexton, MD (01:00:07):

I’ll take number one. I think you have to stay active from your youth to your elderly years. You have to find what activities you enjoy, but keep doing something, even if it’s walking, running, some type of fitness or exercise. But I think activity at the end of the day is the biggest thing to combat a sedentary lifestyle, which can lead to kind of disuse of the bones and soft tissues and ultimately osteoporosis. So keep moving.

Marie O’Brien, DO (01:00:37):

Absolutely. Exercise is number one. And also shortly following that is a healthy lifestyle. So, good dietary habits. There’s all kinds of diet fads out there, but I think a well-balanced diet that works for you. Avoiding the toxins as we alluded to throughout this podcast. Avoiding smoking, avoiding alcohol, seeing your doctor. I think that’s key in being compliant with your medications. There’s a method to the madness. There’s a reason why the medications are recommended, and continuing to take them is important.

Scott Sexton, MD (01:01:14):

Right. I would agree on top of seeing your doctor is getting your appropriate screening tests, not preventing osteoporosis, but knowing you have it because it’s a silent condition. Unfortunately, many people don’t know they have it until they get a fracture. So I think one of the ways to separate it out is … primary prevention is getting your screening, getting treatment if need be, whereas secondary prevention is kind of too late. That means you’ve kind of already had your first fracture and now we’re kind of rushing to get your bone density test, rushing to start treatment to prevent your second fracture. Because most studies show that the biggest risk factor for getting a fracture is actually having a prior fracture. So kind of doing everything we talked about – diet, exercise, regular checkups – that’s all important and part of primary prevention because we don’t want to be seeing you in the emergency room with a broken hip when we could have done something to stop that.

Amanda Newman (01:02:14):

Lots of awesome tips. Do you have anything else you’d like to add?

Marie O’Brien, DO (01:02:18):

Yes, I mean, we definitely want to make everyone aware. Lehigh Valley Hospital, we have a Bone Health Clinic [LVPG Bone Health–Hausman Road], so orthopedics and rheumatology and endocrinology, Dr. [Scott] Sexton and Dr. [Philip] Dunn lead our Bone Health Clinic [LVPG Bone Health–Hausman Road] where we actually target those osteoporosis patients. We manage osteoporosis. We screen. Patients are screened, whether by their primary doctor or they’ve had a fracture and they’re seen in the hospital and they’re connected with our Bone Health Clinic [LVPG Bone Health–Hausman Road] so they can start therapy to prevent future fractures and also treat their underlying osteoporosis. If they’re complicated cases, we as specialists, we see them as well. And we partner with our endocrinology colleagues too.

Scott Sexton, MD (01:03:03):

We started this Bone Health Center [LVPG Bone Health–Hausman Road] as a multidisciplinary approach with orthopedics, rheumatology and endocrinology with the main goal of identifying people who’ve already had one fracture and doing everything we can to prevent that second fracture.

(01:03:19):

One of our leaders and mentors kind of said something that really left a mark. She said, if someone comes to the hospital and has a heart attack, if they went home on no medications to protect their heart and brain, people would think they were crazy, right? But a lot of people who have had fractures go home and, “I’ll just tough it out. I’ll just get back to doing what I’ve done before,” and never get seen, never get medications. But there’s a lot of things we can do to dramatically lower that risk of getting a second fracture when you start to think of it as a bone attack, right? So you had a fracture, you had a bone attack, and there are strategies and medications we can prescribe and use to significantly lower your risk of having another fracture. Just realize there’s a lot of support systems and we’re offering one to help make a big difference.

Amanda Newman (01:04:14):

Well, Dr. Sexton, and Dr. O’Brien, thank you both so much for joining us today and sharing lots of helpful information with our listeners.

Marie O’Brien, DO (01:04:22):

Thank you for having us. Great to be here.

Scott Sexton, MD (01:04:25):

Thanks so much.

Amanda Newman (01:04:26):

To learn more health tips, visit LVHN.org/healthyyou. You can also learn about services offered at Lehigh Valley Orthopedic Institute or schedule an appointment at LVHN.org/ortho. Remember to subscribe or follow The Healthiest You wherever you get your podcasts, so you never miss an episode. And remember, be safe, be smart and be the healthiest you.