This article is a transcribed edited summary of a video Bob and Brad recorded in September of 2020. For the original video go to https://www.youtube.com/watch?v=P130CIaRjpc&t=756s
Brad: Hi Folks, Brad Heineck, physical therapist,
Chris: Hi, I’m Chris, the pharmacist.
Brad: Bob, unfortunately is not here today, he’s enjoying life somewhere else. He’ll be back. We're happy to have Chris here today. He's got plenty of expertise for this title: Osteoporosis, Osteopenia Causes, Treatment & Can It Be Reversed or Prevented. This is highly researched. You spent many hours on recent research for this. We have a lot of good information. Let's clarify Osteoporosis and Osteopenia first Chris. What is it and who does it affect?
Chris: Well, I guess, they’re both brittle bones, weakening of bones. Osteopenia generally would come before osteoporosis. It’s kind of that gradual stage in between: normal bones you go to osteopenia and then you go to osteoporosis. Kind of step wise motion there.
Brad: So, if you have osteopenia, it’s not that bad. Your bones are stronger than they are if you have osteoporosis. That’s measure by what they call a T-score. If you go into the doctor’s, they’ll give you some numbers. I believe if I have this right, -1.0 to a -2.5 is considered osteopenia.
Chris: Correct.
Brad: If it goes worse, a -2.5 or lower, then you’re in the osteoporosis range. I think some people hear the name and they really don’t fully understand. It happens, pretty much to everyone as you age, it’s like getting gray hair. The big thing is, you can treat it, self-treat it to a certain degree. You can do that successfully. So, my question is, as the title, can it be reversed, or prevented, yes or no?
Chris: The answer is yes, so that’s good news.
Brad: All the time?
Chris: I think, most of the time. You have to kind of adhere to some rules. Basically, the big thing with osteoporosis and osteopenia really is to make sure that we’re exercising. You need to have weight-bearing exercise. That’s going to be one of the key elements to trying to reverse or slow it down, depending on where you are in the spectrum.
Brad: Obviously, as a therapist, you’re talking about my wheelhouse. So, it’s like, yes, I can get into this. What else is there?
Chris: Besides the weight bearing exercise, we can look at eating our daily diet. We have to eat a healthy, balanced diet. That’s critical folks. The biggest thing is if you can get your calcium through foods. Dairy products, that’s kind of the primary one for most. Some of us are lactose intolerant. So, then we go to nuts, we go to green leafy vegetables.
Brad: Hold on, Chris. Before we go any farther, I think we need to talk about, what is the big deal with osteoporosis? What happens if you get it? What are the dangers?
Chris: It’s brittle bones, Brad. It means that bones have a higher risk of fracturing. They are most commonly found in your hip, your spine and your wrist. Those are the three most common, but they can be anywhere.
Brad: In therapy, you’ve heard of compression fractures. That happens in the vertebra and these can be very painful. It’s going to change your life for a number of months before it heals. A compression fracture in the spine is not like your bone that completely fractures. A vertebra actually crushes, it changes shape. Your body has to heal and readapt to that, which is very uncomfortable. It’s not an enjoyable thing at all. The hip, you said, is another thing, obviously, I’ve had people that are pretty old at this point. Literally just walking osteoporosis so bad that the bone broke, just snaps, without falling. It’s not real common, but it can happen. Obviously, we want to get after this at an early age so that’s the biggest part of osteoporosis, is the bone being brittle.
Chris: Yes. Basically, the bone is brittle. Basicly, it's like sandstone. Doctors have certain x-ray techniques that they use a variety of different ones but when they look at it, the bone actually looks porous. Bone is a flexible living material and it’s constantly building up and breaking down through all of our lives. What happens over time, by 30, that’s kind of when it really kind of stops increasing. That's pretty young and that's when we want to start to pay attention.
Brad: So, that’s across the board? Male, female, age 30?
Chris: Yes, doesn’t matter. It’s a little bit later for males but I think 30 is reasonable. A lot of times, a lot of the hormones that govern this are what kind of drives the bone formation and at least the bone loss and reformation. When it gets worse for women, menopause, so about 50 is when it really gets bad. For men, our testosterone levels drop off at about age 65, so that’s when that osteoporosis window there. So, what do you do between 30 and 50?
Brad: Right but at that rate, it started but it’s typically very low. You’re not even to osteopenia yet.
Chris: No, not yet. But this is where we can start to pay some dividends. It’s kind of like having a bank and you put money in every week to keep saving it for your retirement. You can think of using calcium the same way.
Brad: That’s a good way to look at it. I like that.
Chris: If we go with that, we are going to try to put calcium in our bank, so to speak and what are we going to do? We are going to do it through diet and exercise are really kind of the primary ways.
Brad: Okay, so drink a bunch of milk.
Chris: Well, yes you can, as long as you’re not lactose intolerant. There are other things we can use. There are supplements that we can use and the most common one is going to be calcium carbonate. That’s a tablet form. These are all over the counter products. Basically, the calcium carbonates, it would be in an antacid like Tums, that’s it’s primary driving force. You can find it in certain vitamin supplements too. One of the keys with making calcium to absorb the best is to make sure it’s coupled with vitamin D. You’re probably going to want to add a thousand IUs of vitamin D.
Brad: I’m not an expert at this, I’m thinking, well, vitamin D, calcium, isn’t both of that in a good healthy milk?
Chris: Sure, can be. Now, food is fortified with D in a lot of cases because D is hard to extract out of the diet. It’s very challenging. The most D that we get is standing right outside in the sunshine. So, in about 10-15 minutes of controlled exposure, and we have to be careful with skin cancer risk but 10-15 minutes without sunscreen, your body generates about 20,000 IUs of vitamin D or 500 micrograms.
Brad: So that’s quite a bit?
Chris: It’s a lot.
Brad: You’re not going to drink that much milk?
Chris: You will never ever, your stomach will explode. Which is a bad day. So, from that standpoint, you’re going to have some serious gastrointestinal stuff.
Brad: For people who don’t want to take pills, even though the pills are across the counter and they’re made out of natural ingredients. Are they made out of natural ingredients?
Chris: Yes, there’s a lot of different ingredients. When you think of calcium carbonate, it’s basically limestone. I mean, rock. It can come from crab shells. There’s a lot of different sources of it. People are very very finicky on what they get for their calcium.
Brad: So, the pills oftentimes are basically natural ingredients, or they can be.
Chris: Yes, they come from the earth.
Brad: I kind of got off track there. Is there other diet supplements or vitamins that are going to help the bone density?
Chris: Absolutely. So, we talked about calcium and D. There’s different forms of calcium, so that again, you’ve got a calcium citrate. Sometimes calcium carbonate, which is the most common one, can upset your stomach a little bit. It can cause things like gas, constipation. It can be rough on you.
Brad: That’s the pill form? It’s calcium carbonate.
Chris: Yes. Then we want to go to something more like calcium citrate. That doesn’t really require, and I should probably backtrack on calcium carbonate. It’s the hardest one to break down also. It requires stomach acid, so you want to make sure you take that with food. When you start to eat, it turns up more stomach acid. What it does is it breaks down that calcium. It absorbs in your intestines better, so it gets into your system better. Some people that bothers their stomachs, so calcium citrate is a lot gentler for them. The knock-on calcium citrate is that you don’t get quite as much calcium. So, you’ll have to take a little bit more to get that 1000 milligram dose. You can go to any pharmacy, you can go to the web, Amazon, whatever source to get it. You can look for calcium supplements. There are a variety of different ones. Calcium carbonate, calcium citrate are probably two of the more common sources. But then they have some of the more exotic things where they actually make it out of algae’s and plant sources as well. For vegan people or vegetarian people or people that just don’t, they may have stomach troubles with calcium carbonate. There’s options for everybody. The best is through the diet.
Brad: If we have viewers that are interested, you know, they want to drink their milk, and maybe do a supplement and they go online, can they just see how many stars they have for a good option?
Chris: I think that’s one way of looking at it. I would tend to be a little bit more critical. I’d look for USP ratings because that stands for United States Pharmacopeia. That guarantees and its independently lab tested that what’s in that bottle, is in that bottle. Sometimes, again, I”ve used that phrase before, it’s kind of the wild wild west, people mix and match whatever they can and give good advertising but yet it may not be the best supplement.
Brad: USP kind of guarantees if it’s on there, that’s kind of a quality control.
Chris: Yes. And that’s what you really want to strive for in just about any vitamin or supplement that you’re taking.
Brad: I want to go back and touch on exercise a little bit because that’s my wheelhouse a little bit. Chris and I both swim. I’m a big advocate for swimming in general for exercise. But for this bone density thing, it’s not really going to help much.
Chris: No, it’s good for the heart, which is excellent. It's good for the muscles, which is excellent. The problem is, it doesn’t put that stress or force on the bone and the bone needs gravity to try and help to stimulate bone formation. Whether it’s weightlifting, walking is great. People like dancing, jumping around, playing tennis.
Brad: Actually, some impact is helpful. The biggest thing I’m concerned about is, when we talk about impact, there’s a balance issue then, potential for fall risk. I did hear of one therapist who did classes strictly for bone density with elderly people. She’d have them hold onto a rail and actually do some gentle bouncing to get that impact, so that stimulation for the bone growth would occur. Walking, you know, jogging or running is great too, but a lot of people don’t want to do that. Particularly in their older years. They’re concerned about their joint integrity, etc. I think just plain walking is very good and it’s good for so many other things as well. Is there anything else we need to cover? If this doesn’t work, let’s say someone’s in the osteoporosis and their numbers are low, are they going to have to go to the doctor and get some help?
Chris: Yes.
Brad: That’s not a big deal, it’s used commonly.
Chris: Correct. Osteoporosis is a silent disease. A lot of times we can be walking around, we just don’t eve know it and all of a sudden, we had a bad fall, or you went to the doctor and all of a sudden you’re shorter. At that point, you’re going to have a mindset that they’ve got to treat you. They’re probably going to do some x-rays and see where it’s at. They’ll look at your spine specifically, they’ll see if you’re hunched over. If you’re having some back pain, you didn’t know why. So yeah, it’s one of those things where they’ll examine that. They’ll do the x-rays and the special testing and from that standpoint, the mainstay of treatment Is going to still be exercise and certainly supplementation but they’re going to use pharmaceuticals. There’s a variety of different medications that they will use to treat osteoporosis. At that point, depending on the treatment course and things and they vary from course to course, treatment to treatment. It can get pretty complex and pretty expensive. You always want to check with your insurance company. It’s one of those things that will be a necessary evil to make sure that these people can say healthy and active as long as we possibly can.
Brad: Sure, sure. Absolutely. Wow, we’re going to talk about some specific vitamins and calcium on another video in about a week or so, so we are going to cover that in just a few minutes between you and I both. You’ll see that video coming up in a week or so we’ll have that one as well. So again, Chris, Bob and I, our goal has always been, to keep people healthy, fit and active. And possibly fix everything except for –
Chris: A broken heart.
Brad: I don’t think this is going to be helpful for that but we’ll give it a go. Cheers.
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