On Thursday evening, May 16, the Navigating the Medical System Lecture Series featured a virtual lecture with Monhit Shukla, MD, FACR, attending rheumatologist at NewYork-Presbyterian Queens, hosted by Congregation Etz Chaim.
Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone. He shared that everyone would get this condition sooner or later, and that treatments have changed significantly over the past five years. When he was in medical school 50 years ago, they taught that your bones eventually fade and take away calcium. Today, there are newer medications to treat this disease. Dr. Breite said that he feels it should be treated by a rheumatologist or endocrinologist.
Next, Dr. Shukla spoke in detail about the disease and various treatment options. He said it is a disease of the bones – a skeletal bone disease. It involves excessive bone loss or less production of bone – or both at the same time – and it leads to weak or brittle bones, which can lead to fractures.
He displayed an illustration of normal bone structure compared to bones with osteoporosis. The normal bones were whiter than those with osteoporosis, which are more porous. He shared that 54 million Americans have this disease. One in two women breaks a bone due to osteoporosis. Experts predict that by 2025, the cost of the disease will be $25 billion.
It is diagnosed with a bone density test that calculates the T score. A T score of “-2.5 or lower” is osteoporosis. A person with a history of fragility or someone with more than 20% in ten-year probability of fracture qualifies for treatment.
Doctors use DEXA scan, which is a form of x-ray, to determine bone density. -1 and above I normal bone density -2.5 and below is osteoporosis. Women 65 and older, as well as patients with risk factors should be screened. If you have a family history of fractures, then you have a risk factor. Men 70 or older, or men 50-69 with low body mass, smoking, or prior fracture are at risk. He shared other risk factors for women, such as small body frame or anorexia, low Vitamin D, or low calcium levels, sedentary lifestyle with little exercise, cigarette smoking, alcohol use, and certain medications. Also, Caucasians are at higher risk. In addition, breast cancer medications are a risk factor, as well, as are rheumatoid arthritis history or hormonal conditions.
He explained that osteoporosis is a silent disease. Signs include a decrease in height, hunched or stooped posture, lower back pain, or sudden back pain. Sudden back pain could indicate a spinal fracture.
The goal of treatment is to prevent fractures. Women can lose up to 20 percent of bone density. They should take calcium and vitamin D supplements. He noted that risk increases with age.
In men, low sex hormone can lead to it. Also, some treatments for prostate cancer can lead to it. Men have a lower recovery rate from osteoporosis than women.
Next, he spoke about lifestyle measures to reduce bone loss. First, adequate calcium and Vitamin D is important. He recommended 1,200 mg of calcium daily and 800-mg units of vitamin D for post-menopausal women. For men until the age of 70, 1,000 mg of calcium daily, and 1,200 mg for men 71 and up. For men aged up to 70, 600 mg of Vitamin D. For men 71 and up, 800 mg of Vitamin D. The website of the National Institutes of Health tells which foods are rich in calcium and vitamin D.
Exercise is important. No smoking or heavy alcohol, and fall precautions are also necessary. He illustrated the types of exercises, such as low-impact weight-bearing squats, walking, sit to stand. You should engage in weight-bearing exercise at least 30 minutes every day, and muscle-strengthening exercises two or three times a week.
He then detailed the various types of medicines and when they are indicated. He recommended referencing the National Osteoporosis Foundation website for detailed nutrition section and news and treatment option information.
The community appreciates these thorough and informative lectures.
By Susie Garber
