Ep 23: Bone Health 101: What Every Woman Should Know

I see it all the time in my practice: women who feel perfectly fine put off their DEXA scans, brush off conversations about medication, or think, “That won’t happen to me.” But the reality is sobering. Half of all women over 50 will break a bone because of osteoporosis. And in many cases, it could have been prevented.

What makes osteoporosis so dangerous is how quietly it develops. There’s no pain, no obvious symptoms—just a seemingly harmless moment, like moving a coffee table or missing a step, that ends in a serious, sometimes life-altering fracture. By then, your independence and quality of life may already be at risk.

This episode kicks off a three-part series on bone health, designed to give you the knowledge and tools you need to protect yourself. We’ll break down how your bones function, how menopause affects them, and what you can do to stay strong, starting today. You'll also learn the difference between osteopenia and osteoporosis, and how to assess both your lifestyle and medical risk factors.

Your bones are your foundation. Let’s make sure they stay strong for the life you want to live.

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Audio Stamps

00:55 - Introduction to a three-part series on bone health, covering how bones work, lifestyle strategies, and medication options to prevent osteoporosis.

01:36 - How bones constantly remodel using osteocytes, osteoclasts, and osteoblasts working together to break down and rebuild bone tissue.

04:06 - How menopause disrupts bone remodeling when estrogen drops, plus the three stages of bone health.

06:06 - Why osteoporosis is called a "silent disease", and a real patient story showing the importance of early detection and prevention.

7:38 - Risk factors for osteoporosis broken down into modifiable factors and non-modifiable factors.

11:06 - Episode recap covering three key takeaways.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:02

Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health. Welcome back to Reset Recharge. Today we are starting a three part series, all about your bones. Yes, those silent, sturdy structures that are holding you upright and you might not be thinking about, you might not be thinking about them much, but they really do matter more than you realize. And here's why this episode is so important. One in two women over the age of 50 will experience a fracture due to osteoporosis, but that doesn't have to be your story. While that is a powerful statistic, it is also a preventable one, and you have the power to take action before the fracture occurs. That's what today's episode is all about. So let's dig in and talk about your bones first. Bones are built like your homes, so I want you to think about your bones, like your favorite home renovation show. My favorite show is Fixer Upper and has been for a long time. I love Chip and Joanna Gaines. I think they're so funny and relatable. Unfortunately, when I was younger, I really loved Trading Spaces, and I think that show made me somewhat delusional. When I was in my intern year, I decided to try and paint my apartment. I ended up picking what I thought were red and beige and they ended up being red and yellow. And my apartment looked like a McDonald's. It's really important for people who are remodeling homes, obviously, to know what they're doing. I did not know what I was doing when I was painting mine, but the good news is that your bones do know what they're doing. And so let's think of your bones, like your favorite home renovation show inside your body. Your bones are undergoing constant remodeling. It's a process that involves three types of cells. Number one, osteocytes. You want to think of these as your architects that are monitoring your bone health and directing any change. They're basically telling. Every cell that is working on maintaining the strength of your bones, what to do. Number two are the osteoclasts, and these are like your demolition crew, breaking down old bone and making sure that the aged bone is being chewed up so that it can be replaced by brand new bone. And the osteoblasts. These are your builders and they are laying down fresh, strong bone. So the way that I divide it up in my mind is when I'm watching fix or upper, the osteocytes are like Joanna Gaines. Who is like the master visionary planner of the whole? Renovation project. And then the osteo class, which are like the demo crew are like chip gains. We all know he loves demo day, so imagine him coming in there with his sledgehammer and taking things out. And then the osteoblasts, those are the builders. So these are all the people who are working on building up the newly gutted home into something beautiful. And even though we think of our bones as being hard and unchanging, they're actually alive. They're constantly. Shifting and rebuilding to meet the demands of your everyday life. Without this constant remodeling bones would snap under even regular movements, like all the twisting, bending, jumping, walking, running, that we do on a daily basis or even throughout our lifetime. So it's important to know that your bones are number one, constantly remodeling so that they can stay healthy. So this beautiful system of your bones constantly remodeling by breaking down and then rebuilding usually stays balanced until menopause hits. Menopause is when estrogen starts to decline. And because estrogen is supporting the remodeling process, that's when your bone health starts shifting and changing. We reach our peak bone density in our lifetime, around the age of 35, and for some women it may extend into their early forties, but after that, as estrogen levels begin to decline our bone strength gradually starts to decrease as well. The osteoclast will keep demoing away, but the osteoblasts, which are the builders slow down significantly, and so that imbalance will lead to weaker more brittle bone over time. So what exactly is osteoporosis? It is a condition where your bones become less dense and more fragile over time. And the way that we know this is we use a test called a DEXA scan or a bone density scan, which will give us a T-score that compares your bones to that of a healthy 30 to 30 5-year-old woman. It. What we look for is how many, what we call standard deviations below the bone health of a healthy 30, 30 5-year-old woman you are. And this is how we categorize it. Normal bone density is where your T score is between zero and minus one. So that's one standard deviation below. That of a 30 to 30 5-year-old woman, and that is generally okay. Your bones are normal, bone density at that point. Osteopenia, which is now referred to as low bone mass or low bone density. Is a T score between minus one and minus 2.4. This is that precursor stage to osteoporosis. And osteoporosis is a T score minus 2.5 or lower. But you wanna know what the real danger of all of this is you will not feel it happening. Osteoporosis is often referred to as a silent disease because there are no clear symptoms until a fracture happens, and pain finally brings it to light. So your first and only symptom of osteoporosis is going to be. A fracture. You may feel fine and even strong, but you don't know that you may still be losing bone mass silently, and that is why it is so important to talk to your doctors about getting a DEXA scan in a timely manner. I once had a patient in her eighties who saw me regularly for her thyroid management. I had been seeing her for years and every year I encouraged her to get a DEXA scan because she was well past the age. That is recommended by some of the societies that. Manage the guidelines around osteoporosis, and she always said, I feel fine. I'm active. No one in my family has osteoporosis. I don't want to do anything about it. I don't want to know. I don't want treatment. I'm fine. I don't have osteoporosis. Then one year she walked into my office and she was in a back brace. When I asked her what happened, she said that she fractured her spine just while moving a coffee table. And that one moment changed everything for her: her independence, her mobility, her confidence, and that's why I always say knowledge is power at every stage of your life. The more you understand your body, the better equipped you are to make informed, confident decisions about your health. Let's talk about understanding what your risk is for developing osteoporosis. I usually divide it into two buckets, what you can control and what you can't control. Those are referred to as modifiable. And non-modifiable risk factors. So the modifiable risk factors are things that you can change, and this includes things like smoking, drinking more than two alcoholic beverages per day, having a sedentary or inactive lifestyle, not getting enough calcium or vitamin D, and not getting enough protein, which will weaken your muscles and raise your fracture risk over time. These are all things that you can start working on today as measures to keep your bone as healthy as possible. What you also need to be aware of are your non-modifiable risk factors, meaning the things you can't change or may not be within your circle of control to change. And the number one for this is age, especially post-menopausal women. Over the age of 50, we can't control that. We're all getting older. I wish we could, but we're not there. Gender is the second risk factor on the list Women are at higher risk of osteoporosis than men. Family history is third on the list. If you have a family history of osteoporosis or fractures, your lifetime risk is increased. You can't control what happened to mom or grandma, but you can know about it and be aware so that you're getting screened at an appropriate time. There are certain medical conditions such as rheumatoid arthritis, if you've ever had an eating disorder, chronic kidney disease, all of these things can lead to. Developing osteoporosis sooner than your average person. And then long-term medications is last on the list. So things like steroids or even potentially GLP one agonists where you are getting muscle loss if you're not paying attention to your diet. All of those things can contribute. And lastly, and very importantly, if you are of Asian or Caucasian descent. Your lifetime risk of developing osteoporosis is going to be higher. Largely because women in these groups tend to start out with lower bone density. It's not about blame or saying, I didn't do enough to take care of my bones. It's always about being aware and being proactive about your. So when should you be screened? There are two key guidelines that help determine when a DEXA scan is needed. The US Preventative Services Task Force, or U-S-P-S-T-F, and the American College of Obstetrics and Gynecology, also known as acog. Recommend that women over the age of 65, regardless of risk factors should be screened. Women under the age of 65 who are postmenopausal and have high risk for fractures should be screened according these to, according to these two governing bodies. According to these two professional societies, according to these two groups, the American Association of Clinical Endocrinologists, which is what I tend to follow as an endocrinologist, recommends that all women over the age of 50 who are high risk for osteoporosis should be screened. So if you're post-menopausal and you fit into any of those categories that we've discussed, it's time to start talking to your provider about getting a scan. Here's what I want you to remember from today's episode. These are three takeaways that I hope that you'll carry with you and do something about. Number one, your bones are alive and dynamic. Think of them like a house that is under constant renovation. There's demoing and rebuilding that's happening, and when you hit menopause, the demoing starts increasing and the rebuilding slows down. So that's why we have to do something about it. Number two. Osteoporosis is serious but silent. You will not know it's there until something breaks. Literally a fracture is going to be your first and only symptom of osteoporosis, and that is the only time you will feel something. Okay. And then number three, awareness is your first line of defense. Understanding your risk factors, knowing that you can act on the modifiable ones and starting that conversation early are all going to get you to a place where you can be healthier for longer. There are statistics that show as we get older, our mortality from fractures increases significantly. The mortality rate of an osteoporosis related fracture after the age of 85 has a mortality of 50%. Over the age of 75. It is 20 to 40%. We can do so much better for people out there who are struggling with osteoporosis and give them a better quality of life for the long term. In our next, so coming up in part two of this series, which is Bone Health 102, we are going to explore number one, what actually hap, we're going to explore what actually happens during a DEXA scan meeting. How is it done? How frequently do you need to get it done? We're going to talk about how you interpret the bone density results, and then we're going to talk about what you can do from nutrition to exercise, meaning non-pharmacologic treatment to strengthen your bones and prevent loss. And then our third episode will focus mostly on the medications, so you can have a better understanding of these medications when they're being recommended to you. That's all for today. I'll see you on the next episode. Hey there. Quick announcement before you go. I've officially opened my own practice. It's called Eastside Menopause and Metabolism based right here in Redmond, Washington. I'm so grateful to be helping women navigate perimenopause, menopause, and metabolic health. It's truly some of the most fulfilling work I've ever done. If you're interested in working with me, head over to eastside mm.com. You can book a consultation and stay tuned. I'll be launching a membership program as well as an online course for those of you outside of Washington. Lots more to come, so keep listening and thank you for being here.