Low Bone Density at 40+? A Dentist’s Journey from Osteoporosis to Osteopenia — What Actually Worked

In this deeply personal and empowering episode of Hormones & Hope, Dr. Chhaya Makhija is joined by a very special guest—Dr. Cynthia, a retired dentist and longtime patient at Unified Endocrine & Diabetes Care.

✅ What is osteoporosis?
✅ Why do so many women delay osteoporosis treatment?
✅ Are osteoporosis medications really necessary?
✅ What happens if osteoporosis is left untreated?
✅ Is osteopenia the same as osteoporosis?
✅ What daily injectable osteoporosis treatment is really like

This episode goes beyond clinical guidelines and statistics. It explores the real-life fears, professional dilemmas, and decision-making challenges that many women face when diagnosed with osteoporosis, especially those who understand the risks all too well.

Dr. Cynthia shares what it was really like to start bone-building therapy, how daily injections fit into her life, and what surprised her most about the results. Today, years after completing treatment, her bone density continues to improve—and so does her confidence.

Together, Dr. Makhija and Dr. Cynthia discuss what it means to balance rare medication risks against very real fracture risks and how delaying treatment can sometimes carry the greatest danger.

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Disclaimer: This podcast is for educational, informational, and entertainment purposes only. It’s not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

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Transcript

00:00
All right, so the first one is before treatment,  one word you associated with osteoporosis medications.  one word was risk.  One thing you would share with postmenopausal women now after completing osteoporosis treatment. Do it.  Do it. Can you share that again? uh Do it.

00:23
Thank you.  One word to describe how your body and health feel today compared to five years ago post osteoporosis treatment. One word, confident.  Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.  I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya,  a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.

00:52
Each week we dive into the powerful intersection of clinical medicine  and real life lifestyle strategies  to help you feel stronger,  live longer  and show up as your most vibrant self inside and out.  So let's get empowered. Hello and welcome to another episode on Hormones and Hope. This is your host Dr. Makhija and today is another special episode. But I'll put this in quotations. This is a very special, special, special episode.

01:20
Since  I usually will have  guests who are physicians or you've heard our solo podcast.  But today I have a amazing professional. She's a retired dentist and also a patient.  And she's been with  Unified Endocrine and Diabetes Care for almost three and a half, four years,  which is in California. That's our practice.  And to my delight.

01:46
She's been amazing with her health and today she's going to share about osteoporosis journey. Now the reason I'm calling this as special my friends is because her profession which is relevant to our oral health, oral hygiene and dentition  and osteoporosis medications which have this rare side effect which we'll get into the details. But  as a patient  and as a physician how a human being

02:15
can actually make the right decision for their health and still be successful in their health journey is what we're going to learn from our guest today, which is Dr. Cynthia. It's my honor and privilege for you to be on our podcast and share the journey.  And I feel by the end of the episode, you're just going to empower so many women out there that there will be showers of gratitude for you.  Thank you, Dr. Cynthia. Well, thank you for having me. Yes. Yeah.

02:41
Before we dive into our usual rapid fire and deep dive questions, can you tell us something about yourself, where you live or how many years you've practiced and anything special with your enjoyment in the dental world, anything fun about you? Well, I practiced dentistry for about 40 years. And in my early career, prior to going into private practice, I actually did a deeper dive into medicine. So I worked in a hospital settings.

03:11
I did residency that  allowed me to really expand upon medical parts of dentistry instead of just going in there and drilling and filling. So that was  kind of early history stuff. Other than that, I enjoyed a very long and happy career.  Now we're tired.  I love that long and happy career. Thank you. So we have our uh rapid fire questions for you.

03:38
These are again one-liners or if you think you have a one word answer. And then we deep dive. Deep dive is just about the bone held osteoporosis and some fun stuff that we learned from you. Okay, cool. All right. So the first one is before treatment, one word you associated with osteoporosis medications.  The one word was risk. All right. Risk  of osteoporosis medication. Sweet. Number two.

04:04
One concern you had that was stopping you from starting osteoporosis medications.  Again, it was the risk and the risk was associated with what I knew  academically about what osteoporosis medications do to you, as well as what I saw in my practice. So I saw uh enough cases of  the side effect that I thought,  going to do it. Thank you. Number three, as a dentist.

04:31
What made the decision to consider osteoporosis treatment harder for you? The same? Yes, it rolls back into question number two.  Can you tell us those two risks or one risk? Well, the one risk that we see in dentistry is called osteonorchosis of the jaw or ONJ. Number four, one thing you would share with postmenopausal women now after completing osteoporosis treatment? Do it.  Do it. Can you share that again?

05:00
Do it. Thank you.  And number five, one word to describe how your body and health feel today compared to five years ago post osteoporosis treatment. One word, confident.  I love that. Thank you so much. So now we get into the deep dive. you know, Dr. Cynthia, we've again, like I said, we've met, we've been  together  as patient physician, but also you've been a great supporter and friend.

05:29
for us at Unified Endocrine. When did you learn about the diagnosis of severe osteoporosis  and how long did it take for you to get convinced? So can you just walk us through that period before we met? Well, I have a history  of, my family history is of osteoporosis because I'm lactose intolerant. So I never drank milk as a kid and my eating habits were poor at best. So

05:58
I knew  and my grandmother,  actually had fractures because she was osteoporotic.  She had fractures just by reaching into the cabinet to get  some spices. She fractured her vertebrae just by doing that. She wasn't doing anything. She didn't fall down, nothing. Wow, that's severe.  And she fell and broke her clavicle.  And so that's  my background history. Now, my mother on my hand,

06:27
She wasn't lactose intolerant, so she drank a lot of milk. She ate probably better than I did, and her bones were very, very healthy. So I knew in my 40s that I was already osteopenic, I'll forgive you. Okay, so you already had the awareness, the screening, yes, and you were well informed about the diagnosis. So from around mid 40s that you were more perimenopausal to almost what, 62 or so? 63.

06:56
that he decided to start treatment. So what was that? Why the duration? Why did it take so long? And what was done during that time in terms of prevention or lifestyle measures?  Prevention, I exercise a lot. I try and do weight-bearing exercises.  I would be very, very body at best taking calcium supplements, tried to eat  calcium-rich foods that weren't  dairy-based.

07:25
You have to eat a whole lot of spinach to get the kind of calcium you need to get from other sources. And I just thought that I would be like my grandmother. There were no osteoporosis medicines when she was alive. So she broke bones, she healed from them, and she lived to be five days short of 100. So thought, okay, that's going to be my journey. And then my cousin, his mother is a pharmacist. She's now in her late 80s.

07:55
But her pharmacy story is that she wouldn't take it either as an osteoporotic gal. So when she didn't take it, she actually fell and horribly fractured her vertebrae so that she had to have surgery to stabilize. When they went in to do that, what happened is they had to put a rod in her spine and they were drilling into cottage cheese,  literally.  It was mushy.  And so it was failure. They could not.

08:23
stabilizes her. so now, even till today, she's bedridden, she can't get out of bed, and she is in horrible pain all the time. Yeah. I don't want that either. Yeah. So that's actually what it was fear and a sense that maybe that's going to happen to me that I said, okay, I have to do something about it now. Yeah. You bring up very good points. One was awareness and you were already thinking about prevention by getting the screening and knowing.

08:49
that what's happening and  what could I possibly do, but then I have this either fear or anxiety of being on medications versus my risk of not treating it. I just wanted to point this out because I usually will add this in my first discussion when individuals are coming for the consultation that which I really want you to  elaborate on would be the risk from your specialty. But in United States of America, two million adults

09:18
experience osteoporotic fracture annually. And most of them are hip and spine. So what you were mentioning about your pharmacist friend.  within one year, the risk of mortality is one in three for men, which is insane.  And 21 to 30 % in women. So one in 20. So for men, it's actually higher  as compared to women in terms of the mortality after one year of hip fracture. That's insane. That's crazy.

09:46
and the dependability, you know, being in institutions, rehabs, hospitalizations, again, which you're talking about your friends' mother's surgery. And what's sad is that the risk  that you are again going to elaborate, the ONG and the osteonecrosis of Joe and atypical femoral fractures, the incidence is lower. But before we go into that, can you just shine more light based on your expertise in the dental world?

10:15
that what you've encountered with osteoporosis medications and ONJ and what built that concern over time. Well, the academics are, you you see the red box label warning, warning this can happen to you. And then of course, in all of my studies, I don't think it was during dental school because that was too long ago, but it was after dental school and all my other continuing ed classes. When you see cases of

10:45
of osteodoron crosis of the jaw. The scary thing is that if you have any kind of dental infection, like you need a root canal or you have gum disease,  or in one case, one of my friends told me, his patient, all she did was she ate something hard and it poked at her gums, at her gengua. So all it took was that and it started to affect the bone, started to kill the bone. Yeah. This is all in patients on osteoporosis medication.

11:14
Like the bisphosphonate? Yes, bisphosphosate especially. Like the phosphomide, actinol? Exactly. Okay. And the scariest thing is that there's nothing that we can treat it with. You can't give it antibiotics. There's no medication to stop this bone destruction. So we see it, you go, oh yeah, your bone's dying. And all we could do, literally, and it's just a horrible visual, is scrape it out, scrape out the dead bone and hope that your body will fix it.

11:44
And then they come back, now there's more that's dead bone. You scrape out more. And eventually you either lose  all your postpartum, big portions of your jaw and your teeth,  or your body eventually kind of says, okay, let's try and fix this. Yeah. Clinically, did you see that there were like predisposing factors based on the oral hygiene or say some patients have, you know, poorly controlled diabetes and they already have  poor gingerbread health, any?

12:12
predisposed on. Actually, the studies that I saw were long, long, long term, this is FosUse and people who had had chemo. So cancer patients who are already at risk for a whole bunch of other things. So if you had chemo anytime in your history, you are way more predisposed to getting OJ. Yes. So that is

12:38
Yeah, so what you were witnessing clinically is also  seen in our literature and studies and clinical trials. That's again a very valid point and I love the fact that your last rapid fire was the confidence that you've come up with and the confidence also to share this with especially my women patients and whoever will be the audience or if your spouses and uh your wives are dealing with this confusion. Should I? oh

13:07
consider osteoporosis therapy or not  is I would love for you to repeat, but ONJ, uh the incidence  that I have is  one in 10,000 to one in 100,000. And  of course it's higher  if patients have had cancer, chemotherapy or bone metastasis.  Because just for the audience's awareness that medications like bisphosphonate, fosamax, actin-L or even Prolia, that's the six monthly injection,

13:35
They can also be  used for treatment of osteoporosis or prevention of fractures in patients with cancers. Yes, different types of  cancers. So I really love that you're overlapping the clinical medicine  with what we have in clinical trials. So again,  lots of empowerment. I personal friend who he has  prostate cancer,  like aggressive,  and  how he even found it because he didn't like going to the doctor.

14:02
Yeah, is that he actually had bone pain. Uh-huh. Okay, it had already metastasized to his bones  and his bone was cottage cheese. Yeah as well. He's really short now. Yeah, and I knew him as a as a 20 year old He was tall and now he's  as short as I am. Yeah, so he was shrinking and stuff Well, yeah, they ended up giving him  bisphosis just because they didn't want him to fall down and hurt himself. Guess what?

14:31
He's been on chemo, he's done this and this  and he hasn't had an ONJ.  And he's had dental infections and he hasn't had ONJ. So here's that. Exactly. You never know if that's you or not. I can catastrophize and say, you know, everybody who's on chemo is going to get it. No, that's not true. Yeah. You're so right. You know, that brings me about to a personal share, which I wasn't planning to share, but you because you're talking about your friend's story is my father, he had multiple myeloma. m

14:59
And for almost 15 years that he was with it and fought with it. And the main thing that it affected was also the bones. So with, know, it's basically osteoporosis. And so because it's a blood cancer, we crossed also, a zolotronic acid, but it was timed based on kidney functions or renal functions, but also to see what's the mobility, what's the functional health. And there were two times that he had a fall just because he was riding the scooter. He was very physically active throughout.

15:29
and he did not have a fracture, which I would think that, oh my gosh, know, with severe osteoporosis, yesterday on a reclass and you fall on your hips, like on your butts or buttocks and you did not have a hip fracture.  I started appreciating, truly appreciating osteoporosis medications at that time. This is almost, you know, 10 years ago,  but you bring about the right knowledge that every person with malignancy.

15:53
using osteoporosis medications does not necessarily go through, I'm sure. Well, and there's a whole balance of quality of life. Yes, absolutely. So with that, you know, I would love to also learn more about when you say the balance, the quality of life, right? The patient physician shared decision making. Now, yes, you're a physician, you're very well read and very well researched too in terms of, you know, the

16:19
preventive measures as well as the treatment measures or pharmacological. When we met, you'd already read a lot of studies. What I remember, this was three and a half, four years, and say, but this happens, this happens, and so on. Yes, you said that likely the fear convinced you that you should start the medications, but can you walk us through that journey, like helping someone else simplify decision-making? Yes, the articles, but everyone is not well-read like you.

16:48
But what was a discussion? What was  the state of mind for you to say, let's do it. I've read enough.  I've known enough. I think this is the right, or I believe now this is the right step. Well, I can tell you right off the bat that from the time that I was osteopenic so early,  every physician said, you need to be  on bisphosis.  And I would say no. And they'd say,

17:16
You need to be, are you refreezing treatment? I'm going, well, guess what? And I look him right in the eye. I said, can you guarantee that I will not get ONJ? Because I can't even guarantee as the dentist that I won't get a Dell infection. Dell infections happen, you don't know when it's going to happen. You know, Saturday night in the midnight go, oh my gosh. So they would say no. then.

17:44
stop talking to me about this. And they would stop because they knew that I knew that risk because I saw the risk  on not a daily basis, but it says, no,  note to self, I'm not going to be on this medication. One of my dental school mates, who she's another female dentist, her physician convinced her, look, just take it pre-menopausal,  just for a year, and that's going to cover you.  And in retrospect,

18:13
I should have listened to that kind of advice, but I just was too stubborn. So stubbornness is not a good quality, I guess.  but it was,  A,  I am probably more active than my grandmother was. And so I knew that my risks for having an active life was going to be affected by the fact that, if I fall down and I,  as a, just a side note, I have worked forever on balance. So,

18:41
All of us need to work on that because it's not about the hip fracture or the current. It's about just don't fall down. So, right. So once  this was what again, four years ago,  once you're seeing the repeated scans done and there is this decline, leading us to from osteopenia to severe osteoporosis, which is  based on T-scores. You did not have any fracture. No, I did not.

19:07
How did you decide now? So now it was, now you need more powerful medications, right? So what convinced you? Part of it was looking, doing a little deep dive into, okay, I don't want to just spare my bone. I need to build bone.  And  too late, Kate,  I just didn't do the right things for whatever reason that I just couldn't build bone. I thought, well, okay, this is it. And this is a, it's also involves risk taking

19:36
you know,  daily injections is a risk as well.  And then again, there's a friend of mine who she's Asian. She's even the normal that I am. And she actually had been on TMLS for even longer than the recommended. And she didn't get SGS sarcoma. She's perfectly fine.  So I thought, well, I'm going to follow that rather than my own fears. oh

20:02
I just wanted to add this that osteosarcoma is only seen in rats or animals. Exactly. We don't have  it. Yes. Exactly. Yes. Good. I'm a catastrophist.  No, I'm glad you're sharing that because,  every person out there has this concern that if there's a black box warning,  that it might happen to me even though it says it's going to happen in animals. Right. Right. Right. And I read that. I saw that. Yeah.

20:27
So when we met, know, the Tim Los was started because I agree that when we're in severe osteoporosis and we don't have any contraindications, know, use the bone forming medications rather than relying on these antipytoxides. It's expensive too. And, you know, so I've already kind of come onto that whole thing.  Shoot, I could have saved myself a whole lot of time and money. Thank you. That's a great point that I couldn't about. And I just didn't do it. Yes. Yeah. And I wish that they're more, you know,

20:54
because we're trying to prevent something with good medications. So hear out if any of the, you know,  institutions are watching that as we talk about prevention, we know the stats of fractures, you know, please make these medications more affordable for all. Your  decision was different than other patients, but I call that as personalized. And that is also a great informed shared decision making where you used the anabolic therapy or the bone forming medication, which is a daily injection.

21:24
for almost a year. We have the FDF rule for 18 to 24 months. You probably had more than 12  months. How did you  feel  while you were on the medications? Were you able to still continue living your life, travel,  anything that you would like to share in terms of your personal experience? Well, it would, and I'll be really honest, it would make me little nauseous for about 20 minutes after the injection every night.

21:51
So I did it at night time so that I could just lay down and not just go to sleep and not feel nauseous or nauseated. put a little crimp in my, because you have to keep this stuff refrigerated, it put a little crimp in my traveling. But you just have to make sure you have a ice chest or that kind of thing around. Other than that, it was really not that big of a deal at all. Yeah. It doesn't hurt either. It doesn't hurt.

22:20
You don't even feel the needle is so, so thin. You don't feel it. So that part of anybody's brave of that. Yes. Thank you. So, but otherwise the entire course was pretty much uneventful for you. Yes. Right. And then, you know, these medications are followed by something called as anti-resorptive. So you went through that also.  And now it's almost what two years since the last part of the treatments.

22:44
during treatment versus now two years, right? You've had more bone density scans to see the results. So can you share that in your networks? Yes, it's pretty amazing.  I am building more bone even though  I am not on  any medication.  And here's a Medicare,  anybody out there who has to do that  thing. Yes.  I changed, I wanted to change plans  and I wanted to go with a plan that

23:13
It wasn't age related.  Cause you know, you go on it, you go, okay, every year, just because you're getting older,  your premiums go up.  my friends, this is health insurance plans that you're talking about.  So when I was changing plans, okay, this is totally cool to me. When I was changing plans in November,  they were grilling me as if I was, they wanted to know all my predispositions, predisposing factors, risk factors. So  I had.

23:43
put in  online like a screening thing, do you have osteoporosis? And I put yes, guess what?  It says you're not qualified for this plan because they want the healthiest of healthy for the plan. And so  I backspace, delete, delete, and I said, well, guess what? I am not osteoporotic anymore. So I put no.  And then they called me to get more information. And they go, oh, so

24:12
Are you on osteoporotic medicine? I go, nope.  If I had said yes, because then I would have again not qualified for the plan that I For the right health. Yes. And they accepted me. In the end, they accepted me. Because they said, when's the last time you took osteoporotic medicine, know,  bone medicine? Yeah. Two years ago. I was totally was not fudging at all.  And at that...

24:40
is just an aside.  I would not have expected that. And so it's all  good. Yeah, it's all good. Yes. And  the goodness is also, know, when we speak like in terms of data versus translating that into  for the patient's language that, you had severe osteoporosis where the risk of fracturing is very high and within three years of treatment.

25:04
You've had two bone densities, which still shows that the bone is,  you know, building bone. And now it's from severe osteoporosis to osteopenia, low bone density, which is massive reduction in the risk  of four fractures.  And this is beautiful because in the United States, we have to enroll in health insurance plans that automatically reduces your risk, makes you healthier.  And you get to.

25:30
opt a plan which is  favorable for you rather than paying extra amounts. Thank you. These are all learning lessons  for what you're sharing.  For what you're sharing in terms of, you know, healthcare costs, your health, your independence, and how do you make that shared decision making? How do you, you know, make sure that you simplify the research and the data and don't wait too long to make that decision? Can you also add

25:57
What you've done, even you said you're very physically active and exercising, right? What are your few important necessary steps in your daily routine? Most of the days, that's  helping. I'm going to  step back. Yeah. Like maybe 15, 20 years ago. When I was in practice, I played this game when I started feeling like,  I'm getting old, but I wasn't old yet because I'm old now. And I would...

26:25
play this game when patients who come in who I knew they were retired, just because I know,  I'd say, because I always just look at their chart. I know what the birthday is, right? I go, hmm, how does this person  act, look,  interact with me? And  then I'll look to see how old they are, go, woof, and then I'll ask. And one gentleman, two people in particular, one gentleman, I said, you know, I know he's retired.

26:53
He tells me all the stuff he does, but he acts, looks, and thinks like he's about 55. You know, he plays tennis, like, every other day, all this stuff. We talk politics, we talk sociology, he's a really bright, really sharp guy. And I look at his chart, and he's like almost 80. I go, pfft. So I asked him, how did you do that? Because I want to be like you.

27:22
I'm totally honest at this point.  And he goes, doctor, it's called just keep moving. He says, going to the gym, playing tennis, they're all necessary. Putting on my socks is optional, literally. The minute I get out of bed, I know I have to move.  thought,  okay, so I've really taken that and put that as a thread in my daily consciousness  of, okay, you got to keep moving. So when you don't move, that's when you...

27:52
Don't move. That's it. that's, is that answering your question? It's like we're only words of wisdom. You know, movement and we may think that all you have to do this, there's some magic mantra or magic hill that needs to be done, but it's as simple as keep moving. Yeah. Yeah. Oh yeah. I'm happy to say that, you know, my granddaughter who's 16, she now motivates me. Popo, I want to go to the gym because she wants to go to the gym and she knows I'll take her. So that is my motivation to get moving because

28:21
If she's going, then I'm hanging out with her, I'm spending time with her and  I'm  accomplishing my needs of moving. uh So you're trying to fit that in your daily routine rather than making it separate. That's beautiful. Last words of wisdom.  And this is especially because we spoke, what, a month ago and after looking at bone density, I was like, Dr. Senthia, can you come on our podcast and just share some words of wisdom?

28:48
For so many of my patients who are still hesitant, despite having, I would say, 10, 15 conversations,  any words of wisdom that you would want to pass along to our community, to the women out there, dealing with osteoporosis, still in that confused state of, should I do it, should I not do it? What else can you provide them with today? I would say, set aside your fear. And if it's not fear, it's  doubt.  Set aside those doubts.

29:18
because you're going to always hear something on the dark side of any treatment  and just do it.  I didn't think that I would be as delighted with my results.  I asked, I'm really surprised. I thought, well, I can at least hold my own, just stave off things, but no, I feel definitely better. I have less fear, literally up, falling and  still work on your balance. I'm still working on my balance, but

29:47
If I fell now, I know that I go, oh no, no, no, no, no. So yeah, set away, sit down, fear and doubt. Just do it. Yeah, just do it. Just like Nike says. I know, it's true. It's really true. Well, I appreciate this. Thank you. Thank you for having Simple and powerful. So yeah, no more words for us. All right. Thank you. You're welcome. Thank you. Thank you.

30:15
Thanks for hanging out with me on hormones and hope.  If you've loved this episode, do me a favor,  hit subscribe, share it with someone you care about,  and drop a review if you're feeling generous.  Want more tools to support your hormones and health?  Head over to unifiedendocrinecare.com.  We've got free guides, resources, and more waiting for you.  Until next time,  stay curious, stay kind to your body, and keep your hormones happy.