Osteoporosis Explained: Risks, Screenings and Strength Training

Osteoporosis is often called a silent disease because many people do not know they have it until they suffer a fracture. But when should you start paying attention to your bone health — and what can you do now to protect yourself?

In this episode of Baptist Health Talk, host Johanna Gomez speaks with Dr. Maria Kyriacou, primary care sports medicine physician with Baptist Health Orthopedic Care, about osteoporosis, bone density, menopause, weight loss medications, strength training and prevention.

In this episode, you’ll learn:

•  What osteoporosis is and why it matters 
•  Why bone loss can begin earlier than many people think 
•  How menopause affects bone density 
•  What a DEXA scan measures 
•  Why strength training is key for stronger bones 
•  How nutrition, calcium, vitamin D and protein support bone health 
•  Whether Pilates, yoga and weightlifting are safe 
•  How weight loss medications may affect nutrition and bone density 
•  Why men also need to pay attention to osteoporosis 
•  How AI may help patients access better resources and information 

If this conversation was helpful, subscribe for more trusted health guidance from Baptist Health experts.

Host:
Johanna Gomez
Award-Winning Host & Journalist

Guest:

Maria Kyriacou, M.D.
Primary Care Sports Medicine Physician
Baptist Health Orthopedic Care

Transcript

SPEAKER_02 0:00

A lot of studies have been done and they're actually showing in the 30s for women, we start to already have a decrease in the density of our bones. Now, it's very slow in progression. Okay. We see it more with um women that don't do a lot of strength training. Of course, there's other risk factors that are involved. But once you start to hit menopause, that's when we see the significant reduction in the density of our bones, and that's when it becomes concerning.

SPEAKER_00 0:25

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_03 0:35

Hi everyone, I'm your host, Joanna Gomez. Welcome back to a new episode of Baptist Health Talk, where we answer your most search questions on trending health topics. Today, we're talking about bone health and osteoporosis, what puts you at risk, how to protect yourself, and why this matters earlier than most people think. From weight loss medications to strength training and screenings, we are breaking down what you need to know to stay strong for the long run. We are joined by Dr. Maria Kiriyaku, primary care sports medicine physician with Baptist Health Orthopedic Care. It is great to have you here. To start this conversation, though, we need to break down and go back to the beginning, basic 101, because I think when people hear osteoporosis, they're like, oh, I don't think I fall in that category, but what is it? So can you just start us off with what is it?

SPEAKER_02 1:29

Absolutely. And thank you so much for having me here. So essentially, osteoporosis means that the density of your bones have reduced so much to the point that you're at a very high risk of having a scary fracture simply from falling from a sitting, going to a standing position, or even a forceful sneeze. Oh, so it can be pretty scary when somebody tells you you're diagnosed with osteoporosis.

SPEAKER_03 1:53

But when I hear that, I automatically think, okay, I don't have to worry about that now. That's something that I just have to worry about when I'm older.

SPEAKER_02 2:01

Unfortunately, that's not the case. A lot of studies have been done, and they're actually showing in the 30s for women. We start to already have a decrease in the density of our bones. Now it's very slow in progression. Okay. We see it more with women that don't do a lot of strength training. Of course, there's other risk factors that are involved. But once you start to hit menopause, that's when we see the significant reduction in the density of our bones, and that's when it becomes concerning.

SPEAKER_03 2:28

Okay, you just said menopause, and a lot of women are like, I have frozen shoulder or this hurts, something else. Is it something silent that we should be looking out for, or is it something that we're going to feel? And how can we tell the difference? Yes.

SPEAKER_02 2:42

If it's menopause or, you know, just so when it comes to um reducing the reduction of the density of your bones, it is unfortunately a silent disease. You don't know that it's happening. You're already having little by little less dense in your bones. It becomes slightly brittle. And unfortunately, the point where you have the symptoms is when you have pain is from a fracture. Now, there's some things to look out for. You might notice a reduction in your height. Um, some patients like shrinking. Yes. So when you see your your grandma and you're saying, Oh, you know, my small grandma, yeah, there are probably some um concerns that they probably had at some point in their life, what's called a compression fracture of the vertebral bone in their spine, and you lose your height. There's also uh posturing when you start to see uh patients slumping forward. Yes. Um, and then of course the pain. If you're starting to notice some back pain, um even hip pain, always make sure that you follow up with your physician to assure that you're not having concerns of osteoporotic fractures.

SPEAKER_03 3:40

When you say all of this as a woman, I'm like, my hip always hurts. Okay, pick one. I had three babies that carried them. Well, everything hurts. So at what age should we start saying, now we have to get checked? And what does that look like?

SPEAKER_02 3:53

So essentially the way they um approach having a screen for osteoporosis or the DEXA scan, for women it's age 65, for men it's age 70. But you actually want to be seen by your physician much early. And I would actually recommend around the time of perimenopause and menopause. So you said women 30. So around the age 30, we're starting to have already a slight reduction to the density of our bone. Meaning appreciate that at some point in your lifetime, we're starting to already have reduction. Make sure that we're practicing healthy habits at an early stage. Good diet, good exercise, good strength training. But when it comes to the concern, am I in the realm of osteopenia or osteoporosis? Um, probably get check around your 50s. If you have certain risk factors that increases your risk of having osteoporosis at a much younger age, you can have approval to get that DEXA scan at a much younger age than age 65. Okay, so let's just go back. You said a DEXA scan. What is that? So it is essentially a fancy X-ray that allows us to see the density, the calcium, and the minerals in your bones, and how much of it have you lost. Now it gives you a T-score, which standardizes you or compares you to a healthy individual around your age. So if you are less than negative 2.5, that is the diagnosis of osteoporosis. If you're negative 2.4 up to negative 1.1, you're osteopenia. You're not at the the extreme reduction of density of the bone for that high risk. But studies are showing even those that are in osteopenia have a risk of fractures as well.

SPEAKER_03 5:38

Okay, so I go to the doctor regularly to have a physical. I have not had a conversation with any doctor about osteoporosis. How do I even begin this? And how do I where do I begin? Do I just go to my doctor and ask for this?

SPEAKER_02 5:52

So that is an excellent question. Uh you have to be proactive. You have to ask the questions in terms of, well, here are some of my risk factors. And when you guys have conversation or when you have a conversation with your physician about concerning risk factors, that's when they might bring up, well, you know what? It might be time to do a DEXA scan to check. For the most part, if you're a healthy individual, if you don't have some of these risk factors, then we're safe to wait until age 65. But I would still recommend once you hit um close to age 50, or even if you had menopause at a much earlier stage, we have some patients, um, women that undergo what's called primary ovarian failure, where essentially they're going through menopause, but at a very early stage in their life, mid-30s. And so you already have from your mid-30s that risk of um osteoporosis at a much younger stage in life. So there's medical backgrounds as well that you need to have a conversation with your physician.

SPEAKER_03 6:45

That's very scary, though, because you said it's silent. And a lot of women go through menopause, perimenopause at all different points in their life. So we can't specifically say 30, 40, you know. But is it more common to see women being diagnosed with osteoporosis?

SPEAKER_02 7:00

Absolutely. It is more common. We see it in women compared to men. Uh again, with men, um, we have the in terms of the DEXA scan screening at age 70. With women farther, correctly, exactly. And it actually comes from menopause when we lose that hormone estrogen. So many wonderful things. Yes, estrogen is required for everything. Yes. Um, but especially for our bones, estrogen is responsible in maintaining that healthy balance, that metabolism to the bone. So when you lose it, that's when you have that exponential decrease in the density of your bones.

SPEAKER_03 7:35

So look, no one is in the clear here. You all we all have to get shagged, but what are some of the warning signs for men?

SPEAKER_02 7:42

Um, so for men, it's similar in terms of the shortness of your um the reduction of your height. Um, if you're starting to experience any back pain, curvature of the spine as well. Um, but again, it's unfortunately it's a silent disease. So you won't know until you have that scary fracture.

SPEAKER_03 7:58

Is this hereditary? Like if your parents had osteoporosis, is this something that you should obviously be, you know, have a red flag about?

SPEAKER_02 8:05

Yeah, absolutely. So when uh I have my patients come in to go over, discuss osteoporosis and the risk factors, one of the questions that we do ask is um, is there any family history of an osteoporotic fracture, mom and dad? And that is that is a question that we commonly go over and we talk about. So yes, it can be.

SPEAKER_03 8:23

Let's talk about what happens if you have already been diagnosed. What does that look like, medication life moving forward?

SPEAKER_02 8:30

Yeah, so it is an excellent question and for patients to appreciate that when you're diagnosed with osteoporosis, it's not the end. This can be reversible. Now, depending on the severity of the osteoporosis, there's certain medications out there, whether it's a it's a weekly pill or a monthly oral pill, there's other medications that when it's very advanced, that it's a monthly injection or every six months an injection. But what I do want to emphasize is once we're on a medication and a good nutrition plan and you're also including strength training program, we follow up with the DEXA scan to see if there's any improvement, and we do and studies show significant improvement in your bone density. So it is important that once you're diagnosed with it, to follow up with your physician, to follow the protocol of the treatment because we can improve this, we can reverse osteoporosis. Now, we take patients off medications and we follow you every two years with a bone density. If we start to notice that it's going back down, then we start the treatment protocol again. But we don't want to miss that opportunity in treating it because the complication from osteoporosis is a severe one. Unfortunately, if uh we do have patients that when they experience these fragility fractures, the big ones is the hip and the back. Um, the hip, a patient that has a uh hip fracture, 20% unfortunately can um die from complications from a hip fracture. And then with the vertebral fracture for every vertebra in the spine, it does increase the risk. So we really want to be aggressive in treating this as soon as we find it and not ignore it.

SPEAKER_03 10:06

Yeah, and by the way, your lifestyle completely changes once you have it because you are very cautious of things that you can do, and you know, you're just living with such high anxiety.

SPEAKER_02 10:16

Uh 100%. And the other issue that we also see because of this anxiety is well, I don't want to go out anymore. I I don't want to do the exercise anymore. And unfortunately, that makes it even worse. One of the bigger issues that we see, especially with our elders that have osteoporosis and don't want to do the exercises concerning of a fracture, is you start to become weak and you start to lose your balance. What is the biggest risk factor of a osteoporotic fracture? Is far falling. Correct. So you want to make sure that you are doing the strength training exercises. There's certain balancing exercises. This is another reason why you see a physician so we can set you with the physical therapist appropriate to help guide you on these exercises.

SPEAKER_03 11:00

Weight loss medications, so many people are on them. It's obviously a very hot topic. I am assuming that the weight loss medications actually have something to do with osteoporosis. Can you just break down all the correct things? Because there's a lot of theories out there.

SPEAKER_02 11:18

So the weight loss medication, um, you know, this is something that has been very beneficial for a lot of patients out there. Whether it's a it's a patient with diabetes that's been struggling or an obese patient that has several um medical issues due to the obesity. We do highly recommend these medications. Now, of course, like any medication, we have to be prepared for what's gonna happen once you're on it. The medication is responsible in um basically um slowing the gastric emptying of the stomach. You feel fuller a lot sooner, right? So that means you're gonna eat less. And unfortunately, that can have an effect on your nutritional intake. You're eating less protein, you're eating less calcium, you're essentially eating less of the building blocks that your bones require to stay healthy. So when you're deficient to those building blocks, well, the body's gonna find other places to replenish it in your system. One of the first places is your bones.

SPEAKER_03 12:11

So if you are on weight loss medications, is it something for you to really put up on the let's check how my bone density is going?

SPEAKER_02 12:21

Uh yes and no. So depending if it's a young patient, you're in your 30s, early 40s that are on weight loss medication, not necessarily. If you're a patient that are in your 50s, uh menopause, um, I would probably have that conversation because that increases risk factors of reduction in your bone density due to the fact that you have less nutritional intake from that medication. And then, of course, when you lose the weight, you lose the mass and you lose your lean muscle mass. Right. And your lean muscle mass is very um important in terms of triggering response of the bone, your exercising, your weight lifting, that's what wakes up the bones to build more bone. Got it. So if we're losing the mass, that's less weight to the bone, you won't build as dense.

SPEAKER_03 13:07

Uh you know, we all know this because you mentioned it also earlier. Lifestyle, strength training, it's extremely important. What are some of the things that we can do to maintain strong bones?

SPEAKER_02 13:20

The lifestyle modification absolutely is important. So the first thing that I always talk to my patients in terms of concerns of osteoporosis is you want to maximize your nutrition, nutritional intake. That includes are we eating enough um dairy products? Are we eating enough protein? So I have a lot of patients that, you know, are vegetarians or um are not at all intaking any dairy. So we want to make sure that we're supplementing appropriately. So it is absolutely important that, you know, even talking to a dietitian or a nutritionist, not just your primary care, to see if we can optimize your nutritional intake. And then, of course, it's the strength training. So with my patients, I tell them, look, it's non-negotiable. You need to do some form of strength training because that's really what's gonna wake up our bones in increasing their density.

SPEAKER_03 14:07

Okay, so when you say that, I automatically am thinking of myself in the gym lifting these heavy weights, going, but I have weak bones. So it's not like I kind of feel like I'm doing something to counter what I should be doing to protect my bones.

SPEAKER_02 14:20

Yeah, so that's a good point. You're absolutely right. You don't want to start with 40, 50, 60 pounds. Obviously, you want to start gradual and slow. You can start with five pounds. You can even do resistant bands and then little by little bring it up, but you don't want to stay at that same um weight or resistance because that will no longer trigger further growth of the bone.

SPEAKER_03 14:42

So Pilates, I know it's you know, it's been around for such a long time. Is Pilates good or yoga for osteoporosis?

SPEAKER_02 14:51

So let's first target Pilates because yoga can actually be well, as well as Pilates. So as long as there's some form of resistance happening, okay, um, then that is a positive for strengthening the bones. Gotcha. But if there are concerns of already osteoporosis, especially in the spine, you want to be careful that you don't put the spine in an um intense angle, whether it's in flexion or an extension. So, like in yoga when you're doing the sunrise or the downward dog, and if there is a concern of osteoporosis that's pretty advanced, then you might increase a risk of a vertebral fracture. So some of those extreme bending of the back, we need to be careful. Oh, good.

SPEAKER_03 15:33

I'm glad I asked you that. Okay, we're gonna go into some truths or myth. Okay, so I'm gonna ask you some questions and you'll tell me, break down if it's true or if it's just a myth. Cardio alone keeps bones strong.

SPEAKER_02 15:47

So that's a myth. Unfortunately, cardio alone is not enough. It it is absolutely important because improving your circulation improves the health in all of our tissues, right? Muscles, bones, your organs. But unfortunately, again, when it comes to the health of the bone, it's the resistance, it's the strength training part that really optimizes building a bone. You need both, in other words. 100%.

SPEAKER_03 16:08

You need both. Okay, active individuals aren't at risk for low bone density osteoporosis. Is that a true or myth?

SPEAKER_02 16:17

Uh unfortunately it's a myth. And I'm saying unfortunately a lot as well. Well, so I have and it comes again with uh the nutrition part. So we have very active individuals, but if you're not optimizing your nutritional intake, then you can do all the strength training and exercise in the world. But if you don't have the appropriate building blocks, your nutrition, your calcium, your minerals, then there still can be an issue of osteoporosis.

SPEAKER_03 16:41

Yeah, and I and I asked you the this already about lifting weights. We already know that it is not dangerous to do it, right? Depends how much you're lifting.

SPEAKER_02 16:50

So, and that's correct. It depends on how much you're lifting, and also if you have any other medical problems. A lot of our patients that are trying to optimize their strength training at our point in their life that likely they're dealing with a little bit of osteoarthrosis, maybe some arthritic changes in their weight-bearing joints like the hip and the knee. Right. So you want to be careful in terms of certain modalities of weight lifting. It's always good, always good to talk to your your physician first to make sure medically you're clear. And if there is any medical problems that prevent you from doing certain weight lifting exercises, to work with a physical therapist first.

SPEAKER_03 17:29

Um, let's talk about everyday habits that people can actually do to help themselves just be healthier. Is there anything that they can take over the counter or something that their doctor can prescribe them?

SPEAKER_02 17:41

Excellent question. So, a couple things that you can do for yourself without any prescription. Again, it's the nutritional intake. Calcium, you want to make sure that you're getting close to 1200 milligrams a day. So you can look into um the certain food groups that you're you're eating and see if you can add it up to make sure it's up to 1200. Now, obviously, you can get that in uh supplements as well, but it's always good to do it through through your diet. Uh, when it comes to medications from your physician, the vitamin D supplement, um vitamin D3, somewhere between 2,000 and 5,000 for patients that already have the diagnosis of osteoporosis, it's a good idea to optimize. Vitamin D helps with the absorption of calcium, which is a very important building block of your bones. So you want to make sure that you are taking your vitamin D supplements. And then we already talked about it before your proteins, protein, protein, protein. It's extremely important that you optimize your protein intake.

SPEAKER_03 18:33

Smoking, drinking alcohol. I know the answer to this, but I'm asking because I must.

SPEAKER_02 18:38

Yes. So, like everything else, how alcohol and smoking affects the body, it absolutely can affect the bones. So, yeah, we highly recommend to talk to your physician to come up with a plan to help um quit smoking and decrease intake in alcoholic consumption.

SPEAKER_03 18:57

So, this question's probably going to sound a little weird, but let's work through it just for the sake of saying that it's out there on the internet. Is there something I'm gonna put my parent hat on right now? Is there something the parents can do to look out for early signs that say, hey, as my child some weak bones, does this mean he or she will have osteoporosis? Or, you know, because right now we're in it. So what can we do for future generations? Uh so very loaded questions.

SPEAKER_02 19:25

So, and the reason I say it that way is because um there are things that we can do now. We also need to keep in mind of things that our our young generations are currently doing. There's the extreme. Yes, there is the the, yes, absolutely the hunching over that can affect the spine. But there is those that we have young athletes, uh especially like our runners, our gymnasts, our swimmers, our slimmer athletes that when they're exercising, they're really using up their energy and they're not quite optimizing their caloric intake. It's kind of what we talked about before. If you're not increasing or optimizing your caloric intake, your nutrition, you are losing those blood building blocks. And so when it happens at a young stage in your life, like a teenager, that can be very problematic. It's called relative energy deficiency syndrome. And we see it very often with our slim athletes that I mentioned before. And you want to make sure that you um bring this to your their awareness, the parents, the the athlete as well, because optimization or maximizing the density of your bones happens at the peak of your teenage years, somewhere between 18, 19, and 20. So if you have not optimized your caloric intake, you're really using up your energy in your in your sport, you might actually lose that opportunity to having healthy density of bones. And so you already at a young stage in your life having a lower density of your bones with ink, which increases your risk of osteoporosis at a younger age. So it was a valid question.

SPEAKER_03 21:01

100%. Yes, it was a value. Very valid question. A valid question. Speaking of the future, how is AI and science helping you guys kind of figure out a better way to help us deal with osteoporosis?

SPEAKER_02 21:15

Uh so with AI, the way we've been able to use it to our benefits is to provide the resources that our patients need when they're unable to get them on their own. Um, for example, a lot of my patients, especially my elders, they're unable to find transportation to go to physical therapy. Uh so we're able to provide um these video exercises, we're able to provide handouts where we're using AI resources to really give them the information that they need. Um, of course, you know, we're we're always uh having the conversation. Well, I looked up through Google, I looked through AI, and so they always put in a way it's still a good thing because they bring up these conver uh these questions that really helps to. Open the conversation. Well, I heard about this and I read about this, and uh, you know, I I asked the Gemini and this is you know what the response told me. And and it brings up really good points. For instance, um, how you were asking, well, you know, uh somebody that's either going through perimenopause, you know, I didn't have a conversation with my physician about the health of my bone density. Well, that's how one of my patients um brought it up to me. She had her, her mother had a really bad fragility fracture due to osteoporosis. She started asking questions, and then when she followed up with me for an arthritic issue, she brought up the concern of osteoporosis. And and that's kind of how it opened the door to have that conversation. So it can be an issue at times, giving false information, but it certainly can open the door for having that conversation.

SPEAKER_03 22:47

If there is one takeaway that you want us to have from this conversation, what is it?

SPEAKER_02 22:55

Eat healthy, uh, gain have that good nutritional intake and exercise, including strength training. I can't tell you how many, especially my female patients, that you know, they want to have the lean muscle mass. With strength training exercise, you're you're not gonna become a bodybuilder. That that does not happen unless you truly focus yourself. You incrementally bring up the the weights. You you get to a point where you're you're able to satisfy not only the health of your bones, but the the appearance that you want and not to look like a bodybuilder. So I try to tell my patients, don't shy away from it.

SPEAKER_03 23:32

Yeah, it sounds way easier than what it really is. But thank you so much. This really has been a wonderful conversation. Thank you for sharing all of your insights and expertise with us. If you are watching at home, remember your health matters. If this conversation was helpful, be sure to subscribe for more trusted guidance from Baptist Health Experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts. Thank you so much for watching and stay healthy.

SPEAKER_00 24:01

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