Dr. Kristi Tough DeSapri: Menopause & Postmenopausal Osteoporosis

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You're listening to Aging Today, the podcast where together we explore the options to

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aging on your terms.

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When I get older, lose a fire, many years from now, we used to be sending me a fountain

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time birthday greetings out of one, if I did I'd kill quarter to three would you like

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the dawn?

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Will you still leave me, will you still leave me when I'm sixty four?

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And now the podcast where together we discuss proactive aging on your terms, connecting to

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aging process.

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Now here's your host, Mark Turnbull.

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And welcome back to another lively discussion on Aging Today, we are the podcast where together

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we explore the many options to aging on your terms.

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out to me your host, Mark Turnbull and my email is Mark with a K, mark@agingtoday.us.

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Well as you know this is about a podcast about the story of aging and I've already said that

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if you're too busy, not too busy being born, you're too busy aging and you know think about

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that, that's, there's nothing more to it than living on this planet and for how many years

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that we're living and we're all aging at various levels.

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But one of the things that has always intrigued me about the body, the human body is as we age

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and as we grow older things change and sometimes I don't like the changes that are going on in our

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bodies and I have a lot of questions for why, why we're, we're changing so dramatically.

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And one of the things that that where we see a lot of change is in our bone structure,

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we see a lot of changes in our hormonal structure.

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I don't know if that's the right word but I'm using it and here to guide us today along this journey

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is Dr. Christy Tuf Disapri and she's going to be leading us in this discussion on osteoporosis,

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menopause and other age related sagging issues if I may say so. Dr. Disapri, welcome to aging today.

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Hi Mark, happy to be here. You're right, we are all aging but as I like to say we can do that

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gracefully, we can do it with strength and we can do it without fractures. So I think we're going to

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talk about all of those things, bone health, bone strength, falls and prevention of fractures today.

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Yeah and I love that you are so optimistic about aging gracefully because if you look at my smile

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and mug, it's not grace, there's nothing graceful about me. So but maybe that's my own image issue,

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right? Okay, so let's get into it and maybe that aging gracefully as we take care of our bodies

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is that when you say when that's kind of it's a loaded term gracefully. So what does that mean to you?

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Yeah, I mean I think, right, I think we all, particularly so my area of interest is women's health,

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I'm a menopause specialist, I'm also a clinically certified dentist, a tomatrist, I'm a board certified

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internist and I have practiced in women's health after my fellowship at the Cleveland Clinic. So I

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have seen women, you know, through the reproductive span and then my focus really is on women after

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the reproductive years and so what happens in the menopause transition and menopause years beyond?

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So when I say gracefully, I think of that as all the body systems, right? Looking at cardiovascular,

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looking at breast health, looking at bone health primarily and again, making sure that we're

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individualizing treatment for women who come with certain pass medical histories and then want to

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look forward to maintaining good health and I think there's so much now in midlife women's health,

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a lot of, you know, technologies, a lot of medications, a lot of more awareness about those years

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beyond child bearing. So that's sort of how I, you know, see women as an individual and then also

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think about what's going to, you know, help her live well and live a long time without any of those

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medical issues we want to prevent. Yeah, and there are solutions. And we're going to talk about

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those solutions today to aging gracefully, aging well, another way of saying it and so let's get

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into it. The thing that holds us upright is the bones that we have in our body, the skeletal structure.

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Without that, we'd like us be like jellyfish slithering across the floor, right? So the bones

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are extremely important. Absolutely. Well, you're right. Yeah. Right. So go ahead. I was going to say,

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what is osteoporosis? What is happening to us and our bones as we age? Yeah. So you set the framework,

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you know, no pun intended really well with talking about the skeleton and, you know, our bones. And

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so you're absolutely right. The skeleton is very important for mobility, for supporting our internal

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structures. We actually also have a lot of our main nutrients and vitamins, you know, inside of our

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bones like calcium and different phosphorus and different minerals and cells. And then, you know,

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when we think about bones, we usually don't think about those until someone, you know, has a fracture

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or is diagnosed with osteoporosis or has broken a bone or thinks about things like arthritis. And

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and so we really don't think about, you know, our bones until maybe, you know, sometimes it's too late.

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So what is osteoporosis? This is probably one of the most common questions that I get. I see

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women, you know, day and day out in my clinical practice talking about osteoporosis, what it is and

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what it isn't. And really osteoporosis means, osteosus is a term for bone and porosis porous. So it

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means weakened or thinner bone bone mineral density, which means that your bone density is weaker,

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your bone strength is is compromised and that leads to an increased risk of a fracture. We call those

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low trauma fractures. So fractures from a standing height or less or fractures from in our spine can

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even be from like a twist or a bend that's exaggerated. So, you know, unfortunately,

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osteoporosis, you know, this is a term and a sort of a condition that is silent. So many women

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don't know they have it unless they've had a screening dexa, which we'll talk about. I'm sure in

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terms of how we screen for osteoporosis or on, or, you know, the more unfortunate is they've had a

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low trauma fracture like a fracture of their wrist, forearm spine, hip, pelvis and that's really either

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you know, changed their life. You know, they're either had in a cast or they've been immobilized or

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hip fractures really carries some more significant consequences. So osteoporosis is really the end. So

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of where we want to prevent, we want to prevent getting thinner bone density, want to understand

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why we have that condition and we obviously want to treat that and we'll, I hope, you know, get to

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talking about all those components today. Yeah. I want to talk a little bit about the bones

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themselves and what makes up bone, what chemicals, what nutrients, what, and the reason why I ask

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that question is when we start out as children, our bones are a lot more pliable and then as we age,

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whatever is happening in the aging process, they become more brittle or in osteoporosis, the more

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what was the term you use? Yeah, thinner, yeah. Yeah. Yeah. So what's happening? I mean, we just

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not getting the right nutrients and is it, is it possible? Maybe not today, but is it possible

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into the future that will they be able to find the solution that will keep bones pliable and healthy,

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till you're 120? Yeah. Well, I think that there's definitely, there's a lot to that question

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and you're right. So, you know, bones are made up of many different cells. They are made of,

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like I mentioned, calcium, phosphorus, different types of bone cells that we call osteoblasts or bone

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forming cells, osteoclasts or bone breakdown cells. So we have something called osteocytes where

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a sort of the nerve conductor of the cell. So we have all these, these sort of cells within our

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bones and they all work together to, we call either do some modeling or bone formation, which

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primarily occurs in our teens, our 20s. And then depending on the skeletal site, like the wrist or

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the ribs or the, the clavicle, we know that you really sort of achieve, achieve peak bone mass

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in your 20s, which means you've really built up your bone bank is how I describe it to my patients

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is all the bone that you're going to have in your early 20s, maybe, you know, closer to your 30s,

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and then you sort of plateau and primarily for women, we know that, you know, the time of menopause,

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whether that's surgical menopause or natural menopause, or we're starting to lose our primarily

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estrogen hormone secreted from the ovaries, that that is where that imbalance of bone being formed

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by the osteoblast and bone being broken down by the osteoclast starts to go haywire. And we know

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that when there's a lot of drops in estrogen, again, around the time of menopause, which can be for many women,

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women, sometimes age 40 to, you know, 60, depending on when that final menstrual period is and when

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those hormones are changing, is that there is an imbalance of more bone breakdown than bone formation

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is happening. So, you know, you're on the aging today podcast. I mean, we are all aging. The,

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the trick is, right, we want to trick our bones into building up more bone or building,

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simulating what we call the osteoblast, tricking our bones to reduce the osteoclasts, but also just

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allowing our own bone to remodel as it would because both, all those, those cellular structures and

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those cellular processes are very important to maintain healthy bone in both the trabecular bone

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compartment, which is primarily bones in our spine and our femoral neck of our hip and cortical

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bone, which is primarily densely packed bone in our long bones of our body, like our wrist, our femur,

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etc. So, every bone in our body is made up of those two different components, slightly different

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cells, slightly different rates of remodeling and bone formation. But again, really important,

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and, you know, genetics plays such an important role, exercise calcium, like I mentioned, because

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that mineralizes the bone, plays these all things, play a really important role in how each one of us

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is different in terms of how much bone is being formed or your bone bank and how much bone is being

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broken down. And for, like I said, for women, so important to know what's happening at menopause,

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and really building and boosting the bone bank, as much as we can, and understanding your history

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as it relates to bone health and how that's impacted before the time of menopause. I mean,

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that's, I think, what we're going to, what we're talking about here today, really, the pivotal time

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of menopause where we need to understand, you know, what our bone density is to prevent more fractures

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and prevent bone loss. So, is there a difference between men and women and their bone bank?

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Absolutely. So, you know, men obviously have, generally, when we look at the, you know, the curves

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for bone formation and bone breakdown, we know that men start with a higher bone mass, again,

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probably due to size, testosterone, men also do have estrogen, actually, as well. So, you know,

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we know that generally for most men, we know that the bone acquisition, bone marrow acquisition is

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higher for men than women, and also that men do not have a menopause, right? There's no

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time where men lose a dramatic amount of testosterone where women can lose up to 20% of their

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bone mass in both the tribicular and, and a cortical compartment at the time of menopause.

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We know from literature that women who are thinner, women who have family history of bone loss can

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lose more bone density. So, again, men don't have the menopause. We still can lose bone density and

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men, and it's still important to do screening bone marrow density in a men of a certain age,

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primarily men over age 70 or men who have a, some chronic medical conditions that might contribute

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to bone loss or increased risk of fractures. So, yes, we don't want to forget about the men.

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Yeah, yeah. Well, and this is a relevant topic to today. I mean, we're questioning what is a woman?

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And what you're saying is that there is a difference between the sexes. There is two sexes,

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and they're uniquely designed, and they have their own, their own challenges, and it must be in the

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DNA or there must be a lot of things that are going on there. Why were so different? You would think

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why does there have to be a difference in the bone structure between a man and a woman

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when we're both equal in the sense that we're walking this earth? Why did there become a difference?

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Right. And well, there is some interesting research done in that in the gender,

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affirming hormones and bone health that's ongoing, and really in its infancy, but is gaining more

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traction because we do are seeing this more often. And when we look at the large scale, you know,

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eight million women have osteoporosis that we know of in the United States, about two million

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men. So again, you know, some of the, again, the sex differences in terms of bone mass acquisition,

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menopause, certain, you know, conditions primarily, things like autoimmune conditions can sometimes

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preferentially affect women. So those sometimes carry risks of needing things like

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blue-gabocorticoids or steroids as their treatment, we know that there's such a large component of

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women now getting diagnosed with hereditary breast noberian cancer. And so a lot of those women

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who have undergone early surgical menopause that can affect their bone mineral density as well. So

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really again, you know, again, age of menopause is very important for understanding, you know,

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what our peak bone mass is and how to preserve it for those, you know, menopausal years, as we know,

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women are living a third to sometimes a half of their lives in the post-menopausal years.

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Yeah, yeah. And it's only going to get, we're only going to live longer, I believe. I mean, there's

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some amazing things that are happening out there with longevity. And we've already seen, you know,

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the longevity of humankind working together and moving forward. It's not uncommon for us,

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you know, I have an in-home care agency and a hospice agency and it's not uncommon for us to

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be caring for people in their hundreds. And I don't know if that was really a prevalent thing, maybe 40,

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50 years ago. Yeah, absolutely, absolutely. On a personal note, I have a maternal grandmother who

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turned 100 this month, which is very exciting. So, I mean, again, anecdotally, but I agree with you.

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And, you know, the other thing with, you know, aging again comes with, well, what are the consequences?

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And so one, you know, interesting to statistics is that, you know, right, we are living longer,

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women are living longer, men are living longer. However, with osteoporosis, again, because of

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the silent condition, you know, it's, it's, you know, sort of projected that hip fractures will double

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by the rate by the year of 2050, which means, right, that if we're living longer and our bones need to,

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you know, we need to, you know, have our bones grow with us. The end consequences of thinning of

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the bone as we talked about with osteoporosis is, it's fractures in women, primarily, again,

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and men too who are in the 80th and 90th decades of life tend to have, you know, the prevalence of

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hip fractures are higher than women in their 50s and 60s, and that's because, again, when we think about

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falls, you know, one in three women fall over the age of 65 and, and males as well, and we know that

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that is one of the main reasons, you know, for emergency room visits, it is falls and, you know,

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elderly. And so when we think about, you know, prevention of osteoporosis, treatment of osteoporosis,

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you know, the hip fractures is in, in our field, in the bone health field, like into, you know,

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heart attack or, you know, cardiovascular event, meaning, you know, we want to prevent things until we,

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you know, we want to prevent your falls and your fractures before they occur because though those

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fractures are, again, the hip fracture is really a sentinel event, and really, again, you know,

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we look at the large-scale literature, you know, a third of, you know, a third of people do not,

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you know, walk or live independently again. We know that there's a high mortality rate after

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hip fractures, again, from the fracture itself and from the sequelae. So, really when I see women

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and we know that looking at the hip bone mental density is so pivotally important as we age is

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really an indicator of what the bone strength is. We really want to prevent, you know, all fractures,

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but, you know, really the life-changing fractures for hip fractures and women and men who are,

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are, are, are those demographics is, is really important. Because we're all, aging and we're all

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living longer as we age, what are some of the things that we can do to prevent the

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bones from, you know, deteriorating and, and is there things that we can, you know, foods,

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is there certain foods that are more that we should be introducing into our diets more to keep

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our bones more pliable and healthy as we age? So, this is such a common question, you know, we get about

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lifestyle, you know, which includes, again, you know, exercise and then also nutrition. I think,

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you know, where we are now in our world, we have so many options. So, I spend a lot of time talking

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about the things that are, again, what I mentioned, but are, what are the building blocks to bone?

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And so nutrients, but, you know, essential, you know, minerals, just calcium are very important.

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We're so lucky, you know, in this country and I really think many, you know, countries that have

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calcium-rich foods or dairy sources or non-dairy sources of fortified foods with calcium.

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And there's, you know, the recommended daily allowance, really for, for again, postmenopausal women

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is really 12 to 1500 milligrams of elemental calcium a day. And, and again, so getting that calcium,

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whether that can be through dietary sources or supplements, primarily, again, that's really an

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individualized discussion in terms of your history, making sure those are safe. They're not going to

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cause constipation in kidney stones and, and, and looking at the total inventory of what you're already,

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you know, doing that's really important. We talk about vitamin D, which also helps absorb calcium,

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certain nutrients, primarily things like protein intake. We know so much more of that about that,

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and how that is supporting muscle around the bone. So, you know, there are a lot of observational

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studies looking at calcium and vitamin D, but we really know, again, those are building blocks.

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But what I always like to share is, you know, and I'm very much, you know, counseling as the whole,

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whole person is that if you have osteoporosis and that's, you know, again, sort of more, you know,

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bone loss that is at advanced to a point that, you know, really calcium and vitamin D, and we know this

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from, you know, placebo controlled studies, calcium and vitamin D alone are not going to mineralize

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or strengthen the fill in the bone, general density that's lost. We really need to do something to

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boost those bone cells and really work on, and within the bone mechanics that I talked about,

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really to strengthen the bone that's either there or build up some new bone mass to really support that.

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And, you know, it's similar to, you know, a lot of our other chronic conditions where we sort of,

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you know, want to control the blood pressure and the control the lipids, and again, make those levels

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look optimal because we know those are the areas where, you know, optimal aging, you know, occurs,

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and then we don't have the signs of bone loss and fractures. So, this is really, again, a discussion

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about treatments beyond calcium and vitamin D for women who, you know, again, have advanced

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bone loss or osteoporosis. Yeah, and there's really kind of two categories. It's the pre, you know,

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when we're younger, we should be making sure that we're taking enough vitamin D and calcium and

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all the other things that are going to build up that bone bank in us. And then there's, when the

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bone bank is empty, it's dry, if you will, then things, then there's another process or another

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approach that you're taking. Is that what you're saying? I mean, exactly. I mean, I think right for

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each decade of life, it can be a little bit different pre-bent-aposal versus post-bent-aposal.

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You know, again, we know that calcium, you know, we should probably be talking about that in our,

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you know, with our pediatricians and with our younger children too, things like that leach calcium

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out of the bones. We want to, you know, avoid those, like, excess, you know, sodium or salt,

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excess, you know, sodas, things like that, which can affect, you know, that calcium balance.

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And then I think, again, it just becomes paying more attention. I think, you know, as we age,

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we need to pay more attention to, you know, the macronutrients, even the micronutrients. And I think

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calcium is one of those ones that kind of sometimes gets overlooked or has a bad, you know, rap,

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some people say they're allergic to that or, and I, there's, of course, there's lactose intolerance,

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but there's a lot of other ways to get calcium for folks who have done it by like that. And I think

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sometimes it's just, learning, I, I, I share a lot of things like looking at certain websites,

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like the Bone Health and Osteoporosis Foundation, which is a great non-profit that really tries

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to educate both clinicians, healthcare providers, as well as patients, in terms of understanding

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osteoporosis and, you know, again, how to live with this diagnosis, how to prevent and treat the,

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the diagnosis as well. Yeah, and I think, you know, one of the, we've had a lot of guests on, and we

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talk a lot about, you know, whole-food plant-based nutrition and different things. And so if you're,

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you're not going to do a lot of dairy products. So you've got to find other ways to get the calcium

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and the, you know, the vitamin D if you're not going to take, you know, have dairy products. Because

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it sounds like dairy products are the highest form is am I correct or the most, or the most convenient

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form to get calcium in our diets? Yeah, I mean, absolutely. I mean, they're not, they're not fortified,

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like some of the other products, however you can, like from a lot of our non-fortified,

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you know, our fortified milk products now, which examples like almond milk, coconut milk,

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soy milk, all of those can be fortified with calcium. And so sometimes those are good options,

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but I mean, there are so many out there. And so again, it's, you know, what is it? What works in your

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diet? And then consistency is key because we know that with low calcium or low vitamin D,

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again, that's not, you're not mineralizing your bone. And as we age, I said, there was, you know,

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more bone breakdown happening. Well, we need to replenish those doors. And so we need to make

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sure that the mint bone is mineralized. In addition to very common when I see patients, you know,

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they think if they're on an osteoporosis treatment, you know, either a medicine that prevents bone

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loss or one that stimulates bone formation, either oral or injectable, that they know, they know,

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they're now like off the hook for taking calcium, vitamin D, that that's doing the trick. And that's

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something that, you know, it's so important to know that no, you need to still take, even if you're

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taking a medication, great, we still need the building blocks. So including calcium, vitamin D,

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you know, again, some sort of exercise, resistance exercise, posture balance, all of those things.

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Let's talk about the elephant in the room, menopause. And so how does menopause affect osteoporosis?

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And what is menopause? And then how does that, what's the relationship between the two?

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Sure. Yeah, I think that's just really, you know, menopause itself is really getting a little bit more

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media attention. I think we've got some celebrities talking about how, you know, they're menopause,

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you know, journeys. I think that there's some more physicians and technology out there.

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But it's really important, you know, that, you know, menopause is a natural state, okay? So

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this is really defined retrospectively. Menopause is a time period in women's life where they have

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undergone 12 months of no periods or what we call amenorea. And sometimes that's, again, a lookback

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diagnosis. Some women have irregular cycles for many years up until the final, their final menstrual

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period. And we call that time, you know, the early or late hairy menopause time before we enter

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sort of the menopause transition and then the final menstrual period. And then the year's postmenopause

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would be would be after that. So, and again, if there's surgical menopause, that can be an abrupt

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cessation of a period because again, the ovaries are removed. Oftentimes I see women who have

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undergone, you know, chemical menopause. So, or either taking medications primarily for,

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like, cureditrile breast nobarian cancer or chemotherapy radiation that really stops periods. And

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so as I mentioned in this country, the average age of menopause is 51 and a half. But that can,

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there can be a long, you know, span. We know, you know, menopausal symptoms such as, you know, hot flashes,

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night sweats and things like that. And don't just happen, you know, in menopause, they can have an

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early in the, in the, in the hairy menopause and really can continue for someone from for seven to

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10 years. So, hot flashes and that in vasomotor symptoms and night sweats and disturbed sleep,

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joint pains and mood symptoms in Samnia, things like these can be more commonly related. There are

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some other uncommon, you know, things that we hear about with menopause, like, dryness of the skin or

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chest or palpitation. But the one we don't talk about often is bone loss, right? So, no one comes

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to me and says, "Oh, I'm in menopause, you know, like, what's going on with my bones?" They say, "I'm in

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menopause, like, what's going on with my joints? Her, you know, I'm having vaginal dryness. I can't

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sleep at night." But again, when we know what's happening, you know, underneath the skin, so to say,

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in the, in the bones, we know that at the, the 12 months before the final menstrual period,

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that estrogen declining, the bone loss, particularly, we know this from, you know, looking at bone

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markers and looking at bone density declines, that the bone has already started to decrease more. We

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see those changes in the spine, so in the trabecular bone, and so women come with their spinal,

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bone mineral densities that can be lower than their hip and they're confused. And that, again,

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is primarily because of the, the rate of remodeling that happens in the bone at the time of menopause.

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So, that's why it's, you know, again, really important, you know, to know when you're,

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going through menopause and then what your risk factors for bone loss might be because, you know,

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at the time of menopause, you know, if you have risk factors for bone loss, which are many, you know,

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family history, genetics, medicines, surgery, etc., you know, the bone mineral density, you,

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you need that as that, right, with either a fracture risk assessment or a bone mineral density spring.

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You're listening to Aging Today with your host, Mark Turnbull and his guest, Dr. Christy

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Tuff DeSapri and the understated topic in menopause, postmenopause, and osteoporosis.

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You can find out more at her website, boneinbodywh.com. We'll have more with Mark and Dr. DeSapri in just a moment.

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Sometimes I'd like to smack old age right in the kisser.

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Oh, yeah, still got those moves. I would be fabulous.

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Comfort care can help with as much or as little home care as you need. From medication reminders and meal prep

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to everyday chores and errands. Let us create your personalized care plan and find the perfect caregiver

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match so you can live your best life possible. Call Comfort Care at 503-636-0417.

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A Did You Know Moment from Comfort Care Home Care of Westlin.

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Did you know in the US, 6,000 women enter the menopause transition every day? That's more than 2 million

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per year and one in two women over the age of 50 years will sustain an osteoporosis-related fracture,

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a broken bone. In her lifetime, which is more than one in eight women who will be diagnosed with

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breast cancer. And finally, once a woman has sustained an osteoporosis-related fracture or broken

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bone, she has a five times higher risk of having another fracture in the following years.

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This Did You Know Moment was provided by today's guest and is brought to you by Comfort Care

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Home Care. Call today at 503-636-0417.

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And now more with Mark Turnbull and his guest, Dr. Christy Tuff Desaferi.

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In our discussion about menopause, postmenopause, and osteoporosis on aging today.

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I was wondering if there was cause and effect. Does menopause cause osteoporosis, osteoporosis cause

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menopause? Or is it individual and they're independent of each other? How closely related are they?

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Well, I think oftentimes we're only getting a bone marrow density assessment at the time of menopause,

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unless women have come for the premenopausal years, have had bone loss due to either anorexia,

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eating disorders, or they've had genetic predisposition. Maybe they've had a lot of stress fractures.

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So really again, we know that there are many risk factors for osteoporosis, including like I said,

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genetics and medical history. So certain things like diabetes, rheumatoid arthritis,

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celiac disease, I mean, so many that can affect the way that calcium is metabolized. Those can

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contribute again to bone loss that we are not only picking up at the time of menopause because for

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many of our medical societies, really the indication for a bone mineral density screening is

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the time after the final menstrual period until the age of 65 if you have risk factors for

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bone loss. So, you know, age of menopause being on the lower body mass, surgical, surgical history

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medicines, particularly like things like steroids or breast cancer survivors are on the Roma

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Tase inhibitors, all of those things. So just because we pick it up at menopause, in the time of menopause,

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we know that bone loss is occurring before and again, awareness is really like, you know, I'm working

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here today with amgen on awareness about, you know, when, you know, when is bone, when is bone

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mineral density, when do we need to think about that and how do we need to think about that too? Again,

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think about preventing those fractures in the future and maintaining bone mass.

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Yeah, and when it comes to menopause, menopause is it hormonal primarily? Is the body losing its

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hormones and then that's what causes this transition in life? Absolutely, yep. Okay. And

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so, loss of estrogen from the ovaries, we know testosterone also decreases, but that actually declines

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sort of more in a stepwise fashion even starting in our 30s. And, you know, again, we have estrogen

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receptors everywhere in our body. So all those symptoms that I just mentioned in terms of, you know,

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sort of things like brain fog, joint pains, cardiovascular symptoms, those are all because we have

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estrogen receptors, both estrogen alpha and beta in all of our body and all the cells of our body.

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So from our, our, our head really in the high-booked alimus that affects hot flashes to our toes

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and our joints even in our feet and ankle. Yeah, so we really need to take menopause seriously because

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if we don't take it seriously, then it's going to have an increasing effect upon our bone structure.

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Right. Absolutely. And it's one part, right? So I mentioned there's some women who come, again,

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most women come with symptoms of menopause, or I say they're the lucky few that get no symptoms,

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but we know 70, 80% of women get some sort of symptoms of menopause, whether that's, you know,

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the panopelete symptoms I mentioned or just a few of those symptoms. But again,

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bone loss is that hidden silent, you know, symptom of that. That's the hidden silent one. Yeah. Exactly.

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So even more important that we think about calcium hormones at that time if they're indicated,

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because we know we're even leaching more calcium out of, uh, out of our bones at the time of

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menopause. So again, just to bring it back to the calcium being important at the time of menopause as

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well. Yeah. And so there's a, there's a lot of talk about hormonal, um, replacement therapies and

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how important is that because, um, and I say that and I, I talked to my wife, Christina,

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and I said, it's okay if I talk a little bit about you because she's going through it as well,

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and she's gave me permission. So one of the things, you know, that she's, she's not done anything.

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And, and I'm going, well, shouldn't you? And she says, well, the doctor said, don't, don't do any

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replacement things until there's some problems or whatever. And I'm just sitting there going,

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well, that's not very proactive in my mind, but I don't know what I'm talking about. Yeah.

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So how do you approach that? Yeah. Well, I think, right. So if we're really thinking, um, you know,

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about like thinking about like looking at bones, sort of in isolation. So we're thinking about,

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again, the menopause transition, you know, women in their fifties for natural menopause. Again,

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we're, if we're talking about this, this demographic. So it, if you do have bone loss, which is the

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beginning of bone loss is called something like osteopenia. Now we call, we refer to that as low bone

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mass, you know, or osteoporosis hormone therapy. We actually call it hormone therapy, not hormone

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replacement therapy. So hormone therapy is really the correct term because, you know, we're not replacing,

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you know, all of the hormones that are lost at the time of menopause. We're giving back small

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fractions to offset bone loss and off and also treat symptoms, you know, that are there. We're not

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trying to replicate a pre-menopausal state. So you're right. This is a very nuanced discussion.

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Again, also individualized, you know, when we think about the medical societies, particularly,

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I'm very involved in the menopause society. And we look at the evidence for, for using hormone

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therapy. It really is for women who have symptomat symptoms of menopause moderate to severe

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bothersome, phasomotor symptoms and those symptoms I mentioned. Treatment of genital urinary syndrome

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of menopause, another great topic. Maybe we can talk about on your show another time, which is a

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vaginal dryness, a painful intercourse for current urinary tract infections changes that happen.

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Again, due to lack of estrogen and the vagina and the vulva and lower one, third of the,

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of the bladder. And then, you know, again, and it's sort of like the third one is hormone therapy is

377
00:37:03,640 --> 00:37:09,240
indicated for the prevention of osteoporosis. It is no longer conservative,

378
00:37:09,240 --> 00:37:13,560
it's approved for treatment of osteoporosis after a woman's health initiative study.

379
00:37:13,560 --> 00:37:18,120
However, when we look at women who are low absolute risk for fractures and who are

380
00:37:18,120 --> 00:37:23,320
less than age 60 and less than 10 years since menopause, there's some good evidence that

381
00:37:23,320 --> 00:37:30,520
hormone therapy also, you know, prevents fractures. And so, and maintains the bone mass. And so,

382
00:37:30,520 --> 00:37:34,840
this is where the discussion comes in with women who generally have a couple of symptoms and they've

383
00:37:34,840 --> 00:37:40,360
had some bone loss. And if they have no absolute contraindications for hormone therapy, we, we,

384
00:37:40,360 --> 00:37:45,880
we do talk about that hormones actually. Again, is then that class of preventing bone loss.

385
00:37:45,880 --> 00:37:50,840
We know that there are a lot of other ones, oral injectables and things, but this can be one of

386
00:37:50,840 --> 00:37:55,640
the options that we talk about both that treats menopausal symptoms and helps, you know, again,

387
00:37:55,640 --> 00:38:01,560
offset bone loss. And there's so many different ways hormone therapy comes. I, you know, bio-identical

388
00:38:01,560 --> 00:38:08,200
hormones is a marketing term, but they generally need biosimilar hormones, hormones that are similar

389
00:38:08,200 --> 00:38:13,080
to what our own ovaries made in our reproductive years that are given either orally or transdermally

390
00:38:13,080 --> 00:38:19,400
or in the perl of vagina. So there, and then there's also a progesterogen, which is the second part,

391
00:38:19,400 --> 00:38:24,920
which prevents the uterus lining from thickening. Are very important if you have not undergone

392
00:38:24,920 --> 00:38:31,160
a hysterectomy. So again, we tie talk a lot every day about, you know, what would be the indications,

393
00:38:31,160 --> 00:38:38,280
what's the contraindications. And then I think we are still in this sort of gray zone or whether we're

394
00:38:38,280 --> 00:38:44,760
now recommending women for prevention using prevention, a hormone therapy for prevention of aging.

395
00:38:44,760 --> 00:38:50,120
And I don't recommend that, but I do think for women with symptoms or with signs that we see,

396
00:38:50,120 --> 00:38:55,960
things like bone loss, genital urinary syndrome, and menopause really, you know, again, we don't necessarily

397
00:38:55,960 --> 00:39:00,440
just suffer through menopause anymore. And that's really the message that I think is so important

398
00:39:00,440 --> 00:39:05,400
from the healthcare community. And I hope also from, you know, media and other things that are

399
00:39:05,400 --> 00:39:09,640
happening around the menopause discussion. Yeah, I wanted to talk a little bit about, you know,

400
00:39:09,640 --> 00:39:16,120
there's always two philosophies or two approaches to everything. And one is, you know, the more natural

401
00:39:16,120 --> 00:39:21,720
approach versus, you know, more of a, I don't know, for lack of a better word. And again,

402
00:39:21,720 --> 00:39:28,440
it shows my ignorance. You can correct me on this, but more a pharmaceutical approach to, you know,

403
00:39:28,440 --> 00:39:37,720
addressing the whole menopause. Which are thoughts on that? Yeah. And I would say it's the same with

404
00:39:37,720 --> 00:39:44,200
addressing osteoporosis. So, you know, you know, my thought is that, you know, menopause is like I

405
00:39:44,200 --> 00:39:49,800
mentioned is a natural process. You know, osteoporosis or bone thinning, some of that is inevitable, you

406
00:39:49,800 --> 00:39:56,040
know, with again, looking at each and woman as an individual or as men as well. But we can prevent,

407
00:39:56,040 --> 00:40:00,600
you know, the outcome of thinning of the bones such as fractures. And so I think they're all

408
00:40:00,600 --> 00:40:04,680
important together. I mean, it's kind of like you ask a dentist like what's more important

409
00:40:04,680 --> 00:40:09,320
brushing or flossing? I mean, it's kind of like, yeah, you said analogy. I mean, it's like, they're

410
00:40:09,320 --> 00:40:13,960
both important. Like, right? And they ask you every time if you're doing both for, so I think it's

411
00:40:13,960 --> 00:40:18,280
really important. Well, we always have those those extremes. So we always want to compartmentalize

412
00:40:18,280 --> 00:40:24,680
and put people into camps and I just go, well, maybe, maybe both can, can you have both, you know,

413
00:40:24,680 --> 00:40:29,720
right? Absolutely. So, right. So, that is absolutely, you know, as a trained physician, I'm really,

414
00:40:29,720 --> 00:40:34,120
you know, within, you know, really, you know, within this field of bone health and menopause,

415
00:40:34,120 --> 00:40:38,680
it's a rent again. I think I try and set it on on both and keep up with the research on both,

416
00:40:38,680 --> 00:40:44,360
because I don't, I think, and pay, I learn from patients, you know, oftentimes, or I review the small

417
00:40:44,360 --> 00:40:50,440
studies that are, you know, brought in and then sort of say, okay, yes, maybe, or we don't have the,

418
00:40:50,440 --> 00:40:54,360
we see, you know, we don't have all the answers in medicine. But what I would say, you know,

419
00:40:54,360 --> 00:40:59,080
when we think about, you know, particularly when we think about osteoporosis, and like I said,

420
00:40:59,080 --> 00:41:02,840
you know, women who say I like to do this to the natural root, I obviously always want to

421
00:41:02,840 --> 00:41:08,920
support things like healthy, invited, the exercise, balance, training, reduction of falls. But again,

422
00:41:08,920 --> 00:41:14,040
we really need to support the natural structures that we already have. So, the things like the osteoblast,

423
00:41:14,040 --> 00:41:18,760
we need to, you know, support that and boost that up and we have medications that can do that.

424
00:41:18,760 --> 00:41:23,640
We have medicines that can work on reducing that bone turnover. So, slowing that down so that

425
00:41:23,640 --> 00:41:28,360
your own body sort of naturally fills in its own bone. So, again, I think it's sort of working within

426
00:41:28,360 --> 00:41:32,520
the, these are, you know, a lot of these medications are, are working within the compounds of what

427
00:41:32,520 --> 00:41:37,240
we already have within our bone and just stimulating. And so, you know, I often recommend, you know,

428
00:41:37,240 --> 00:41:42,280
many websites, which I mentioned the bone health and osteoporosis foundation. There's another one that

429
00:41:42,280 --> 00:41:49,720
is understandop.com, which is again, where there's some more information on, you know, being proactive,

430
00:41:49,720 --> 00:41:54,600
how to start that conversation with a healthcare provider, you know, again, trained in bone mineral

431
00:41:54,600 --> 00:41:59,560
density or trained in, you know, you know, there can be so many different clinicians that know about

432
00:41:59,560 --> 00:42:05,640
osteoporosis, whether that be rheumatologist, endocrinologist, primary care, gynecologist.

433
00:42:05,640 --> 00:42:11,000
So, sports medicine, I mean, there's so many different takes on this. So, really starting that

434
00:42:11,000 --> 00:42:16,440
conversation, if you have had bone loss or you are at risk for fractures or really, you know, sort of,

435
00:42:16,440 --> 00:42:20,920
you know, educate yourself and then hopefully, you know, again, start that conversation.

436
00:42:20,920 --> 00:42:25,480
Yeah, and it's not that you can reverse menopause, but you can slow it, the progression or the

437
00:42:25,480 --> 00:42:31,560
effects of it by exercising and diet and, you know, making sure that you're getting enough calcium

438
00:42:31,560 --> 00:42:36,920
and vitamin D and on and on a ghost, correct? Yeah, for bone loss. I mean, we think about, right? So,

439
00:42:36,920 --> 00:42:41,560
right, we live in the menopausal years. The estrogen deficiencies, again, are across our body. So,

440
00:42:41,560 --> 00:42:45,960
we want to treat the symptoms. So, you know, for women who have vasomotor symptoms, you know,

441
00:42:45,960 --> 00:42:49,960
again, not just like tapping that out, you know, really get there's hormones, there's non-hormonal

442
00:42:49,960 --> 00:42:56,040
options, things like vaginal dryness. We have lots of, again, hormone estrogen-like options, you know,

443
00:42:56,040 --> 00:43:02,440
non-hormonal options as well. And then for, you know, bone loss, we do have things like, like we mentioned

444
00:43:02,440 --> 00:43:08,520
that slow bone loss or, again, treat osteoporosis because, you know, again, once bone has been lost,

445
00:43:08,520 --> 00:43:13,640
you know, more dramatically, we want to work within the confines to, you know, reduce the risk of

446
00:43:13,640 --> 00:43:19,960
fractures because, as I mentioned, I mean, I see so many women, you know, for both things like, you know,

447
00:43:19,960 --> 00:43:24,440
prevention of the first fracture, it's very hard because osteoporosis is not tangible, you know,

448
00:43:24,440 --> 00:43:30,040
what does a risk fracture look like, you know, and I've seen patients, you know, who are, you know,

449
00:43:30,040 --> 00:43:34,280
with risk fractures, primarily that's happening in women in their 50s and 60s and they might be at

450
00:43:34,280 --> 00:43:38,680
the peak of their career and their architects and their drawing and they're, you know, and they're

451
00:43:38,680 --> 00:43:44,120
trying to continue exercising and we know that injuries really, you know, can set people back and

452
00:43:44,120 --> 00:43:48,440
then not to mention, like I talked about the hip fracture and the sequelae of those things. So,

453
00:43:48,440 --> 00:43:54,920
again, it's trying to treat, so we prevent the, either the outcomes primarily again, fractures

454
00:43:54,920 --> 00:43:59,400
because fractures as we age are becoming more common. We know that, you know, one and two women

455
00:43:59,400 --> 00:44:04,680
over the age of 50 will stain an osteoporosis-related fracture in our lifetime and one in four men. So,

456
00:44:05,320 --> 00:44:09,960
you know, we have a lot of work to do. This is why things like this are very important,

457
00:44:09,960 --> 00:44:15,160
creating awareness, you know, in the media, creating words with, you know, with, with amgenus,

458
00:44:15,160 --> 00:44:19,320
so important because we, you know, we need to get this message out, so we do a better job at

459
00:44:19,320 --> 00:44:23,640
screening, diagnosing, and treating osteoporosis to make those a shift in those numbers.

460
00:44:23,640 --> 00:44:32,440
Yeah, and because I'm a guy and I want to fix things, okay, so when my wife is going through,

461
00:44:32,440 --> 00:44:36,920
you know, some of the symptoms and I'm thinking of hot flashes and night sweats, you know,

462
00:44:36,920 --> 00:44:43,880
I'm like, okay, what can I do to help? How can I fix this? And, you know, she says, relax, you can't,

463
00:44:43,880 --> 00:44:51,800
okay, but how, how then should the partners respond and to support someone that's going through

464
00:44:51,800 --> 00:44:58,760
menopause? And did you found effective? Yeah, so I always joke that it's, I don't think I'm the

465
00:44:58,760 --> 00:45:02,760
first to say it, but it's sort of like putting the men back in the menopause, right? So,

466
00:45:02,760 --> 00:45:07,400
and it's very kind that you, you know, are an entopold that you are thinking about that. So,

467
00:45:07,400 --> 00:45:11,960
yeah, I mean, there are a lot of things I would find, I would primarily say that, you know,

468
00:45:11,960 --> 00:45:16,520
you know, if you're listening and you're, you know, there are a lot of good medical societies where

469
00:45:16,520 --> 00:45:21,640
you can find that, you know, a trained, you know, clinician, so there are, you know, there's a

470
00:45:21,640 --> 00:45:26,600
society called the menopause society where you can find a physician all, and I or a clinician all

471
00:45:26,600 --> 00:45:30,440
throughout the United States, and there's even an international menopause society if you're

472
00:45:30,440 --> 00:45:35,080
listening and you're international. So, that would be the first step, I would say, to find someone

473
00:45:35,080 --> 00:45:41,240
who is not, is going to validate your symptoms. And, and again, like, you know, talk to you about

474
00:45:41,240 --> 00:45:45,480
the treatment options, besides things like, you know, a cooling blanket and a fan and keeping your

475
00:45:45,480 --> 00:45:51,320
room 65 to 65 degrees. I mean, there are lifestyle, you know, things to do, you know, we go, you know,

476
00:45:51,320 --> 00:45:55,880
with your partner to the appointment as well. And sometimes, you know, we underestimate things,

477
00:45:55,880 --> 00:45:59,880
and then our partners remind us how important they are. So, I think that would be the, you know,

478
00:45:59,880 --> 00:46:05,240
the, the, the good first step. I think there's some really great literature out there. There's some

479
00:46:05,240 --> 00:46:11,480
good podcasts. You know, again, I would stick with sort of the, the, you know, the physician or medical

480
00:46:11,480 --> 00:46:15,560
community bent, which again, are very, I think, both, you know, talk about all the things we've talked

481
00:46:15,560 --> 00:46:23,080
about lifestyle, risk factors, and what to do. So, yeah, so, so good, some good information out there,

482
00:46:23,080 --> 00:46:27,080
more books that are coming out. I feel like every day, yeah, yeah, talk about this.

483
00:46:27,080 --> 00:46:34,520
Knowledge is power. And the more knowledge that we have, you know, it'll, it'll improve all of our

484
00:46:34,520 --> 00:46:39,240
lives. Yeah, I think educate the knowledge and making sure that it's coming from an educated,

485
00:46:39,240 --> 00:46:43,880
you know, source, primarily physician source. I think it's very important around this topic. Yeah.

486
00:46:43,880 --> 00:46:51,080
And along with that, knowledge is power. There's a lot of knowledge out there that maybe isn't

487
00:46:51,080 --> 00:46:57,480
accurate or incorrect. And there's a lot of misconceptions. So, what, what are some of those

488
00:46:57,480 --> 00:47:04,200
misconceptions that we can address? Yeah. So, I think a lot of the misconceptions, you know, are around

489
00:47:04,200 --> 00:47:09,880
the fact that, you know, osteoporosis is inevitable. Fractures, height loss, you know, is inevitable. But

490
00:47:09,880 --> 00:47:14,760
we know with, you know, a lot of our therapies, like we've talked about here, you know, we can reduce

491
00:47:14,760 --> 00:47:20,840
the risk of a fracture by 40 to 50%. So, it's not that, you know, we just need to live with this,

492
00:47:20,840 --> 00:47:25,640
that, you know, osteoporosis can be treated, can be prevented. You know, the other thing that we,

493
00:47:25,640 --> 00:47:31,640
you know, we forget is that, you know, once one fracture occurs, sometimes, you know, fractures are

494
00:47:31,640 --> 00:47:37,080
treated in places like the emergency room or, you know, are sort of forgotten about, you know, we sort

495
00:47:37,080 --> 00:47:42,760
of sustain a fracture and then move on. But what we're really appreciating now is that, you know,

496
00:47:42,760 --> 00:47:48,440
if you've had one osteoporosis-related fracture, you're five times more likely to have another fracture

497
00:47:48,440 --> 00:47:53,640
and the risk of another fracture is highest between the person, you know, one to two years after an

498
00:47:53,640 --> 00:47:59,240
initial fracture. So, it's not like one and done, you know, we know that this, once you've got a fracture,

499
00:47:59,240 --> 00:48:03,960
it tells us something about your bone mineral quality, your bone mineral density, your bone strength,

500
00:48:03,960 --> 00:48:09,480
maybe you're falling, you know, we need to address that. And so, I think common misconception is,

501
00:48:09,480 --> 00:48:15,000
you know, this is inevitable, this is just, you know, aging, this is the natural suppression, but it's

502
00:48:15,000 --> 00:48:20,840
not, and it doesn't go away, right? So, finding someone to talk about, let's say I mentioned that

503
00:48:20,840 --> 00:48:27,560
website, understandop.com, but finding someone to, you know, to talk about osteoporosis to get your

504
00:48:27,560 --> 00:48:32,440
options for treatment, whether that's, you know, again, the combination of lifestyle options,

505
00:48:32,440 --> 00:48:36,920
nutritional options, and then therapeutic options, putting exercise in there as well,

506
00:48:37,800 --> 00:48:42,520
is really, really important because I think, oh, there's, again, you know, a run thinks, you know,

507
00:48:42,520 --> 00:48:48,920
fractures are just a sign of aging, but really is, again, something that we can alter and we can affect

508
00:48:48,920 --> 00:48:56,840
in a positive way. So, you've mentioned that every woman will experience menopause at some point

509
00:48:56,840 --> 00:49:05,240
in their life. And so, what are some things that women and men can do to prepare themselves

510
00:49:06,040 --> 00:49:12,440
for that day when menopause comes knocking at the door? And it's, you said it was around 51,

511
00:49:12,440 --> 00:49:18,440
you know, is there pre-menopausal? And we've talked a little bit about that, you know,

512
00:49:18,440 --> 00:49:24,120
things that you can eat and, you know, exercise and all that, but what are there some specific things?

513
00:49:24,120 --> 00:49:30,600
And then as you're making that transition, there's all kinds of symptoms. And I know you've already

514
00:49:30,600 --> 00:49:34,680
spelled out a lot of those symptoms, but let's talk about some of those symptoms and then

515
00:49:35,240 --> 00:49:40,920
post-menopausal. So, let's take right through the process. Yeah. So, you know, you know, right,

516
00:49:40,920 --> 00:49:46,760
parrymenopause is also sort of this time where it's very nebulous. You know, it can last anywhere.

517
00:49:46,760 --> 00:49:53,480
Some women start parrymenopause in their early 30s. You know, on average, we think parrymenopause,

518
00:49:53,480 --> 00:49:58,600
you know, is sort of starts in late 40s. And that can be at hallmarks of different things. So, we know

519
00:49:58,600 --> 00:50:04,440
that menstrual cycle changes, particularly if you're having, you've had, you know, sort of regular

520
00:50:04,440 --> 00:50:09,640
remensual cycles or, and you're not on a, you know, contraceptive, we know that menstrual cycle changes

521
00:50:09,640 --> 00:50:15,560
start to happen. Sometimes periods get lighter, heavier, sort of get closer together. So things like,

522
00:50:15,560 --> 00:50:20,440
you know, seeing women who have cyclists within like, you know, every 21 days, some people then

523
00:50:20,440 --> 00:50:25,960
start to skip cycles. So, have like one month skipping, two month skipping, so skipping cycles.

524
00:50:25,960 --> 00:50:30,600
And then symptoms, right, symptomatology. And it's very hard, you know, a lot of women come and they

525
00:50:30,600 --> 00:50:34,840
want to know their estrogen level and they want to know certain levels. But we know that that's sort of

526
00:50:34,840 --> 00:50:40,520
a moving target in the parrymenopause. I'm very hard to, you know, see where you're at or you're

527
00:50:40,520 --> 00:50:44,280
getting close to menopause or you're not getting close to that much. I didn't know that. I thought estrogen

528
00:50:44,280 --> 00:50:49,720
levels were one of the two. It's like, you know, checking your oil, you know, you got a dipstick. And

529
00:50:49,720 --> 00:50:53,720
now that has nothing to do with it. No, yeah, it can be, and unfortunately, a lot of the

530
00:50:53,720 --> 00:50:57,640
laboratory companies now do think that that is the way. But really, if you're going to check estrogen

531
00:50:57,640 --> 00:51:02,600
level off contraceptives, it really has to be like the third day after your first day of,

532
00:51:02,600 --> 00:51:06,680
first day, meaning your first, you know, day of menstrual bleeding at the third day. But that's what

533
00:51:06,680 --> 00:51:11,240
we do in reproductive, in the reproductive, you know, we check something called the estridialin

534
00:51:11,240 --> 00:51:15,400
and FSH. But that really is more when women are trying to get pregnant and we're looking at like

535
00:51:15,400 --> 00:51:21,560
things like reproductive endocrinology and reproductive infertility. So it's very hard to be reliable,

536
00:51:21,560 --> 00:51:26,840
is basically what I'm saying. So, symptoms of menstrual cycle changes, things like parrymenopauseal

537
00:51:26,840 --> 00:51:31,480
symptoms can be things like if you've suffered from, you know, mood symptoms before your cycles.

538
00:51:31,480 --> 00:51:36,920
That can be one, sleeplessness changes in, you know, things like anxiety. Like I mentioned,

539
00:51:36,920 --> 00:51:43,480
some people have some palpitations. So again, those, these are all things that can be, you know,

540
00:51:43,480 --> 00:51:47,320
parrymenopause and some women have them and some women don't. But it is important. I think when

541
00:51:47,320 --> 00:51:53,880
you're going to your either annual gynecologist or annual, you know, or internist, hopefully,

542
00:51:53,880 --> 00:51:58,680
again, they're asking you these about these symptoms. You're aware of these symptoms. For a lot of

543
00:51:58,680 --> 00:52:03,480
women in their 40s, they're still on contraceptives and that is safe up into the time of menopause.

544
00:52:03,480 --> 00:52:09,560
Again, if we think of, look at your, it's not just age that determines what sort of contraceptives

545
00:52:09,560 --> 00:52:15,160
we can use nowadays. We have to look at your, you know, medical history, medicine, things like that

546
00:52:15,160 --> 00:52:20,680
to determine what's safe and so some women are on things like the oral contraceptives or a patch or

547
00:52:20,680 --> 00:52:26,680
the IUD have had, you know, different procedures done. So again, we have to look at those things because

548
00:52:26,680 --> 00:52:31,640
those might impact your, you know, having symptoms or not having symptoms. So sometimes we try and

549
00:52:31,640 --> 00:52:36,440
replace back some of the hormones. And then other times again, it's, you know, lifestyle things,

550
00:52:36,440 --> 00:52:41,480
making sure we're safely prescribing something. So I think again, you know, making sure you know your

551
00:52:41,480 --> 00:52:46,520
numbers, like you're knowing your cholesterol before you hit menopause, you know, we know that, you

552
00:52:46,520 --> 00:52:53,240
know, the weight changes, you know, in 99% of women, we know that when at the time of metapause,

553
00:52:53,240 --> 00:52:59,320
so much is happening in terms of our, our, our changes in glucose metabolism, fat metabolism,

554
00:52:59,320 --> 00:53:04,760
that we become less metabolically active. So more of our muscle tissues sort of get converted into

555
00:53:04,760 --> 00:53:11,080
adipose or fat tissue. So really trying to work on adding in resistance exercises, really trying to

556
00:53:11,080 --> 00:53:16,600
achieve an optimal, you know, body weight, muscle mass. All those things are really important before

557
00:53:16,600 --> 00:53:22,600
menopause because naturally things will shift with that decline in estrogen. We know that this is

558
00:53:22,600 --> 00:53:29,080
very common. So really trying to get into, you know, again, shape for is different for every woman,

559
00:53:29,080 --> 00:53:33,720
but getting into it, I would say just like the best metabolic self that you can is really important

560
00:53:33,720 --> 00:53:38,360
making sure your cholesterol is normal. Your diabetes screen is, is good, you're working on

561
00:53:38,360 --> 00:53:44,440
resistance exercises and have keeping body mass within the normal limits. It's very important

562
00:53:44,440 --> 00:53:50,520
because we know that things can change through the menopause transition. Yeah, yeah. And who do we see?

563
00:53:50,520 --> 00:53:59,080
What kind of a doctor? Do we go to the primary physician to start with or and they refer us on or,

564
00:53:59,080 --> 00:54:04,280
you know, do we, is a primary skilled enough to go through this whole thing?

565
00:54:04,920 --> 00:54:11,000
Yeah, so this is like where, you know, the, you know, the field of menopause medicine is a little bit more,

566
00:54:11,000 --> 00:54:16,680
is too small. You know, we really need more, you know, women who are looking at their life women through,

567
00:54:16,680 --> 00:54:21,400
you know, the lifespan. So a lot of women are seeing a gynecologist, so particularly if women have

568
00:54:21,400 --> 00:54:27,000
had children and then are, you know, moving on, so gynecologist, some internist. You know, again,

569
00:54:27,000 --> 00:54:32,520
the level of knowledge changes. I'm working a lot with different organizations like Ms. Medicine,

570
00:54:32,520 --> 00:54:38,440
again, like working with the North American, the menopause society, other educational events to,

571
00:54:38,440 --> 00:54:44,200
our organizations to kind of improve the education for internist gynecologist. I mean, and some have,

572
00:54:44,200 --> 00:54:48,920
you know, just, you know, good training and then sometimes again, patients, you know, bring that up

573
00:54:48,920 --> 00:54:54,520
and then find, you know, find who they want to talk to. I'm interestingly in this field now, there's more

574
00:54:54,520 --> 00:55:00,600
telehealth options for women in paramedics and menopause to talk through their symptoms. I think

575
00:55:00,600 --> 00:55:06,120
because again, we've got a dearth of medical providers really, we're siloed more in internal medicine

576
00:55:06,120 --> 00:55:11,880
and gynecology and these organizations are trying to sort of target women who might have these

577
00:55:11,880 --> 00:55:16,600
direct questions. So I would say again, finding someone through the menopause society website is

578
00:55:16,600 --> 00:55:21,320
important, asking your gynecologist or internist that they have this knowledge. And if they don't,

579
00:55:21,320 --> 00:55:27,080
then finding someone that does, if you are having questions that cannot be answered. And I think that

580
00:55:27,080 --> 00:55:32,680
is what I hear often, you know, they're finding patients and women are finding their way. And I think

581
00:55:32,680 --> 00:55:38,120
again, discussions like today and really a lot of the educational efforts that are coming out of

582
00:55:38,120 --> 00:55:44,920
the menopause society and etc., really trying to expand, you know, how we, how we reach women and also

583
00:55:44,920 --> 00:55:50,760
how we discuss treatments and how we answer the questions that they have, right? Meet them where they

584
00:55:50,760 --> 00:55:55,480
are rather than say, oh, you're not in menopause yet. See you when you are. There's a lot of things that

585
00:55:55,480 --> 00:56:00,440
happen before menopause that we need to address. Yeah. And I don't know if this is a great question,

586
00:56:00,440 --> 00:56:04,680
but I'm going to ask it anyhow. So throughout the ages, we're living longer.

587
00:56:04,680 --> 00:56:14,520
Was menopause at some point at the age of 31? Now it's 51. In the future, is it going to be 61, 71?

588
00:56:14,520 --> 00:56:20,520
Yeah, it's a good question. There's like some other, you know, some, some thoughts about that as far

589
00:56:20,520 --> 00:56:25,160
as what I've seen in the, you know, the literature. I mean, I think we're, again, living longer, the average

590
00:56:25,160 --> 00:56:32,440
life span of women now is 81.3 years. I don't think that age has menopause has changed. I mean,

591
00:56:32,440 --> 00:56:39,320
we haven't, you know, we look at like the sort of census data or, you know, sort of rest of the,

592
00:56:39,320 --> 00:56:44,360
I have not seen that that has changed. You know, you do hear like some changes in terms of what's

593
00:56:44,360 --> 00:56:49,880
happening with like men arc or puberty. Maybe that is, um, moving, changing, you know, earlier.

594
00:56:50,760 --> 00:56:55,320
You know, we do know some women who undergo earlier menopause can be, you know, you have, if you're

595
00:56:55,320 --> 00:57:01,080
a thinner, a smoker, you know, women who have family history of earlier menopause. Sometimes those

596
00:57:01,080 --> 00:57:08,280
things can also trigger an earlier menopause autoimmune conditions. And so again, if those are you,

597
00:57:08,280 --> 00:57:12,600
you could start to be having these symptoms. It's not just, you know, normal, right? You have to,

598
00:57:12,600 --> 00:57:16,040
we have to think about what are the symptoms? What does your menstrual cycle look like? What

599
00:57:16,040 --> 00:57:20,840
contraceptives have you been on? What's your, you know, reproductive health history before we make a

600
00:57:20,840 --> 00:57:25,640
good assessment and then find something that'll work for symptoms or that we say, okay, things look

601
00:57:25,640 --> 00:57:29,880
like they're progressing. You let us know, you know, here's what we would recommend for the stage. And

602
00:57:29,880 --> 00:57:34,920
then, you know, here's what we would recommend for the stage based on again, who you, you're, you know,

603
00:57:34,920 --> 00:57:40,520
your, your sort of makeup. When, when someone comes to you for the first time, do you, do you have a

604
00:57:40,520 --> 00:57:47,000
list of questions in order and, and talk through that process? And because I think that might be helpful

605
00:57:47,000 --> 00:57:53,480
for a lot of women, especially and men also, when they go to talk to their doctor, it's, it's,

606
00:57:53,480 --> 00:57:57,960
sometimes you don't, you're so ignorant that you don't even know the right questions to ask.

607
00:57:57,960 --> 00:58:05,480
Well, so yes, I mean, I'm pretty, I try and be very comprehensive and I'm, I'm very lucky that I

608
00:58:05,960 --> 00:58:11,240
have my own practice, bone and body women's health where I can have a lot, I, I, I now have a lot of time

609
00:58:11,240 --> 00:58:16,600
to spend with my patients and I, and so my plan is, yes, I mean, I, I honestly do what we've sort of

610
00:58:16,600 --> 00:58:20,680
been talking about, talk through, particularly again, I see a lot of women with fractures and bone

611
00:58:20,680 --> 00:58:25,800
loss. So I ask them about, you know, all their fractures, including, you know, stress fractures,

612
00:58:25,800 --> 00:58:34,200
I ask about a family history of osteoporosis, you know, first, mental cycles, what that looked like,

613
00:58:34,200 --> 00:58:40,360
what their childhood activity looked like in calcium, pregnancies, lactation, any, the alcohol,

614
00:58:40,360 --> 00:58:47,560
smoking history, activity level, you know, falls, dizziness, balance, all of those things that

615
00:58:47,560 --> 00:58:52,280
are important really in the, in the bone health, any secondary osteoporosis, which is really a medical

616
00:58:52,280 --> 00:58:57,160
term for anything that could contribute to bone loss. So like we mentioned some of those high level

617
00:58:57,160 --> 00:59:03,800
medications or surgeries like things like gastric surgeries that might impact, you know,

618
00:59:03,800 --> 00:59:10,120
absorption of things like calcium and vitamin D medications, even things like proton pump inhibitors,

619
00:59:10,120 --> 00:59:16,200
you know, so, you know, rheumatoid, rheumatoidic conditions. And then it's really, it's,

620
00:59:16,200 --> 00:59:21,560
it's, it's, it's, it takes me a long time. Yeah, it does. And I, and I, and I look at all the labs,

621
00:59:21,560 --> 00:59:25,640
and you know, we look at the dexas, the times of them are coming to me with many dexas to look at

622
00:59:25,640 --> 00:59:29,720
and so I look through those and, and really mammograms, all those things are very important,

623
00:59:30,280 --> 00:59:35,880
and really again, understanding like what is the, you know, mid-life women's health picture. I see,

624
00:59:35,880 --> 00:59:40,840
I see again, with the focus on, you know, again, we don't talk about osteoporosis and prevention of

625
00:59:40,840 --> 00:59:44,920
bone loss. So a lot of women will come to see the osteophenia or osteoporosis and they had,

626
00:59:44,920 --> 00:59:49,480
didn't even know what the time of menopause. So that is again, a workup that we do to make sure that

627
00:59:49,480 --> 00:59:53,880
there's no underlying causes and we can do that very easily with some, you know, blood tests in your

628
00:59:53,880 --> 00:59:58,440
intestine, then really talk about the individualizing the treatment options, which are many. Yeah.

629
00:59:58,440 --> 01:00:06,680
And in the age of technology, are you taking patients from different states? Like I'm out here in

630
01:00:06,680 --> 01:00:13,960
Oregon. Yeah. So if I, if I called you up, can you take me on as a patient? And I don't know

631
01:00:13,960 --> 01:00:20,440
personally, but I mean, yeah, anybody that, you know, that is living in another state and they've

632
01:00:20,440 --> 01:00:25,240
been listening to this, the interview and this, this conversation that you and I are having and

633
01:00:25,240 --> 01:00:30,200
they go, wow, this is in pretty incredible. And I'd like to begin this process.

634
01:00:30,200 --> 01:00:37,160
I'm actually outside of Chicago, but that's where my practice is located out of in Wineca,

635
01:00:37,160 --> 01:00:43,000
Illinois, outside of Chicago. I do see some patients for virtual visits. That is an option.

636
01:00:43,000 --> 01:00:48,840
I have, you know, there's so many interesting things about prescribing outside of your area. I,

637
01:00:48,840 --> 01:00:53,960
you know, I usually say if I, if I, if you'd like to see me, I'm happy to talk to you and then

638
01:00:53,960 --> 01:00:58,360
sometimes I can connect you with some other, you know, folks across the country too.

639
01:00:58,360 --> 01:01:03,000
Sure. Make referrals in the various states. Yeah. I've got this a great group of a great,

640
01:01:03,000 --> 01:01:08,760
you know, a lot of bone clinicians that are really, you know, share a lot about their patients and

641
01:01:08,760 --> 01:01:14,360
had to make sure that they get the right treatment. So, yeah, again, my, I think you have my resources.

642
01:01:14,360 --> 01:01:18,280
You could probably share those if you want it. Yeah. Yeah. What is your website? Because I know

643
01:01:18,280 --> 01:01:20,700
know our listening audience would appreciate that.

644
01:01:20,700 --> 01:01:31,740
- Yeah, it's um, my website is it's bone, B-O-N-E, A-N-D, B-O-D-Y, w-H-Δ-C-O, bonebody, w-hΔ-C-O.

645
01:01:31,740 --> 01:01:38,080
- Alright, which the wh is women's health, so bone and body women's health.

646
01:01:38,080 --> 01:01:39,740
- Yeah. I only see women, yes, thank you, thank you.

647
01:01:39,740 --> 01:01:42,620
- Yeah, yeah. Except for you're seeing me today.

648
01:01:42,620 --> 01:01:44,620
- Except for you're seeing me today.

649
01:01:44,620 --> 01:01:48,140
- I, I, I, I appreciate that. - And I appreciate that. Yeah.

650
01:01:48,140 --> 01:01:54,380
- Well, and you've, you've exposed all my ignorance and so, um, but it's, it's, you know,

651
01:01:54,380 --> 01:02:01,660
when you're living with, you know, people that you love, you're my mom and my, my wife and,

652
01:02:01,660 --> 01:02:06,300
you know, my sister and then all the other people that are around my sphere.

653
01:02:06,300 --> 01:02:13,180
I mean, it affects men as well. And, and like you said, I think sometimes I wonder, you know,

654
01:02:13,180 --> 01:02:16,620
if I'm going through manopause, you know, there, I think there's some, there's some things

655
01:02:16,620 --> 01:02:21,940
that are going on in my body that are changing and I'm going, wait a minute, that's not possible.

656
01:02:21,940 --> 01:02:26,740
- No, there, I mean, I know there's always these questions about this andropause, but I mean,

657
01:02:26,740 --> 01:02:32,100
I don't think it's as dramatic as as women's menopause, but, um, you know, there are, I, I,

658
01:02:32,100 --> 01:02:37,780
right, each, each ex has their, has their specific, uh, specific changes, so.

659
01:02:37,780 --> 01:02:42,060
- Yeah, absolutely. Alright, well, is there anything else that you would like to leave

660
01:02:42,060 --> 01:02:47,180
with us, any thoughts that we haven't covered? I, there's, there's actually a few things that,

661
01:02:47,180 --> 01:02:53,940
you know, we, I wanted to talk to on was, uh, muscle decline, uh, skin elasticity, but, you

662
01:02:53,940 --> 01:02:57,180
know, I don't know if that's appropriate for another, you know, interview.

663
01:02:57,180 --> 01:03:01,860
- Yeah, maybe we'll do it. Yeah, maybe because that I know I always say like every, every discussion

664
01:03:01,860 --> 01:03:06,380
could be an hour in themselves. That's why my, uh, visits tend to, you know, everyone,

665
01:03:06,380 --> 01:03:11,420
I have questions for them and women always have lots of questions for me. So, um, yeah,

666
01:03:11,420 --> 01:03:16,340
no, I, I just think this has been, you know, completely informative. I, I think it's so important

667
01:03:16,340 --> 01:03:22,260
that again, you know, we think about menop, we think about bone health, um, and, and changes

668
01:03:22,260 --> 01:03:26,380
that are happening at menopause along with the things that we talk about, like weight and

669
01:03:26,380 --> 01:03:30,860
vasomotor symptoms and vaginal dryness because we, we have treatments for all of them, whether

670
01:03:30,860 --> 01:03:35,140
people, you know, want to know about those and hormones and non-homonal options and we

671
01:03:35,140 --> 01:03:39,940
have, you know, treatments to offset bone loss, um, and, and prevent and treat osteoporosis.

672
01:03:39,940 --> 01:03:45,300
So I think again, this effort, a lot of efforts, you know, with, with the companies, you know,

673
01:03:45,300 --> 01:03:49,940
we're working with to try and, you know, make a difference in how women, you know, feel

674
01:03:49,940 --> 01:03:56,420
and, and, and experience menopause is, is really, uh, it's really important because, you

675
01:03:56,420 --> 01:04:02,300
know, again, like you said, education and, and appropriate knowledge, uh, and from, you know,

676
01:04:02,300 --> 01:04:06,500
for trained professionals is really important to, to sort of help the masses.

677
01:04:06,500 --> 01:04:11,180
Yeah, and, and just one last thought and one last comment that I'd like you to comment on,

678
01:04:11,180 --> 01:04:17,420
you, you had written that osteoporosis is a chronic disease that shouldn't be accepted

679
01:04:17,420 --> 01:04:20,820
as the normal part of aging.

680
01:04:20,820 --> 01:04:22,860
Explain that for our listening audience.

681
01:04:22,860 --> 01:04:25,100
Ah, so I think that is a great recap.

682
01:04:25,100 --> 01:04:31,100
I mean, again, we, we, we think about, you know, aging and we think about maybe some

683
01:04:31,100 --> 01:04:36,740
people sort of conjure up images of like, you know, women in, in wheelchairs or have, or

684
01:04:36,740 --> 01:04:42,220
posture, you know, again, or having, you know, fractures or potential living and like, you

685
01:04:42,220 --> 01:04:43,220
know, assisted living.

686
01:04:43,220 --> 01:04:48,380
I mean, some of this is aging and we're, and we're, we're working through each thing individually.

687
01:04:48,380 --> 01:04:53,020
But we do not need to accept that, you know, osteoporosis, you know, starting even our

688
01:04:53,020 --> 01:04:57,820
50s and 60s, uh, is something that we need to live with, that we, you know, we can prevent

689
01:04:57,820 --> 01:04:59,180
and treat fractures.

690
01:04:59,180 --> 01:05:02,860
We know we talked about in the beginning, you know, trying to age, you know, gracefully

691
01:05:02,860 --> 01:05:08,100
with strength, posture balance and, and fracture free is possible.

692
01:05:08,100 --> 01:05:13,660
Um, primarily again, if we think about dying, making appropriate, you know, screening

693
01:05:13,660 --> 01:05:18,820
first, making appropriate diagnosis and then treating if we have bone loss, whether that

694
01:05:18,820 --> 01:05:24,700
is mild, uh, to moderate, like osteopenia or low bone mass or more, more advanced, like

695
01:05:24,700 --> 01:05:25,700
osteoporosis.

696
01:05:25,700 --> 01:05:26,700
Yeah.

697
01:05:26,700 --> 01:05:31,900
Well, well said and, and we, we are against the end of our conversation and I just want

698
01:05:31,900 --> 01:05:32,900
to say thank you.

699
01:05:32,900 --> 01:05:34,900
You've been, and lighten me.

700
01:05:34,900 --> 01:05:39,060
You've educated me on a lot of things that, that I had questions about.

701
01:05:39,060 --> 01:05:42,940
And so that, if, if no one else got anything out of this, at least I did.

702
01:05:42,940 --> 01:05:43,940
Yeah.

703
01:05:43,940 --> 01:05:44,940
Well, good.

704
01:05:44,940 --> 01:05:49,580
I hope you can bring some back to your, your wife and also, yeah, to the wider audience

705
01:05:49,580 --> 01:05:50,580
that you're impacting.

706
01:05:50,580 --> 01:05:52,180
So I thank you for your time.

707
01:05:52,180 --> 01:05:54,620
Well, we have about 200,000 followers out there.

708
01:05:54,620 --> 01:05:58,820
So I'm, I'm assuming that there's a few out there that are going to be getting, cleaning

709
01:05:58,820 --> 01:06:03,100
some of the, the nuggets of, you know, your wisdom and your knowledge.

710
01:06:03,100 --> 01:06:07,340
So I want to say thank you so much for being on aging today.

711
01:06:07,340 --> 01:06:08,340
You.

712
01:06:08,340 --> 01:06:09,420
All right.

713
01:06:09,420 --> 01:06:14,060
This is Mark Turnbull, your host, and I want to thank all of you for tuning in to aging

714
01:06:14,060 --> 01:06:15,260
today.

715
01:06:15,260 --> 01:06:20,820
And we are the podcast where together we're exploring the many options to aging on your

716
01:06:20,820 --> 01:06:22,020
terms.

717
01:06:22,020 --> 01:06:27,620
And as every Monday, when we release a new conversation on aging today to your favorite

718
01:06:27,620 --> 01:06:32,660
podcast channel, and remember, we're all in the process of aging.

719
01:06:32,660 --> 01:06:36,140
And as we age, we really are better together.

720
01:06:36,140 --> 01:06:37,540
So stay young at heart.

721
01:06:37,540 --> 01:06:41,780
You make me feel so young.

722
01:06:41,780 --> 01:06:44,940
You make me feel like spring is from.

723
01:06:44,940 --> 01:06:51,140
And every time I see your face, I'm such a happy individual.

724
01:06:51,140 --> 01:06:57,420
So moment that you speak, I want to go play hide and see.

725
01:06:57,420 --> 01:07:06,860
I want to go and bounce the moon just like a Torreville moon, well, you and I, I'll just

726
01:07:06,860 --> 01:07:11,860
like a bullet tauts running across the metal.

727
01:07:11,860 --> 01:07:19,340
They can have lots of, forget me night so you made me feel so young.

728
01:07:19,340 --> 01:07:24,780
And maybe there are songs to be sung, there will still be wrong and wonderful things to

729
01:07:24,780 --> 01:07:26,180
be fun.

730
01:07:26,180 --> 01:07:29,220
And when I'm old and grey.

731
01:07:29,220 --> 01:07:34,660
You've been listening to aging today, where together we explore the options to aging on

732
01:07:34,660 --> 01:07:36,140
your terms.

733
01:07:36,140 --> 01:07:41,700
Join Mark and his guest next week for another lively discussion on proactively aging on your

734
01:07:41,700 --> 01:07:47,620
terms, connecting you to the professional advice of his special guests with the goal of creating

735
01:07:47,620 --> 01:07:50,460
better days throughout the aging process.

736
01:07:50,460 --> 01:07:52,940
Your host has been Mark Turnbull.

737
01:07:52,940 --> 01:07:58,380
Join Mark and his guest every week on aging today, your podcast to exploring your options

738
01:07:58,380 --> 01:08:00,220
for aging on your terms.

739
01:08:00,220 --> 01:08:03,340
And you went all grey.

740
01:08:03,340 --> 01:08:07,140
You make me feel the way I feel today.

741
01:08:07,140 --> 01:08:11,180
Oh, you make me feel so.

742
01:08:11,180 --> 01:08:14,340
You make me feel so.

743
01:08:14,340 --> 01:08:19,660
You make me feel so young.

744
01:08:19,660 --> 01:08:21,660
So young.

745
01:08:21,660 --> 01:08:24,660
You make me feel so young.

746
01:08:24,660 --> 01:08:26,660
You make me feel so young.

747
01:08:26,660 --> 01:08:29,240
(upbeat music)

748
01:08:29,240 --> 01:08:34,420
[Music]