well hello and welcome to HealthLine.

>> I'm Jennifer Blomquist.

I'm so glad you joined us tonight.

If you're one of our regulars you know the deal how it works.

We're live in the studio.

We take your questions live and you're guaranteed to learn something and and get some free advice if you're a newcomer.

Welcome.

And we're so glad you joined us and we hope you'll continue watching this program because you do learn a lot and you get some wonderful advice from local medical experts so you can't be that let me just remind you how it works.

Then we will take phone calls throughout the program so the doctor and I are going to start talking about our topic which tonight is osteoporosis.

He's an endocrinologist.

So if you have anything you want to ask about that topic, call us at any time.

The number is (969) 27 two zero and if you're outside of Fort Wayne, just put an 866- in front of there.

The call is toll free.

I want to remind you that you will talk to a call screener first so we don't just throw you on the air and you have two options.

You can have the call screener and relay your question to us and I can ask the doctor that way or a better way I think is for you to ask the doctor directly.

We'll give you some a heads up about when you're going to be on air with just your voice of course and then you can ask the doctor your question.

I like that better because sometimes the physician needs to ask you some questions to give you a better answer.

So if you feel up to it and you're not too shy, I would recommend the second option.

So let's go ahead and meet our guest tonight a newcomer and did this all last minute for us.

So thank you so much with the holiday and everything.

>> So we appreciate it.

As I said, he's an endocrinologist and it's pronounced Humza Dr.

Hamza Quadri.

>> Yep.

You got it right.

All right.

Don't ask me how to spell it but but I wanted to make sure you pronounced it correctly.

>> So you know, I think a lot of people probably don't think about the specialty of endocrinology until they have an issue, you know, because it's not the kind of practice that you normally go to for like a you know, for a screening or anything like that.

>> Typically.

>> Yes, I get that a lot.

Yeah.

A lot of my even my family members go like which is so I'm like trust me once you start seeing us then you'll learn.

>> Yes.

Yeah.

So so you do all kinds of I mean you know everyone probably is familiar with the endocrine gland and you probably could handle a lot of diabetes cases.

>> Would you say that's probably the here so endocrine it's a huge umbrella.

>> We cover all kind of hormonal issues with it starting from the pituitary gland, the thyroid and thyroid we have malignant nonmalignant thyroid then we have the adrenal glands.

>> Yeah.

And then osteoporosis is also part of it because hormonal physiological with hormonal changes.

>> So we yeah.

So all the hormones under endocrinology and diabetes is a big one.

Yeah.

So 60 to 70 percent of the population that we see as diabetes and diabetes is growing so much as well so diabetes and all other hormones they all come under endocrinology.

>> Well when I saw that you're going to be the guest and you an endocrinologist and we are going to talk about osteoporosis a lot of times people will go to their ob gyn for that.

But is that something that you're better off going?

Is more specialized now because years ago my mother in law used to just she had to she had issues with that disorder and so she would have to go for I don't know, an infusion every so often and just did it through, you know, the gynecologists.

So I guess I want to ask you that because I'm thinking a lot of women are probably wondering the same thing.

>> You know, should I go see an endocrinologist?

Yes.

There are multiple specialties which take care of osteoporosis starting from primary care medicine.

Sure.

They also take care of osteoporosis and rheumatology also and OBGYN and endocrinology.

>> It comes under endocrinology because it's more with the hormonal changes physiologically especially in women and especially if it's in men as well.

>> It's due to hormonal issues testosterone related so it can be taken care of by other special.

It is but it endocrine we look at it at a more a bigger picture of it the causes of it ruling out any other secondary causes of osteoporosis and treating it primary care can take care of it as well.

>> But when it comes to like bigger medication such as infusions or monthly or six monthly shots then it's better off with endocrinology just for better continuity of care and looking out for other things to make sure we're not missing out.

And as we go on the show we'll talk about some medications and stuff.

So it's always better with endocrinology.

>> It's in a safer aspect.

I'm just wondering so if we start in the beginning the diagnosis most women I would think they probably don't know they have it because I always associated it with, you know, women who are hunched over, you know that.

>> So obviously I guess if that started happening you would know but how does the diagnosis happen and do most people are there any symptoms to look for ?

>> That's a very good question for osteoporosis we always hope that it's diagnosed before the symptoms show up and if the symptoms show up then it can be a little tough.

But the aspirin guidelines any all women over the age of sixty five should be screened for osteoporosis and it's a pretty simple straightforward test that we do.

>> It's called a DEXA scan.

It's like an X-ray of the bones in which it looks at the density of the bones so all women women over the age of 65 should be screened for it and so yeah so and a lot of people are probably wondering is that typically covered by insurance?

>> Yeah, OK.

After the age of 65 it's covered by insurance OK only in the US I mean there are ten million patients of osteoporosis.

>> It's pretty common because it is more of a physiological process than a disease because as women as the I always say blow more candles.

>> You know that's a nice way to put it.

Thank you.

I have a birthday coming up another of my in my family to say that when your estrogen progesterone hormone levels go down it's a physiological the bones tend to weaken so it's more of a physiological process.

>> So everybody after the age of sixty five should be screened for that and then how often do you go or does it depend on what your scan looks like?

You know the colonoscopy they say if it looks fine you're good for ten years seven to ten years I think but what about for this.

>> So we started sixty five it shows osteoporosis then we do it every two years OK?

>> Yep.

And if it doesn't then it depends on the clinical status how often we can do it.

>> Yeah.

So what are you looking for when you do the scan.

Like how can you tell that there's an issue so basically in bone density test the Texas scan which we also call it's like an X-ray it looks at the bone quality.

>> OK, so basically if we describe osteoporosis it is at a microscopic level there becomes pores in the bones so it's like a porous bone and most of the time osteoporosis is painless.

>> A lot of people confuse it with osteoarthritis or osteoarthritis is when the joint space narrows and you know it's like bone and bone.

>> So that's painful.

>> Osteoporosis is at a microscopic level.

They're small pores in the bone so your bones become soft and easy to fracture.

>> So the DEXA scan looks at the bone density.

We also look at the pictures.

>> I always show my patients the picture of the bone density as well because it's always good to see how your bones look like.

You know, I try to explain that ,you know, this is what we're seeing.

>> So the bone density the DEXA machine gives us some numbers which is called a T scores depending on that we make a diagnosis of osteoporosis and we go from there.

>> Now is there a certain I like can it be really mild and you would tell a patient we're just going to watch it or if you see any sign of it at all, do you usually have to intervene?

>> So basically before osteoporosis there's a term called osteopenia, OK, which is the weakening of the bones.

Yeah.

So the T score which we were talking about if it's less than two point five in anybody minus point five there osteoporosis anything between minus one to minus two point five two point four I would say that's osteopenia that is like it's not there yet but it's eventually going to get there so for osteopenia we can watch with lifestyle interventions such as calcium and vitamin supplementation, active lifestyle.

>> But if it's osteoporosis, if it's anything less than two point five, then we have to treat it.

>> Can you actually improve it?

Is it or is it something that once you've got the osteopenia is that just going to progress?

You know, at some point would you expect to have osteoporosis?

>> We can definitely improve it.

OK, and yeah, it is a reversible condition.

>> I didn't know that.

Yeah, I didn't know if you could actually prevent it especially if you have osteopenia.

You know we recommend lifestyle modifications such as vitamin D and calcium supplements which we talked about when we talk about calcium supplements a lot of people have questions how much calcium should we take?

How do we go about with it?

>> So if we look at the osteoporosis guidelines, the calcium is about twelve hundred milligrams of calcium is daily required.

>> The best way is through get it to getting it through your diet with high calcium foods.

But otherwise you know you can also take it and calcium pill forms so we recommend twelve hundred milligrams of calcium every day and Weidemann D about 800 international units of vitamin D every day if you do this and I tell my patients as well one of the most important things and the best treatment you can do for yourself is exercise if you have especially weight resistance exercise because when do you do a weight resistance exercise?

You know when the muscle rubs against the bone there is a wear tear wear and tear at the microscopic level and when that happens neuborne forms a new bone is always good, you know, so exercise vitamin D and calcium is the way to go if you have osteopenia even if you have osteoporosis these three things really matter a lot and they can reverse your condition and if you're an osteoporosis range then we treat it with medications on top that and with compliance on medication and with good medications from osteoporosis.

Our goal is to bring you back in the osteopenia range if we can.

>> So you could potentially get to a point if you had the osteoporosis where you would need to have an infusion or take the medications anymore.

>> Yep, that is the goal for a lot of osteoporosis medications.

>> We don't want anybody to be on osteoporosis medications for the rest of their life are always goal as we call it a drug holiday.

You know, we always want to build your bone for a couple of years and then give you a drug holiday in which we repeat bone density test and see how the growth progress is going.

>> And as far as treat like I mentioned my mother in law and this is she has passed away a number of years ago but before that she was doing something like I said it was only every few months it was I think it was maybe three times a year she would go have this infusion at a doctor's office or a gynecologist office and that was it.

And it really didn't seem like it was that big of a deal.

You know, she and she never seemed to worsen.

So I don't know are there you know, that seemed to me that seemed like the brand new thing to do.

>> But is that common?

Is that is it done by infusion for the most?

Yes.

Yes.

>> And osteoporosis treatment and we talk about it we have medications which you can take once a week pill ranging from infusions once a year.

>> You literally just said yes once a year for twenty minutes and you're done for the entire year then their shots which you can do every six months then there are some bigger if you have severe osteoporosis we call anabolic medications which build a lot of new bones.

>> Those are some of them are monthly shots for twelve months and some of them are daily shots for two years.

>> These two are also not long term treatments.

We do it for one or two years depending on that.

>> Then we transition you to an easier form of medication like a yearly infusion are weekly tablets.

>> Well and I want to remind everybody, Dr.

Quadri, that you're only here until a little before eight o'clock so we only get on for a short time.

We haven't had anyone call in yet but he's got a wealth of information we could share with you about osteoporosis or if there's something endocrinology related, please feel free to give us a call at any time.

We're going to continue to talk about it but we'd love for you to interrupt us.

So again, it's (969) 27 two zero.

It's still toll free call if you call or put an 866- in front of their so in light of what you were just saying about how this is so treatable and you can you know, you can reverse, you know, the effects I'm shocked that I would see somebody with advanced osteoporosis, you know, I mean and usually when I've seen it it's been in women who are quite elderly probably in their 80s or 90s.

So is it just maybe that they didn't get the treatment or are there some forms of it that inevitably you're going to have the you know, it just looks it does look sad when they're hunched over like that.

>> So our goal in treatment of osteoporosis is making sure that you what you're talking about hunchback you know.

>> Yeah.

Our goal is to avoid that.

Yeah.

And that can be only done with early intervention.

>> OK, and the main goal one of it when we talk about osteoporosis is to avoid any fractures that if you have a fall we want to make sure you don't break any fracture because there's some fractures which really affect the quality of life starting with the hip fracture for sure the pelvis fracture, the wrist and the spine.

>> If you fracture some of these your Moretown there is some data out there which shows if you have a hip fracture you have a 20 percent chance of mortality within one year and 40 percent chance of increased mobility and then you need higher level of care with that and you see that a lot.

>> And once you have a hip fracture then you're stuck in a cycle.

>> It's hard to get out of it.

Yes.

So our goal with treatment of osteoporosis is always tell my patients is my goal is to yeah.

>> To have a good number and the bone density scan of course but also if you ever have a fall we want to make your bones strong enough that you can bear the fall and you do not have a fracture because these fractures which I talked about we call them osteoporotic fractures for example if you fall from a standing height or if you have a very low level trauma and if you have these fractures like the hip fracture, the wrist, the pelvic or the lower back then we don't even need we don't even do a bone density testing in these patients.

>> We just we call them osteoporosis finding fractures and we go ahead and treat them well.

>> So that is our goal and when we talk about treatment, there are a lot of medications that we can talk about.

>> And you know, it's interesting because we've we've done programs if you if you watch our show over the years we've done a programs a number of years about how dangerous it is excuse me for an elderly person to fall and there was even a place where people could go that specialized and it was like a fall clinic because if you're a younger person you don't think about it.

A lot of times you might get hurt bruised.

You know, you just get up you might be sore for a few days.

But if you're an elderly person I mean I can attest to it happened that way for my grandfather.

You know, he fell getting up in the middle of the night and couldn't get to the phone and so we didn't find him till the next day and then sadly he passed away a few months later.

It does it just kind of they get stuck in this cycle and I think mentally too oh, it gets very hard on them to recover from that.

>> So for sure when I'm talking to my patients about osteoporosis treatment, what treatment we're going to do, I always talk about fall prevention as well.

Yeah.

You know, making sure they go through their medications any medications which has a risk of fall, making sure you know, you have no drugs on the floor if you're waking up in the middle of the night making sure you have a light in your room, you take some kind of support in the middle of the night.

>> So fall prevention is big when it comes with osteoporosis treatment.

Yeah, you know and actually this week is a good time to talk about it because we have had some very slippery weather.

I we're getting some more snow tomorrow so you know, hopefully a lot of those folks can just stay home or if not, you know, if you know somebody who maybe has to get to the doctor's appointment or maybe you know, they always go to their mailbox every day, you know, maybe help them out a little bit so that they don't have to you know, you can be there to hold on to or get their mail for on stuff like that.

So Winter decided to come very early this year so we weren't prepared for that.

>> I you know, I was going to ask you to what are the are there any studies on hereditary factor, you know, like and do men ever get osteoporosis because I always associated it just with women.

>> So that's a very good question.

It is definitely more prevalent in women 40 percent of the women after the age of 65 at risk of osteoporosis.

OK, and as we discussed, it's more physiological than men.

There's always some underlying cause of osteoporosis.

And when you talk about Heggarty causes well, we always look at genetic factors and family history of osteoporosis.

Yes, that does play a role if you have if you have a parent who had osteoporosis or hip fracture, you're more risk.

>> So when you come to endocrinology we look at all these secondary aspects as well and especially if it's in men.

We tried to treat the cause of it and there are a lot of other endocrine issues as well which can cause osteoporosis.

So when we see you for the first time for osteoporosis we always go through a checklist making sure we're not missing any that which we call secondary causes of osteoporosis.

If we talk about for example, like chronic steroid therapy, if anybody has been on steroids for long term, they're at risk of osteoporosis cigaret smoking and you know that can put you at risk of osteoporosis.

>> OK, and there are some endocrine disorders such as the parathyroid hypoparathyroidism hyper thyroid isn't you hear these terms these can put you at risk of osteoporosis.

>> So we see a lot of patients who have osteoporosis due to hypoparathyroidism.

>> It's a gland in the body.

It's behind the thyroid.

>> That's why we call it the parathyroid and it controls the calcium levels in our blood if it becomes overactive sort of out all the calcium out of your bones and cause us to process and you can keep on treating osteoporosis but it will not improve until you look at treat the primary cause of it.

That would be the hypoparathyroidism .

>> So there are apart from physiological which we call there are the pathology causes of osteoporosis as well which we always evaluate and look into.

>> Well and I think hopefully most people go for a yearly screening or checkup with their doctor and so with some of this stuff even appear on blood work, could that possibly you know I mean it seems like they always do like basic labs yearly so so for thyroid and hypoparathyroidism which I talked yes it does come back with basic lab calcium levels would be up sure.

Like a BNP RCMP or if your thyroid labs would be abnormal suggesting hypothyroidism those can put you at risk of osteoporosis.

>> OK, well we did have somebody brave enough to call in and both of us are not wearing contacts tonight minds because of old age.

His is not because of old age.

So I don't have to look at this camera right here but we we had somebody named Carol call and she says her hands are deformed due to osteoporosis and what can be done about that now?

I did I've not heard of that.

>> I just always thought it was affected, you know, the spine.

So a lot of times hand deformities could be due to rheumatoid arthritis as well.

>> OK, rheumatoid arthritis caused that and if somebody is being treated with steroids for rheumatoid arthritis, they can end up with osteoporosis as well.

>> I see.

But yes.

So those are that is the main factor usually for hand deformities when it comes to osteoporosis it is more likely due to some other underlying condition which is causing it.

But as we discussed, you know, if there is hand deformities as well, physical therapy is the way to go for that.

You know, for this patient I would highly recommend, you know, touching base with their primary care doctor seeing what options they have for physical therapy or looking at other causes as well which can cause the heart deformities.

Can that also be reversed as well?

Like could could she potentially have her hands looking somewhat normal or and functioning normally?

>> Yes, it takes time but it's not impossible with good physical therapy and you know, figuring out the exact root cause of it and doing the right medications.

All right.

Well, Carol, thank you so much for your question and I hope that goes well for you.

I will say I've been to physical therapy not myself but with my children and it's a it's kind of fun.

>> I mean it actually is I mean most we've been to a number of different offices but they they are very happy upbeat people and music playing and stuff like that so it don't dread it.

I guess, you know, it was a very positive experience for us .

So hopefully it will be if I if that's what she pursues we still have just a few minutes left so we could take another quick question.

So if you want to call please do.

It's (969) 27 two zero again it's toll free call if there's an 866- in front of there.

In the meantime, I wanted to ask you about is there a lot of research going on right now that where you think that this could you know, this condition could be treated even more efficiently in the future or you know, maybe even more preventable?

>> So when we talk about research, I would like to shed some light on the treatment of osteoporosis as well.

We have new medications coming out.

You know there are medications but when we talk about the treatment of osteoporosis, I will want to bring this awareness to patients if you're a treat being treated for osteoporosis, there are some medications which you cannot stop cold turkey.

>> OK, OK.

There is like some medications called denosumab which are like six month you get the shot every six months.

A lot of times patients are on it and then they just lose follow up or there's some insurance issues and if that's the kind of medication that you cannot stop, OK, you have to transition to some other kind of osteoporosis treatment for that because if you stop that medication at the seventh month you're at you're at higher highest.

>> So fractures OK, OK.

So we do have a lot of research going on in that yes there are new medications coming up for osteoporosis as well and there's as we talk there are two kinds of treatments for osteoporosis and two presumptive and anabolic agents want to resort to pretty much do is that they improve the bone density but the sort of stop the deterioration of it as well whereas anabolic therapy builds new bone.

>> OK, so a lot of times we use anabolic therapy to build the new bone and then we follow it up with and to resort to to maintain what is build a tank.

>> So there are some good medications for anabolic agents such as Taperoo Tide and Romosozumab.

>> These are the medications.

They're injectables but again they're short term ranging from one year to two years of treatment and we always want to transition these medications also we don't want to stop cold turkey because if you build the new bone we want to make the best of it and want to transition to other medications infusions which we talked about.

>> I always tell my patients if you're an osteoporosis medication, just make sure you don't stop cold turkey.

Look, always consult with your doctor about transitioning to other medications.

Do not stop it without a doctor's advice.

Sure.

And that's the main goal and this is something I'm really vocal about and I always tell my patients, you know, to make sure that you know, you don't stop working because then all the a lot effort that you've done will go to waste.

>> Well, it's just kind of like you know, they're always reminding you at the doctor's office with an antibiotic, you know, finish it and you might feel you might have strep throat and feel better after 48 hours they're like you got to finish it.

>> Are you going to get you know, it's probably the same concept, you know, so you don't want to have to I guess retreat.

>> So yeah.

And if you if you're an osteoporosis medication, if you're concerned about side effects, always talk to your physician about that and yes, some medications do have side effects but there are always alternatives for example bisphosphonate therapy those are like the once a week pill.

OK, a lot of patients it's a big pill OK, it's a once a week so it can cause that yeah.

>> it can cause acid reflux.

>> I always tell my patients, you know, if you have acid reflux we won't do it but a lot of patients can develop acid reflux.

>> You do that and they just stop taking it.

You know, we have an IV form of that as well which I talked about once your infusion then we stopped that when we can go to the IV part, you know, and do it once a year infusions, you know, and another thing I always want to bring up with osteoporosis treatment is that there's a rare side effect of most of the osteoporosis is medications, the osteonecrosis of the jaw.

It's just a nasty infection of the jaw which can happen if you're an osteoporosis medications and you get any invasive dental work which involves cutting of the gums, you're at risk of this infection.

>> So always tell your dentist when you go there that you know you're an osteoporosis.

Great advice.

I feel terrible we're out of time because I could talk to you all night.

It's very, very interesting.

Dr.

Hamza Quadri, thank you so much and have a wonderful Christmas.

Happy holidays to all of you.

I will see you next year.

This is my last show for the for this year but I'll see you in January.

Thank you so much for watching everybody take care.

>> Be safe and we'll see you next January