Welcome, my name is Dr Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and video. station. I'm absolutely delighted today to have a colleague who I actually trained with locally here, Helen Cooley, a rheumatologist. Thank you for joining me today, Helen. Thanks for having me. So we were talking before we actually hit the record button here about osteoporosis and the impact on so many people broadly. Just for those listening, if they don't have any background or a great deal of knowledge. How do you define osteoporosis? What does it actually mean? Well, osteoporosis basically means thin bones that are easier to break. If you want to think normal bone might look like a piece of honeycomb with lots of little small holes in it or like a sea sponge, but osteoporosis, your bones start to look like Swiss cheese. So it's got bigger holes and finer branches. So you can understand that that makes the bone more fragile and easier to break. Helen, some people might hear the word osteoporosis or may even hear the word osteopenia or may hear the word osteomalacia. Are they all related terms? They are all related. Osteopenia refers to having a lower bone density than normal, but not as low as what you would define with osteoporosis. So one of the ways you define osteoporosis is by having a test called a bone density. And it basically looks at your bone density and compares it back to the range when you were 20 and 30, which is when we think people have their peak bone density and you get a score from that. Having said that, if you are in the osteopenic range and you have a fracture, that is actually considered to be osteoporosis as well. Osteomalacia is a slightly different condition, and that's where you have soft weak bones due to inadequate calcification purely from vitamin D deficiency. And the childhood equivalent of that is rickets. And that is usually pretty easily fixed with vitamin D supplementation. So in my certain practice as a rheumatologist, I'd mostly deal with osteopenia and osteoporosis. Okay. Look, you said that the scans, and I think they're called DEXA scans, are calibrated and related back to your potential bone mass in your 20s and 30s. Yes, that's right. So I'm guessing that age must be one of the contributing factors to development of osteoporosis. Absolutely. So age is the predominant one, getting older. And women have more osteoporosis than men because they have menopause where their estrogen levels drop. And all women will have a fall in their bone density at around menopause. And then the bone density, and in men as well, will continue to gradually fall as they age. However, there are lots of other reasons. If you don't achieve your peak bone density as a child or younger person, and certainly in our very older people, they may have been a child in the Second World War. where starvation and certainly diet insufficiency were problems. Also, if you had anorexia or an illness as a child, you may not reach your peak bone density. The female athlete triad is also a risk for osteoporosis where women who are exercising, it is a problem in elite athletes, may then lose their periods and their risk of having low bone density. There are genetic reasons and certainly in my area, inflammatory conditions such as rheumatoid arthritis and lupus are risk factors for lower bone density. Other inflammatory conditions such as Crohn's disease or ulcerative colitis where there can be malabsorption or the use of drugs, which I'll come back to. Thyroid conditions, having an overactive thyroid gland is a risk factor. Celiac disease. Having a high active in your parathyroid glands. Now, they're different to the thyroid and they control your calcium and phosphate balance in your body. If they're overactive, you can also be at risk for osteoporosis. And then really common things like too many cigarettes and too much alcohol are risk factors for osteoporosis as well. Wow. Well, for anyone listening, that's an overwhelming. number of associations or things that can feed into osteoporosis. So, look, it must be common. How common would you say the condition is? It's actually hard to know for sure because osteoporosis is a silent disease until you break a bone. So it's estimated that over a million Australians have osteoporosis. And if you're 50 or over, it's estimated that about 60% of the population has osteoporosis or osteopenia. And they know looking at data that it's something like, you know, 700,000 fractures a year that can be attributed to low bone density. So, you know, it's a big problem. And it costs the community lots of money. Yeah, well, that was one of the things I was going to ask. breaking a bone is not the way you want to find out that you've got osteoporosis. That's just too late. But up until that point, I imagine people don't have any awareness. So is there routine screening? A bit like at 50 we get a bowel cancer screening kit or women sign up for mammography screening. Is there a routine for screening? There is. You can have a bone density at 70 as a screening. That's the screen. a bone density at 70, you might say, gee, that's quite late. But I think it really, really comes from the fact that in younger people, which we can talk about, if they have low bone density, their risk of fracture isn't the same if you've got a very low bone density in your 70 as opposed to when you're 50. And it can impact on how effective the drugs are. So I think they're the major reasons why bone density is 70. Having said that, if you've got people with any of the conditions, you know, that I've listed, certainly, you know, you can screen much earlier for low bone density and you should be doing that. Is that scan at 70 years of age, is that supported by a Medicare rebate? Yes, it is. You can have one done earlier, but it's not supported by Medicare in the absence of any of these other indications that I've listed. Okay. And how much would a scan like that cost an individual out-of-pocket? To be honest, I'm not entirely sure, but it's not horrendous. Maybe a couple of hundred dollars? Oh, if that, yeah. Okay. Look, one of the things that you may have mentioned and I could have missed is there tend to be a family history with osteoporosis, like granddad, mum had it, could I have it? Yes, yeah, yeah, that's correct. And that would trigger people perhaps having a desire to get earlier screening and being ahead of the game? Yes, I think so. And it's certainly not an unreasonable thing to do. It doesn't immediately mean that they need medication. And there's a lot of lifestyle things that are incredibly important in trying to improve your bone density that should be put in place first. Well, that's a really nice summary around what osteoporosis is, the impact it has, what are some of the things that might drive it. and how we can at least start to get a feel for what's going on. I'd be delighted if we could talk about some of your thoughts on what we put in place for people who've been identified. Would you be okay to speak to that? Maybe if we kick off on a second podcast, could that work for you, Helen? Yeah, sure. Let's do it. We'll wrap it up there. We've done about 10 to 15 minutes on osteoporosis. I hope you found that valuable. Helen, thanks so much for sharing. I think this is a huge, Hugely important condition. And things like fractures, they must be linked to mortality and morbidity. Yeah. If you have a hip fracture, you've got, as an older person, you've got about a 50% chance you will never get home and about 30% are dead within 12 months of the fracture. Yeah, that's staggering. So this is a serious condition, a silent serious condition. Again, Helen, thanks so much for sharing. I really look forward to picking up what we do for these people. For those listening, if you have any queries or questions, drop me a note at info at drWarrickbishop.online. Thank you so much for listening. Until next time, live as well as possible for as long as possible. Take care and bye for now. Join the Healthy Heart Network and become part of our growing community. If you're interested in your heart health and risk of heart attack then join the Healthy Heart Network for only $5 as a lifetime member. This represents $55 worth of value. We offer and help people understand their present state of heart health, what their current level of risk is and the positive steps they can take. to improve their risk of heart attack in the future. Go to www.healthyheartnetwork.com.au and click the join the family button.
