[music plays] [no dialogue] >>Lori Banks: In the U.S., more than 40 million people either have osteoporosis, or are at high risk.

Are you one of them?

Today on Being Well, physician assistant Keith Ballinger from Sarah Bush Lincoln will be here to talk about the silent disease, or osteoporosis.

We'll learn more about who's at risk and what you can be doing right now to lessen your chances of developing it.

That's all coming up next on Being Well, so don't go away.

[music plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

[no dialogue] Welcome to this edition of Being Well.

I'm your host, Lori Banks.

And today, we're talking about osteoporosis.

And Keith Ballinger, who's a physician assistant with the Toledo Clinic of Sarah Bush, is joining us.

Thanks for coming over.

>>Keith Ballinger: Thanks for having me.

>>Lori Banks: So, tell us a little bit about your practice and what you do down at the Toledo Clinic.

>>Keith Ballinger: I've been a PA for 13 years.

Currently, I'm working at Sarah Bush in the Toledo Clinic.

I've been there for four years, practicing in family practice.

Over the last 13 years, I've had experience in family practice, as well as a seven-year stint in urology.

>>Lori Banks: Okay, and what's interesting about Keith is he was actually an accountant for several years.

So, you joined medicine later in life.

>>Keith Ballinger: Yes, I did.

>>Lori Banks: That's wonderful.

So, when we were talking to you about topics, you said, "Hey, I want to talk about osteoporosis."

Why was that an important thing for you to educate the public about?

>>Keith Ballinger: Osteoporosis is a condition that is, has been widely overlooked for the most part, until it's a problem for the patient.

I, approximately two years ago, Dr. Ranchero and Dr. Stevens and I got together and identified a problem.

We identified an area that we're lacking, as far as addressing women's issues, as far as osteoporosis.

Because patients simply don't typically come in asking to be screened for osteoporosis.

>>Lori Banks: So, let's start with the obvious question.

Explain to us what is osteoporosis.

>>Keith Ballinger: Osteoporosis, basically if you take the word, break it apart, it refers to bone, porous, and a condition.

It's a condition of porous bone.

It's a condition of bone loss.

You lose bone strength, therefore it subjects you to increased risk of fractures.

>>Lori Banks: So, who out there in our population is at higher risk for getting it or developing it?

>>Keith Ballinger: Typically, it impacts women more so than men.

Men are not excluded, however.

Post-menopausal women definitely need to be screened.

>>Lori Banks: So, why is it women are getting it, and why later in life?

What's the connection?

>>Keith Ballinger: Typically, it's the estrogen.

Once a woman goes through menopause, they lose that estrogen production.

Therefore, we see an increased osteoclastic activity, which leads to additional bone loss.

>>Lori Banks: So, when I was looking at osteoporosis for this show, I'd seen a term called osteopenia, and I'd never heard of that before.

And I want you to explain the difference between that and osteoporosis.

>>Keith Ballinger: Sure, osteopenia is literally a condition that's going to lead to osteoporosis.

When you have a DEXA scan done, it's resulted based upon standard deviations.

It'll have a negative score.

And if it's negative, or zero to negative one, you're at low risk for a fracture.

Negative one to negative two point is higher risk, but still not severe osteoporosis.

So, you have a little window of opportunity in there that we label as osteopenia, which means you're losing some bone, but you're not to the osteoporotic stage yet.

>>Lori Banks: Mmhmm, we're talking about osteoporosis, osteopenia.

It all has to do with bone density.

And I want you to kind of talk about bone density, and when are we creating and building bone density through our lives.

>>Keith Ballinger: You attain maximum bone density by the age of 30.

So, as early as 30 and thereafter, you start losing some bone density, unless you get proactive and try to develop and adapt lifestyles that will promote good bone health.

>>Lori Banks: Okay, so what are some of those healthy things that we should be doing, that maybe we're not?

>>Keith Ballinger: Well, eating right, exercise, calcium supplementation, making sure that you take in enough calcium and Vitamin D on a daily basis to minimize your risk of chance of developing osteoporosis.

>>Lori Banks: Okay, so really, starting at age 30 is when we should really start thinking about this and doing something about it.

But it's a little more than just drinking a cup of milk a day.

You need more than that.

What are the recommended levels of calcium per day?

>>Keith Ballinger: For post-menopausal women, I usually recommend at least 1,200 milligrams of calcium and Vitamin D on a daily basis.

And the nice thing is most of your over-the-counter calcium supplements are already developed, and they'll have 600 milligrams of calcium with 400 international units of Vitamin D. Take that twice a day, along with your other nutritional intake that you're consuming throughout the day in your meals, you've got your calcium level satisfied for the day.

>>Lori Banks: And calcium comes in lots of, in food form.

I mean, obviously we have our dairy, but it also comes in other forms, such as... >>Keith Ballinger: Oh, you can get calcium in certain vegetables.

Kale, yogurts, cheeses, dairy products.

There's, calcium's... or calcium fortified cereal.

>>Lori Banks: And breads, and things like that.

Can you take too much calcium?

Can you overdose on calcium and Vitamin D?

>>Keith Ballinger: You can, you can.

You can actually ingest too much, and that's not recommended or advisable either.

>>Lori Banks: Okay, so what happens if you're taking in too much?

Or what are some of the side effects of maybe if you're-- >>Keith Ballinger: For the most part, with calcium you're going to have increased GI irritation.

You can also have constipation as a result.

Vitamin D, it's a little harder with Vitamin D to ingest too much, but you can.

And it has a whole other set of issues and problems associated with it.

>>Lori Banks: Okay, so starting at about age 30 is when we need to start thinking about this.

So, what if you're watching this show, and you're my age, and you're 45 or 50, and you haven't started thinking about it?

Is it too late?

>>Keith Ballinger: No, it's not too late.

Main thing is get proactive.

Talk with your primary care provider.

If you haven't had a DEXA scan done, and you qualify for one, get it done so you know what your T-score is.

>>Lori Banks: Alright, that's what I was... you had said you would like for all post-menopausal women to be screened for their bone density.

Is that something that your primary care is going to look at your chart and go, "Oh, it's time for you to be screened"?

>>Keith Ballinger: Hopefully, yes.

But unfortunately, we're all very busy.

Patients typically come in for other issues, complaints, concerns we're busy addressing, and so forth.

So, I try to encourage all my patients, and even people that I speak with, talk to your primary care provider.

You know, bring up osteoporosis.

If you're post-menopausal and you've not had a DEXA scan, you know, just give them a little reminder.

>>Lori Banks: Okay, so really, it's more on you as the patient.

You're the one that should be more proactive in asking for that.

>>Keith Ballinger: Exactly, be more proactive.

>>Lori Banks: So, how does, I've never had a DEXA scan.

I don't... how does it work?

>>Keith Ballinger: A DEXA scan is a simple radiographic study done at the hospital.

Non-invasive.

It's literally a glorified X-ray with very low radiation exposure.

>>Lori Banks: Okay, so you don't have to drink a bunch of fluid or anything.

Let's get back, let's talk about osteoporosis.

So, are there any symptoms?

>>Keith Ballinger: Unfortunately not.

There's no, it's usually found by incidental finding.

And what I mean by that is, typically a patient presents to ER, to the office, or orthopedics is involved because they've had a fracture.

And that's when we identify, oh, there is some osteoporosis going on here.

>>Lori Banks: So, there's no outward symptoms of pain or anything like that?

>>Keith Ballinger: It's always after the fact, unfortunately.

>>Lori Banks: Okay, so what if you, you know, we've probably all seen elderly women that are kind of stooped over.

Is that a telltale sign of osteoporosis?

>>Keith Ballinger: That's typically associated with compression fractures of the spine.

And that, too, is indicative of some underlying osteoporosis.

>>Lori Banks: So, can it be reversed?

Or how does it work?

So, if it's caught early, you take, you know, some kind of, we'll talk about medications in a little bit, can it be reversed?

>>Keith Ballinger: We can make some significant improvements.

To say it is completely reversible, getting you back to a T-score of zero, that's probably a little misleading.

But with the medications that we have, absolutely, we can make some definite improvements in your bone mineral density just by calcium, Vitamin D, and other medications that are designed to actually improve that bone loss.

>>Lori Banks: Is there a point at which it's too late, and you can't quite get that back?

>>Keith Ballinger: Yeah, if you have severe osteoporosis, it's more of a challenge for us to get you treated adequately and get that bone mineral density back even close to even an osteopenic level.

But nonetheless, we don't want to ignore it either, because it is going to continue to progress and get worse.

So really, I mean if you have osteoporosis, your biggest risk factor are fractures, easy breaks and fractures.

Are there any other risk factors or other things that come along for women who have osteoporosis?

>>Keith Ballinger: RIsk factors that lead to osteoporosis?

>>Lori Banks: Or if you have osteoporosis, other things that happen as a result of it.

Or is it just fractures?

>>Keith Ballinger: Basically, it's bone fragility.

You're at high risk for fractures, you're high risk for falls.

You know, we discussed earlier, you know, which one kind of came first.

Was it the hip fracture causing the fall, was it the fall that caused the hip fracture?

Nonetheless, with osteoporosis that risk of fractures due to falls is significant, sometimes can be quite disabling for some of these patients.

>>Lori Banks: So, that's something we need to keep track of, just like we keep track of our blood pressure, our, you know, diabetes and things like that.

Let's talk a little bit about activities that help build our bone density.

>>Keith Ballinger: Mmhmm, for the most part if people will stay active.

Walking, riding a bike, dancing, stair step.

Any type of physical activity that requires some weight bearing activities is going to be beneficial to maintaining good, strong bones.

I like to send a lot of my patients over to physical therapy, just to work with them a couple times to help them develop a nice home exercise program that they can complete at home to actually increase and maximize what activities they're doing, just to increase that bone strength, as well.

>>Lori Banks: But clearly, if you have more mid- to advanced stage osteoporosis, and you never exercise, you probably don't want to go out.

And you need to be a little mindful of the activities you do.

>>Keith Ballinger: Right, and you really need to talk to your primary care provider, and get their input, as well.

>>Lori Banks: We talked about some of the people who are more at risk, obviously, are women.

And why are women of thin or smaller stature, low weight, at risk?

>>Keith Ballinger: One of the articles I recently read tagged women who were 127 pounds or lighter are at higher risk for developing osteoporosis.

And I think it goes back to the fact that their bone mass is less than men, and with their being such a small frame, light weight, their weight bearing activities is going to be significantly less of a demand on the body than someone who's heavier or stockier build.

>>Lori Banks: What about, you know, that smoking leads to lots of other things.

What impact does smoking have on osteoporosis?

>>Keith Ballinger: Smoking impacts many organ symptoms.

And the bone is a healthy tissue, it's a living tissue, as well.

So, smoking is going to impair the proper bone remodeling to occur within that bone.

And it's just going to worsen the bone health overall.

>>Lori Banks: Mmhmm, so let's get into a little bit of treatment options.

At what stage does someone, does a doctor recommend a medication, a prescription kind of option for osteoporosis?

>>Keith Ballinger: Well, calcium and Vitamin D is going to be the first mainstay.

I mean, most everyone by the time they're 30 and beyond can start that on their own accord.

If you have a DEXA scan and it comes back showing osteopenia, the sooner you can intervene and treat that condition, the better your outcome's going to be.

So, the better our chances of getting you back to a normal bone density is going to be definitely to your benefit.

>>Lori Banks: So, you really do step in fairly early and start treating?

>>Keith Ballinger: The sooner, the better.

>>Lori Banks: Okay, so what's... we don't need to get into all the actual names, but the medication can take several forms.

I've seen pills and injections.

How do you know which one is the best one?

>>Keith Ballinger: It's basically, I evaluate each patient individually to see how significant their osteoporosis is.

If they've had fractures, any previous fractures.

And I always kind of assess the patient and look to even beyond.

Okay, what's the likelihood of this patient fracturing in the next 12 months, two years, whatever.

And I kind of evaluate the patient and decide which treatment modality would best fit their need at this point in time.

The medications come in all sorts of forms.

There's oral medications, there's injectables, there's IV infusion.

Part of deciding which one to choose is which one I can get the patient to cooperate with and take.

>>Lori Banks: Okay, so one isn't for more severe cases than the other.

>>Keith Ballinger: One, we have one medication that is anabolic.

It does actually rebuild bone.

But it is an injectable medication.

Some people cringe because they do have to do that every morning or every day themselves.

But still, there, certain medications we do, I do lean toward with my more serious cases.

>>Lori Banks: Okay, let's kind of go backwards a little bit.

What role does our early nutrition play in our future bone health?

So, if we had a poor diet growing up as a kid, is that going to impact our chances for osteoporosis later in life?

>>Keith Ballinger: It can contribute to it, it sure can.

We're seeing more and more research showing that young females who engage in fad diets, who lose weight repeatedly and frequently, are predisposing themselves to osteoporosis at an earlier age.

Basically, through the first 30 years of your life is when you're building up the maximum bone density.

If that's affected in any way by poor dietary intake, fad diets so to speak, that could very well predispose you to developing early onset of osteoporosis later in life.

>>Lori Banks: Okay, so it's important as a kid to, and as a young adult to eat healthy, and that up and down weight loss, which is problematic for young women who want that thin, ideal build, which is obviously, as we know from talking to you, is a risk factor later in life.

What other conditions are risk factors for developing osteoporosis?

>>Keith Ballinger: Other medical conditions that contribute to osteoporosis, such as diabetes, thyroid disease, parathyroid disease, chronic steroid use for like asthma, autoimmune disorders.

We also use steroids oftentimes with certain autoimmune disorders, as well.

So, all those conditions are risk factors to, toward the development of osteoporosis.

>>Lori Banks: So, those are things that you need to be aware of.

When you brought up thyroid disease, that's also something that a lot of women deal with.

>>Keith Ballinger: Correct, very common.

>>Lori Banks: So, what is the connection with the thyroid and calcium?

>>Keith Ballinger: The thyroid is actually very, very crucial in our entire body's metabolism.

The parathyroid glands reside there amongst the thyroid gland.

And those parathyroid glands are instrumental in the calcium regulation within the bones and within the bloodstream.

>>Lori Banks: So, if you have your parathyroid glands removed, you're going to have a hard time... Is it absorbing calcium, or...?

>>Keith Ballinger: Basically, parathyroid glands are going to work to control and regulate the calcium.

>>Lori Banks: I wanted you to... we talked about this earlier.

Can you explain the role that, you know, like our hormones play, or estrogen plays with... and I'll have you, you did a better job explaining it, so there's this kind of little Pac Man thing.

I want you to kind of explain that.

It's a really good analogy on the role that hormones play with osteoporosis.

>>Keith Ballinger: Okay, basically our normal bone remodeling occurs under osteoclastic activity and osteoblastic activity.

The osteoclasts are cells, and I use the analogy of referring to them as the old Pac Man game, they chomp away at the old bone.

The osteoblast, or the builders, they come along and they make those repairs.

When you have a healthy woman who has not gone through menopause, the estrogen actually helps to suppress some of that osteoclastic activity.

So, you have a longer time frame or a longer period where the bones remain healthier because of the suppression of the osteoclastic activity.

Once they pass through menopause and they lose a lot of that estrogen production, that then up-regulates the osteoclastic activity.

And therefore, you get the osteoclasts chomping away like the little Pac Man, and removing bone at a faster rate than your osteoblasts can keep up in repairing it.

>>Lori Banks: So, if a woman had a hysterectomy in her 30s and has been on hormone replacement therapy, is that doing the same, is the HRT doing the same thing as normal estrogen would do?

>>Keith Ballinger: Yes, if a woman goes through a hysterectomy or a bilateral oopherectomy, which is where they take out the ovaries, they're placed on hormones.

That hormone replacement therapy is supplementing the body exogenously, and will actually help prevent osteoporosis from developing.

>>Lori Banks: Okay, but we know, as you said, HRT brings a whole other, that's a whole other show.

>>Keith Ballinger: That's a whole other segment.

>>Lori Banks: I want to, as we're kind of wrapping up here, I think what's interesting about, and kind of scary, about osteoporosis is that it is this kind of silent syndrome that could be going on, and we don't know about it.

>>Keith Ballinger: Right, it's also sometimes referred to as the "Silent Thief," because you have no warning signs, no outward symptoms until, unfortunately, it's recognized with a fracture, fall, break.

Sometimes we can pick it up on plain film X-rays, as well.

>>Lori Banks: Mmhmm, so what should, this is your platform now, tell us what women should be doing and at what age to stave off this "Silent Thief."

>>Keith Ballinger: I would recommend that women starting in, even in their 30s, develop that habit of supplementing your diet with calcium and Vitamin D. When women become post-menopausal, talk with your primary care provider.

Become proactive.

Get that DEXA scan done so you know what your bone health is.

It needs to come just as routine as having your mammograms done, your annual pap and pelvics done, and so forth.

>>Lori Banks: So, it's really, it's a simple thing, but it's one more thing we should add to our, as you said, our list of preventative health.

And it can be, to a certain extent, if caught early, reversed, which a lot of our other chronic diseases can't be reversed.

Like diabetes cannot be.

But this is one that-- >>Keith Ballinger: We can treat it, and we can make some amazing improvement in your overall bone health.

>>Lori Banks: Alright, well Keith, thank you so much for coming on Being Well.

This is the first time we've covered osteoporosis on the show.

And I know my eyes are wide open, and I'll be going out to the store and getting myself some calcium supplements today.

>>Keith Ballinger: Very good.

Thanks for having me.

>>Lori Banks: Thank you.

Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

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