In an article published to Fortune, Jessica Starr, MD, endocrinologist at HSS, and Emily Stein, MD, MS, Co-Director of the Skeletal Health Orthopaedic Research Program at HSS, recommend that patients taking GLP-1 medications work closely with their physicians and incorporate exercise and strength training into their treatment plans to preserve long-term musculoskeletal health.

Read the full article at Fortune.com. A subscription is required to access.

Osteoporosis is the condition through which bones become weak and brittle. We lose calcium naturally as we reach 50 years of age, Dr. Drake said, but that rate can be exacerbated when we don’t take in enough calcium, and the body must rob it from bones to survive.

The body is constantly creating and breaking down calcium, using cells known as osteoblasts and osteoclasts. When osteoblasts fall behind the osteoclasts and the body steals calcium from bones, the bones become weak and brittle and can break. This often happens when older folks fall.

“Just moving and supporting yourself is one of the best things you can do,” he said. “I spend a lot of time with patients talking about limiting their risk for falls. That’s one of the biggest risks for having broken bone is having a fall.”

And just as people seeking to drink enough water each day don’t take it in at one time, calcium for bone strength is best if it’s taken in throughout the day, said Dr. Drake. Meals, for example, should include a solid source of calcium, and that can be enhanced with a supplement.

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Dr. Starr emphasized that bone is not a static structure. "We think of bones as a hard substance that's just there. But bone is very much alive," she said. "Bone is constantly changing; it's building up, and it's breaking down at different rates throughout life."

She highlighted the importance of adequate calcium and vitamin D, regular weight-bearing and resistance exercise, and evaluation for underlying conditions that can accelerate bone loss, including menopause, diabetes, thyroid disorders, and certain inflammatory diseases. Dr. Starr also noted that fragility fractures, such as a broken hip after a minor fall or a vertebral fracture from coughing, can be a telling sign of weakened bones. 

For individuals at higher risk, Dr. Starr recommends discussing bone density testing with their healthcare provider, even before the standard screening ages. She also encourages patients to seek guidance on prevention and treatment options. "It's definitely worth having a discussion with a healthcare provider," she said

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“Americans today are entering old age with more fragile bones than previous generations, and modern life is largely to blame. We are moving less, spending more time indoors, and getting fewer of the nutrients — especially calcium and vitamin D — needed to keep the skeleton strong. At the same time, the specialists best positioned to catch and treat bone loss are in short supply,” Dr. Drake shared.

“The result: an aging population increasingly vulnerable to fracture, and a healthcare system increasingly ill-equipped to help. That makes prevention more critical — and more urgent — than ever.”

Read the full article at fortune.com.

Calcium is a core building block of bone. But the body also needs a steady level of calcium in the blood, explained Dr. Drake. 

If you don’t get enough calcium from your diet, the body gets crafty and steals calcium from bone to keep blood levels stable, said Dr. Drake. That’s not ideal, especially at a life stage when bones are weakening naturally.

To avoid that theft, make sure you’re getting enough calcium from your diet. Women need 1,200 milligrams per day after age 50. Men need 1,000 milligrams per day until age 70, then 1,200 afterward.³

“But here’s the kicker: You can’t effectively absorb more than about 400 milligrams at any single meal,” Dr. Drake said. “So each time you have a meal, there should be some source of calcium,” such as dairy, leafy greens, soy, or fortified foods.

Read the full article at health.com. 

Read the full article at ryortho.com. 

Although osteoporosis is common—around 10 million people over age 50 have it—the condition is still misunderstood. To set the record straight, Alana C. Serota, M.D., internal medicine physician at HSS, shares what many patients get wrong—and what everyone should know— about osteoporosis and bone fractures.

Because the words sound the same, osteoporosis and osteoarthritis, wear-and-tear joint damage, often get conflated, Dr. Serota said. However, the conditions are completely unrelated. “One is in the joints and one is in the bones,” she noted. While osteoporosis doesn't hurt unless you break something, osteoarthritis can be quite painful day-to-day. Also, notably, the two conditions have completely different prevention strategies and treatments, so it’s important to read up on both to understand the differences and how each may play a role in your health (or not).

Read the full article at healthcentral.com. 

“Our goal should always be to prevent the first fracture by identifying those at risk. The Own the Bone program from the American Orthopaedic Association has called on orthopedic surgeons to “capture the fracture” (ie, recognize fragility fractures and recommend treatment for osteoporosis) to optimize bone health prior to elective orthopedic surgery,” explained Dr. Serota. 

"The current paper adds to our growing body of evidence that consideration of underlying bone health is just as important to arthroplasty surgeons as to orthopedic trauma and spine surgeons," said Dr. Serota. 

Read the full article at healio.com. 

Pregnancy and breastfeeding can lead to bone injuries postpartum, particularly if you breastfeed beyond 12 weeks and have a history of missed periods or bone loss. Experts advise postpartum runners to focus on getting in proper nutrition, gradually increasing training load, and listening to your body to avoid injuries running postpartum. 

Research shows that women who are breastfeeding will experience 4-6 percent of bone loss because of the lower amounts of estrogen and calcium loss in breast milk. Women who already have bone loss issues such as osteoporosis are at an increased risk if pregnant or lactating, research shows.

The risk for most women comes after about three months of breastfeeding, however, Dr. Starr said.

“The body has protective mechanisms in place to maintain the calcium balance,” she explained. “Our bodies secrete a parathyroid hormone that tells our bodies to put calcium into bone. When we are nursing, our bodies secrete a parathyroid related peptide that makes sure there is enough calcium for both the breastmilk and the bone.”

Dr. Starr suggests getting a bone density scan (DEXA scan) BEFORE you are pregnant to ensure you have good bone health.

This is especially true if you have a history of bone injuries including bone fractures and breaks, stress fractures, and stress reactions; if you missed your period for a prolonged period due to amenorrhea or relevant energy deficiency syndrome (RED-S); or suffered from an eating disorder or disordered eating.  

Read the full article at themotherrunners.com. 

Postpartum stress fractures in female runners can be common. Hormonal changes during pregnancy and breastfeeding combined with factors such as sleep deprivation contribute to these injuries. 

Dr. Starr says, “Hormones govern this process: Estrogen regulates the breakdown of old bone and the growth of new bone. Levels rise during pregnancy, drop upon delivery, and remain lower lower during breastfeeding.”

“Lactating also stimulates the release of parathyroid-related hormone, which tells the body to break down bone,” explained Dr. Starr.

When Dr. Starr treats athletes with other vulnerabilities—such as pre-existing low bone density or an eating disorder—she’ll discuss the pros and con of breastfeeding, and when to wean, in their specific situation. Still, she rarely advises against breastfeeding altogether.

Read the full article at runnersworld.com. 

Uncontrolled diabetes is like a wrecking ball that crashes into your entire body. Left unchecked, this insidious illness can wreak havoc on multiple organ systems. Over time, your cardiovascular system, neurological function, kidneys, oral health, and even your eyes can suffer damage from drastic blood sugar fluctuations.

"Diabetes is more than just problems with blood sugar. It's a state of chronic inflammation,," said Dr. Starr. 

At least four spinal conditions are thought to be linked to diabetes including lumbar disc degeneration, spinal stenosis, spinal epidural abscess, and vertebral osteomyelitis. The disease can affect each condition’s development in a different way.

Dr. Starr said that none of these spinal conditions directly causes diabetes development. However, she offered an important caveat on this issue.

“Getting epidural steroid injections for pain related to these conditions can lead to diabetes in someone predisposed, like in someone with pre-diabetes at baseline,” she advised.

At the opposite end of the spectrum, Dr. Starr stated that diabetes does not specifically cause any of these spinal conditions. However, uncontrolled blood sugar can set the stage for a condition’s development.

“Having poor glycemic control can make the risk for bone infections, like vertebral osteomyelitis, higher,” she explained.

Read the full article at healthcentral.com. 

Since collagen is a protein, and protein is generally good for bone health, collagen supplements may be beneficial, advised Dr. Russell.  “But it probably doesn’t incorporate into bone” or reduce the risk of osteoporosis, she said. 

She recommended steps such as consuming sufficient amounts of vitamin D and calcium, exercising and maintaining a healthy weight. 

“There are many other things that support bone health,” said Dr. Russell.

Read the full article at WSJ.com.  A subscription is required to access.

Read the full article at Oprahdaily.com.

“Walking affects multiple systems in the body, and so it offers a lot of great benefits,” noted Dr. Robinson. When walking, Dr. Robinson suggested a pace that gets their heart rate up a bit. Being slightly breathless but not completely out of breath; use the “talk test” as described above. “That’s a good monitor that the walking you’re doing will improve your cardiovascular fitness,” said Dr. Robinson.

Dr. Robinson recommended aiming for 150 minutes of this type of walking per week, spanning multiple days. This is in line with the Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services, which recommends 150 minutes of moderate-intensity aerobic exercise per week for adults (or about 30 minutes, five days a week). 

Walking is a weight-bearing exercise, so it may help to preserve bone health and potentially decrease osteoporosis risk, said Dr. Robinson. What’s more, walking also improves core strength, increasing stabilization and balance to help prevent falls as you age, he added.

For the biggest benefits to the bones, Dr. Robinson advised combining walking with a strength-training program.

Read the full article at Everydayhealth.com.

The guideline also recommends sequential therapy (any treatment regimen in which the patient is given one treatment followed by another), which was not addressed in the previous guideline. The recommendations for sequential therapies are based in part on some study designs, long-term follow-up studies, and new clinical trials.

“Some physicians may be surprised about the need for sequential therapy when completing a course of denosumab, parathyroid hormone/parathyroid hormone related protein, or romosozumab. If not done, patients could be at risk of rapidly developing vertebral fractures and bone loss,” said Linda A. Russell, MD, rheumatologist and director of perioperative medicine and the Osteoporosis and Metabolic Bone Health Center at HSS and co-principal investigator of the guideline.

Furthermore, the updated guideline also gives more flexibility on drug selection and considers patient and physician preferences.

Read the full article at the-rheumatologist.org.  

Additional coverage: Medscape.com. 

Dr. Serota recommended wearing low-heeled, sturdy shoes and using any necessary assistive devices such as canes, walkers, railings or grab bars.

She said to clear the floor of extension cords, loose area rugs, toys/games/clutter and to have a well-lit path to the bathroom at night and use a flashlight in dark, unfamiliar areas (inside or out).

She also advised getting regular vision and hearing checks. She noted that hearing plays a critical role in fall prevention because it allows us to localize ourselves in space and contributes greatly to balance. An untreated 25 decibel hearing loss triples the chance of falling (based on a study of adults ages 40-69).

“So I am very much an advocate for getting regular hearing checks and, if warranted, using hearing aids,” Dr. Serota noted.

Read the full article at Chchearing.org.

Dr. Stein and Shannon Clare, research assistant and first author of the study, cited “Our results are notable because we found that the duration of suppression of bone formation extended beyond 12 weeks, a far longer duration than seen previously with intra-articular injections [of glucocorticoids].”

According to the authors, women are not typically screened for osteopenia or osteoporosis before ESI. However, Dr. Stein and Clare noted, “Our results suggest that physicians should consider screening women for osteoporosis who receive ESI, particularly those who are treated with multiple doses. Steroid exposure should be minimized as much as possible by having patients space injections as far as they can tolerate."

The authors stated that further studies are needed of the relationship between these short-term changes in bone turnover and bone loss and the risk for fracture among the burgeoning population treated with ESIs.

Read the full article at Medscape.com.

According to Dr. Goolsby, “With bone health there are things you can control and things you can’t control. We can’t control our genetics which plays a huge role in osteoporosis. Some bone loss over time is unavoidable and some aspects you may be able to slow.”

Dr. Serota underscored the bone is rich in estrogen receptors and that estrogen is important to maintaining bone density. She noted, “At the time of menopause and there’s less estrogen…there is very rapid bone loss in the first five years after the last menstrual period.”

Listen to the full episode at Podcasts.apple.com.

Dr. Stein and colleagues looked to evaluate texture features as a measure of bone fragility, by comparing clinically acquired magnetic resonance imaging (MRI) scans from individuals with and without a history of fragility fracture.

The retrospective study investigated 100 subjects who had lumbar spine MRI performed and texture analysis revealed that trabecular bone was more heterogeneous in fracture patients.

The study concluded that MRI-based textural analysis of trabecular bone discriminated between patients with known osteoporotic fractures and controls. The methodology is promising and will require further investigation to validate, which could greatly expand the number of patients screened for skeletal fragility.

Read the study abstract at Pubmed.com.

Reuters Health spoke to Alana C. Serota, MD, CCFP, CCD, internal medicine physician at HSS, who had no involvement in the study, to discuss the findings. Dr. Serota explained there are a number of things that contribute to skeletal health, and while there is no clear answer regarding the ideal amount of sleep for postmenopausal women, its important to wake up feeling rested. “We know poor sleep has an impact on cardiovascular health, leads to diabetes, poor sugar control and hypertension. It stands to reason these things can also impact the skeleton,” said Dr. Serota. She added, “The most important thing is to stay active. Even if one hasn’t exercised before, it is a good time to start. The diagnosis of any chronic condition, or a transition in any point of life, is a good time for a health reset.”

Read the article at Reuters.com.

NYCityWoman.com spoke to Joseph M. Lane, MD, chief of Metabolic Bone Disease Service at HSS, to discuss ways for women to manage bone health as they age, who suggested those with risk factors would benefit from earlier testing. Those factors include family history, low body weight, long term steroid use or diseases that can cause osteoporosis (e.g., rheumatoid arthritis). “Talk to your internist if you think you may be at risk and get a baseline screening,” said Dr. Lane.

As calcium is important for healthy bones, Dr. Lane advised, “Number one is to improve your diet. Eat something green every day, not peas, but leafy greens.” He also recommends building in rich dairy products, such as yogurt and almond milk.

Furthermore, exercise is a critical factor for bone health, specifically weight-bearing exercise. “You won’t change your bone density, but you’ll improve the quality of the bone,” said Dr. Lane. Rather than just walking on a treadmill, Dr. Lane suggested engaging in a variety of exercises such as Tai Chi and Barre classes in addition to walking and walking up the stairs. “Play sports and have fun. If it’s not fun, you won’t do it,” cited Dr. Lane.

Read the full article at NYCityWoman.com.