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.

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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Though only a handful of them get much attention, there are more than two dozen known symptoms of menopause and perimenopause, the time leading up to and immediately following your last period.

The symptoms are so varied because your ovaries are ramping down production of estrogen and progesterone, sex hormones that have played key roles in all kinds of physiological processes since puberty. Estrogen is the biggest factor: As it declines, tissues in many parts of your body get drier, your bone density decreases and your body changes in lots of other ways.

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

Dr. Starr explains that when treating osteoporosis, there is no one-size-fits all approach. Different medications are available, and treatment should be tailored to a woman’s specific needs. A healthy lifestyle is essential to help preserve bone health, including a nutrient-rich diet and adequate intake of calcium and vitamin D. The daily recommendation for women ages 51 to 70 is 1,200 mg of calcium and 600 international units (IUs) of vitamin D. For women who are 71 and older, the recommendation is 1,200 mg of calcium and 800 IUs of vitamin D. Calcium-rich foods include dairy products; calcium-fortified orange juice; dark, green leafy vegetables, and fish, like salmon and sardines. Since it may be challenging to get the recommended daily amount of calcium from foods, women often take supplements. To obtain the most benefit, they should not exceed 500 mg or 600 mg at one time because our bodies cannot absorb more than that. If a calcium gummy has 500 mg, for example, it should be taken twice a day. For women taking a multivitamin containing calcium, it is advisable to take a calcium supplement later in the day.

The full article appeared in the print edition of Newsday on April 30, 2024.

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. 

“Osteoporosis is a silent disease — until it’s not,” said Dr. Starr. She explains that osteoporosis just means that the natural holes or pores in our bone are bigger than they should be on a bone density test.  

“When they get bigger beyond a certain pre-defined score, we call it osteopenia,” said Dr. Starr. “And when it gets even bigger than that, we call it osteoporosis. But just having those holes in the bone and having them be large is painless.” 

But here’s the thing: even if you don’t feel it now, the risks are real. When these holes or pores get bigger, your bones get more fragile, your muscle mass diminishes, and your risk of falls and fractures increases.  

Ensuring strong bones requires attention at all stage of life. Osteoporosis isn’t just an issue confined to older individuals. An increasing number of people in their 20s, 30s, and 40s are receiving diagnoses.  

While immediate medical treatment may not be necessary for every diagnosis, especially in younger, fit individuals with milder forms of osteoporosis, it’s essential to engage in an open conversation with healthcare providers about steps to fortify bones and prevent fractures. 

“Doing something is better than doing nothing,” said Dr. Starr. “If someone promises me they’ll attend physical therapy for strength training and take some calcium, it’s still a step forward from when I first met them at the door where they weren’t doing those things.” 

Read the full article at creakyjoints.org

Falls might not seem like a big deal to many, but for older adults or those with or at risk for the bone-thinning disease osteoporosis, they can have serious consequences. Falling can lead to severe injuries, make daily tasks harder, reduce your quality of life, and take away the freedom to live independently. In some cases, falls can even be life-threatening. 

As you get older, it’s smart to re-evaluate your home, even if you’ve been living there for decades. “What was safe when you were 40 is not okay anymore when you’re 75 or 80,” said Dr. Starr. Look out for potential hazards like loose rugs. Make sure there’s proper lighting, especially near staircases, and that banisters are sturdy. If your bathtub is high, consider installing support handles to help you get in and out safely. 

Something as simple as being more conscious of your everyday movement can be a powerful fracture prevention step. “Slow down and don’t go up and down the stairs carrying things,” said Dr. Starr. “Go up and down the stairs holding the banister.” 

Read the full article at creakyjoints.org. 

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. 

Osteoporosis is often called a “silent” disease because people typically have no symptoms. They often don’t know they have it until they break a bone in an unexpected way. Osteoporosis develops when bone mineral density and bone mass decrease. This can lead to weakened bones and an increased risk of a fracture. The hips, spine and wrist are most susceptible.

Earlier screening is recommended for women with certain risk factors for bone loss, such as a family history of fractures or the use of certain medications such as steroids. Those who consumed very little calcium in younger years, had an eating disorder, smoke or consume excessive amounts of alcohol may also be vulnerable to accelerated bone loss, Dr. Starr noted. Anyone with a diagnosis of either osteoporosis or osteopenia should talk to her doctor to develop a strategy to prevent further bone loss, she said. The plan may include lifestyle changes and possibly medication. “There’s no one-size-fits-all approach to treating osteoporosis,” she explained. “Different medications are available, and treatment should be tailored to the needs of each individual.”

This article appeared in the June 7-June 13 print issue of Good Health. 

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. 

A gradual return to exercise is key to avoiding injury. “The challenge is that when you have been inactive for a long time, the body gets weaker and cannot handle an activity at the previous intensity,” explained Dr. Wang.

“The foot is particularly vulnerable [to stress fractures],” said Dr. Drakos, “When people think of bones, they think they are hard like metal, but the bones in the foot are more like tree branches. They can bend a little bit and if you bend them enough times, they can crack.”

Dr. Wang recommended seeing a doctor if pain persists after a few hours of continuing an activity, or if people start experiencing pain on days when they not working out. “The ‘no pain, no gain’ mantra should be banished from our vocabulary. Pain is our body’s way of telling us that something is wrong,” he noted.

“It is also important to figure out what led to the stress fracture in the first place,” noted Dr. Wang. “The prevention part is just as important as the treatment part.”

A deficiency of vitamin D can affect healing, according to Drs. Wang and Drakos. Dr. Starr explained the daily recommendations for calcium and vitamin D, and noted that at least half of our calcium intake should come from foods such as dairy products, dark, green leafy vegetables and high-calcium fish like salmon and sardines.

Dr. Drakos emphasized the importance of wearing the right shoes for activity and supportive footwear when not exercising. “Most of us take more than a million steps a year. So, if you take 5,000 to 10,000 steps a day in shoes that are not giving you support, it is that much extra stress on your feet with every step you take.”

This article appeared in the June 2021 print edition and online at Omagdigital.com.

Infectious Disease Advisor spoke to experts who discussed the effects of ART on bone health in PLWH, including Jessica Rachel Starr, MD, endocrinologist at HSS. Dr. Starr explained, “ART, when given intermittently vs continuously, has a better effect on BMD decline, meaning bone density is less negatively affected when patients take breaks from the antiretroviral agents.” She added, “This is a complex topic and highlights how HIV has become a chronic disease, meaning patients with HIV are living long enough to develop chronic age-related conditions such as osteoporosis, although they are perhaps developing these conditions at an earlier time in life and with a higher degree of severity than their HIV-negative peers.”

Dr. Starr expressed the need for further research, stating, “Additional research is needed to tease out the relative contribution of the HIV itself to low BMD vs the medications used to control the virus. There is also a need to determine whether ART affects bone metabolism or vitamin D metabolism or both.”

Dr. Starr also addressed key considerations for clinicians, citing, “Osteoporosis and osteopenia are more common in women, older patients, and those with lower body weight. All patients with HIV should have BMD screening before initiating treatment with ART.”

Read the full article at Infectiousdiseaseadvisor.com.