EP279: Talking Osteoporosis With Doctor Cooley (Rhuematologist) Part 2

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Introduction: Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Helen Cooley, a Hobart-based rheumatologist. The discussion focuses on managing osteoporosis in patients, particularly perimenopausal and postmenopausal women, with emphasis on lifestyle interventions and diagnostic approaches to determine fracture risk. Key Takeaways: Comprehensive medical history is essential when evaluating patients for osteoporosis, including childhood illnesses, medication use (particularly glucocorticoids, epilepsy treatments, and breast cancer drugs), and previous fractures. Fracture risk assessment tools like the Garvin Risk Calculator (available free online) should be used to guide treatment decisions rather than relying solely on bone density test numbers. Smoking and alcohol consumption significantly impact bone health beyond their other health effects and should be specifically addressed in lifestyle counseling. Weight-bearing exercise such as walking and resistance activities are crucial for building and maintaining bone density, though care must be taken with fall-prone elderly patients. Obtaining calcium from dietary sources (dairy, leafy greens, nuts, and fortified soy products) is preferable to supplements due to conflicting evidence about calcium supplementation increasing heart disease risk. When calcium supplements are necessary, they should be divided across meals with food, and calcium citrate may be better absorbed than calcium carbonate, especially in patients taking proton pump inhibitors. Vitamin D deficiency is common, particularly in winter months in Tasmania, and is important for calcium and phosphate absorption; supplementation may benefit those in nursing homes or with limited sun exposure. Vitamin K2, while theoretically beneficial for bone mineralization, has conflicting evidence for treating osteoporosis and is best obtained through dietary sources like leafy green vegetables rather than supplements. Medication decisions for osteoporosis should be considered when hip fracture risk is around 4% or overall fracture risk reaches 16-20% over 5-10 years.