Women Lose Significant Bone Density During Menopause

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1:40Doug Lucas:About half of women and 20 percent of men over 50 break a bone because of osteoporosis. Yet many people with the condition don't get treated. But late last year, we did see the Food and Drug Administration making an important policy change is expected to spark new interest in treating the common bone disease. So instead of waiting years to see whether clinical trial participants experience fewer fractures, drug makers can now measure whether their medicine increases bone mineral density. It'll take and make clinical trials much shorter and cheaper, but it's expected to entice more biotech companies to pursue new drugs and investors to back them.

2:14Doug Lucas:And it'll be interesting about the differences, men versus women, because we know we've talked about that a lot in this segment. Let's get to it. It's time for the Business Week Women's Health segment. We focus on key issues in developing technologies impacting the present and future of women's health around the world. Delighted to have with us Dr. Doug Lucas. He's an orthopedic surgeon, osteoporosis specialist at the telehealth platform LifeMD, joining us here in studio. Welcome, welcome. Thank you. Happy to be here. It's good to have you here. I don't think we talk about it a lot, but I think we should.

2:43Doug Lucas:Tell us about this condition and why you chose to focus on it, especially when it comes to health, bone health in women. Well, I mean, first of all, thank you for letting me talk about it because you're right. We don't talk about it enough. Osteoporosis, as you mentioned, has a very high morbidity rate, meaning the problems that come along with fracture is very high, meaning you could potentially die after a fracture. A third of women and men after a fracture will actually pass away within 12 months. The loss of... Why is that? Because you sound like people get fractures and they deal with it.

3:17Doug Lucas:Why? So a lot of it has to do with who is actually having fractures. Some of these patients are older, they're very frail to begin with, but we're actually seeing fractures younger and younger too. And so while the mortality, the death rate is very high and alarming, it's actually the loss of independence that I think is more important. And not that death isn't important, but we see so many women, especially lose independence much earlier in life than we would anticipate. And it catches them off guard because we're not talking about it and we're not screening. Well, I feel like orthopedic surgeons, you often see an orthopedic surgeon for the first time when you've already had an injury.

3:52You know, you're going in because you need something fixed. And that doesn't sound like we're prepping in the right way or avoiding this in the right way. So what should we be understanding? What should we be talking about? What should we be doing to actually prevent having to go see you? So there's two huge things here. No, it's fine. I actually don't operate anymore because I actually am now in the game of prevention. I want to educate. I want to prevent. And so there's two main things to think about here. One is screening. So screening earlier. Right now, the recommendations from some of the governing bodies like the USPSTF, United States Preventive Services Task Force, recommend screening for women at 65 and men for 70 if they have risk factors.

4:33Doug Lucas:That seems old. It is way too late. And I understand they do it because of the statistics and I get it. But we should be screening, especially women through midlife, perimenopause and menopause, because that is the opportune time to intervene, especially when we talk about hormone therapy. Well, let's go there because I feel like in the last year or so, we've had a whole like kind of enlightenment about some of the research that's been done when it comes to women in hormonal therapy. So what have we learned and what do we need to know now going forward? Well, this is a really fun space for me to talk about because this is where we get to talk about hormones in a different light.

5:07For the last 20 plus years, we've been living in this sort of fear, use as little hormone as possible, only treating symptoms. Those are what the guidelines actually still say for the most part is treat symptoms of menopause. But when you look at hormones through the lens of bone health, we have the opportunity to start saying, wait a minute, the lowest dose that treats your symptoms might not actually be enough to treat your bones, to prevent bone loss. And yet estradiol, estrogen, is FDA approved for the prevention of osteoporosis. But if we're not measuring it, then we don't actually know that it's doing what we want it to do.

5:40And this is where we have to get into a new space of hormone optimization rather than just hormone replacement or menopausal hormone therapy.

5:47Doug Lucas:What happens to people who've missed that window? I mean, this is where, okay, every day we're learning how to treat various ailments across the spectrum, if you will. So what happens for those who've missed out? And obviously, we're getting enlightened about for the next generation, if you will. Sure. there there's a lot of opportunity to talk to different groups of women here for the women that went through menopause over the last 20 plus years many of them are traditionally quote unquote beyond the the window of opportunity which is within 10 years from menopause right i talked to a lot of these women in their 60s and 70s every day and they are angry that they didn't have that conversation that that was that opportunity was robbed from them but at the same time the research actually supports there is opportunity for some of these women especially the women 10 to 20 years from menopause so this is most women in their 60s it's not necessarily too late we just need to take individual risk factors into consideration a lot of doctors unfortunately are still treating as if any time after 10 years out from menopause is too late that's what i feel like i mean as a woman as the mother of a daughter you know it is fascinating um to see have a 23 23 year old daughter, like going into various medical offices and how they're treated, how we're treated.

6:59Doug Lucas:It's not always so ideal in terms of being open to what you say about yourself or the questioning of, well, maybe that's, you know, not kind of really thinking about the diagnosis and maybe pursuing what's wrong. I think you're saying it nicely. I'm trying to be careful here, but you know what I'm saying? Absolutely. No, absolutely. Why is that still? I think there's a lot of reasons. I think for a lot of, uh, for most of modern medical history, we have not treated women as individual, you know, women are different than men. The sexes are different. Women have different needs than men's. And the research shows that research has mostly been done on men until very recently.

7:40There's very little funding for women in medical research, even currently. And so doctors, I think for the most part, mean, well, they want to treat their patients, but a lot of times they don't actually have the tools they need or the knowledge they need to treat a woman as a woman, which is really unfortunate. On top of that, there is this underlying just paternalistic nature of physicians that when it comes to women, we tend to tell them what to do versus when it comes to men, we tend to educate them on the risks and let them decide. Is this being taught in med school these days at all? Which part?

8:13Like what you just mentioned, like what we've tended to do and what physicians have tended to do and ways to avoid that bias when it comes to treatment. Not in my medical school training. No, we do learn from our mentors though, right? So these are how things get passed along from generation to generation in medicine. This is how these biases get passed down.

8:32Doug Lucas:Real quickly, got about 40 seconds. I'm gonna go three things. Calcium and vitamin D, important? Yes, but it's just one part of the bigger picture. Doing weight. Absolutely important. What's the other part of the picture that people should be thinking about here? Get screened early, optimize hormones, resistance training and impact if you can do it. That's the recipe and food. Peptides? Whole food diet. Peptides? That's a longer conversation. The answer is maybe. There's a lot of research coming though. Okay. Will you come back? Absolutely. All right. That would be great. So appreciate it. That of course is Dr.

9:04Doug Lucas:Doug Lucas, orthopedic surgeon, osteoporosis specialist, say that five times fast, at the telehealth platform. It is of course LifeMD.

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