Strong to the Core: Bone Health, Menopause & Midlife Strength with Dr. Kristi DeSapri

22:40So I say, oh, that's, that's positive. You know, it's not negative.

22:44Dr. Kristi DeSapri:Starting low and going slow, as long as women don't have back pain, I have seen it be, you know, moderately, you know, affect, you know, having a small effect. I think, again, time will tell, larger research will, will help us. But I think if, if, if women want to do that, and that wants to be part of the, you know, treatment algorithm in terms of thinking about lifestyle and potentially medications or hormones. And this, they say all the power for it. And I see a lot of women in my neighborhood walking with the weighted vest. I'm sure you do too. Yes. Well, okay. So to kind of backpedal a little bit back to the relative energy deficiency in sport, with that being a risk factor, when we get postmenopausal, the bone is pretty susceptible.

23:33It doesn't like not having enough calories.

23:37Dr. Kristi DeSapri:It can. Yeah. Well, especially calcium. So it's interesting. So what happens, you know, again, when we have more bone breakdown than bone formation is the osteoclast outpaced the osteoblast. And then again, the sort of think about like, if you think about bone as sort of like a, like a structure or, you know, sort of a lattice structure that you're starting to take out little pieces. And then eventually sort of, if you take out enough, right, the building collapses. When there is less, you know, structure there and less calcium, particularly, you know, that's mineral, helping us mineralize and strengthen the bone that can predispose to, you know, to, to, to fractures and to again, low bone density.

24:16So it's interesting, you know, around the time of menopause, where some people are taking out like dairy or gluten, or for whatever reasons, we actually do need a lot of calcium, we have, you know, we do need more calcium or enough calcium to help maintain the bone strength, or help when we have more of that bone turnover. And I think that's something that we don't hear a lot of messages about, but it is important. It doesn't need to be that you're drinking a gallon of milk a day or anything, but getting close to a thousand to 1200 milligrams of calcium daily, either through dietary sources, plant-based sources, or supplementation is possible.

24:49And so I oftentimes, you know, have women think about that at least. And oftentimes too, calcium-rich foods have a lot amount of protein, which is another, again, thing that we're talking a lot more about. and of course protein is helpful for restoring muscle and that's so important as we also go through the perimenopause to menopause right we know that there's some muscle loss that happens you know slowly through that period of time but then more precipitously you know as we get to the 70th and 80th decades of life as well john daly here you know what day it is neither do i i live life daily that's why i only spend on moto casino moto's got daily free bonuses daily tournaments new slots added daily and the best part guaranteed daily jackpots you can't beat that so today's the day you gripping to spend it with me on moto america's social casino play for free on moto.us

25:46well the statistics are pretty uh i was gonna start with this but then i got so excited i didn't Okay. We're backtracking. Every three seconds, an osteoporosis related fracture occurs. And once an osteoporosis related fracture occurs, one in five women will refracture in the next five years. Right.

26:05Dr. Kristi DeSapri:Right. Yep. You did your homework. It's a sad statistic. Right. And so this is the reason why so much number one, we talked a lot about prevention, like, you know, in terms of like knowing your numbers, getting a DEXA, thinking about your calcium vitamin D family history, exercise, potentially, again, if you're a candidate for menopausal hormone therapy, and, you know, we know that that can prevent bone loss, we know that for women who are low absolute risk for fracture within a time period since the menopause without any contraindications, which has a lot of bone benefits. And in addition to, of course, helping with, you know, sleep, sexual function, hot flashes, you know, hair, skin, you know, all these other things.

26:47But if you do have osteoporosis, like the statistic of if you've had one fracture, you're, you know, 20 % of women will refracture, you know, in the years following, and probably the first one to two years that the risk is the highest is because whether, you know, the bone is a little bit destabilized, whether you're at a higher fall risk, whether we've, you know, found that there's a bone mineral density and a bone quality, you know, concern and there. And it's what I do see in clinical practice, right? So it's why we want to prevent the next fracture. And if you have osteoporosis, and if you had a fracture, we consider that severe osteoporosis, and then think about treatment.

27:24So then you're, you're not just, you know, in the realm of, you know, let me do some calcium and vitamin D. I mean, I, I always say to them, that's, that's fine. And those are the, that's kind of the lowest, you know, that's the thing that we should all be doing. But then we need to really address the problem at hand, just like if you had a heart attack, we would just say, okay, you know, you know, get out there and do a little bit more walking, right? Try not to have another one. You know, we'd say, okay, let's, let's really treat this condition. I think sometimes as women, right, unless we can like see it and feel it, we don't necessarily do that.

27:55But the sequelae of a fracture is, is, is pretty life changing.

27:59Dr. Kristi DeSapri:You know, they have fractures, pelvis fractures, you know, not just, you know, disability, but like, you know, pain or long-term consequences. And I, and I see it day to day. And so even vertebral fractures, you know, this can change your height, this can change your bowels. It's, these are not just inconsequential. So again, it's like, take it seriously, find someone that can talk to you about it. Think, research your options. There are a lot of great, safe FDA approved, effective options to reduce your risk of another fracture. And that's what's, again, really important when you've had a fracture.

28:29We call that secondary treatment or, you know, preventing a secondary fracture. And is that when you start the medication or once someone gets, you know, a low bone density scan, like when do you treat it with medication?

28:43Dr. Kristi DeSapri:Yep. Yeah. So very much like, you know, many of our other, you know, things, maybe menopausal hormone therapy is one that we, you know, we are starting to think more about like using as a prevention, right, of preventing fractures and helping our sleep and our hot flashes and night sweats before they get, you know, so bad that we're like, oh, let's crawl our way back. But for for osteoporosis, you know, we have large buckets of medications, a couple of the medicines, you know, prevent more bone from being lost. So they work on the, you know, osteoclast and then other medicines work to build new bone or form new bone.

29:17Dr. Kristi DeSapri:And then we have one medicine that kind of does both. So very much what we do is we say, okay, like, let's look at the DEXA, look at your fracture risk, look at all your clinical variables. You know, do you have any medical history? Do you have any aversion to a medication, any reason we couldn't use this, that or the other, and then want to match that fracture risk with the treatment we recommend. So if you're high, very high risk, we want to think about using the medications that are going to improve your bone density the most quickly as and reducing your fracture risk the most effectively and also quickly.

29:47Right. So that makes a lot of sense. And so those are some of the bone builders and their names are their brand names are Forteo and Timlos and Avenity. And then sometimes, of, you know, we also use medications like Prolia, which is a anti-resorptive medication or reclass. So those are some medicines that are, you know, people might hear, you know, sort of discussed. If the risk is lower than we think about things like hormone therapy, or maybe oral bisphosphonates, or even a medication called raloxifene or, you know, those type of medications. So it just really depends on where the bone density is the lowest.

30:21Have you had a fracture? Let's look at your obviously preference, you know, all of these things go into it. A whole treatment plan. So, all right, GLP-1s. So how does this affect, if any,

30:36Dr. Kristi DeSapri:bone health? Yeah. So I think, again, like this is such an evolving area. You know, I think that the issue is we, you know, we really haven't like done bone mineral densities, you know, routinely, mainly right on, you know, women and men starting GLP one medications, because we didn't really know what we know, like, you know, fat loss and, you know, that can happen, but we didn't really realize what the body composition changes might be. And now I feel like we're understanding, you know, when you lose a fat mass, you or you lose, you know, weight, you're going to lose both fat, bone and, you know, you know, muscle potentially, if you're not doing things to reverse it, like adequate protein resistance training, you know, things of that nature.

31:19So So I think there's a wide variety of what's going on out there, as you probably hear in your landscape, too. So there is a potential that you can lose bone mineral density. And we've known that from, you know, when we when from bariatric surgery. So, you know, prior to bariatric surgery, most individuals get a whole body DEXA where they look at their bone mineral density and they get a DEXA so they know where they're starting from. And then after that, they do it again. So like potentially that needs to be in our algorithm. It's not yet. I do that personally in my practice. If people are on a GLP one, I check if they've come to me after being on it for six months or a year.

31:57I'm like, well, we should check your bone density. I mean, naturally, those are many women coming to me between 40 and 60 anyway. So they're going to get a DEXA. But I think that's an important thing.

32:07Dr. Kristi DeSapri:So I think, again, time will tell how much bone will be lost. I think it depends on where people are starting from and what they do. I think more we're getting concerned about the muscle loss and the sarcopenia. Also, that that is a huge concern, especially for long-term use, especially as we know with aging, we're going to lose the muscle mass. So I think time will tell. I think there's not enough high quality research to tell us, but there's some theoretical concerns for sure. So then if we are losing, and I think that's a major point to reiterate is that so many women have no idea that if they go on this aggressive or prolonged calorie deficit diet, that it can be pulling from bone.

32:59Like that just wasn't, at least from the women that are coming in, in my world, there's, that's, they didn't even think that was a thing. And so, you know, if we keep building and we're building muscle, then we're also working on building bone too. Correct.

33:17Dr. Kristi DeSapri:Muscle and bone for sure talk to each other. I mean, I think this is the thing, you know, that we're going to learn more about in the next, you know, I would say five years because there's so much more research in muscle now and like what's contributing to muscle growth and sustaining mouth growth and what exercise do we do that to do that and whether it helps you know the bone mineral density improve as well I think we will see so I think we're going to see much more of that you know coming as well and I yeah I think it's really important to think about both so bone is not just static it's dynamic and it's changing just like muscle is and the best way to check it again is the bone mineral density that we have now or the body composition scan that can look at all those three characteristics as well.

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34:37As the gold standard, but, you know, there's some different methods out there where some, you know, scales and in-body that can kind of show bone. But that like we we we really don't want to rely on that if we have other options, if women have other options available.

34:56Dr. Kristi DeSapri:Yeah, I think I think, you know, for sure that there's I mean, there's so much out there now. Yes, the in body can be very helpful. It's an indirect measure, you know, a bioimpedance and looking at the different muscle, fat and bone. It has a little bit less hydration status is a little bit less impacted than it is with the DEXA scan. scan. So, you know, ideally, you could sometimes say do the DEXA scan in the morning, etc. But again, I think just thinking about it, you're already like, you know, we've already made a change if you're thinking about or if you're educating your, you know, clients or your patients about saying, okay, are you thinking about calcium?

35:29Dr. Kristi DeSapri:Are you thinking about protein? Should you maybe meet with a registered dietitian? What about doing some resistance training? I think this is all, you know, important. And I think, again, just we've known even taken from like, you know, if we look at the risk factors for osteoporosis, you know, sedentary lifestyle is one of the risk factors, right? Because again, we're not moving our bone bodies, we're not loading the bone, you know, that's always a concern, you know, for me, when I think about like, young kids on devices, you know, that's why I'm always my kids get off their devices. That'll be like, probably on my grave, get off your device, go outside and play.

36:04Dr. Kristi DeSapri:Because I'm like, Oh, my God, this is bad for their bones. And I think that there's like a lot of the pediatric endocrinologists sort of say the same thing. So it affects all of us at all levels, right? Not just the menopause women. Yeah. I didn't even think about that. But I have another quote from you. Okay. I love these. I have a bunch of Christy quotes that I'm loving. And I hope I don't mess them up. Or maybe you don't remember saying them. But I loved this. What is good for the brain is good for the heart is good for the bones. Yeah. Yeah. So there's so many so much I I mean, as we do this more and more, right, you probably see so many things are connected, right, when we talk to our patients.

36:42Dr. Kristi DeSapri:I mean, I love what I do, and I think, you know, we can help women in so many ways when we think about, like, pillars of health, right? Hormones, sleep, nutrition, exercise, chronic stress factors, our medical history that comes to us just because, right? So, but yeah, I think that is, you know, when we think that primary is taken from when we think about exercise, but also we think about hormones, it's the same application, right? We think about estrogen hormones, particularly, again, if you're a candidate for those, because I know that there's lots of women out there with, you know, estrogen receptor positive breast cancer or cardiovascular disease, which doesn't mean you can't get any treatment or suffer through whatever symptoms or osteoporosis.

37:22There's lots of options, but right. We do know from a lot of our studies, our observational studies, the Women's Health Initiative study, that menopausal hormone therapy helps prevent cardiovascular disease, helps prevent osteoporosis, helps with, again, sleep quality, helped reduce our risk of osteoporosis-related fractures, prevented diabetes, all of that. So there's, you know, again, I think it's thinking about, you know, the individualized, you know, risk benefit risk ratio when you're thinking about how to make some of these choices. And I think that's a lot of the guests you've had on have sort of shared the same line of thinking.

38:00I'm still kind of blown away that only like under 10 % of women are taking hormone therapy. Given, I mean, and I think that's going to change over the next, you know, decade. Right. But wow. Wow. I mean, after all of this, I'm like, really? Less than 10 percent?

38:19Dr. Kristi DeSapri:Yeah, I think, you know, I mean, now there's shortages in some of our patches and things like that. So I don't know. I think it's probably exploded. And again, I think that, you know, there was a pendulum and I think it's coming back more to the middle. And how great that we have more, you know, research information and that we just need more clinicians trained. Right. I mean, the statistics that, you know, even, you know, Dr. Rachel Rubin, you know, shared that, you know, when she was talking to the FDA and how little we have, you know, prescribing prescribers because the box warning is concerning or because we don't have consistent messaging because we're not trained to know that, right?

38:54The residents, the fellows, the medical students. So like elevating that training helps us all, right? So we're saying consistent messages,

39:00Dr. Kristi DeSapri:not that I'll have patients come in and say, well, my internist said never hormones, like never, I would never, you should never go on hormones. And it's like, where does that come from? Right? Right. There's no there's no that's a personal opinion or is this like based in science? You know, it's like me saying, you know, never go on, you know, antidepressants like what? Like, why would I say that? Like, that's an individual choice. Right. So I think we need some of those blanket statements to go away. And I'm so proud of, you know, my menopause colleagues and friends that were all sort of saying some consistent messaging and standing up to the FDA and some of these other powers that be.

39:37So to really help our patients, it's what we do day in, day out. But it's great to see on like a massive level. Yes.

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40:22Dr. Kristi DeSapri:Yeah, it's fun. But you too. I mean, I think we all, you know, play our part, right? Consistent messaging, telling people they could be active, keep staying active, give them the tools. It all matters. Yeah. So when we hit like, so the statistic, and I might get this wrong, but it's somewhere once you are in the menopause transition, so three years before, maybe two to three years after that you can lose somewhere between seven and 20 % or something. Correct. Yeah. So again, when we mentioned, you talked about that, that trabecular bone and cortical bone, those bone sites, the cortical bone is more in our long bones and our growing bones, like our wrist and our hip.

41:04Dr. Kristi DeSapri:and trabecular bone primarily concentrated in our spine. But yeah, so with the remodeling or that outpacing of the bone, you know, resorption and the bone formation, some women can lose up to 20 % of their bone mass through that time, particularly, you know, women, if you're starting with a low bone density, and then you're going through that, you're going to obviously notice the drop more, you know, I use the analogy often of like a bone bank. So if you're starting low, and you go through menopause, and you're going to, you know, you're going to, you know, do some more, you know, take, you know, deposit or deficit from your bone density, then you're going to end up with lower bone mass, right?

41:37It just makes sense, right? When we look at the equation.

41:41Dr. Kristi DeSapri:So, so yeah, so it's even more important, right? Why you want to know your bone mass, you know, from the start ish, or your risk factors, and then where you might end up because I the times where I see women who are like 62, 63, and that's their first X or 65. And they're very, you know, frustrated that they have osteoporosis, it's like, well, you know, we just, you know, the medical system failed you, right? We just didn't do the dex soon enough. We didn't capture this. It's like if we did a cholesterol after your heart attack and showed that your cholesterol was 250 and we could have prevented something.

42:14So again, it's like knowing or,

42:16Dr. Kristi DeSapri:you know, knowing earlier, always helpful, right? You know, getting ahead of these curves is always helpful. And if you do have osteoporosis, then treating it. And I always say not being scared to treat it. Medicine is not, you know, a failure, you know, it's like, okay, it's actually can be preventing a fracture if you haven't had one or preventing a second fracture. So I think sometimes we think it's a failure if we have to try something or do something, maybe something, this is more of my patients or the natural, you know, approach versus the maximalist approach. But there's many ways to come to a conclusion where you feel safe and comfortable treating your osteoporosis, whether it's hormones or medications, obviously, including lifestyle, calcium, vitamin D, and all of those things.

42:52So I always say it's not a failure, right, to treat the osteoporosis. It's getting actually, it's treating a condition that you would have a sequelae from if you didn't. And it's a tough one, though.

43:02Dr. Kristi DeSapri:It's a tough one, because I think sometimes that we think, oh, it's aging, and it's an older woman's disease. But, you know, when we look at the statistics, like, you know, they think about 14 % of women have a diagnosis of osteoporosis between 40 or between 50 and 59, close to like 20 to 30 % when you're 60 to 70, you know, 60 to 70. So that's a large majority of women. It's a large percentage, right? So you're with it, you're with, you know, so it's not like this is so uncommon. And again, the sequelae we're trying to prevent is that is that fracture. So for osteopenia, if somebody comes in with low bone mass.

43:40Is that what it's called now? It is. You've got it right. So like the negative one is like just the start of osteo. It's a very first state.

43:49Dr. Kristi DeSapri:Yeah, minus 1.1 to minus 2.4 on that DEXA, if it's done correctly at one of the clinical sites, like the spine or the femoral neck or the hip is osteopenia. Yes. And sometimes there's something called the trabecular bone score, which is a bone marker of like bone micro architecture, or you could say like bone quality or how well your bone is organized. Sometimes that can also push us in one direction or the other. Oh, okay. Good to know. So if somebody comes in with that, that say negative 1.1 and they do nothing over say one to two years, while they, they might've just gone through menopause and they have, you know, one to two years where, where you might have this window, I don't know if window is the right word, but if you do nothing, no, no, no treatment, no exercise, nothing.

44:44How, like, is there an average of a percent of how the bone would change?

44:50Dr. Kristi DeSapri:Yeah. So again, like when we think about around, you gave the example around the time of like menopause. So that woman could lose, you know, again, on average in the spine, seven to 10 % of their her bone density. The largest is probably about 20%. We do know that there's some like age related losses, like as we get further from the time of menopause, which can be about a half a percent of bone loss a year, right? So that can be, I call that kind of like the trickle down approach. So like women who like have a osteopenia for like 15 years, and eventually they're going to maybe develop osteoporosis.

45:24But it's also where like, if you know, they're vitamin D or calcium deficient, that might speed up the process of bone loss. Or let's say, you know, if there's medications like an aromatase inhibitor, if you have a breast cancer diagnosis or a, you know, multiple steroids, either injections or taken orally, if you need to use them for a certain condition, like a rheumatologic or autoimmune condition, that might speed up, you know, bone loss. And then if we see, you know, a recheck a DEXA in two or three years, and you've had more bone density loss, then maybe we would expect that means we have to put on our thinking caps and say, why is this?

45:59Is it a calcium? Is it a vitamin D? Is it a metabolic bone reason, right? That's mostly what I spend most of my day doing, you know, that we're, you know, that we're having a change in the bone density, or is it hormonal? Or is it age related? You know, that sort of thing.

46:12Dr. Kristi DeSapri:But when you say do nothing, it's always hard, because many of you, no one does nothing, right? Because most people are like, okay, I'm going to try and get some calcium, or I'm going to get my vitamin D up, or I know I need to be doing some exercise. Yeah, I hear that often. But, you know, what do I do? So I think the most important message from your question is that like that we rescan. If we do get like a osteopenia or an osteoporosis, we rescan. And if you get a normal DEXA and you're 45, then I would say you're good for at least until the time of menopause, like around if that's 50-51 for on average.

46:46Dr. Kristi DeSapri:If it's earlier, we do, we could recheck. But if it's like we're in a good safety net there.

47:23Are there any other supplements besides vitamin D and calcium that you recommend to your patients?

47:30Dr. Kristi DeSapri:Yeah. So this is when, great question. So, you know, adequate calcium, vitamin D, really important. Vitamin D, we can check on a blood test. Calcium, we really can't. There is something called the 24-hour urine calcium collection that sometimes we do if we're, if we, again, want to work up an osteoporosis diagnosis to make sure that there's no like problems absorbing calcium or hyper excretion of calcium. So there's some two extremes there. So you might be asked to do that testing. And that's important. And then in terms of like, you know, again, adequate protein, probably important again, because that muscle bone crosstalk, we know, you know, certain things like potentially, this is where like, again, there's a lot of potential things like maybe collagen.

48:16There's some small research, you know, that shows that collagen might be helpful. Our bones are made up of collagen, whether ingesting collagen helps our bones is a question mark, but there's some small evidence, you know, to that, to that standpoint.

48:31Dr. Kristi DeSapri:Things like heavy metals like strontium and boron, again, they've been studied, but they're, I see in my mind more, you know, risk than benefit for those. Those are heavy metals. they deposit in the liver, they cause some GI side effects. So I don't recommend those routinely. So again, it's mostly, you know, calcium, vitamin D, again, that takes up a lion's share of, you know, what we think about in the bone. Sometimes vitamin K2 can be helpful if people are not getting a lot of that in their diet. So there's some benefit that vitamin K2 can help support the bone cell, the bone forming cells. So these are small things I say, sure, we can add the K2 and we can add the vitamin D and the calcium and the collagen if you want.

49:15There's some studies on prunes. I know the study is very like out there that, you know, six to nine prunes a day might help the bone density. So again, this is the like, if we're thinking like, let's do the kitchen sink approach, we can add some of these, you know, small things that might make a little bit of a, you know, a benefit. So those are the things that I think about. And those are things that aren't going to hurt just help. So even if you're not benefiting per se, like with your bone, it's going to add something, right? Right.

49:44Dr. Kristi DeSapri:There's even research now going on like, you know, creatine, right? Will that help the bone? I mean, it helps the muscle a little bit again. So will it help the bone mineral density a little bit? Potentially that's the same thing. So I say, okay, if these are the things that we want to like be adding, if you're not like, they're not hurting, but again, is that another thing we want to make sure that again, if it's a supplement, we're getting a third party tested supplement, we're checking for, you know, the, you know, purity, all of these things are also important, right? And then the cost that comes along with it.

50:11So I think, again, like the, a lot of the times it is a little bit individuals, what are you doing? What do you want to add? How much do we want to, you know, think about these, sort of what I would say, supplemental things? Is there an area if we look at, we know that, that we get the wrist, the lumbar, the hip and the femoral head. Is there one, I mean, none of them are great, but if you, is there one that's worse if you're like, this is more of a problem than the others?

50:43Dr. Kristi DeSapri:Yeah, that's a, it's a good question. So what we see a lot in the menopause, you know, is we might see like a lower spine bone density. And again, potentially our lower peak bone mass might be more reflected in that trabecular bone, so in our spine, or if there's a lot of bone turnover going on. But when we look at like big ticket item, I would say, you know, what you're asking me is if your hip bone mineral density, you know, is low, like minus 2.5 or lower, really at any age, we know that that's a very strong predictor of a hip fracture. So again, the lower the bone density, think about it as more like, you know, fragile or thinner bones, bone microarchitecture being compromised, you're at higher risk for having a hip fracture.

51:25And that just increases as we age, right? So, you know, I'm less concerned that maybe someone has, I'm concerned in a different way, let's put it this way. If someone who is 50, you know, 52, let's say, you know, postmenopausal and is 52, who has a hip, a T-score of minus 2.5 in her hip versus someone who's maybe 75 and has a minus 3.1 in her hip, because she's older, more likely to fracture, maybe have other medical conditions and break a hip and then have the sequelae of, you know, to not be able to walk or live independently or things of that nature versus someone who's 50.

52:02Dr. Kristi DeSapri:I'm saying, wow, your bonnet is low to start. And if we do our math, you're going to live for another 30 years because that's on average how long women are living, particularly if there's no other competing, you know, risk factors there. So I'm also saying, wow, we've got a long way to go. We don't want you to lose this bone density. We have to do something to either build your bone density or be able to maintain it over a period of time. But this isn't just what I'm saying. This is also our clinical guidelines that say that, you know, there is a correlation with your risk of a fracture and your T-score at your hip.

52:36And then if you're treated for osteoporosis, there's also a correlation that you'll fracture your hip less. So we call that on-treatment T-score also correlates with reducing your risk of a fracture. So there's, there's a catch 22 there. Wow. So what would be the top, maybe two to three labs or assessments that you would recommend women, you know, get the screenings that they should ask their physician for?

53:04Dr. Kristi DeSapri:Sure. So first, you know, I think you guys are becoming like boneheads. You're becoming excellent bonehead. So your minds are blown. I can, I can see. for sure we talked about the dexa a lot so again find a place you get a dexa ask your you know gynecologist internist specialist you know whoever to get a dexa checking your vitamin d you know very easy also making sure your serum 25 hydroxy vitamin d is being checked important again there's no easy way to do calcium assessment but thinking about the calcium in your diet the quality of the calcium you know in your diet very important you know if a dexa is not freely accessible.

53:44There is an online fracture risk tool called the FRAX score, which is again, you can Google FRAX, F-R-A-X, and that can tell you putting in your, you know, your age and your height and your weight and some of the other variables we assess for fracture risk can be something that you can do or even bring that to your, you know, clinician to talk about bone health and, oh, maybe my risk is a little bit higher or maybe I want to kind of talk about this or what do you know about this? I think that's really important. And of course, I see so many women from all the decades. So I think just again, you know, when you say what one thing I would say, you know, talking about your menopause symptoms or having asked about like, how are your periods going?

54:24What symptoms are you noticing when you're between 40 and 55, 60, 70? You know, these are all important things to being asked now. We're finally able to recognize some of these, you know, the myriad of symptoms and everyone's symptoms are a little different, but being asked Like what's new, what's changed, you know, what could we correlate to maybe hormones? I think it's hugely important. Yeah. I mean, wow. I have, I have so much more on my list. I'm really, I'm really mad.

54:52Dr. Kristi DeSapri:Yeah, no, yes, I know. I, I, uh, no, but I think it's been, I think we've had a lot of great topics really. It's a lot of the highlights. So that's good too. Okay. So on a closing note, if you could wave a magic wand and have every woman 40 plus understand one thing about her health, what would it be? Okay. Well, I'm going to, of course, tailor this to like, you know, bone health, because again, bone and body women's health, this is important. And I think, again, an area like you mentioned, even from the outset that is getting a little bit more traction, right? But, you know, I think we've talked about contraceptives and we're learning more about menopause.

55:32Dr. Kristi DeSapri:And there's so many areas within menopause, you know, thinking about, you know, sexual health, thinking about, you know, cognition, thinking about sleep, thinking about the musculoskeletal symptoms. I mean, I would bucket osteoporosis, arthral, you know, joint aches and pains, muscle changes, all of that is in that bucket, which I think is great, because there's more identification on that. So, I mean, I think if I could wave a magic wand, I think we've talked a lot about it is to like know your, you know, think about bone health, you know, before it's too late. So whether that's a DEXA or a fracture risk assessment or say, yeah, I need to be doing some resistance training.

56:10Dr. Kristi DeSapri:I need to know my, ask my mom, did she have osteoporosis? You know, thinking about those, those things. And I think, again, it touches, it's not just in a silo, right? It touches a lot of the other parts of the things that we're talking about before we hit menopause and after. So that's what I would say. Well, I am, I, I'm going to go look at the FRAX test and I'm going to go request a DEXA. Um, I mean, I was waiting a couple, I mean, I'm almost 48, so I'm not too far away from, from, you know, menopause. So it's a coming. And so I don't know why I was thinking that I would just wait because. Yeah, let me know your results.

56:57Oh, I'm curious. Sounds like it.

56:59Dr. Kristi DeSapri:I mean, right. I mean, again, I think for anything, you know, sometimes we get people. It's nice to get also let's I'm assuming I'm just assuming your bone density is being normal because you're a strong fit woman. But who knows? But it's also if it's normal, it's like reassuring. I'm like, great. Sometimes it's like I love I love telling people their bone density is strong. I'm like, great news. I give them a smiley face. I'm like, this is amazing. Keep doing what you're doing. You either hit the genetic jackpot and you're doing the right thing. So it's also good to get good information sometimes or information that helps guide us or push us on the right path, right?

57:34It's not all, I think sometimes we come to the doctor, it's all doom and gloom, right? It's like, oh, great. They're going to tell me my cholesterol is high. They're going to tell me

57:41Dr. Kristi DeSapri:this, that, and the other. And sometimes it can be positive, but I think that's like, you know, again, also, or it can be enlightening. Let's put it that way. Yes, absolutely. Well, Dr. Disapri, thank you so much for spending your time. I know it's the end of the day for you. So thank you for sharing, sharing all of your wisdom and education with us. Where can women find you? Yeah, great. Of course, this is my pleasure too. So yeah, so I am I have a website, Bone and Body Women's Health. That's my practice. And you can find that. I do some social media. More is hopefully coming. I'm a busy practicing clinician.

58:22Dr. Kristi DeSapri:So I do a lot of like teaching and educating. I have some of those on my website. I'm looking forward to sharing this podcast with my members. And I see patients in Illinois. I've also have a Florida telehealth license. I do do some educational consults as well. So yeah, you can find me there. Great. Well, you'll have to get in Colorado and Utah. So Lauren, I know maybe for my retirement, a bunch of years down the road, but I start falling and it's so beautiful there. Yes. Well, thank you so much, Christy. And we will definitely keep, keep, keep doing what you're doing. And we will definitely keep following you for up to date advice and evidence-based information.

59:06So thank you for sharing your time with us. Oh, you're welcome. Thank you. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the body pod with your friends.

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