"Osteoporosis is the silent killer"

Dr. Mary O'Connor wants you to think about bone health today, before it's too late. Actually yesterday would be better. A conversation I wish I'd had ten years ago, before I was diagnosed with it.

I had my first DEXA scan this past June, after both my primary care physician and my gynecologist¹ said I could get one after I asked, even though I’m only 57. DEXA stands for dual x-ray absorptiometry, and I’m embarrassed to say I’d never heard of this test or its acronym until my conversation with Midi Health CEO Joanna Strober last October. DEXA scans measure bone density, which is the thickness and strength of our bones.

If you were born after 1958 and have never heard of a DEXA scan either, don’t be too hard on yourself. You’re not yet due for one unless you have certain risk factors for osteoporosis. The CDC lists intestinal disorders, multiple sclerosis, and low BMI, none of which I have. In fact, the CDC doesn’t even list surgical or early menopause—which I do have—as risk factors. Even though they most definitely are. And their guidelines don’t recommend getting a DEXA scan until age 65, if you are a woman, or 70, if you are a man.

I am 57. Too young, I thought, for osteoporosis. Well, guess what, kids? I was wrong. And my doctors were right to have me tested early. The diagnosis of full-blown osteoporosis—not even osteopenia, its harbinger—dropped into my patient portal the same week as my car crash, because of course it did. Suffice it to say, I had more immediate and pressing health concerns post-crash, but also, I wasn’t sure where to begin, now that I’d learned that I have the spine of an octogenarian and the hips of a woman in her seventies. Should I call an orthopedist? A spine specialist? What, exactly, was I dealing with here beyond the normal decay of age, and how does one go about rebuilding human bone?

Both my doctors suggested I consult with an endocrinologist. Finding one who takes my insurance was one thing. Getting an appointment with her was another. I was able to nab an appointment (checks notes) six months later, in December of 2023. But what to do with this diagnosis in the meantime? What should I be doing, taking? Is bone loss reversible? I wanted more information than I could glean from a simple google search.

Then I remembered speaking with Dr. Mary O’Connor, co-author of Taking Care of You: The Empowered Woman's Guide to Better Health. Dr. O’Connor is an orthopedic surgeon with whom I’d recently been invited to speak on a podcast for the Mayo Clinic. Hadn’t we touched upon osteoporosis, either before, during, or after our public discussion? What exactly did she tell me? And why didn’t I take copious notes? Why did I simply assume osteoporosis was a geriatric disease, not something that was happening to my bones today, in my mid-fifties?

Turns out, my assumptions about osteoporosis being an old lady’s disease were incorrect. Nearly 1 in 5 women and 1 in 20 men over the age of fifty—fifty!—have osteoporosis. Simply put, this means we are at greater risk of breaking bones. And as Dr. O’Connor points out in our conversation below, which I’ve condensed and edited for clarity, 20% of all patients with hip fractures die within the first year after that fracture.

I wanted to zoom with Dr. O’Connor before I’d learned anything about osteoporosis myself beyond a quick google search and whatever I’ve gleaned passively over the years, which basically amounted to this: Osteoporosis is bad. Make sure to get enough calcium, vitamin D, and exercise. Eat leafy greens. Walk in sunshine without sunscreen daily, for at least a few minutes a day. Engage in weight-bearing exercise. In other words, this is me, knowing practically nothing about the disease or its prevention, having several incorrect assumptions, and learning, in real time, everything I need to know about how to manage my diagnosis. Including why my morning walks in the sun are not giving me enough vitamin D to combat the disease; what I can do to fix that; why vitamin D acts as more of a hormone than a vitamin; why Forteo might be a better option for me, at my age, than Prolia or Fosomax; why men need to worry about osteoporosis as well; and why we should all be gifting our adult daughters gigantic tubs of Vitamin D3.

Deborah Copaken: Had I been put on hormone therapy right after getting my uterus out, would I have perhaps avoided this?

Dr. Mary O'Connor: Most likely, yeah. Well, you would've either avoided it or mitigated it. It wouldn't be as bad as it is now, because estrogen helps protect our bones.

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A discussion with Dr. Mary O’Connor, orthopedic surgeon, Chief Medical Officer and co-founder of Vori Health, and co-author of Taking Care of You: The Empowered Woman's Guide to Better Health.

Deborah Copaken: First of all, what does it mean to have osteoporosis? Let's just define our terms.

Dr. Mary O'Connor: Okay. So osteoporosis is basically when our bones have become weaker. And the challenge here is that puts you at higher risk of a fracture. And particularly as we get older, fractures can be very devastating, hip fractures in particular, as well as fractures in our spine that are called compression fractures. And this is very, very important for women because post-menopause, we lose bone density at a higher rate. Now, I'm going to back up a minute. This is a really important concept. When we're young and we're growing, we're building bone, we're growing taller, our bones are growing, and they're growing not just in length and circumference, but in strength. We reach our peak bone strength in our early 20s. After that, Deborah, the bad news is downhill from there. And honestly, it's a race between, are you going to die first, before your bones get so weak that you fracture? I know, but that's the actual reality, unless you're really proactively engaged in maintaining your bone health.

Deborah Copaken: But okay, so here's the thing. I've heard about maintaining bone health all my life. So I'm healthy. I do yoga. I walk every single day. I eat yogurt and milk, all my leafy greens. I am as healthy as a person can be. What else could I have been doing? And I still got osteoporosis?