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Osteoporosis | Women's Health

In this episode, we are joined by Dr. Deborah Sellmeyer, Clinical Professor, Medicine-Endocrinology, Gerontology, & Metabolism at Stanford University. Dr. Sellmeyer will discuss osteoporosis screening, nuances of interpreting the DXA report, when to screen women under 65, and when and how to add screening for vertebral fractures. She covers laboratory assessment of secondary osteoporosis and how to utilize bone turnover markers. She reviews supplementation pitfalls and covers medication therapies including when to consider anabolic therapies and the role of menopausal hormone therapy. She’ll provide exercise recommendations and resources to share with patients. View CE information and claim credit: https://stanford.cloud-cme.com/course... Key moments: 00:00 Introduction to Women's Health Vodcast series 01:02 What led you to specialize in endocrinology & bone health? 01:50 Indications to screen at an earlier age 04:22 Are there any populations that are under-screened? 05:50 Calculating FRAX without bone density 06:40 Is DEXA screening useful in younger patients? 08:25 Using Z-score to compare expected bone density 09:50 How can T-score be impacted by conditions such as osteoarthritis or degenerative disc disease? 11:15 Using the forearm to evaluate fracture risk 12:30 Isolated osteoporosis at the forearm 14:30 Are there patients where FRAX score might underestimate the risk of fractures? 16:00 Who should be screened for vertebral fractures? 18:55 Oral bisphosphonates 19:56 Drug holidays 22:35 Bone turn-over markers 24:52 How often should you re-screen with DEXA? 29:05 What lab tests should be done on all osteopenia or osteoporosis patients? 32:17 How to interpret a urine test? 35:20 Hypercalciuria and dietary calcium 36:50 Common mistakes with calcium supplementation 40:29 Vitamin D level recommendations 43:20 What is your opinion on menopausal hormone therapy in post-menopausal women with osteopenia? 46:47 DEXA screening and estrogen use 47:50 When would you opt for Prolia (Denosumab) as your first-line treatment choice? 50:25 Prolia (Denosumab) and T-score 51:10 Risks of Prolia (Denosumab) 53:11 What are your counseling points to encourage patients to take medications? 56:59 Threshold for drug holidays and tailored treatment within the Asian population 58:52 Monitoring DEXA scans 1:01:02 What if bone density goes down? 1:03:10 What indications do you consider anabolic therapies for? 1:06:03 What bone density score is low enough to consider an anabolic therapy as first-line treatment? 1:07:08 Higher risk patients and starting with anabolic therapies 1:09:02 Key takeaways 1:09:50 Helpful resources