The Latest in Osteoporosis Treatment and Research AM 570 KVI April 24, 2005 Charles H. Chestnut, III, M.D. Introduction

Transcription

1 The Latest in Osteoporosis Treatment and Research AM 570 KVI April 24, 2005 Charles H. Chestnut, III, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of KVI, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. Introduction Here's another health condition you need to be thinking about this Sunday, and that is osteoporosis and having bones that could become weaker as you age. We'll find out what to do about it next on Patient Power. Good morning on a fairly sunny Sunday morning here in Seattle. I'm Andrew Schorr live at the KVI Talk Radio 570 studios here every Sunday with Andrew Schorr's Patient Power. This is the program to help you and your family, your loved ones, have better health, and if you're dealing with a serious health concern know how to navigate the healthcare system so you get the best. It worked for me. I'm happy to say I'm a nine-year leukemia survivor, and I really had to be proactive about getting the best care. I was in a clinical trial, and guess what, it led to me being in a condition where they can't find the leukemia right now. And let's all, as we do every week, knock on wood. I hope it stays that way for a long time. So I'm a big proponent of you being very proactive to make sure you get what's right for you. Often if you have a diagnosis of something you've never even heard of before how do you get authoritative information and really be the quarterback for decision-making for what's right for you or someone you love. Over many weeks now we've talked about cancer and diabetes. We've talked about chronic pain. We've talked about how you make decisions about surgery. We talked last week about separating medical hype from true medical hope. Not everything is a breakthrough, and you have to have a filter for that. We have to be consumers. And I always welcome your calls if you have any tips for others on how you made a smarter healthcare decision. We're sort of a community here on how we can all do better because I really believe in my case that it saved my life, and many other people will agree that they have better health because they did their research and they got smart. And there's so many people to help you. I'm one of them every Sunday, and I invite you to call on any health topic if we can give you sort of that Patient Power philosophy. Today we're going to talk about a condition that has been sort of a silent condition, and that is osteoporosis. When we're kids we're told drink milk, and there's a million of those "Got Milk?" ads, and you want your kids to have strong bones. But then as you get older you're not building those bones anymore, and particularly for women after menopause the 1

2 bone mass, if you will, may well be going down. Well, if it's really serious it becomes osteoporosis, and the Surgeon General has said that is one of the most serious conditions. And as a matter of fact just looking at a statistic on a great website, the National Osteoporosis Foundation, or nof.org, osteoporosis means porous bones, and the Surgeon General has said that 1.5 million fractures related to osteoporosis cost the nation $18 billion every year, and 44 million Americans are at risk, particularly women, about 80 percent women, folks over the age of 50. Opal s Story Now, we think of kind of the older woman kind of getting stooped from osteoporosis, but the real risk is fractures. I want you to meet someone who is right from Renton who has lived with that. Opal Krisenowski. Opal, are you with us this morning? Yes, I am. Thank you for being with us. Now, let me tell you a little bit about Opal. Opal is a former nurse and certainly up on healthcare issues. She's a grandma and has five grandchildren, two sons. And about 20 years ago, Opal, you started having fractures all of a sudden, and you were telling me just a few minutes ago you've had probably more than 20 fractures, and your bones became so thin, if you will, that it could even happen from coughing, right? Yes. So this is what we're talking about for our listeners with osteoporosis where your bones become so porous that really anything can cause a fracture. And then of course that can lead to pain, disability. It can change your life. For those of us who are in middle age, like me, and you want to be very active and running around and doing--you know, front page of the newspaper today has a whole thing on cruises. You want to take those cruises. Well, if you can simply bump into something or cough and have a bone fracture a lot of those things can limit your life, right, Opal? Right. Okay. Opal, so let me understand. You then got connected with the University of Washington and a top specialist who we're going to have on in just a second, Dr. Charles Chestnut, who directs the osteoporosis research program there. And then you went through a variety of treatments, and then today you're doing better, right? 2

3 Right. So what kind of medicine helped you build back bones? Well, at the time the Fosamax was very good, but because of the history of duodenal ulcers they wouldn't want to put me on that. So anyway the last treatment I had I think has done a lot to increase the density of the bones. It was called the Forteo pen, where I had to have an injection daily. You'd give yourself a little shot. No, my husband did it. Yeah, but something you could do at home. Oh, correct. Yes. And that was to build back bone, right? Yeah. That was to getting me to absorb the calcium too, so it really worked, I'm sure, and Dr. Chestnut will be able to tell you how well it worked. Opal, what do you tell your granddaughters about paying attention to their bone health? Well, they hear me talking about it enough but I haven't directly addressed them, do this or do that, because I grew up on a farm and I drank milk by the gallon and I had sunshine in North Dakota practically all the time but still was not absorbing the calcium obviously. Anyway, out here they have a better chance of more sunshine, but anyway--not more sunshine, but anyway I haven't directly told them not do this or this or this. 3

4 But the good news is there's a lot more to help you. Opal, stay with us. We're going to be right back with more about osteoporosis and your calls related to this health condition and others that are on your mind. Stay with us for more of Andrew Schorr's Patient Power. Good morning and welcome back to Patient Power. I'm Andrew Schorr. This is Andrew Schorr's Patient Power. And I want you to help me. I want not only you to wake up and listen to the show and tell your friends about it each week, but we need to wake up the offense of the Seattle Mariners because they're not hitting. My kid went to the game, oh, my god, c'mon guys, start hitting the ball. So we'll see what we can do there. And certainly the Sonics are in the playoffs. They look good, almost lost the lead, but I'm a big sports fan. We can talk about that related to health sometime. And you know today we're talking about osteoporosis which is porous bone, literally. It affects millions of women in particular but men too, mostly women, as you get older, after menopause. Couple of weeks ago we talked about menopause. Well, this is sort of the other shoe to drop. You make it through menopause, and then you find out oh, my god, my bones are thinning, what do you do? Well, there are medicines to help that, stop the bone loss and tests certainly to measure what you have, bone mineral density tests. And then there are now some medicines to help build back the bone. We have with us Opal Krisenowski from Renton. Opal has been living with fractures, but now with better treatment, right, Opal, you're doing better? Correct. Well, Opal, what do you say to women who are listening today about getting tested to see if they're as risk for this? What would you say? Oh, definitely get tested and don't wait for a fracture to ask the doctor about it because the bone density test is very simple and it tells you an awful lot about your condition. So by all means keep it in mind when you see your doctor, ask questions and so forth. He probably would be happy to do a density test. And if you have any symptoms, of course, then do it immediately. I have on the line with us Dr. Chestnut, and Dr. Charles Chestnut is the director of the osteoporosis research group at the University of Washington. Dr. Chestnut, welcome to Patient Power. 4

5 Thanks, very much, Andrew. Pleasure to be here. And when Opal comes back, pleasure to have her on as well. Why don't you help us understand what is osteoporosis, and really is it a concern for many of our listeners. Certainly people as they age and women, should they be tested? Should this be on their radar really, and are there things you can do about it? Very definitely, Andrew, and as Opal as an example we can see that this is a very serious problem. It's, number one, common, as you've indicated. Number two, expensive. What is essentially not enough bone, a deficit in bone quantity, and we also know there is a problem with the quality, the structure of the bone as well. All of this leads to the fractures, many of which Opal has had, usually in the spine or the hip or the wrist, but also in the ribs, or virtually any part of the skeleton can be fractured due to not enough bone being present and some abnormality of the quality as well. Okay. So should people be concerned about it? Let's say a woman is going through menopause. Should she be asking her doctor, should I have a test, how is my bone mineral density doing, am I at risk for this? And if I am, what about my daughters, my adult children? Very definitely, Andrew. And I think what we have seen over the past 20 to 30 years when osteoporosis has really come to the forefront as a common and expensive problem is that this is a disease that can be, if you will, diagnosed early due to the bone mineral density measurement, as well perhaps a measurement of a little urine or serum test or what's called donor remodeling, all of this lets us know about risk. And how do we know who might be at risk? Certainly individuals with the family history of osteoporosis, so as you've indicated daughters of mothers, but also sons of fathers who have osteoporosis. This is not exclusively a female disease, but also men as well should have a bone mineral density test particularly if there is a family history. If there is a history of a previous nontraumatic, in other words, not a train wreck or anything, not severe trauma, a fracture associated with that, as well exposure to medications such as Opal was, exposure to cortisone over a long period, those sorts of things, all of this contributes to a risk for fracture. And the bone mineral density if low would indicate there's a risk for future fracture, and this is the person who should consider treatment. Okay. I'm going to press a button here and I think we can have Opal join us. Let's see, Steve. Oh, dear. Opal, are you there. 5

6 Yeah, I am. Yay. Good morning, Opal. Good morning, sir. And Dr. Chestnut is Opal's doctor. This is one of the things I love to do on this program is bring people together, and I think notwithstanding all of the privacy rules, Opal has said we can talk about her situation. So, Dr. Chestnut, Opal comes to you and she's having these fractures and quite easily. It's not just like playing baseball or being in a car accident or something and having your bones fractured, it can be, I've even heard, somebody coughing or rolling over in bed. I mean it can happen very easily, and Opal was in one of those situations, right? That's certainly correct. And Opal and I--I think, Opal, we've been together for about 15 years. Right. Time flies when we're having fun, etc., and she came with numerous fractures, as you've indicated fractures only from coughing. I think probably the first fractures were of the ribs. And we defined that bone density was deficient -- there wasn't enough bone there -- and began a number of treatments to hopefully preserve the bone she had and even put some back and have tried any number of therapies, some of which have been successful, others have not, but we have finally we think found at least a medication, only been available for the past two or three years, Forteo, that seems to have reversed the bone loss and as well put some bone mass back that has previously been lost. And that is the little injection pen. That's the injection, and fortunately Mr. Krisenowski is becoming an excellent nurse, Opal. You're teaching him well. 6

7 Risk Factors for Fractures There you go. Now, let's include in the conversation if we can anybody out there who would like to call in, talk about osteoporosis or, I guess of the precursor condition would be osteopenia. Is that right, Dr. Chestnut, where you're sort of thinning bones, you're at risk for this. Is that right? That's correct. And, Andrew, you made a very good point. This is a silent disease, and Opal indicated this as well, until the fracture occurs, and it's imperative we be aware there is risk for fracture obviously even before the fracture takes place if bone density is low. And this can be defined by the so-called dual energy x-ray absorptiometry, which is a real mouthful, but it's a measurement of bone mineral density, easily performed, minimal radiation. Most hospitals now have it in the Seattle area. If those levels are low, even not to an osteoporotic range but what you've defined as osteopenia, which is a moderate bone loss, this is an indication that there is a problem and that this person should indeed consider being treated. Okay. Let's tell people what we're up to. If you're just waking up here in partly sunny Seattle area we're talking about osteoporosis, which is a condition that affects millions of people as they get older or could be at risk of it and the surgeon general has said that it's a $18 billion cost for this, all the fractures. Hundreds of thousands of fractures people are getting all too easily because their bones are becoming porous. We're live with Dr. Charles Chestnut. He is the director of the osteoporosis research group at the University of Washington. Dr. Chestnut has been there 35 years, and he is a true national expert in osteoporosis and bone issues. Also with us is Opal Krisenowski, did I get it right? You did it right. in Renton, who has been living with osteoporosis and is a patient of Dr. Chestnut's. And I'm so happy to see the phones are lighting up here, Dr. Chestnut. We'll be continuing to the top of the hour. We're here every Sunday with Andrew Schorr's Patient Power, the only show on radio, folks, that's designed to help you with chronic conditions like this, cancer, making sure that you connect with the experts and get the best medicine and get smart. 7

8 Osteoporosis Treatment Options And, Dr. Chestnut, just a question about that. A woman might need to say to her doctor, hey, do you think I should have a test, and then really discuss the full options. And fortunately now there are a number of options for women, and men too, dealing with osteoporosis. Is that correct. Certainly true, Andrew, and we've come a long way over the past 10 to 15 years from a disease back in the 70s and 80s when I got started in this area, which only had essentially calcium, which is of value. Certainly we start with nutrition, a reasonable exercise program, avoidance of such things as smoking, excessive alcohol intake, etc. We start with nutrition and a reasonable exercise program, but then we need to build on this with what we call pharmacotherapy, in other words, the medications. And over the past perhaps 10 to 15 years we've seen a number of therapies coming along. Not only calcitonin, which is a hormone given by a nasal spray, medicines like estrogen, and estrogen in general is quite excellent for the bones, particularly in terms of the a fractures. But as we know there are some concerns, real or imagined about side effects with estrogen. There is a group of compounds called the bisphosphonates, Fosamax, Actonel, which have been shown to significantly reduce the risk of fracture at spine and at the hip by about 50 percent. New bisphosphonates, such as Boniva coming along, and also the new medication over the past two years, Forteo, which is quite unique in building bone. It is associated with the daily administration, and for that reason we typically may reserve it for individuals who have had significant bone loss. But the good news is we have a number of therapies now available for this very common and expensive disease. Okay. Well, there's a lot more we can talk about related to that, and the good news is there is a lot to talk about. So today on Patient Power we're talking about osteoporosis and the risk to your bones as you age, particularly after menopause for women but for men too. We have lots of calls. We'll be taking your calls live here. But first let's see what's going out on the roads with the Washington DOT at work on I-5. Welcome back to Andrew Schorr's Patient Power, and I'm Andrew Schorr, live at 8:29 on KVI Talk Radio 570. It was a little sunny but now it's getting overcast. Hopefully we'll have a great day. I know we'll have a great day, and if you're like me, a cancer survivor or you have a chronic health concern, you want to celebrate every day. I know I do. Today we're talking about osteoporosis that affects millions of people and millions of people are at risk. What that is is when your bones become more porous and then you can have a fracture almost by coughing, even by coughing. We have with us a world 8

9 expert on that who is I'm proud to say, right here in Seattle at the University of Washington. Dr. Charles Chestnut is one of the stars of medicine here in Seattle, and he's with us. Dr. Chestnut, thank you for being with us once again. My pleasure, Andrew. Listener Questions We're going to take a call from Jackie, who is coincidentally from the same city that our patient, Opal, is from. Jackie, you have a question or a comment about osteoporosis today? Yes, I have a question. Sure. Go ahead. My first question is how would you build up your bone density, which I have been tested, and they said it was slight. And I was also wondering is there any way I can be seen by Dr. Chestnut and be treated for bone density. Let's talk about both those things. First of all, Dr. Chestnut, I think you were talking about this medicine Forteo to help, right? Sure, Andrew, yes. The answer is we can certainly preserve and have some improvement in the amount of bone you have, and if your loss is slight this might be reasonable with either of the bisphosphonates, as they are called. They're either Fosamax or Actonel. While they don't actually have a stimulation of bone formation, they're not making a lot of new bone as Forteo does, they are fairly easy to take, now, once a week, or the new one now is once a month orally. Forteo is a good medication, but it does involve a daily injection, and that could be a bit of concern for some folks, although as Opal has found it's generally well tolerated. I would say consideration of one of the as they're called the bisphosphonates, Fosamax, Actonel or Boniva, the new medicine, would be appropriate. And yes we are happy to see people in our clinic, not to put in too much bias here. Oh, go ahead. 9

10 There are a lot of good experts in osteoporosis these days. But our number, if I can give it is And that's my direct line, and I like to talk to the people I'm going to be seeing before scheduling them for the clinic to make sure it's appropriate. What a neat guy. Here it is, folks, a world expert, and he's giving you his phone number. Dr. Chestnut, do it one more time. You'll get the calls And I pride myself on calling people back within at least 24 hours. That's not 24 days or 24 years, but 24 hours. So give me a call. I sure will. Okay. Jackie, does that help you? It does. I'll call him tomorrow. Okay. Go do it. Thank you for calling. Thank you. Thank you. You know, this is what this program is all about and that is, folks, there are providers out there who will listen to you, who will talk to you, and who respond to you and will help you understand the full range of options. And, Dr. Chestnut, I think it's interesting. You're one of the lead investigators for a new drug that was only approved a month ago, Boniva, that once-a-month pill you were talking about. And even though you are a researcher and lots of money is spent in investigating these drugs you don't necessarily see any one drug usually as a breakthrough, but it just has to be seen in the broad range of treatments. And I know that's what you discuss with your patients is what's the broad range of what we can do here and then see what applies to you. Is that right? 10

11 That's certainly correct, Andrew. And I think the goods news is, and I think Opal has found this as well, we now have a menu, if you will, a therapeutic menu we can choose between because not every medication is going to work for every patient. There will be some individuals who will have gastrointestinal upset with taking one or another medicine. Other folks may not be able to tolerate say the nasal spray for Miacalcin. Others who obviously may not be able to take a daily injection. And now we can sort of choose between these varies medications we have. We actually have now six approved drugs for osteoporosis, considerably different from when I started in this around 1972 or '73, which says I'm pretty old and that's also true as well. But I think now we can decide which medication works the best for an individual patient. The new drug, Boniva, it is another so-called bisphosphonate. There is alendronate, risedronate and now ibandronate. These are the generic names for either Fosamax or Actonel or Boniva. It has an added advantage of being able to be taken only once a month, empty stomach, about an hour or so before meals. And that's comparatively well tolerated as far as we know from the early data. So again it gives us another particular form of treatment to prescribe to the individual patient. And that's where medicine is headed is--you know, not just the drug companies but your doctor if you have a particular condition and the medicine is right for you, I want you to remember to take it. So the idea is if you can take a does that is once a month, wow, that's a lot easier than trying to remember once, twice, three, four times a day have been some antibiotics. So I know your hope, Dr. Chestnut, is the new medicine, I think that's the first once-a-month pill like that, that it will help people just stay on that therapy if that one is right for them. Well, this is quite true, Andrew, and you've really raised a very important point. Even though we've drawn attention greatly to osteoporosis over the last 20 years and we do have new therapies, what we aren't seeing is increased compliance or continued adherence to taking the medication, say, beyond a year. And obviously for the drug to be effective it has to be taken, and we want to be sure that we can continue these medications probably for on an average at least two to three years or even longer. And anything we can do to increase compliance or continuing to take the drug will be much appreciated. And it could be, although we'll have to wait and see how the market responds, so to speak, how patients tolerate it over the future, there's no reason to suspect it should not be a well-tolerated medicine, and with once a month we may have better compliance and adherence. That will be so neat and hopefully a precursor of things to come for other conditions. 11

12 Well, I told you we want to take your calls. We're about to take a couple from Mary and Linda. Linda, thank you for joining us on Patient Power. I understand you're calling from Bremerton. What's your question today? Are you asking Oh, did I say Linda? I meant Mary. Mary is in Bremerton. Yes. I've got very, very low bone mass, and I've been tested a couple of times over the years. And the doctor, I don't know the number, but he said I'm near the bottom of the barrel. So I've been on Fosamax for a couple of years, and so far I seem to be able to tolerate that. I have had a hip replacement. I've never been on estrogen, and at the moment I've just started taking Arimidex because I had cancer and I had a-- You're a breast cancer survivor, Mary? Yeah. And so I'm not taking any chemo, but I am on Arimidex, which I understand can lower your bone density. Right. That is true. So I guess your question then would be what medicines may lower your bone mass and what do you do about it? Yeah. Okay. Let's get to that. Dr. Chestnut? That's a very important point, Mary, and Andrew just introduced another concept. We're seeing more and more of the excellent medicines we have for other conditions, other than simply osteoporosis, that may be so to speak negative for bone. As Mary has indicated, Arimidex is one of them and also Femara. And typically these are for folks that unfortunately may have a breast malignancy. They are very good for that disease. What they do is totally take away estrogen from the body, which may be beneficial for breast cancer itself, but with that there is associated loss of bone density. And the bottom line here in sort of a long-winded response to your answer is the Fosamax would be very reasonable to at least preserve the bone density you have and actually put 12

13 some back as well, or the other bisphosphonates like Actonel or the new one, Boniva. As long as you are on Arimidex, though, you do need to be on something and it should prevent that bone loss that would be associated with Arimidex. Same can be seen obviously for cortisone, the usage of that, which many people have to take for other conditions, and these medications will be of help, the ones that I've described, including Miacalcin, Forteo, as well, in preventing the loss that may occur with these medications. Do you think I should switch to Forteo? I would say this would be something with your doctor. You know that's usually the response that other doctors will say, or give me a call. Right now the bisphosphonates like Fosamax would probably be reasonable. Forteo has some not concerns but some reasons for thinking about using it that you want to be sure it's the appropriate medicine for you. For Opal, she's found out it works very well, but I'd want to know more about the details before I would recommend it. Mary, thank you so much for calling in to Patient Power. I hope this was helpful for you. Thank you. Good luck with your bone health. And no more breast cancer in the rest of your life, okay? I promise. Thank you. Bye. We've talked before about in cancer about these medicines, Dr. Chestnut, and we'll talk more about it on other editions of Patient Power and how there's prevention or keeping another illness at bay but maybe sometimes needing to manage a side effect as well. We'll be back a lot more with Patient Power. Stay with us on KVI. 13

14 Welcome back to Andrew Schorr's Patient Power live today on KVI Talk Radio 570. I'm Andrew Schorr. We are talking about osteoporosis today, which is a condition that affects millions of people particularly as you get older, and it gets so your bones become so thin or brittle, if you will, or porous, that you could literally just bump into something and have a fracture. And so as I said earlier in the program you're looking forward to your golden years, and then you're debilitated with fractures. Well, it doesn't have to be that way. We're visiting with Dr. Charles Chestnut, who is the director of the osteoporosis research group at the University of Washington Medical Center. He's been there 35 years, and he's truly a world expert and one of the brightest lights in medicine that we have here in Seattle, and we've got some bright ones. Dr. Chestnut, thanks for being part of our conversation today. My pleasure, Andrew. Let's take a call from Linda who is in Seattle. Linda, thanks for being on Patient Power. Thank you for taking my call. Sure. What's your question? Yes. I wanted to know from Dr. Chestnut what he feels about the validity of using that little heel test as a screening tool for checking out whether you need further testing for bone density problems. Great question. The heel test, and this is usually with ultrasound or with x-rays, is reasonable, but it should always be followed up if indeed it is low by a what we call a central test, which is the measurement at the spine and the hip. The problems are you may be normal at the heel but still a bit low. Okay. 14

15 If you are low at the heel then you probably have a concern, and then you should get the spine and the hip, the regular DEXA as it's called, and see what that shows. So it's primarily a screening test. It's primarily a screening test. It can't be used for follow-up either so that's a reason--if you're going to start on treatment you need to have the spine and the hip measurement, occasionally the wrist is as well for a follow-up one or two years later. Okay. Would an example of this be, just in another illness to apply it to other folks, is you go to see the doctor, and they're obviously worried about colon cancer which affects lots of people, all too many. So you have those little occult blood tests. That's simply screening. If they find something strange then you might have a colonoscopy. Would that be a parallel? That would be correct. Again, the heel is reasonable. It's a very small machine. It can be utilized in the shopping malls, etc., where you frequently see it. Yes. But if it is low it definitely requires follow-up. If it's high it doesn't rule out a problem but there is a lesser probability. Thank you. Thank you for being with us, Linda. Thanks for sticking with us while we press the buttons here. Thank you very much. 15

16 Okay. Let's take another call. This is from Erik. Erik. You're on the air. Dr. Chestnut is on the air. Erik, you still there? Yes, I am. Okay you had a question about osteoporosis and heredity. Is that right? Yeah. Let me just say thanks for taking my call. Sure. Dr. Chestnut, an honor to be talking to you. My mom's grandma had osteoporosis, that would be my great-grandmother, and I was wondering if my mom actually would be in line to getting osteoporosis. I think that is probably yes is the answer there. I want to make two points there. Yes, while we can't identify a specific gene that is responsible for the overall manifestations of osteoporosis there definitely is a familial tendency, and if you have a first-degree relative, mother, grandmother, etc., who has had low bone density with or without fractures high probability that this person, the daughter, etc., would have a problem as well. But I might add in here if I can very quickly, Andrew, this is not a disease only of women. We now know that there's probably one male for every three women. We used to think it was one out of every ten it was said would be a male who had had fractures, but now we know that it's much more common in males than we'd anticipated. The point would be that perhaps not only your mom but it might be something for you to think about as well, although typically your father or your grandfather might have had low bone density. The point is I would have some concerns as well with the family history of osteoporosis and not inappropriate to have a bone density test yourself. Well, actually, I'm adopted, so. Great. I would say if you find your relatives, your true parents and so forth it would be something to think about, but with the adoption obviously not as much of a definite trend. 16

17 Erik, look after your mom, though, and I'll bet she'll be fine. The good news as we said in osteoporosis is if that becomes an issue for her there's a lot to do about it. Erik, thanks for joining us from Maple Valley today. Thank you. Well, Dr. Chestnut, this is what this show is about, is helping people connect with experts such as yourself and also to know what questions they can ask their doctor. Now, just briefly, should we be drinking milk throughout our life, calcium, vitamin D. We'll have to go to a beak in a minute but what would you tell people who don't have osteoporosis but just want to prevent it? I tend to be an adherent of milk, and on balance nutrition and exercise are what we start with, and that's easy to do. Make sure your calcium intake is sufficient. One to two milk glasses of milk per day, or for folks who may or may not wish to drink milk, one to two calcium supplements a day may take care of that as well as a multivitamin with vitamin D, 400 units of D to make sure that calcium is absorbed. You can get it in orange juice, too. You can. Either calcium, and of course milk has vitamin D in it also so you can get both there. But nutrition is where we start. It's important. We'll come back with more of Patient Power and Dr. Chestnut in just a minute on KVI Talk Radio 570. Welcome back to Andrew Schorr's Patient Power live on KVI Talk Radio 570. I'm Andrew Schorr. We're coming to the close of our hour about osteoporosis and we'll have some final comments in a second from Dr. Charles Chestnut from the University of Washington and from Opal, his patient. I just want to mention a couple of things coming up. Next week we're going to talk about stress and whether it leads to anxiety and how do you know when you should go to the doctor. Should you just take a vacation, or do you need to talk to the doctor or even go to a psychiatrist? Do you need one of those medicines advertised on TV? So we will have on one of my friends who is a psychiatrist, a top one in the city. In two weeks we're going to talk about weight management and have an expert 17

18 from Swedish Medical Center on how do you really, seriously control your weight. What do doctors say really works. And then after that I will be out at a major cancer convention, and I think we'll be broadcasting live on the latest in cancer news. But let's go back to Opal and Dr. Chestnut. I wanted Dr. Chestnut to just give us some take-home points about osteoporosis for people who are dealing with it and people who are at risk for it. Great, Andrew. Appreciate the opportunity of being on today. Excellent program. We get the word out. Three points. First is this is a common and expensive disease about which we can do a lot. Secondly, if you have risk factors, family history, etc., get a bone density test and find out indeed is there increased risk for fracture. Thirdly, we have now six approved treatments. The problems are that this is still an undertreated disease and particularly in terms of continuing medications. If you need to take one of these medications get started on it and continue it for as long as your doctor feels it's worthwhile. And, fourthly, Andrew, I hope the Mariners can learn to hit with men on base as well, but we don't need to go into that too much today. No. We're going to get the Mariners hitting in the week. So I can't get Opal back, but I know if she were with us, Dr. Chestnut, she would just say connect with a good doctor. Dr. Chestnut, I want you to give the audience your personal UW phone number again if they wanted to see you or connect with your clinic there at UW Medical Center. Sure. I'm very happy to be able to do this Give me a call. I'll get back to you. Okay. Thank you. So osteoporosis is another chronic condition we've discussed that affects millions of people. Could affect you or your loved one as you age. Could have some hereditary link, so that's something to have a discussion with your doctor. If they don't bring it up, particularly if you are a woman going through or postmenopausal, you're on one of those cancer medicines for breast cancer we talked about, do you need to be worked up, if you will, screened for this. Next week we'll be talking about anxiety and stress, so join us again. The best thing you can do, I think it's a real gift, just tell your friends and say every Sunday from 8:00 to 9:00 there's Andrew Schorr's Patient Power and they take your calls and talk about 18

19 important health issues. Thanks for being with us once again. Send me an at We look forward to you being with us next week as we talk about stress and anxiety. Thanks. Have a great week. Please remember the opinions expressed on Patient Power are not necessarily the views of KVI, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. 19