Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.

Podcast Episode Summary

Introduction: Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Helen Cooley, a Hobart-based rheumatologist. The discussion focuses on managing osteoporosis in patients, particularly perimenopausal and postmenopausal women, with emphasis on lifestyle interventions and diagnostic approaches to determine fracture risk.

Key Takeaways:

• Comprehensive medical history is essential when evaluating patients for osteoporosis, including childhood illnesses, medication use (particularly glucocorticoids, epilepsy treatments, and breast cancer drugs), and previous fractures.

• Fracture risk assessment tools like the Garvin Risk Calculator (available free online) should be used to guide treatment decisions rather than relying solely on bone density test numbers.

• Smoking and alcohol consumption significantly impact bone health beyond their other health effects and should be specifically addressed in lifestyle counseling.

• Weight-bearing exercise such as walking and resistance activities are crucial for building and maintaining bone density, though care must be taken with fall-prone elderly patients.

• Obtaining calcium from dietary sources (dairy, leafy greens, nuts, and fortified soy products) is preferable to supplements due to conflicting evidence about calcium supplementation increasing heart disease risk.

• When calcium supplements are necessary, they should be divided across meals with food, and calcium citrate may be better absorbed than calcium carbonate, especially in patients taking proton pump inhibitors.

• Vitamin D deficiency is common, particularly in winter months in Tasmania, and is important for calcium and phosphate absorption; supplementation may benefit those in nursing homes or with limited sun exposure.

• Vitamin K2, while theoretically beneficial for bone mineralization, has conflicting evidence for treating osteoporosis and is best obtained through dietary sources like leafy green vegetables rather than supplements.

• Medication decisions for osteoporosis should be considered when hip fracture risk is around 4% or overall fracture risk reaches 16-20% over 5-10 years.