Bones Turnover Markers and Osteoporosis

Physical Therapist interviews Dr. Stuart L. Silverman on the role of bone markers in the osteoporosis treatment and management.
0:00 Introduction: Dr. Stuart Silverman
2:25 How to Best Communicate Fracture Risk to Patients (RICO (Risk Communication in Osteoporosis))
3:34 Dr Silverman Introduces Bone Markers
4:15 Conflict of Interest Declaration
4:44 Bone Remodelling Overview
5:43 Introduction to Bone Turnover Markers
6:17 Two Reference Bone Markers
8:52 Dr Silverman Presents a Bone Strength Triangle Model: Use of Bone Turnover Markers
10:34 When Does Dr. Silverman Use Bone Markers With His Patients?
13:25 How Bone Markers are Tested: CTX, P1NP and NTX
16:16 Osteoporosis in Cortical Bone
17:28 How to Prepare for Your Bone Marker Test
17:50 Sources of Variability of Bone Markers
19:41 Does Collagen Supplement Affect Bone Marker Results?
20:12 Automated Technology: Reference Range for P1NP and CTX Markers
21:23 Frequency of Orders: Bone Markers
22:30 How to Measure Least Significant Change
23:17 Bone Markers Can Predict the Rate of Bone Loss
23:57 Bone Markers and Fracture Risk
24:41 How Widely Used Are Bone Marker Tests in Therapeutic Decisions for Individuals?
26:38 Applications for Bone Turnover Markers
26:53 Some Uses of Bone Markers
30:08 What are High Bone Turnover and Low Bone Turnover Osteoporosis?
31:29 Bone Health Therapy for Younger Individuals (Below 40)
34:13 Prolia Transition and Bone Markers
37:15 Bone Markers and Drug Holidays from Bisphosphonates
37:39 Definition of Drug Holiday
39:28 Dr. Silverman Discusses Prolia Usage
40:11 Prolia for Younger Patients
40:53 Prolia, Bone Fragility and Dental Work
41:39 Guidelines for Prolia Use With Dental Surgery
42:30 Dr. Silverman Discusses His Strategy for Prolia Patients and Dental Surgery
44:32 Are There External Factors That Can Influence Bone Turnover Marker Results?
46:41 Where Can You Get a Bone Marker Test and What are the Approximate Costs?
47:41 How Often Does Dr. Silverman Use Trabecular Bone Scores (TBS)?
48:46 The TBS Does not Catch Cortical Bone Loss
49:22 Dr. Silverman's Approach: A More Comprehensive Focus on Measuring Bone Health
49:43 Outro
Stuart L. Silverman MD FACP FACR is the Clinical Professor of Medicine at Cedars-Sinai Medical Center and UCLA School of Medicine, and Medical Director of OMC Clinical Research Center
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Medical Disclaimer
All the information, content, and material presented in this video is for informational purposes only. It is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.

[@margaretmartinpt]

I interview Dr Stuart Silverman at UCLA Medical School about bone turnover markers and how he uses them. Very informative.

[@dianebakermason5535]

An extremely helpful interview, especially for those of us whose doctors refuse to even consider the importance of monitoring bone turnover, and/or have no access to P1NP/CTX (in Ontario, Canada, they ARE available!). For those attempting to safely exit Prolia, CTX monitoring is key. By the time a DEXA is taken, the damage from the rebounding turnover is already done. I am one of the many post-Prolia patients with out-of-control rebounding turnover and multiple spontaneous vertebral fractures. Fortunately my endocrinologist monitors my CTX.

[@gordonhalstead9846]

❤❤😊Dr Stuart Silverman and Margaret topic bones markers osteoporosis truly educational podcast presentation❤ ❤

[@margaretmartinpt]

Thank you.

[@ConsiderItHealth]

This talk was fantastic. I learned so much! Thank you!!

[@margaretmartinpt]

You are so welcome!

[@MrsKDFerguson]

Margaret, you continue to be my main source of credible and reliable information about osteoporosis and effective, safe exercise to build muscle and bone. Thank you SO much for everything you do in this field. You are truly a one-off and I recommend you to everyone I know who has osteoporosis. ❤

[@pmelick1]

Thank you! This is the first time so much of this is beginning to make sense to me. Somehow the dexiscan scores alone never made sense, this approach is much more understandable. Now maybe i can find the courage to try the meds even though i frequently have nasty reactions to many of them.

[@robyn3349]

Thank you. My PCP told me bone markers are only used in research. I feel I am left making decisions in the dark.

[@harleymama5919]

My PCP said it is too late. BUT she referred me to a rheumatologist who ordered the testing.

[@wandayonder9772]

Very interesting, thank you for asking all the right questions.

[@nancyriley3929]

Thanks Margaret for sharing Dr Silvermans knowledge about osteoporosis. I learned a lot today. Great discussion!

[@margaretmartinpt]

You are welcome. Thank you

[@pamelaandpabloortiz6250]

This was a fantastic discussion . The dr is a wealth of knowledge and treats each client on their own personal markers and needs ! Thank you !

[@margaretmartinpt]

Thank you.

[@pamelaandpabloortiz6250]

Very interesting that the Stronium only makes your bone density look better than it really is ( if I’m understanding your comment correctly) .

[@kathyeaton6011]

Thanks for this Margaret!

[@margaretmartinpt]

You are welcome

[@BBurns-vg9om]

Wow!! Wish wr had this on the UK. We have no one looking at bone markers.I would love to get my bone checked like this. But,no one here who foes this work. Thank you for this wonderful videos.

[@LancashirelassCan.]

Same in canada. Controlled by Govt and Big Pharma. !

[@maryhogan5505]

Thank you, I may listen again to comprehend all. I have been on recast for 2 years, the next infusion will be coming up. I had asked the endocrinologist I had consulted with about Telopeptide test. He said it was not accurate and did not recommend last year when I asked about it. I wish could consult with Dr Silverman !? I am also wondering when to schedule my next dexascan before or after my 3rd reclast infusion?

[@bowler8]

My endo has never mentioned bone markers, just sees the dexa and determines I need medication...Im still on the fence with this and need a second opinion. I spoke with my PCP, he said he didnt know too much about them, so didnt feel comfortable ordering the tests.

[@elainebush3605]

Excellent!

[@bbonenfant]

What an interesting discussion!

[@margaretmartinpt]

I enjoyed doing the interview. I learned a lot.

[@bbonenfant]

@@margaretmartinpt Me too!

[@lyndashimoda3628]

Very interesting I don’t understand it all but would love you to recap in layman’s terms

[@leilachahine578]

Thank you!! Very informative and valuable! Did he say that osteoporosis can be reversed?

[@deborahachen7214]

Excellent information. Thoroughly depressing to not get this type of approach or knowledge in Canada, despite being a patient with an endocrinologist at the Osteoporosis Clinic where I live, despite itts apparent highly regarded reputation. Never tested during a drug holiday and rapid decline not discovered until finally allowed to have another DEXA in 2 years. Will be asking for bone markers at next appointment to test progress of being out back on the same oral bisphosphonate and contemplating paying for Forteo out of pocket. I usually feel gaslighted, however, when I ask such questions. Nonetheless, the information you provide is invaluable. Hoping to use in on this journey.

[@katedagg287]

I'm on your page, Deborah. It is clear that Margaret is working hard for us, bringing us the knowledge of these specialists. I am very grateful for her. But, it is so frustrating to know that there are experts who take thoughtful approaches to managing this condition, and we cannot access them, or anything approaching their level of care, in Canada.

[@deborahachen7214]

@@katedagg287 A bit of good news, I went to my Endocrinologist today and with everything I learned I was actually able to get her to do a bone marker test before we decide if it is necessary for me to start an infusion or injections versus staying on oral bisphosphonates. The oral bisphosphonates worked so that I did not get worse while on them for 6 years. But I rapidly declined on a 2 year drug holiday during which time I had no tests or DEXA scan. I was restarted on them in the fall. It was only because I came armed with information that I got it and I insisted on another DEXA one year after the one I had last June. She said I am high risk regardless but I did convince her. I said that if I had been tested and a yearly DEXA during my 2 year drug holiday during which time I rapidly and significantly declined, then I would have been started on a different medication at least a year earlier and not be as bad as I ended up. This recent KZbin from Margaret couldn’t have been better timed! Wishing you all the best!

[@katedagg287]

@@deborahachen7214 Well done, Deborah. And thank you for telling me about your success. It gives me hope! Is your doctor, by any chance in Toronto???

[@lovesdiscobeat]

My endocrinologist wouldnt order a CTX blood test. She said they are not accurate enough. I told her that they can be useful if you follow the guidelines before the test.For instance, fasting overnight, no biotin ,Collagen for a number of days before & take the test early morning & repeat in 3 or4 months . I paid for the test myself!!!

[@sharonmitchel1377]

The vibration equipment is so expensive for many of us. It’s too bad these aren’t marketed to gyms.

[@debramanuszewski3523]

I had Gastric Bypass RNY. I had 1 Prolia with many side effects. I want to get off it. How can I do that? Next Prolia is due Aug 12.

[@yvonnehernandez6233]

I was diagnosed with osteoporosis on October of last year, my physician put me on Ibandronate Sodium tables 150 mg, but I got such a scary and terrible reaction did he ask me to stop takin it, so he send me to another medication which it was an infusion I think it was Reclast, but when I got to get the procedure they told me my doctor change it to Prolia, but after that I read like you can have so many bad side effects did I call my doctor and told him I want to stop having it, I don’t know if I don’t understand very clear about pros and cons , so he give me an appointment to sit with me and explained me really about the medication, because my next which will be my second Inyección it’s scheduled for August

[@dianebakermason5535]

Please be careful - you can't "just quit" with Prolia. You need to speak immediately with your doctor about being relayed off of Prolia using an alternative antiresorptive (yes, it might be ibandronate, but there are other bisphosphonates) AND having the Prolia's "rebound effect" treated and monitored. The manufacturer's warning materials, the clinical studies, and professional association statements are all clear that once you're on Prolia, you need to be properly relayed OFF it again. You can't just change your mind and quit. Please talk to your doctor!

[@yvonnehernandez6233]

@@dianebakermason5535 Thank you so much Diane, I finally spoke with my Dr, and he explain to me what can happen if I don’t fallow the treatment he told me he’s very concern because my osteoporosis it’s kind of severe specially on my spine and that’s the reason he wants me to continue with it, he told me did by next June of 2024, he will do again my DEXA, which by that time will be already the two years of my first one, I’m just hoping and praying god did everything will be ok, I’m still scared but I think I need to do what I need to do.

[@user-zh5hy1zg8b]

​@@yvonnehernandez6233i wonder if you get any side effect from Prolia? Im bit worried after reading people's commemt about the bad side effects . My mom is scheduled to get Prolia 1 august. Thanks

[@vivienmartin9661]

I understand in Japan, 45 mg of K2 NK7 daily is recommended...natto is the source many Japanese use but is a taste not many westerner appreciate. Where in North America can I source 45 mg of K2 NK7 in pill or cap format? I have found K2 NK7 in 100 mcg caps which is a miniscule fraction of the dosage recommended in Japan. I am not just osteopenic but have osteoporosis in the neck of my left femur.

[@sharongauss9298]

What is NK7? I was recently diagnosed with osteoporosis and am having trouble finding a rheumatologist that takes Medicare. The ones that do near me have poor reviews . I also cannot swallow pils and I have heard about the terrible side effects of the drugs; ie. jaw necrosis, etc.

[@selmam1284]

@@sharongauss9298he was referring to MK7

[@sheryl3268]

Do you have links for some things mentioned in this video (the osteoporosis questionnaire referred to at the end; and the studies he mentions earlier)? Thanks for all you do!!

[@margaretmartinpt]

I do. I am writing a blog post based on the interview and will link them in the article.

[@sheryl3268]

@@margaretmartinpt Yay! Thanks!

[@dangcoppock7362]

I just founding your channel today and I see what I like and subscribed..! I have a question to you. Is The Med, Forsamax is good..? What is good ( up ) side..? And what is down side ( effected)..? I have Osteoporosis should I taking this med..? But want to do natural healing I’m 73..!

[@dianebakermason5535]

@@margaretmartinpt wonderful!!

[@bakokat6982]

@@dangcoppock7362 I realize this is a year past your post, but I have your same questions regarding Fosamax. I have been Reluctant to take it because of the possible side effects of jaw bone death.

[@anne-marieamos3485]

Do you recommend vibration plates

[@margaretmartinpt]

Yes, when it is appropriate for the client. You can learn more here: melioguide.com/products/marodyne-low-intensity-vibration-platform/

[@bowler8]

I think bone markers should be seen as some form of control, like you would when doing research. Why endos want to just put you on medication without even thinking about controls, is beyond me. Its as if theyre on a percentage from the pharmaceutical companies.

[@LancashirelassCan.]

Absolutely .Big Pharma, Govts all in control. Disgusting. I refuse meds. Do your own research.

[@richard01983]

Prescribe drugs before you do blood tests to know what the patients current condition is. Saw two endochronologists in the past who prescribed drugs with no results. Before I would see a third I saw my primary care who ordered the tests to diagnose my current situation so I could make a knowledgeable decision. Insurance payment is irrelevant, it's your health so pay for the test if necessary. Treating using guessing is not competent care.

[@LancashirelassCan.]

Same in Canada. My endo refused any discussion. Drugs ! Fear ! Contro;lled by Big Pharma. I will seek out private lab.

[@dianecotman9213]

I tried so hard to buy through you so you could get the commission. But, failed. I bought a machine. I really am sad that you didn't get commission. I tried.