Your back does a lot for you. It’s about time you returned the favor. Spine Time, a new podcast by Nebraska Spine + Pain Center, brings physicians, surgeons, physical therapists, and healthcare professionals together for honest conversations about one of the most misunderstood parts of the human body: your back and neck. We bust common myths, answer the questions patients are too nervous to ask in the exam room, and talk about what staying healthy looks like right here in Nebraska.
For our inaugural episode, we sit down with Jen Kaluza, an adult nurse practitioner at Nebraska Spine + Pain Center with hands-on experience in patient care, to break down everything you need to know about bone density tests and how we conduct them at our practice. You can watch the interview on our YouTube channel, or listen along on Spotify or Apple Podcasts.
Episode Transcript
Zach
Hello everybody, and welcome back to Spine Time: Nebraska Spine + Pain Center’s podcast, where we take some time to interview some of Nebraska’s best expertise and professionals that know everything about back and spine. In today’s episode, we’re going to be talking about bone density testing, and I have the pleasure of being joined here today by Jen Kaluza, who’s going to tell us a little bit more about the testing and what you can expect having done it here at Nebraska Spine + Pain Center. It’s a pleasure to have you here today, Jen!
Jen
Thanks, Zach!
Zach
Why don’t you go ahead and tell us a little bit about yourself and how long you’ve been here?
Jen
I’m Jen Kaluza. As you said, I’m a nurse practitioner. I’ve been at Nebraska Spine + Pain for almost four years. Been a nurse practitioner for almost 20 years. I work in the pain suite with Dr. West. I run my own clinic schedule and see patients every day.
Zach
We recently started doing bone density testing. Can you tell us a little bit about what that is and what it actually measures?
Jen
Yeah! The testing shows us how strong our bones are. It actually measures calcium and other minerals, and lets us know if the bones are healthy, if there’s any evidence that they’re getting weak, or if we’ve even gotten a diagnosis of osteoporosis, where your bones are thin and at risk of a fracture.
Zach
Who should be thinking about getting a test like this done? Is it mostly just for older people, or should younger people even start maybe investigating or looking into it?
Jen
Bone mass starts to decrease at the age of 30. I think a lot of people are shocked to find that out. There are certain people that have a higher risk of thinner bones. It can be related to hormone changes, like after a woman goes through menopause with lower estrogen. Certain medications and certain disease processes put us at risk. Typically, a woman before the age of 65 should have at least their initial screening test done. Men, they say, more around the age of 70. There really is not great evidence that’s even out there about routinely screening men. Things that we look for here in clinic are if people have lost a lot of height. That is an indication that potentially we’re having some shrinkage of our bones, and we need to go look at the quality of the bone health with a bone scan.
Zach
A lot of people really don’t think about their bones until something breaks or they start to have that breakdown. Why is catching bone loss early so important for a potential patient?
Jen
It’s always easier on the front end, on the preventative end, to make changes and work on things. Once we start to see some of those changes, or to maintain the level that we’re at, once we get to the point that we’ve had a fracture, it is significantly more complicated. Fractures are very painful for some individuals. It can increase mortality even. So it is pretty significant. Similar to exercising regularly and how that benefits your overall health and well-being, bone health has the same importance, with starting preventative issues sooner rather than later.
Zach
What does it mean to offer this service to people around the Nebraska area and surrounding cities? What does it mean to have this available to them? What can they look forward to?
Jen
I think specifically our surgical population is where we perform it, mainly here. When there’s any type of question about how healthy the bones are, the surgeons want to make sure that the surgery that they do is going to be successful and that the bones will heal appropriately. It makes it easier for the patient. It’s another test that we can have done internally and get the results back right away, without having to refer out to a potential other center to do it.
Zach
Now, you mentioned osteoporosis already, and I’ve also heard the term “low bone density” before. What’s the difference between those two?
Jen
So, osteopenia would be the low bone density, which is when the bones start to show signs that they’re not as dense, and you actually are at higher risk of a fracture at that level as well. Without certain interventions, that can progress to full osteoporosis and have more of an impact on your quality of life.
Zach
Kind of moving on to more of the experience around the test, what should someone expect when they come in for a bone density test? What does that process kind of look and feel like for a patient?
Jen
It’s actually very easy. You can typically wear your own clothes. I think they don’t want zippers that might interfere with where they do their scans, but it’s a quick test of about 10 to 15 minutes. It’s non-invasive. A technician helps get you situated on to the scanner table, they do their few pictures, and then you’re done!
Zach
Is there anything a patient needs to prepare for the test beforehand, any exercises or dietary changes to do a bone density test?
Jen
Typically, no.
Zach
That’s a short and simple one! Is a bone density test painful in any way, or is there any discomfort that should be expected?
Jen
Not typically! They have you lying on the table with a nice cushion behind your lower back, so it’s supportive, and it’s such a short time for the test. I don’t think most people would have any pain or discomfort.
Zach
Is there any poking and prodding, or anything? How is the test conducted?
Jen
Here at Nebraska Spine, it’s a QCT test that we do. There’s also a DEXA scan, which is a different but similar type of testing out in the community. They are non-invasive, so the CT scan takes different measurements of all the different lumbar vertebrae, and then a computer program helps to do the math and generate how healthy each area of the bone is.
Zach
So, once you have the test done, and you’re kind of trying to understand the results, how do you explain those to a patient in a way that makes sense? After they have all the data ran on them, what are they looking for? What’s going to be the most valuable thing to tell the patient?
Jen
When they do their reports, they come up with two different scores. It’s kind of cool. One, they actually compare your bone density to somebody in your own age group. They actually will compare your bone density to a healthy 30-year-old, and that gives us two different scores. The closer you are to zero, you match that peer that they coordinate with. The worse your score is; negative one, negative two and a half, compared to the healthy baseline number, is how we come up with that diagnosis of osteopenia or osteoporosis. It’s easy for the provider to look at those scores and know where the patient is at and be able to explain to them if they’re at the normal level that they just need to do routine preventative things, or if they’re getting to the point that potentially medications need to be started.
Zach
What are some of those preventative things that a patient can do, maybe prior to taking medication for it?
Jen
Weight-bearing exercise is probably the best that all of us can do for strong muscles and strong bones. It’s typically recommended to do at least three times a week for 30 minutes to do those type of exercises. Even if you don’t go to a gym, you can do body weight exercises like squats or lunges, which is helpful. Walking even puts pressure on the bones and helps to increase the density.
Zach
What happens if patients’ results come back maybe a little bit more concerning than were expected? What are the initial first steps? For example, if somebody was maybe not quite at the stage of osteoporosis, but was looking to recover, what would they do versus somebody who definitely is showing signs of osteoporosis?
Jen
The first things we would want to do is to look at if there’s anything lifestyle that potentially they could make changes to, and what I mean by that is smoking, primarily excessive alcohol use, not exercising, those kinds of things. So we’d want to make sure all of those are addressed and that the patient understands why they’re so important. Then we’d start looking at supplementing calcium and vitamin D, which is an easy over-the-counter type of initiative.
Zach
How often should you have bone density tests done? I know as you get older, you’re more likely to show signs. Is one a year enough? One every five years? How often should you really be checking it out?
Jen
The guidelines recommend every two years is the frequency once your doctor has determined regular screening is indicated.
Zach
How does bone density connect back to overall spine health in general? Where would you start to see those breakdowns beyond just height changes? What are some of the potential health signs that you could be tied back to bone density in the spine?
Jen
With the patients that we see who are at the midlife age, even the 40s to 50s, it’s really surprising how many people have not had even a basic education on bone health. From our perspective, we’re really looking at pain control, and how important movement, exercise, and all of your healthy lifestyle options like eating healthy and limiting excessive alcohol. All those things really do make sure that our bones, joints, and everything stays healthy and is moving correctly, which then gets us to that goal of better pain management.
Zach
Is there anything beyond these questions that you think would be valuable for incoming patients to know about, whether it’s how we do bone density testing here or just about the process that maybe is commonly overlooked or not discussed enough?
Jen
I would really encourage any patient that if they’re not sure if they’ve had their bone density checked or what their score is, or how often they should be doing it, to either discuss with any of our providers during their visit, or with their primary care physician, to make sure that they are up to date on all their testing. That way, they’re doing everything within their power to make sure their bones are as healthy as they can be.
Zach
Well, thank you so much for joining us today, Jen. This was super enlightening. I think the fact that we offer this test now is fantastic. I think it just continues to show the level at which we are constantly expanding our services to our patients, and I’m excited to even have mine done as well. And to you, our viewer today, thank you so much for tuning in. We will see you in the next episode!