May 27, 2026
Breaking down osteoporosis: bone loss, fracture risk, and treatment
Osteoporosis is often called a “silent disease,” but its impact can be life‑changing. In this episode, co-hosts Carmenn Miles and Dr. Tamika Perry welcome Candice Moore, NP break down what osteoporosis really is, who is most at risk, and why early awareness matters.
Docs in a Pod focuses on health issues affecting adults. Clinicians and partners discuss stories, topics and tips to help you live healthier.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.
CARMENN MILES
Hello everyone. I'm Carmenn Miles and we are delighted to have you with us today on the award winning Docs in a Pod, where we come to you every week with a look at a variety of health and wellness issues as they affect anyone of any age, but primarily for those who are 65 and older. Our resident co-host today is the Dr. Tamika Perry. She takes great care of her patients at WellMed at Redbird Square in Dallas, Texas. Dr. Perry is associate medical director for WellMed and works to support the providers at a number of WellMed clinics located in the Dallas area. She's been with WellMed for more than 10 years now, where she works diligently to deliver quality care and a compassionate, patient experience. Dr. Perry earned her undergraduate degree from Prairie View A&M University, then went on to Philadelphia College of Osteopathic Medicine, where she was a National Health Service Corps Scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, where she served as Chief Resident. Dr. Perry is board certified by the American Osteopathic Board of Family Physicians. She's earned a master's in public health with an emphasis on health management and policy from the University of North Texas Health Science Center. She's also a diplomat of the American Board of Obesity Medicine. I'm exhausted for you, Dr. Perry.
DR. TAMIKA PERRY
That just says I'm a professional student. I spent my life in school. At one point, my mom was like, baby, youÕre going to get a job, right? I'm here now. I have a job.
CARMENN MILES
Exactly. Let's talk about putting in the work. Good for you. Let's take a moment to introduce our guest for today, Nurse Practitioner Candice Moore. Nurse Moore earned a Bachelor of Science in nursing from the University of Mary Hardin Baylor in 2008. She began her career as a cardiovascular ICU registered nurse, where she spent nine years caring for and recovering open heart surgery patients. Motivated to expand her impact in patient care, Candice returned to school and obtained her Master of Science in Nursing from Walden University. Since 2017, she's been practicing as a family nurse practitioner and a family and general practice setting. She proudly joined WellMed in 2023, and we're so glad to have her. Outside of her professional life, Candice enjoys spending time with her family, including her husband of 12 years, their six year old daughter, and their energetic dog. She is passionate about eating well, staying active, getting proper rest, and giving back to her community through involvement in church activities. Candice and her husband also share a love for travel with Singapore and Vancouver ranking the highest among their favorite destinations. Sounds like, Nurse Moore and Dr. Perry, you two have something in common. You both travel to some fantastic destinations when you're not caring for patients. It's wonderful. So, you guys have some things to chat about off the show. Nurse Moore, I'm a dog person, so I have to ask about this energetic pup of yours. Tell us about it.
CANDICE MOORE, NP
Oh, yeah. He's a Rhodesian Ridgeback mix. He's got a ton of energy. In fact, our goal was to get a full bred one. Then our little niece came over we went to an ice cream shop by Petco. Petco was having their adoption dog day, and that's how we got him. He is a funny little individual.
CARMENN MILES
Gotcha. Thanks for sharing. Today we're diving into a topic that affects millions of people worldwide. But often goes unnoticed. We're talking about osteoporosis, often referred to as the silent disease or silent thief. And for good reason. You may not even know that you have osteoporosis until a bone suddenly breaks. So, there's a lot to cover on this topic far beyond the 30 minutes we have today. So, we're going to jump right in and explain, Nurse Moore, what osteoporosis is and how it is diagnosed, if you will.
CANDICE MOORE, NP
Yes, ma'am. I think a lot of patients or people just feel like osteoporosis is broken bones. They are not quite broken. It does lead to that. However, it is a disease that is characterized by low bone mass, and your skeleton is fragile overall. So, that increases your risk for fractures. They can be spontaneous. But typically, we know that people over the age of 50, particularly women, will experience osteoporosis, but it is not limited to women. Men experience it as well. Like you said, people don't realize it until they have fallen or have had a spontaneous break. Typically, those breaks happen in your spine, hips, wrist, your humerus and your pelvis. So, when patients come in and they get their annuals, which that's why we preach so much about patients coming in at minimum for their physical so that we can make sure that if they are of age, that we go ahead and get them screened for that.
CARMENN MILES
All right. Let's welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles chatting with co-host Dr. Tamika Perry along with our special guest today, Nurse Practitioner Candice Moore. Docs in a Pod is available wherever you listen to podcasts, and you can also find us on the radio in several Texas markets. Nurse Moore, understandably, bone mass naturally starts to decline at a certain age. Is osteoporosis more prevalent in male or female patients? I am also curious to know if you have a parent or family member who has been diagnosed with osteoporosis, does this increase your risk of getting osteoporosis?
CANDICE MOORE, NP
Yes, it's more prevalent in women. Typically, it's kind of like a hormonal base. If you are premenopausal or perimenopausal and then for those who have had a total hysterectomy, where their ovaries have been removed. But typically, at age 50, that's when it's recommended for patients to go and be examined via a bone density test. Essentially it's just an x-ray. It focuses primarily on your large bones, so we're looking at your pelvis. We're looking at your hips, right where your femur socket kind of goes into the hip area. And then your lower spine. Those are the most common areas where patients will see low bone mass.
DR. TAMIKA PERRY
YouÕve been making some great points. I was going to say earlier that she's probably far smarter than me. It was two people who loved in the hospital. It was ICU nurses and ObGyn nurses. Those men and women were so sharp. They would ask me for orders and I would say, what do you think? That's what we're going to do. So, Candice is super smart and she is on the money when she's talking about it here. What happens is that as women approach menopause, we have we start to decrease our levels of estrogen. Estrogen helps us with a lot of things besides just being a girl. But it also helps with a certain type of cell called osteoblasts, which build up bone. And at the same time that we're building up bone, we're also degrading or breaking down old bone via cells called osteoclasts. Well, as you approach menopause and that estrogen declines, the osteoclasts keep working, but the osteoblasts slow down. So, now the rate at which you break down bone is faster than the rate that you build up bone. So, your bones become hollow or fragile. It makes it easy for you when you do fall for those bones to break. We've come a long way in science and we can take care of a broken bone, but it's the sequelae or the consequences of being in the hospital from their broken bone that really do women dirty. So, we try to prevent that to begin with. Some women, as Candice will tell you, because Candice is in awesome shape. Some women are more prone to have osteoporosis than others. So, if you're a girl who's always been thin and petite, your bones aren't very dense to begin with. Like my grandma told me, I'm big boned, right? Because my bones have been carrying a whole lot of woman their whole life, so they're much denser. So, I can still get osteoporosis. I'm just less likely. Correct me if I'm wrong, Miss More. Is that correct?
CANDICE MOORE, NP
That is that is correct. Petite, usually very fair skinned individuals as well that are petite.
DR. TAMIKA PERRY
Yeah. The fairer skin is more so because typically people of Caucasian or Asian descent are smaller people than women of color. Typically, we have more body mass. I'm just trying to say weÕre pleasantly plump.
CARMENN MILES
There you go.
DR. TAMIKA PERRY
One of the prevention treatments is actually weight bearing exercise. Lift some weights. It makes your bones denser.
CANDICE MOORE, NP
That's right.
DR. TAMIKA PERRY
Before we even go to that, as with any disease, early detection obviously is key, right? I'm curious to know at what age shall we consider taking a bone density test and what are some of the warning signs you see in patients that may lead you to suggest a bone density test for your patients?
CANDICE MOORE, NP
As any good provider like myself and Dr. Perry, weÕre going to make sure we get a really good HMP. Those are risk factors. Outside of your age, we're looking at things like smoking, poor nutrition, sedimentary lifestyle, increased alcohol intake, previous falls and then cortical glucose therapy like steroids. All of those placed you at risk. So, we look at that and then if you are of age, that just compounds your risk for osteoporosis and osteopenia.
DR. TAMIKA PERRY
You might not have any physical signs. Your bones aren't going to hurt because they're less dense. It's not like your skin is going to look different or your nails are going to act different. So, you might not have any physical signs. That's why screening is important. The US task force suggests early 60s, like 62 to be exact. Most certainly if you fall into that category that Candice talked about, you're a smoker, you're petite lady, you're Asian, you're Caucasian, you have a family history, you may want to see if you can get your insurance to cover that screening earlier, or ask your doctor if they can get their insurance to cover that screening earlier. Or take part in community screenings that have little to no cost associated with them.
CARMENN MILES
Very good. We want to get into prevention, but what we're going to do right now is take a quick break but stay with us as we continue to unpack osteoporosis, why it happens, who's at risk and how to prevent it, or at least for the effects of it. You're listening to the award winning Docs in a Pod presented by WellMed.
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CARMENN MILES
We're back on Docs in a Pod. Thanks for sticking with us through the break. Nurse Candice Moore is with us today. Nurse Moore, we've all heard the saying milk does the body good, but the calcium and vitamin D in milk is great for our bones. Not to mention the protein we get from milk that helps strengthen the muscles that support our bones. So, we know that being low in calcium and vitamin D can lead to weakening of the bones.
CANDICE MOORE, NP
You're absolutely right. Yes, ma'am.
CARMENN MILES
Is there anything that patients can do to avoid or slow the effects of osteoporosis, besides getting more vitamin D and getting more calcium? Talk to us about that.
CANDICE MOORE, NP
Absolutely. As we mentioned previously, some of the modifiable, modifiable just means things that you can do, to help prevent that would be exercise. Just like Dr. Perry mentioned, weight bearing. I think some people think, oh my gosh, I don't have a gym membership. I just tell patients, please start walking. Walking is a really great exercise. It is low compact and some patients just feel like they can't get to the gym. So, walking is important. Another hack that I recommend for patients who either are so busy at work they can't exercise or they have a sedentary lifestyle, there are things you can do. You can get a pedal bike. If you are one that walks, you can put on some ankle weights because any kind of muscle strengthening will help. You're still walking, you're just making your walking more meaningful. So, I think that people should think a little bit outside the box. Weight lifting and toning exercises are something that we recommend, but if that doesn't fit your lifestyle, moving is going to be the most important thing.
DR. TAMIKA PERRY
I'm just going to piggyback off of what you just said about exercise in weightlifting, because I am notoriously frugal and money conscious. One of my favorite stores in the whole wide world is Five Below. No judgment here, please. I noticed the other day when I was in Five Below, and this is not a paid advertisement for them, but they had like two, three, four pound weights in there that were obviously $5 or less. So, where there's a will, there's a way. You can get cheap weights from there. Ross, Walmart. While you're walking, you can have cans of green beans in each hand, and you're just simply going up and down with your arms. This is what she means by weight bearing. If you have a little bitty pooch like I do, I have a little pug that is 14 pounds. When she gets tired, pick her up and walk because now your weight bearing. So, anything to do weight bearing is going to help those bones and muscles become strong. You will not look like Arnold Schwarzenegger back in his day. We're not trying to make anybody look like that. We just want to make sure that they are strong. Another great resource is YouTube.
CANDICE MOORE, NP
Yes.
DR. TAMIKA PERRY
You can put in weight bearing exercises for seniors, weight bearing exercises for seniors with low back pain or weight bearing exercises for seniors with rotator cuff dysfunction or pain or shoulder pain. It's going to bring towards exercises that you can do that is going to help you but not hurt you. If you're unsure, your ultimate resource is Candice or myself, please seek out your primary care provider because that's what we're here for.
CANDICE MOORE, NP
Absolutely. I even take a step further sometimes, Dr. Perry, because we do have some patients who maybe you're not great with their phone, and I will ask them to go to their internet, and I will literally type in weight bearing exercises. Or some patients that have issues with their knees so they cannot stand because they have advanced osteoarthritis or something that keeps them from walking. Movement is imperative. I literally say, well, then let's do chair yoga. Because not only are weight bearing exercises important, but you also want to do postural exercising because, like Dr. Perry said, if you fall and you break something, it's likely because we have low, dense muscles. We also don't have very strong supporting. So, those exercises in the chair are helpful too. If you watch Netflix, that should be your cue. The first 15 minutes, march in your chair. There are so many ways you can be active. I think these days it's not just about going to the gym. Like Dr. Perry said, you just got to use your resources.
DR. TAMIKA PERRY
Yes.
CANDICE MOORE, NP
So, that's number one. We want to prevent a fracture by falling. Let's not fall. Those are ways you can do that. Another thing that we may want to consider are people who are chain smokers. Not only does smoking raises your risk for osteoporosis, but there's so many other bad things outside of take your money. It would be a really great idea to stop overall, but that is a modifiable thing that you can do to help reduce your risk. Nutrition. Eating healthy is super important. I know these days with inflation, there can be a bit of a challenge, but I usually will recommend supplementation. We should be getting all of our vitamins, especially our D and our calcium from our food sources. However, it's highly unlikely that most patients, including myself, are getting the exact amount that we need in our diet. So, supplements are going to be key. They could be in tablet form. For people who struggle with tablets, there's options for liquid. There are even options for protein shakes0 that give you your minimal dietary needs. If you are at risk, then you need to do more than minimum. You can't be mediocre in this category. You're not 21. So, you're going to need more in order to prevent you from experiencing fractures associated with osteoporosis and osteopenia. Did you have any price savvy ideas there, Dr. Perry? I get patients asking me about supplements all the time.
DR. TAMIKA PERRY
There's, like, a thousand ones over the counter, right? Here is where your pharmacist is going to be your best friend. If you go into Walmart or CVS and say, my doctor wants me to be on 1200 milligrams of calcium, which that is what's recommended for women over 51, and you say which calcium brand is most effective and most cost effective? He's going to point it to you. Take that Nature Valley right there, or that Equate brand or vitamin brand X. You don't necessarily have to go to the vitamin store where itÕs pricey. So, rely on your pharmacist for those over-the-counter recommendations there. Remember, like Carmenn mentioned earlier, lots of our foods are fortified with these supplements. So, be sure to read labels. If you have a choice between orange juice with calcium or without, choose the orange juice with the calcium. Same price, but you're getting the extra added benefit. Now, vitamin D, the recommendations for that, it's a little bit different. The typical multivitamin only has 400 international units of vitamin D, but really probably the average American needs 1,000+ international units of vitamin D3. The average American woman needs 2,000 to 5,000 international units of vitamin D3. That's over the counter. The best way to get vitamin D3 is being outside. Our skin makes vitamin D when it comes in contact with the sun. However, melanin does inhibit some of that production, and we want to be careful of being in the sun. So, you put sunscreen on because you donÕt want to get burned. You donÕt want to get cancer. Now your vitamin D production is going down. Not to fret. You can get it either in the supplement or your food. Get your milk that's fortified with calcium and vitamin D. It costs the same, but now we have the extra benefit.
CANDICE MOORE, NP
I'm so glad you mentioned that. I have so many patients, especially men, even though men can, by the way, experienced osteoporosis. So, guys don't think that this conversation is not for you. I do find that when male counterparts are in with the female patient, who is my patient that I'm seeing, they are kind of like, we get we get outside and walk. How much sunlight are you getting? Like Dr. Perry said, you also have to be careful about the sun exposure because of issues with skin cancer and such. So, I do want people to get outside, for sure. But for those who are melanated, yes, a supplement is probably going to be something that you're absolutely going to need. Even for people who work at night. I think those are my worst offenders because they're asleep all day and they work all night. So, I think that that's a class of individuals that shouldn't be forgotten.
DR. TAMIKA PERRY
You have probably seen this on your labs. I almost get surprised when I see people in my patient population who has a normal vitamin D level. That's because this is an industrialized nation. We're not outdoor farm migrant farmer workers. We're all inside. Even now, the artificial light in my office is not helping me produce any vitamin D. So, it doesn't matter if you're a janitor in the US or the president of the United States or anybody in between, there is a great chance you're going to be vitamin D deficient because that is not the nature of our economy. Our workforce is mainly on the inside. So, just keep that in mind when you're making dietary choices. If supplementation is needed for you, most certainly consult your primary care provider.
CANDICE MOORE, NP
Yes.
CARMENN MILES
I have a question. In terms of general medications, obviously, you want to consult your doctor when you're introducing supplements to your regimen to make sure that they don't interfere with your prescribed medications. Are there some medications that can lead to deterioration or the weakening of the bone? How do we avoid that?
DR. TAMIKA PERRY
It's a love hate relationship because most certainly steroids can lead to joint bone weakening, and some individuals have to take them long term. Like if you have autoimmune disorders. If you have really, really bad asthma, you may be on it intermittently more times than not throughout the year. So, we have to weigh our risk benefit ratio. For these individuals, not only are osteoporotic medicines may be your friend, but also lifestyle, diet, exercise, supplements. Cannot put enough stock into that.
CANDICE MOORE, NP
Absolutely. It's not the thing. It's all the things that work together to assist. You mentioned what medications we can use for people who are diagnosed with osteoporosis. Like previously mentioned, it is something called a bone density. So, whenever you go into your doctor's office, a bone density scan is what we're referring to. That's what we use to determine whether you have osteoporosis, osteopenia or if your bones are normal density. So, osteoporosis is the worst, and in between there's osteopenia. So, that's your warning sign. But if you do end up with osteoporosis, you do need to be on medication. The drug that we usually use is first line, as a bisphosphonate. Those are medications that are oral, usually taken weekly. They do help build back the bones. I will say, I do have some patients who take it, including my mom. She's not my patient, but she does take it. It can cause some issues with your abdomen. Some people have abdominal discomfort. As long as you take it as prescribed, it typically is okay. I will say, there are different options if oral, for whatever reason does not work, then we can always transition to an IV form if need be if you're intolerant.
DR. TAMIKA PERRY
You're so smart.
CARMENN MILES
You're both a wealth of information. Believe it or not, ladies, we're out of time for this episode. We could have spoken for a couple of hours on this particular subject, but to our listeners, remember, your bones are the foundation of your body. Taking care of them now helps to protect your future. So, take steps today towards stronger, healthier bones. Thanks to our guest today, Nurse Practitioner Candice Moore and our great co-host, host Dr. Tamika Perry for your great insight on osteoporosis. You're listening to Docs in a Pod presented by WellMed. Until next time, everyone stay well.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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