Ways to support bone and joint health as we age

Discover the ways wellness is connected to bone and joint health in this episode of “Good Health, Better World.” Experts discuss strategies for preventing bone and joint problems, important action steps for recovery when an injury or surgery does occur, and new programs for supporting people in their overall health as they age.

 

Related to this episode:

• The Bone and Joint Center at UPMC Magee-Womens Hospital
• UPMC Program for Spine Health
• The UPMC Magee-Womens Wellness Center for Bone and Joint Health
• Podcast: Health Break: What to know about bone health and osteoporosis
• Facts about bone density (DEXA scan)

Episode Transcript

Ellen

Stronger communities begin with good health—for everyone.

You’re listening to the “Good Health, Better World” podcast from UPMC Health Plan. This season, we’re exploring the joys, challenges, and opportunities associated with healthy aging. We’ll talk about what it means to age well; how to care for body, mind, and spirit as we get older; and the tools and programs available to ensure a good life, throughout life.

I’m your host, Dr. Ellen Beckjord. Let’s get started.

In this episode, we're joined by Dr. Chris Standaert and Dr. Tony DiGioia to talk about bone and joint health: how to support the health of our bones and joints as we age, disparities that exist in receiving and accessing care, and health and wellness interventions for recovery when an event does occur.

I'm very excited to welcome both of these guests, and I'll note that Dr. Standaert is a physical medicine and rehab physician who really specializes in the delivery of nonsurgical care for spine and musculoskeletal health issues, and we’ll also couple his perspectives with that of Dr. DiGioia, who's a practicing surgeon.

Ellen

Dr. Standaert, welcome to “Good Health, Better World.”

Chris

Well thank you. Very happy to be here.

Ellen

Doctor DiGioia, welcome.

Tony

Thank you, Ellen.

Ellen

Let's start with a general question, Dr. Standaert. What are some of the changes that naturally occur to our bones and joints as we age?

Chris

You know, the problem with being human is we're not designed to last forever, right? And when you think about aging and medicine and health and bone and joint problems, they change through the spectrum, right? So when you start at children and adolescents, children are growing and their bones are growing faster. They get thick, right. They get longer, they don't get denser. Their tendons and muscles are really strong. They get bone problems, so a lot of stress fractures and other sorts of things. People hit their 20s and they become a little more invincible, right? Where everything seems to be good. You hit adult bone density at age 21 for women, about age 25 for men. And then people are, you know, OK. Trauma is a problem there, but aging isn't so much of a problem there.

As we get older and we get into 40s, 50s, we get a lot of what we term “degenerative phenomena.” They're really just sort of aging. Our joints are lined with the cartilage, the cartilage starts to wear and thin a bit. Bone density starts to decline as we get older. We lose a little bit of muscle mass and muscle cells. We lose some of those as we age. And then people tend to get more sedentary. The jobs get more sedentary, activities get more sedentary. And often there's an accumulation of trauma of various sorts, like things start to add up: the sprained ankle, the bad knee, the bad week, the bad day, the cold, the flu, the COVID, the whatever. They start to add up. And then people find themselves with problems as they get older—as the joints are essentially wearing, is what's happening to us.

Ellen

That's a really excellent explanation. I love the introduction, you know, we weren't built to last forever.

Chris

No. <laughs>

Ellen

That's pretty much the whole purpose of this whole season is then to say, and so then what does that mean? What does that mean about how we adapt and still make the most of the function that we have? Certainly, today we're talking about our bones and joints and physical function. But, you know, over the course of our lifespan. I love that.

Dr. DiGioia, do you have anything you’d like to add?

Tony

Osteopenia and osteoporosis, which is a loss of bone mass and loss of muscle mass—unfortunately, they happen no matter what. That's the biologic process that starts actually in your 20s and 30s, and it continues, and it's a loss over many, many years.

What we can control, though, is where we start out, having good bone mass, good muscle mass, so that our starting point’s very high. And then we also can control how fast or how slow we lose bone and muscle mass, which is the most important part after your 40s and 50s. And that's one of the reasons we always say that bone and joint health is not just a disease of the middle-aged and old, it's actually a disease of the young because you build all your muscle mass and your bone mass in your 20s up until your 20s and 30s, and then that decline starts.

Ellen

So, what are some things that we can do to last forever? <laughs> No, I'm just kidding. What are some things that folks can do—and starting when I think is an interesting question as well—but what are some things that we know can help support bone and joint health as we inevitably age?

Tony

Well, first of all, if you talk specifically about osteoporosis and osteopenia, the key things are exercise, strengthening (that also strengthens your muscles), and nutrition (meaning have good vitamin D and calcium content). And then also some things that we can control very much so: smoking, for instance. People don't realize that smoking actually can affect your bone density. So, all these things tied together are things that you obviously can start early and never stop. But also [an] important point I tell to our patients, it's never too late to do those kind of things too, because you can improve or decrease that slow loss.

With muscles, it's a little different. We do lose muscle mass over time. It's sometimes less apparent than bone density because it's not something that's easily tested. But starting from 40 on, you lose the mass, that also creates problems with stability, with mobility, with activities. And that, again, is important to prevent many of the diseases like osteoporosis and osteopenia.

But doing endurance strengthening and strengthening combined, doing exercises that focus on stability like yoga, tai chi, even getting out and walking, are all things that you can do to slow down these kinds of processes. And in the end, too, it also has a protective effect: number one, protective against the loss of bone density, muscle, but also stability and joint health too. Many times, people see the problems of their joints later in life with the development of arthritis. But if you do these protective things for bone, for your muscles, you are also indirectly protecting your joints and improving your chances of never falling again.

Ellen

I appreciate the callout on stability because it seems like, especially as we get older, fall risk is so important and that that one fall can set off like a cascade of other health-related problems. So, avoiding falls and having good stability—it's also personally very validating because I do a lot of strength training. And sometimes when people ask me like, well, what do you think the results are? Usually, the first thing I say is, if I'm standing on one leg, it's really hard to knock me over. <laughs> Like that's kind of what I feel like the main result of my strength training is like that just, stability. Like you can really feel it. And it's a good feeling.

Tony

It's a good test.

Ellen

Dr. Standaert, is there anything you'd like to add?

Chris

Yeah. Joints stay healthy by moving, right? People talk about their joints wear out or whatever. Actually, if you don't move a joint for a while it gets very unhealthy and the cartilage starts to break down, the joint does poorly. So, in the old days we used to cast people for long periods of time. We actually harmed their joints because we immobilized them. We need motion to stay healthy.

So movement keeps you healthy, right? That's what helps your bones and bones and joints. And bones do well with stress and use and weight bearing. And we talk about, you know, walking and weight bearing exercise for bone density. But strength training your muscles, pulling on your bones also helps keep them stronger.

Your muscles have this capacity to get stronger, to get more effective essentially indefinitely. So we should use it. And when you think about, you know, risks of aging, falling is a problem. Like we talk about bone density, and I have lots of patients who have bone density concerns and problems. And when you look at our measurements of bone density, what we're really doing is we're calculating fracture risk. That's what a bone density test does, a DEXA. It gives you a number, and that number correlates to a fracture risk that you can calculate. And so, if we're treating bone density, we're essentially trying to minimize fracture risk. So, there are other ways to do that too. So being stronger certainly minimizes your risk. Having better balance minimizes your risk. Getting a safe home environment minimizes your risk. There are lots of other ways to do that. So, they all benefit one another and compound. The benefits compound, they grow.

Ellen

Dr. Standaert, when an event like a fall does occur or an injury, what are some of the things people should think about as they navigate recovery? And are there things that are different about recovering from an injury in terms of what's best to do, that are really distinct from the kinds of things people can do to prevent injury in the first place?

Chris

There are other things to think about, I think. One, obviously, sports is a leading cause of sports injuries, right? <laughs> If you don't try, you don't get hurt. So, there's some risk we take when we do that, right? There's more risk in doing nothing. Doing nothing will catch us way faster than being active and waiting till we're hurt at some level.

When you look at sports injury, the biggest predictor of injury is an under rehabilitated prior injury.

Ellen

Oh, wow.

Chris

So, to prevent further injury, you have to rehab the primary injury. And so, I take care of a lot of spine problems, for example. And some people having an acute injury where they hurt their spine, other people come in and describe it a bit like death by a thousand cuts. They hurt their back. Their back goes out, they shut down. They don't get up for two weeks. They take a bit of a hit in terms of their endurance and strength, and then they just move on and they don't go back up. They don't get back where they were. Then do it again and again and again. And you get this pattern of what used to happen once every two years, and then it happened once every year. Now it happens five times a year. Now I can't pick up, you know, my dog food without throwing out my back. And it wasn't an event. It was this accumulation of things. So, when you're injured, you really want to get back to normal. Get back to where you were.

And we talk about a pattern of recovery from injury, right. So, a lot of times I'll talk to people what we call “return-to-play criteria.” And we use it in sports, but I use it for everything. I use it for work. I use it for life. I use it for walking your dog. I use it for everything. And really, the way it goes is that when you get hurt, you know, the injury has to heal. You have a broken bone, the bone has to heal. You tore a muscle, the muscle has to heal. Right? So, you allow some time for adequate healing. You restore range of motion early. You want to move early. Once your range of motion comes back, you start working on cardiovascular fitness. And then once you have healing and normal range of motion and fitness, you can get stronger. And then as you start to add strength, you can go back into sort of training to do what it is you wanted to do, be it tennis or walking your dog.

One important consideration in injury I talked to people about a lot is the difference between getting better and staying better. A lot of people who get hurt, they will focus on getting better. I will wait it out, I will ice it, I will get myself better. The trick though, is staying better.

Getting out of trouble and staying out of trouble are two different things, right? So getting out of trouble is good. Getting out of acute pain is good, but the idea is to stay out of acute pain and injury. And that's where the rehab comes in. And the idea that if you fall back a bit with your injury, you have to get back to where you were. You have to try to get back to where you were, and that's how you stay out of trouble.

And a lot of people sort of neglect that half, they just kind of get better and move on, and that leaves you with a higher risk of getting hurt again. So again, the difference of sort of getting out of trouble versus staying out of trouble.

Ellen

Both are important.

So, you mentioned that sports are the number one cause of sports-related injuries. And this is just, this is just really a question purely out of curiosity, like what is your position on pickleball? And is it true—<laughs>—so I'm fascinated by what seems like kind of a phenomenon and it really increased participation in this sport and that's wonderful. But are folks rolling into playing pickleball not adequately conditioned in a way, like are we seeing a lot of pickleball-related injuries? Is this exacerbating some of the problem that you're talking about with respect that people want to get back out and play when they haven't really fully returned to baseline? I'm curious about that.

Chris

You know pickleball is—I like pickleball. Pickleball is a less intensive and less demanding sport than like, tennis. So pickleball has advantages in that it's not so hard and so intense. You don't have to run quite as much and hit the ball quite as far.

I have seen a number of pickleball injuries I've wondered about, like, do we set up a pickleball clinic or a pickleball prehab to keep people—so the challenges in pickleball are there's a lot of rapid change of direction, side-to-side movement, a lot of crouching, and backing up. And so, people lose their balance when they back up, they turn and twist quickly, and their knees and their ankles go. And really, the trick is you have to keep your body prepared for what you do.

And I have this, you know, again, I'm a rehab person. I've done this for a long time. I've seen a lot of people hurt. I think if you go back to that aging question and you start at 20 or 25—when you're 20, people who are healthy, who don't have musculoskeletal issues, don't have neurologic issues, can do all sorts of things. They can throw a Frisbee, they can throw a ball, they can go for a bike ride. They can do whatever. And as you move through life, often people view the activity as the exercise, right. So, I run three times a week. I play tennis three times a week. I play basketball three times a week. I play pickleball three times a week. That's my exercise. However, what happens once you hit, I don't know, 40ish, cross-training is a thing, right? It really matters. And once you start getting an injury or two, especially related to the impact, the sport, the sport isn't really the exercise. You have to exercise to be able to play the sport. The sport becomes the reward for doing the exercise. So, I do my weights on Monday. I do a home Pilates routine on YouTube on Wednesday, I do some stretching on Friday, and I'm pretty good for pickleball or tennis on Saturday. It sort of works that way.

Ellen

Yeah, that makes sense.

Chris

That as you go, you have to keep your body prepared for the stresses you're going to give it or you fail. And if you get to that, you have a prior injury, bad ankle, a bad knee, or bad hip that you didn't really push through rehab on, we break at our weak link. There are lots of rules to injury and rehab. One clear rule is, you don't get hurt because of what you're good at. You get hurt because what you're bad at. But the corollary is, if I tell people to go to a gym, they all want to do what they're good at, because it’s way more fun. But that doesn't help them from getting hurt. You have to go address your weaknesses if you want to avoid getting hurt.

Ellen

Tony, what are your thoughts?

Tony

Well, as you pointed out, most important is prevention, preventing falls, preventing fractures, preventing injuries, because it does lead to immobilization, and something that a lot of people don't realize [is] that being immobile or being on bed rest is actually a very bad medicine because you quickly lose or accelerate your bone loss, you accelerate your muscle loss.

So, prevention is important. Now, when it happens, there's a couple things. I mean, one practical thing we always talk about, even if it's not leading to a fracture, is we teach patients on how to get up from the floor. Because it sounds so simple, but many times injuries are made worse because patients are on the floor immobile for extended period of time.

And some of the things with that is to adjust your home, make sure throw rugs aren't in the way, make sure you're mobile, you're able to maneuver around your house safely with that...But you should always have a strategy that if you fall, because people do fall, this is how you get up from the fall and contact help.

Now, if something happens that, for instance, is a fracture or causes you to need surgery afterwards, it is a challenge based on your age group particularly because not only does it affect that acute time, but it can accelerate your loss of mobility, accelerate loss of muscle, accelerate loss of bone mass. And it is hard to bounce back from that kind of thing. Look at your bone density. Osteoporosis can lead to fragility fractures, which is a big problem too. So, there are things you can do, but with the idea you really want to get up, exercise, increase your mobility as quickly as possible to head off that decline, that accelerated decline.

Ellen

Dr. DiGioia, if I could ask for your perspective specifically as an orthopedic surgeon. So not necessarily in the context of a fall or an injury, but can you talk us through some of the decision-making process around when someone's quality of life, their function, their mobility is impaired simply because they've got a problem with one of their joints and they are thinking about making a decision to have surgery for joint replacement?

Can you talk our listeners through how you think about that, through your lens of the work that you do as an orthopedic surgeon?

Tony

Sure. And we specialize in the area of treating hip and knee arthritis and all the spectrum, nonoperative and operative. And yes, a significant number of patients eventually do require joint replacement, which does cure them of their arthritis and most importantly, pain.

So, the discussion we have with patients, the earlier the evaluation the better because it gives you time to have interventions long before you may even need surgery. Number one, it's again, exercise and nutrition are the most important interventions to slow the progression of arthritis. Arthritis is not an all-or-nothing event. There's a continuum of arthritis. And we actually grade it for normal, slight, moderate, near end-stage, and end-stage, and usually based on X-rays, simple X-rays that we get in the office.

The problem with arthritis in any joint is not just the joint space narrowing the loss of cartilage, it's actually the pain that it causes. Pain is by far the number one reason that brings people in to have a joint evaluated. Pain also affects what you can do in your activities of daily living or interferes with what you would like to do. And each person is a little different. So in the end, if patients have what we call near end-stage (which means you only have a little bit of cartilage left), or end-stage (which is what everyone calls bone on bone), and you have pain, then that's the time for patients to consider surgery, and the pain that impacts their activities.

Ellen

And can that also cause problem in other parts of the body? So, do people typically maybe try to compensate for the joint that is really compromised? Can that set off a cascade of other physical problems because they may carry themselves or put too much stress on the other side of their body? I imagine that it can be sort of like, a cascade of bad things that just kind of pile up starting with that one joint but then generalizing to other parts of the body. Is that something common that you see in patients as well?

Tony

Absolutely. And, you know, hips and knees, since they're weight-bearing joints, they're the number one and number two joints that develop arthritis. And again, it's all related to the mechanics. But as you mentioned, there's indirect effects from that. You start limping. One leg could be shorter than the other if you have hip arthritis, for instance. This affects your gait. Those things can affect your back and the way the [pelvis] aligns. So, there are these whole litany of indirect effects that we talk to patients about. And there are other factors too—remember this becomes a spiral where you have arthritis, you become less mobile, you become more unstable, your bone density decreases, your mass of muscle decreases. So, you can start this cycle, and it's unfortunately a spiral that's down and not up.

Ellen

And, I would guess that another part of that type of cycle often is weight gain, because you're less mobile, you're moving around less. And then, yeah, it just really kind of escalates in the wrong direction.

Tony

Absolutely. That’s another factor. You know, we always tell patients for every 1 pound of body weight, for your hips and knees, they think it's 5 to 6 pounds of pressure. So that means, just a simple weight gain of, say, 10 pounds—your hips and knees think it's 50 or 60 pounds. Now, on the reverse, it's good too. If you lose 10 pounds—it doesn't have to be this massive weight loss—if you lose 10 pounds, your hips and knees think they recover 50 or 60 pounds.

And I always, I like to tell patients it's real simple to check, right. Take a bag of groceries. Something we do, you know, every day. And climb up and down the steps with and without. And you will instantaneously see the effect of these small weight gains, these changes on your joints. So, this is another factor. It's both preventive and it can make things worse.

Ellen

Yeah. Yep.

One of the themes that we revisit in every season of the “Good Health, Better World” podcast is health equity in places where health disparities negatively affect the health and well-being of traditionally underserved groups. Are there issues related to health disparities or ways that you're specifically thinking about health equity within the work that you do that you care to comment on?

Tony

Yes, especially in the whole area of bone and joint health. We've established a wellness center for bone and joint Health at Magee within UPMC to just raise the awareness not only of bone and joint health, but there are disparities in care. We learned it more from the hip and knee side, but it spans the entire area of bone and joint health.

And at the highest level, there's many gender disparities. Men and women physiologically are different. As an example, the incidence of osteoporosis in women is much higher than men and it's related to the hormonal balances. And although men do get osteoporosis as well, the way women perceive pain is very different—and particularly arthritic pain. One interesting finding we found is that women tend to delay having an initial evaluation a lot longer than men. And when you think about it, as we were saying, one of the important thing is the earlier the evaluation, the earlier of the diagnosis, the earlier you can develop a preventive plan that can slow down many of these factors. And women sometimes lose that opportunity because they seek later care.

So, there are things like that at the gender level. Now there's another level two. There are racial disparities. And again, it's related to both physiologic and socioeconomic. Latino and African American women are much higher incidences of arthritis in their major joints. Sometimes it's related to the lack of access, but it's not always. There's physiologic effects with that. And obviously it also ties into your comorbidities, weight management, diabetes, all these things also affect that. So individually there are disparities among racial groups.

And then we always also like to point out more there's community disparities. So, in Pittsburgh, we're very community oriented, right. A Wexford community is very different than [New Kensington]. Or Homewood. Or Shadyside. So, there is another level of disparities in how the community perceives bone and joint health, which then also affects individuals.

Ellen

Wow, that's a that's a great point. And I also, if I'm hearing you correctly, I think it's interesting that as a surgeon, you're saying evaluation shouldn't happen when just to say well let's evaluate you for surgery. Like do upstream evaluation because there are things that can be done even if the end point eventually, someday will be surgery. The longer you can lengthen that timeline, use other nonsurgical interventions to improve quality of life, reduce pain, restore function, you can potentially delay surgery. But I would also imagine end up optimizing the surgical outcome, the healthier you get and the more function you can preserve and even potentially regain in advance of surgery. Is that fair to say?

Tony

Absolutely. That's a very important point. I always, tell patients, the best prepared patient has the fastest recoveries and the best outcomes. So, all the things we were talking about that are preventive also optimize you if it comes time for surgery.

Ellen

Dr. Standaert, let me turn to you. What are your thoughts?

Chris

So, I run the program for Spine Health, a UPMC program, for people with spine issues that are that are challenging, that aren't readily manageable or getting better.

And we built that sort of on this belief of five things people need to be well. We need to sleep. Sleep is when you repair yourself from the trauma of the day. We need a decent diet. We are what we eat. We need some form of exercise because we are use-it-or-lose-it creatures. We need social engagement and we need a passion or a mission, a reason to get up every day and go. If you have all five of those things, you're a pretty happy person, right? I didn't talk about money. I didn't talk about a few other things because they really—they pale compared to those five.

But then you think about our society and how does this work, right? If you don't have a gym, if you don't have a pool, if you don't have time to go there, if you have to work two jobs to feed your family, exercise, as many other people may think about it, or as media may describe it, is a luxury. It's sort of a foreign concept. The job is physical. And how do you how do you recover and heal if your job is what's harming you? Or if the demands of your family or demands of taking care of your parents and three generations of your family, right? It's hard. And what if we don't have support out there? What if there are no places to go? What if there is no respite? What if there is no gym? What if good food is hard to come by and too expensive? What if your neighborhood has two pharmacies for 20,000 people and it's hard to find them when you need them? These are sort of socioeconomic structural barriers that we—that exist in this country. And probably most countries.

And so how do you then stay healthy in environments where the environment is sort of toxic? Where sleep is challenging because it's noisy, it's loud, it's violent. Where, you know, mental health issues become sort of prevalent. It gets a lot harder to do. And bone and joint health are tied to health in general.

So, we built our spine program and we deliberately didn't call it a pain program because we really believe that your spine being healthy is tied to the rest of you being healthy. So, managing your diabetes, managing your stress, managing your sleep, managing your diet are tied to bone health, are tied to joint health, are tied to spine health, because they all go together.

Ellen

Yeah. And as you're talking, I'm just thinking about how your skeletal system is like the foundation of your physical form. And it's going to bear the brunt of all the ways that, as you've I think really described well, the hostilities of the environment that you're in and how easy or difficult it is to participate in those five things or to have those five things that you mentioned be true. And that's the foundation of so much inequity in health is that it is much harder for some people to realize those five goals than it is for others, for reasons that often have nothing to do with how much they would like to participate in or receive those behaviors or care, it's just simply much, much harder. It's where a lot of inequity lies.

Chris

It is. I mean, how...I'm a rehab person. I like pools, and how many pools do we have in Pittsburgh and where are they, right? And who can get to them? And what are the hours? And so can people use them? And how many gyms are there? And can people actually afford that? And can they go and do they have time? And again, we talked a bit about, you know, food and sleep and environment. But they all become important. And I think, if we come to the conclusion that we're in this together in terms of a society and our health, investing and keeping one another well makes an awful lot of sense to me because I don't, I've done this a long time and I don't think any of us are well if all of us aren't well. It just doesn't work that way.

Ellen

What are you most hopeful or excited about within the context of the work that you do in spine health?

Chris

I personally love working in my clinic, in the spine health clinic. We really help people and we have built essentially a transdisciplinary culture, which is this idea of we have a whole bunch of people: nurses, doctors, a PA; we have dietician and health coach and physical therapists, and we all work and we talk regularly—we meet every week and we work collaboratively, and we really help people through barriers. And we work very closely with our surgical colleagues and with our sort of across the board, our pain management colleagues, our radiology colleagues. We work well with all of them, but we have a very tight-knit team and we really help people live more effectively with the challenges they face.

So that's very meaningful to me. And I think, the good and the bad of it, the good is the discovery that time and understanding and expertise and collaboration actually helps make people better. The tricky part is translating that in a way that works in our system, right?

So, in the space of caring for people who have challenging problems that are not readily solvable, there's a tension in our system, in our society, between sort of actual help and benefit and opportunism. And there are lots of sort of—“Here's a quick, easy way to get better. Here, just buy this for $100, do this for $10,000. Come over here and we'll magically fix you.” And this idea of we “fix” things. We don't really fix things. I don't have a magic wand. I joke all the time to patients that they showed up on Thursday, but magic wand day was on Tuesday. They were just two days too late. I don't have it. They missed the sale.

And these secrets to health aren't really secrets. This idea of be well, of eat well, and sleep well and exercise and de-stress yourself and engage with people who you care about and are fun to be with for you and find meaning in what you do—this is not a mystery. I'm not the first one to think of this in history. I think people thought of it thousands of years ago. And it clashes a bit with this, well, “just fix me.” Oh, it'd be so nice just to be fixed. There's a lot of opportunism out there of false promises and other sorts of things, which I think sort of derail people from going where they have to go sometimes.

And so my optimism side is that if you can really sort of spread the idea of discovery that if we take care of one another, we do better and we really think about health and we really think about, you know, joint health is tied to other health and if we can sort of work to help people make themselves healthier and be healthier and make spaces for people healthier, the world will go better. People will do better, right? That's where it is. It's not in, you know, a widget on late-night TV. That's not it.

Ellen

Well, and I think I hear you saying, while on the one hand these sort of silver-bullet magic-wand solutions, lots of opportunistic behavior there. People being—understandably, who have been suffering for a long time—super vulnerable to being drawn in by those things. Those things don't exist. But there are solutions that do exist. They're feasible. And with the right combination of services brought to the table and space created for a person to heal, that meaningful progress and regain of function and improvement in quality of life is absolutely achievable. Which is great news.

Chris

It is, it is. And I think this idea that we may be able to tell people which drug will work for them and which one they won't tolerate, and which one they're sensitive to, and which one they won't. If we can get into sort of more of the genetic makeup of people and how certain things may work better and what they're more predisposed to and then start going backwards a bit and saying, well, if that's what they're predisposed to, how do we keep them away from it and keep them well and keep them healthy? And we can start to really think about our system in a much more structured, personal way than we have it now. So, I think there's another good reason for optimism that as we sort of encroach on that, that piece of data, that piece of information, we will do better with causing less harm along the way.

Ellen

What are some of the things, Dr. DiGioia, that you're the most hopeful about when it comes to bone and joint health or the, I guess the things that are that are on the horizon or just past it that are the most exciting for you in your field?

Tony

Well, I would say just doing this session for one. A big part of our wellness center, which is our nonoperative side of the program, is raising the awareness of bone and joint health because it's a bit of an orphan set of diseases when you think about it. We're not life threatening as much as looking at quality of life; although, like we talked about, if you do develop bone and joint problems, it can lead to a shorter lifespan. But that said, you know, we're not up there with cancer and heart disease and all. But we have much more effect on function and pain free function and letting patients—especially as we have longer life spans, we want to have healthy, longer lifespans with that.

So, number one, I think we have to raise the awareness of the bone joint health. And we do have a very aggressive education outreach program. We go into the communities all the time and we're testing for osteoporosis, we’re testing grip strength (which is a surrogate variable for overall health, too). We're teaching them what to do, and it's very interactive.

The second phase of that though is we're actually have a bit of a different care model when it comes to bone joint health. We use a tool. It's called what matters to you. And it's flipped the question for patients. Instead of us saying, what's the matter with you? We ask the patient, “What matters to you?”

Ellen

Oh, that's great.

Tony

And when it comes to the bone and joint health, it's important because some people have arthritic problems. Some people have osteoporosis problems, osteopenia. Some people have weight management, nutrition problems. Some people have pain management problems, right? Or exercise mobility. So, we always start with that. And the care model is unique because we build a care plan then, based on what the patient wants. And we put that plan together and it's a very individualized, customized plan.

And then our wellness center becomes what I call a connector. So, all the services that we're talking about are available in our community. I mean, we're fortunate to have UPMC and all the different imaging and hospitals and outpatient centers. So, one of the roles is just to connect our patients through in the wellness center to those services based on their individual needs. So, it's very different. It's—again, it's what matters to you. It's a connector role taking advantage of resources and education. Every step of the way is education.

Many of the things that we're talking about don't involve medicines. They don't involve injections. They are things that people can do right away. And the two big areas are exercise and nutrition. And there's a theme we've been promoting, is that food is medicine. Exercise is medicine. The benefits you will see from exercise and just nutrition and nutritional evaluation many times outweigh all the other kinds of interventions that we could do.

Ellen

Yeah. Dr. Standaert, is there anything we haven't talked about that you would like to mention for our listeners to hear?

Chris

Yeah, I would say a couple things. Don't be afraid to ask questions. I think everybody deserves a health care provider who will answer their questions. Everybody deserves to understand what is in their way. They should not really be told what to do so much as how this might or might not help you.

You deserve to know what options you have. You deserve to know how to be better. You deserve to know what you're up against and what makes sense for you. And if there are resources available to help you, you should have them. So yeah, and sometimes it takes a bit of work to get there. But don't stop trying.

Ellen

That's wonderful advice.

I think it's so relevant to the discussions that we're having about aging, because there are certainly people who need to participate in medical care from the beginning, very beginning of their lives and throughout their lives, but on average, our need to interact with the health care system is correlated with age. You know, we're going to have more reasons that we have to do it.

And, I really appreciate everything you've just said about the expectations that we should have of being treated with dignity and respect—some of the core UPMC values, being cared for and listened to—and to not give up on that expectation. Maybe sometimes you're going to have to navigate a few different parts of the system before you find the part that will give you the treatment that you, I think, are entitled to expect. But it's wonderful to hear a provider articulate that so well. So, thank you for that.

And thank you so much for joining us on the podcast today.

Chris

You're welcome.

Ellen

And thank you, Dr. DiGioia, for talking with us on “Good Health, Better World.”

Tony

You're very welcome. And thanks again for the opportunity.

Ellen

We hope you enjoyed this episode of “Good Health, Better World.” Be sure to tune in next time and visit upmchealthplan.com/goodhealth for resources and show notes.

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their care provider. Views and opinions expressed by the host and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.

Guest speakers:

 

Dr. Chris Standaert

Associate Professor

Vice-Chair for Outpatient Services

Fellowship Director for Value-Based Spine and Musculoskeletal Medicine Fellowship

Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine

Director of Spine Health, UPMC

Dr. Standaert is a specialist in Physical Medicine and Rehabilitation with a clinical focus on nonoperative spine and musculoskeletal care. He graduated from Harvard College in 1987 (majoring in Biological Anthropology) and from Harvard Medical School in 1992. He completed his residency in Physical Medicine and Rehabilitation at the University of Washington in 1996 and a fellowship in sports and spine medicine in 1997. After 10 years in private practice, Dr. Standaert joined the Department of Rehabilitation Medicine at the University of Washington in 2005. In 2017, he began work at UPMC and currently serves as an Associate Professor and Vice-Chair of Outpatient Services in the department of Physical Medicine and Rehabilitation (PM&R) at the University of Pittsburgh School of Medicine. He is also the Medical Director for Spine Health for UPMC, leading a value-based integrated spine clinic. Along with the clinic, he serves as fellowship director for the UPMC Value-Based Fellowship in Spine and Musculoskeletal Medicine, a novel collaborative training program within UPMC and the UPMC Health Plan.

 

Dr. Tony DiGioia

Co-Medical Director, The UPMC Wellness Center for Bone and Joint Health

Medical Director of both the Bone and Joint Center at UPMC Magee Womens Hospital and the UPMC Innovation Center

Anthony (Tony) DiGioia, M.D., is an engineer, entrepreneur, and practicing orthopedic surgeon from Pittsburgh, PA, who is renowned for innovations in health care that combine the art and science of medicine.

Tony graduated with university honors from Carnegie Mellon University’s Civil Engineering program and obtained a graduate degree in Civil and Biomedical Engineering before pursuing his medical degree. He attended Harvard Medical School where he graduated with honors in a Special Field, then completed his orthopedic residency in Pittsburgh at the University of Pittsburgh Medical Center (UPMC) and a Fellowship in Adult Reconstruction Surgery at Massachusetts General Hospital. Dr. D is board-certified in orthopedic surgery and a Fellow of the American Academy of Orthopaedic Surgeons and the American College of Surgeons and has presented and published many articles in an effort to share his breakthroughs in medicine and engineering.

In 2018, Dr. D published The Patient Centered Value System: Transforming Healthcare Through Co-Design. The book is a guide to implementing patient centered care in any care setting or specialty. The PCVS approach has been implemented in over 65 different clinical conditions and is increasingly being adopted nationally and internationally.