Welcome back to the Healing Pain Podcast with Pam Tutten, OTD, OT, CHT

We are discussing ways to increase bone density with Dr. Pam Tutten. She is a doctor of occupational therapy and a certified hand therapist who practices at BenchMark Physical Therapy in Ellijay, Georgia. Pam became interested in osteoporosis because of the number of women with preventable risk fractures that she was seeing in her practice. She later on developed a group program that addresses the importance of diet in exercise to improve bone health and provides options to medications for patients who are looking to treat osteoporosis as well as osteopenia. On this episode, you’ll learn what is osteopenia and osteoporosis and how it gets diagnosed. You’ll also learn alternative medication for those diagnosed with osteopenia and osteoporosis. How changes to one’s diet can improve bone health, how exercise and physical activity can improve bone health, and why this is important to improve the quality of life for people living with pain.

Pam has also provided you with a free gift to accompany this episode, which includes three different PDF handouts about the treatment of osteoporosis as well as osteopenia. The first one is called Food For Thought: How Nutrition Has An Effect On The Health Of Your Bones. The second is a full exercise program for osteoporosis, and the third is helpful links for patients with both osteoporosis as well as osteopenia. To download these free gifts, all you have to do is text the word 180 download to the number 44222 or you can open up a new browser on your computer and type in the URL, www.IntegrativePainScienceInstitute.com/180download. I highly recommend you download those three PDFs that accompany this episode. Let’s begin with the wonderful Dr. Pam Tutten.

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How To Increase Bone Density With Pam Tutten, OTD, OT, CHT

Pam, thanks for joining me on the show.  

Thank you for having me, Joe. I appreciate being here.

I’m excited to talk to an occupational therapist. I have to be a little bit better and get more occupational therapists like yourself on the show to talk about pain and the various conditions and diagnoses that all of you treat. You’re an integral part of pain care and multidisciplinary treatment of pain. Many OTs like yourself are working in private practice that has so much to offer to people who are looking for health and other types of treatment for their conditions. One of your specialties is osteoporosis or osteopenia. Tell me how you became interested in that topic and treating people with that.  

There are a few different reasons that I became interested in. One of them is that my mom has osteoporosis. Another one is I am a certified hand therapist. I treat a lot of hand injuries, specifically wrist fractures. A lot of times those fractures might have been prevented if somebody had known they had osteopenia or osteoporosis and had treated it through the ways that we’re going to discuss. The other reason is when I was studying for my doctorate in occupational therapy, one of the projects I selected was osteoporosis and osteopenia. It opened my eyes to what can be done besides medications. Many of the medications have many side effects that I was happy to know that there’s a lot of diet and exercise options that show great results in improving bone density.

We’re going to talk about all of those and maybe even some of the things that you’ve found in your doctoral work. When you reflect back on your practice and these patients who are coming in with wrist fractures, is there a typical type of patient or person who may be predisposed to developing osteoporosis or osteopenia?  

As you know, because I’ve read your book, that we have a very sedentary population in the United States who follows the standard American diet, which is not very healthy. They sit on the couch watching TV, and so their bone density is going to be lower. At least 80% of the patients that I see in my practice in Georgia are obese or may be overweight. Their BMI is going to be over 25. At least 50% are over 30. That’s going to contribute to wrist fractures. Their diet, lack of exercise, and all that we know contributes to bone density.

What type of fractures are you seeing? Obviously, wrist fractures. You’re also a certified hand therapist and doctor of OT. This is well within your specialty. What different fractures happen with people who fall?  

Typically, the distal radius fracture. A lot of times, it could be both bones. A lot of times the little tip of the 05:13 that is going to be fractured as well. Typically, it’s falling on an outstretched hand. Distal radius fractures and complications with ligaments sometimes, but it’s mostly the distal radius fracture that is the prime symptom of osteoporosis and osteopenia.

You mentioned falls. People tend to think that people who fall are the elderly or old. Would you say that’s true or that’s a myth with regards to the patient?

As we age, our balance may deteriorate a little bit and you have to be a little more careful. I do see all ages of patients in my practice, but it’s the over 60 population that I’m most concerned with in terms of bone density. That’s being careless, in a hurry, tripping over the curb in the parking lot, slipping in the shower, those are the typical injuries that I find. They’re trying to stand on a ladder to change a light bulb or stand on a stool or chair. I’ve had patients climb on a counter. If you’re 60-plus years old, you shouldn’t be climbing on a counter. In this rural area that I practice, I have women climbing on roofs and cleaning gutters. They might have fractured anyway, but they didn’t know that they have osteopenia.

Tell us about the difference between osteoporosis and osteopenia.  

It’s a continuum, but it doesn’t necessarily have to progress past osteopenia. A patient or a person who has a bone density exam, which is pretty much the gold standard for diagnosing bone density issues, is going to get a T-score within a normal range. If you think of the standard curve. We’re talking about the normal population is at the top. This is the average number on the floor, that within one standard deviation is going to be -1 to +1. The peak of that is a 30-year-old female. She has a perfect bone density. It’s not a zero. Anything between a zero and -1 is going to be considered normal. You then get -1 over that small part of that curve, -1 and -2, -2.5, then we’re talking about osteopenia and osteoporosis. Osteopenia is -1 to -2.5, then it’s osteoporosis.

What we’re finding in a lot of research is it doesn’t necessarily have to progress and we can reverse it with diet and exercise. That’s why I hate to say it’s a continuum because people think, “Just because I have osteopenia, it’s going to become osteoporosis.” That is not necessarily true and it can be reversed. One thing I do want to mention too is that I believe we underdiagnosed this in the United States. Most of the research is being done in Europe. They aggressively treat this. We’re worried in our society about fall and fracture prevention, but the root of it a lot of times is bone density. One other piece of important information when you’re talking about this is that one of the big contributors for bone density is the antacids, Nexium, Proton Pump Inhibitors that almost everybody’s on.

Everybody seems to have heartburn, whether it’s due to obesity, poor diet, lack of exercise, whatever reason, they all are on this medication, which weakens your bone density. My guess is that not only are we going to see more people with this diagnosis, but more men because it’s typically a women’s disease. Women of slight build and Asian build. Those are more common, but we’re probably going to see more men. My husband is one of those men who’s had heartburn all his life. Not because he’s been unfit, but because of some hiatal hernia that he had. For years he’s been on Nexium and he suffered from knee pain that we discovered was osteonecrosis, which with further testing we found out he had osteopenia probably from being on these medications for years. We have switched dramatically his diet. We put him on my program, which we’ll discuss more. Hopefully, I’m praying that his next bone density will be more normal. Men need to be warned too that this is a risk and hopefully, we will address it more in our society.

There are many good take-homes there for people that they can come back to exactly what you said. If I could help you summarize a little bit. A T–score of less than a two puts you in the osteopenia range, not osteoporosis. In that range, you have the ability to either halt the progression or potentially even reverse it with lifestyle-related treatment. People think that, “Once I have this, that’s it, my bone is going to continue to deteriorate and I have to be on medication, there’s nothing else to do.” You’re saying that the research shows that’s not true.  

Another piece of important data, especially for women, is that for years past, hormone therapy was a big thing. Everybody was on hormone therapy. They go through menopause, they go on hormone therapy. All of a sudden, the American Heart Association came out and said that hormone therapy is a risk to cardiovascular health. In 2013, the International Osteoporosis Association came out and said, “It’s very important to consider hormone therapy because of your bones and the risk of bone disease, osteoporosis or osteopenia, bone density problems, is higher than the risk of cardiovascular problems. They’re saying, “You should consider hormone therapy.” Honestly, I think that’s safer. If you want to take something besides diet and exercise and you feel like you’re doing something, talk to your doctor about hormone therapy. I can’t prescribe that. I’m not a medical doctor. Talk to your doctor about that and remind them of that 2013 statement that came out. You can look it up for yourself at the International Association of Osteoporosis. They said they support it based on research.

You also mentioned Proton Pump Inhibitors, which on this show we talk a lot about nutrition, diet, the role of the gut and how it affects the rest of your body. Can you explain to people why Proton Pump Inhibitors can predispose someone to osteopenia? There’s a good data that those with fibromyalgia, upwards of 70% to 90% in clinical studies have IBS. People are taking things like Proton Pump Inhibitors for their gastritis, their heartburn and their IBS and things like that. They’re not making the connection between what is treating my heartburn have to do with my bone health.  

I wish I was a chemist and could explain this better because I’m terrible at physiology. Maybe you might even know more than I do about that. I do know that it depletes. Somehow it depletes the calcium in the gut. You probably know a little bit more about it. If I was reading this blog, I would research it and talk to my doctor about it specifically. I should know more and I’ve read about it but for some reason, it doesn’t sink in my brain.

You said it 100% right as far as calcium in the gut. Proton Pump Inhibitors decrease hydrochloric acid in the stomach. You need the hydrochloric acid to break down protein in your digestive tract. If you’re not breaking down protein, your body can’t absorb and utilize the amino acids that need to build bones because your bones use the amino acid. Also, as you’re cleaving proteins and you’re breaking down other types of macronutrients, the calcium is not liberated and the calcium is not allowed to pass through the gut and get absorbed by the rest of the body. You have lots of different factors with regard to Proton Pump Inhibitors. The other thing about those medications is they can also because nutrient depletion, meaning even if you’re taking in a certain amount of nutrients like magnesium, it doesn’t get properly absorbed either. It’s such an important point that I wanted to go back to. It brings up the point about men as well. I even see kids take things like this and we know that bone health starts at a young age. 

We’re building our bones up until we’re 30 and then after 30, it goes downhill. We better start paying attention to keeping your bone density nice and strong. You do bring up nutrients too. I don’t know if that’s part of our thing but with calcium, there’s been a lot of discussion in the community about osteoporosis and osteopenia. Do I need to supplement calcium? Do I get it enough in my food? I get that question a lot. The research is pointing to the importance of vitamin D over calcium, especially for bone health. I’m usually a stickler about having my patients get a blood level for their vitamin D. The standard has changed and the labs haven’t kept up with it.

What they’re saying is a number of 30 or over is the right number but it’s actually not. It needs to be 50. The new standard is 50. A lot of my doctors want their patients at 60. Some of the rheumatologists are recommending 60, because we’re finding vitamin D has a whole lot more than just about bones. It also is about autoimmune. It helps your immune system. It helps prevent autoimmune disorders. It helps with even dementia, they’re finding. Preventing dementia not causing it of course. Vitamin D is what I stress with my patients and I also recommend based on the data that I’ve read that people take for maintenance dose of 2,000 IU a day. I don’t think we get enough from our food. It’s difficult to get enough from your food. I feel like almost everybody needs vitamin D supplementation.

Ironically, especially for people with darker skin, with the melanin.  My physiology is not as great, but melanin has a role in the way vitamin D is absorbed. I wonder if that’s why we see more immune-deficient African-American versus white-skinned people. Osteoporosis or osteopenia are more white-skinned and small Asian. Vitamin D deficiencies can be more prevalent in the darker skin community. For what it’s worth, I’m a big fan of vitamin D but less of a fan of supplemental calcium. I feel like it’s important to take calcium in your food sources like yogurt, milk, dairy, cheeses. That’s super important but if you can’t tolerate it or if you’re lactose intolerant then you might need to supplement a little bit.

You can also find some vitamin D in some cold water fish. It’s in the meat as well as the skin of the fish.

I’m a huge proponent of eggs and if you like liver, that’s good.

Liver is very good for you. People can incorporate that in. I appreciate you mentioning and keeping us up to date on making sure you have your vitamin D tested. It’s amazing how many people do not. It fluctuates throughout the year, especially if you’re in a Northern climate or if you have darker skin. It’s something you have to stay on top of. You mentioned calcium. Talk to us about some of the foods and things we should stay away from that can adversely affect your bone health, osteoporosis and osteopenia.  

Smoking, alcohol, and typical things. There’s mixed information on carbohydrate on carbonated drinks like sodas. People will hear that but I haven’t found anything solid that I can hang my hat on and say, “This is super bad for you.” Mostly it’s too much caffeine. Sometimes there’s an argument for too little or too much protein. I’ve seen some of that in the literature like sodium. Some of the things that aren’t good for you anyway like too much caffeine. Interestingly, you probably know this, the American Heart Association came out and said that you can have up to eight cups of coffee a day and it won’t affect your cardiovascular system. That’s good for Starbucks.

That’s extremely high for people. They claim it’s okay for your cardiovascular system, I’d like to see more research on that,  but it definitely affects your cortisol levels, which can have an effect on not only your chronic pain but also your bone density. We know that because people who are on corticosteroid medications, those are one of the medications that affect people’s bone density. As you play with cortisol, you have to make sure you’re under that curve. If you’re in the outskirts, it can be a problem and a challenge for you.  

There’s a couple of other medications like any of the rheumatoid medications, methotrexate and excess of thyroid medication. I knew there was one more that I was forgetting. I needed to look down at my notes.

Thyroid disease like hypothyroidism is the number one autoimmune disease in the country. Any of the disease-modifying anti–rheumatic drugs all have that side effect on bone density, which a lot of people with chronic pain are on some type of DMARDs, Disease-Modifying Anti-Rheumatic Drugs. It’s very important. If you’re on those medications, always make sure you get your levels checked. Make sure you’re following some of the lifestyle recommendations that she’s outlining in this episode. Ask your doctor, “What’s the lowest dose I can be on that’s beneficial.” I often find that sometimes people are placed on very large doses of medication that they don’t need instead of starting out at the smallest amount and seeing what the change is for people.

One important thing that I didn’t mention is the difference between vitamin D2 and D3. There are some good studies on that. Interestingly, every time I have a patient who has very low vitamin D, the doctors prescribed 50,000 IU of D2. D2 is collected from plant-based. It’s a plant-based supplement. D3 is an animal-based supplement, meaning they’re taking the skin of the pigs who sit in the sun and derive vitamin D from that. D3, the animal-based is much more efficient and effective in elevating vitamin D levels than D2. I don’t know why the prescription dose is D2 and the over-the-counter is D3. I have patients who’ve been years taking 50,000 IUs of D2 a week and they don’t get better. I say, “Why don’t you ask your doctor if you could take 5,000 IUs sublingual, which I think is better. Sublingual D3, which you can get for $10 on Amazon and try that. For me, it’s a better source. You might have ideas on that. That helps them get their levels back up. The D3 is just a little more efficient in the body.

I agree 100%. Somewhere between 2,000 IUs and 5,000 IUs is what’s needed to start to shift people’s D levels. Anything below 2,000 is quite low and you’re not going to shift it, especially if you’re not getting in the sun and eating some foods that we talked. Sunlight is beneficial for people.

Sunlight is the number one source of vitamin D. I’m glad you mentioned that because ideally if you could stand naked in the sun for fifteen minutes at noon, you might have enough vitamin D doing that.

Let’s shift to physical exercise and physical activity since we’re both in the realm of physical medicine and rehabilitation. It’s so important for people with pain, osteoporosis, and osteopenia. Tell us what your recommendations are for exercise and physical activity.  

The most important exercise is the weight-bearing exercises. I know there’s a strong push to aerobics or aquatic therapy. All those are fun and good and they’re great exercises, but it’s probably not going to build the bone that you need. If you have a special need like osteoporosis or osteopenia, you need to lift weights. Honestly, I do a lot of impacts. There are a lot of hikers around here. I live in the mountains. I’ll have people instead of walking, march a little. Give yourself some weight-bearing. One of my favorite exercises that I give my patients is bouncing on a big therapy ball. They love it and they usually buy one. They’ll sit in front of the TV and they’ll bounce. I teach them about posture so they’re not bouncing on a spine that’s all forward and out of whack. I teach them the importance of impact, and that impact will stimulate the bone cells to regenerate.

The biggest piece of research that I love to share though is the vibration platform. There’s been a whole lot of work. There have been two articles that I love. One on jumping that was done in China, and the Asian population have a high risk of osteoporosis and osteopenia. They found that jumping benefited the hip, especially. A lot of my patients have osteoarthritis, which is different. If you have osteoarthritis, maybe jumping might not be a great choice for you. Between 25 and 35 hertz of vibration, ten minutes a day has been shown to promote bone density.

I have a vibration platform in my office. I have everybody try it, who has osteopenia and osteoporosis. There’s a home unit that I’ve partnered with, a company that put out a great product and I use their product every day. I don’t have osteopenia, but I feel like it’s a good way to prevent it and to still help my bones. I’m 60 years old so I want to maintain my bone health. I have my husband doing it of course because he has osteopenia and I’m doing it. It’s also a good tool to work out on it. I do planks on it for my upper body strength and it accentuates the benefit to your muscle. Do you have any experience with the vibration platform at all?

I’ve read the research on them, which are fascinating. For those who may not know what you’re talking about. Explain what the vibration platform is.

The one in the clinic is a big disc that vibrates. It has to have this side to side vibration because that’s exactly what the research has shown that helps versus the static. It goes at a rate of like 25 to 35 hertz and you stand on it. If you stand completely straight, you’ll almost feel your bones vibrating. You could do squats on it, which would be good for your muscle but not as stimulating to the bone because you’re not getting that impact that we want. The home unit doesn’t have a handle to hang onto or a control panel in front of it like the one in my clinic. It’s a flat platform that you place next to your dresser and it has a remote that’s connected by Bluetooth. You turn it on and you elevate it to the intensity or the hertz that you want, and you stand there. I usually do that ten minutes a day. I also add some squats or add some planks on it in order to keep my body strong.

It is  The idea of the impact that you’re mentioning is almost the opposite of what people will think, “If my bones are becoming more fragile, why should I do impact? It wouldn’t be good for me.” It’s a paradox. It’s the exact opposite.

That’s why education is so important. There’s also been research on educating people with osteoporosis. Does this work? It does work because it is a paradox. It isn’t instinctual. It isn’t something that you’re going to naturally do if you’ve been told that your bones are fragile. You’re like, “I need to protect them.” You need to exercise and stimulate them. Make them grow a little bit more in a carefully controlled way. That’s why education is important. It has to be done with good posture. We don’t want to stir up more knee pain or back pain or any of that. We want to make sure that people are doing it with correct form. I do tend to have people who don’t want to exercise. They’re not exercising. Standing on a platform is an easy way for them.

They’re more likely to buy that platform than to maybe go for a hike or do some of the other exercises I try to make. The exercises I give geared towards the people who don’t exercise too much. If they want to exercise, I give them more. I’ll give them some easy Thera-Band exercises that they can do sitting. I will teach them how to do a chair squat so that every time they get out of the dinner table, they leave the table, they get up and they go back down and do one squat. Up and down, you get up from the couch to go to the bathroom. Get up from the couch, go down to the couch, and stand up again. You’ve done a squat. I try to incorporate everything into their daily activities.

One of the things that they laugh about and I like is I have them using their electric toothbrush. Mostly everybody has an electric toothbrush. I said, “That’s two minutes. I want you to balance while you’re doing the two minutes. I want you to do squats while you’re doing the two minutes. You’re already standing there doing nothing so incorporate. Maybe you’re standing at the Walmart line and you’ve got to wait in line. You work on your balance. I teach people a tandem stance. You can balance while you’re in the Walmart line. You can balance on one leg, let go of the cart for a minute, and see how long you can go. Let’s improve your balance. I try to make sure that the exercises are simple. They’re very simple. Anybody can do them and they should hopefully make a difference if you incorporate them in daily activities.

I love that you’re interspersing little bouts of activity throughout the day, which is important. As I listened to you talking about this, what you’re doing with all these techniques, whether it’s the vibration, the impact exercise, or little bouts of exercise, you’re helping build someone’s physical resilience, but you’re also helping them feel more confident about their physical ability to function daily in life, which is so important for people to follow.  

They do and they come back to me. My program is only for four weeks. It’s a group session once a week for four weeks.  It’s very structured. They end up with a notebook with all the exercises that they need and they come back. Some of them have shared their bone density, which nobody’s gotten worse. Some have gotten a little bit better. Some don’t do the exercises and admit it. That’s the nature of our practice sometimes. Most of the feedback has been positive that many of the primary care doctors in my area have started referring to this program.

You skipped a rock over your program. I want to hear some more detail about the program. Other practitioners are going to be interested in this because we talk about building programs a lot on this show. You have a program specifically for osteoporosis and osteopenia. Tell us what else is involved in it.  

The program itself consists of one-on-one evaluation and then four consecutive group sessions. The groups are between 3 and 5 people. I have spoken at length to insurance companies and Medicare. I’m talking to the practitioners. Medicare is billed as a group rate. It’s usually 100% covered for the Medicare recipient. If they have a replacement policy. I’ve talked to Humana and United. They’re all on board as long as there are no more than four people. You can do this program and bill your insurance. Many times it’s reimbursable. A lot of practitioners shy away from these programs because they’re like, “How am I going to get paid?” You are going to get paid.

I have had a physical therapist in my company do this program and love it. She worked at a life care center. She had lots of potential customers and she loved it. I have another OT doing it and I’m hoping that we catch on a little bit more with my company. I do work for BenchMark Physical Therapy, which is also known by Drayer. It’s part of the Upstream Group. It’s a huge, probably number three, rehab provider in the country. We’re hoping to provide this in more sites. I would even package it for sale if anybody’s interested. I believe in this program and we’ve seen it work. It’s backed up by all current research. The evidence is there. The hardest thing is getting the doctors to diagnose this or even care that much about osteopenia. I think that’s in this country and less than in Europe, but this is an important problem. This is contributing to falls. It’s contributing to fractures. We need to keep that in mind.

Is that because in the beginning, osteopenia is symptomless?  

It’s a silent disease until you fracture. Fracture is the number one symptom. The other symptom is back pain that doesn’t go away. That’s the sign of a fracture. You could have a vertebral fracture. If it’s bad enough, you could fracture a rib or your spine just rolling over in bed. I’ve had that happen with people. They bent over to pants up and they fracture. A severe case is going to be that easy to fracture. If you have constant pain that isn’t relieved with heat, cold, exercise or stretching, you might want to get an x-ray. That’s all I would say.

What type of physicians are you referring to your program? Are they primary care doctors?

Mostly primary care and rheumatology. I’m expanding. We got a new rheumatologist in our town. It’s a small town so it’s thrilling for me to have a rheumatologist and he loves the program. Endocrinology would be a source to tap into if you have an endocrinologist around too, but definitely your PCPs. I’ve had tremendous support from them and the nurse practitioners and physician assistants. They don’t know what to do with these people. They get these bone density back and all they know to do is to provide medication. I’ve had to educate them and say, “This is the research.” My best recommendation is to take a piece of the newest research showing that diet and exercise improve osteoporosis. I don’t know if I shared that with you or not, but I can send it. Take that, go to your PCP and say, “Can we try this before we try medication?” The medication side effects are not very good and most people don’t want to take them.

Can you tell us about some of the side effects that people are unaware of?

The most serious one, which depending on what you’re reading is prevalent or not prevalent, is osteonecrosis of the jaw. It is one of the side effects of a bisphosphonate that can occur. It will say in all the literature that the patient gets that that could be a side effect. The other most prevalent side effect is gastric distress. People don’t know that with the bisphosphonate, they have to take it first thing in the morning. They have to stay upright, not bend over, not eat, not have your cup of coffee for one hour and then you have to eat. In order for you not to have the gastric upset. The bisphosphonates, Fosamax or the more common ones, that’s the first line of defense. Typically that’s what the PCPs will recommend. The Prolia and Forteo are injectables that are usually reserved for more serious cases or for people who can’t tolerate bisphosphonate. Wouldn’t you want to try diet and exercise first? Maybe hormone therapy. That to me sounds a little safer than going to these strong drugs.

The idea of having osteonecrosis of the jaw is terrifying for me. Has that a similar outcome to osteonecrosis of the hip?

I don’t know what the outcome is but I did talk to my dentist who has seen it. It was due to bisphosphonate and they’re like, “I’m never going to take on this dentist to be freaked out by it.” It probably means it’s not easy to chew.

You lose the function of your jaw.  

32:05 graft of some kind or some surgery to strengthen your jaw, you couldn’t eat.

Most jaw conditions are extremely painful. Is there a name of your program?  

I don’t have a name. The doctors referred to it as the osteoporosis program or the osteo program. I guess I should come up with a name.

We’re going to work on a name for you for that. Even if you have to call it Pam’s osteoporosis program. We’re going to create a good name so we can help this program go as far as possible. 

That would be great. I would love that.

People are going to want to learn more about your program and all the great things that you’re doing. How can people reach out to you and learn more?  

My email is probably the best. It’s [email protected] for physical therapy. Our website to find a location, maybe ask for the program, and then we can coordinate. It would be BenchMarkPT.com. That will lead you to the whole Upstream family. We have clinics, all over the country. I don’t think we have any in California or Florida, but we’ve even expanded into New York, into your territory a little bit. I’m not sure what it’s called.

What town in Georgia are you in.  

I’m in Ellijay, Georgia, which is about an hour and twenty minutes north of Atlanta.

People can go to BenchMarkPT.com and look for you specifically in Ellijay, Georgia. All her information are on there. This is the first episode we’ve done on osteoporosis and osteopenia. It’s an important topic for both men and women with regard to living a healthier life. Definitely looking at lifestyle regarding diet, food, and physical activity. All the things we speak about in this show. Pam, I’m so happy that you were here and you can share your knowledge with us. At the end of every episode, I may ask you to share this with your friends and family. Make sure you grab this link and share it with your friends and family on Facebook, LinkedIn, Twitter. If you’re on your cell phone, make sure you click the little share button. You can share that through iTunes and text it to your friend or your family members so they can read all about it. I want to thank Pam from BenchMark Physical Therapy for being on the show and we’ll see you next week.

About Pam Tutten, OTD, OT, CHT

Pam Tutten is a doctor of occupational therapy and certified hand therapist who practices at Benchmark Physical Therapy in Ellijay GA. Pam became interested in osteoporosis because of the number of women with preventable wrist fractures she saw in practice. She developed a group program that addresses the importance of diet and exercise to improve bone health and provide options to medications for patients.