Infusion Care for Osteoporosis: What Patients Should Know

Osteoporosis can silently weaken bones long before a fracture happens. In this episode of Baptist Health Talk, host Johanna Gomez talks with April Tchumy, orthopedic nurse practitioner with the Bone Health and Fracture Prevention Program at Baptist Health, about how infusion care and injection therapies can help protect bone health and reduce fracture risk.

Many people hear “infusion care” and think of cancer treatment, ports and hours in a chair. But for osteoporosis, infusion and injection treatments can look very different — and may be an important option for patients at higher risk of fractures.

In this episode:
 • How osteoporosis is diagnosed through bone density screening
 • When screening may be needed before the standard age guidelines
 • The difference between oral medications, IV infusions and injections
 • Why some patients may need bone-building treatments first
 • Common side effects and what patients can expect
 • How calcium, vitamin D and strength training support bone health
 • Why preventing hip and spine fractures is such a major treatment goal
 • How treatment success is measured over time

Listen to Baptist Health Talk for more conversations on prevention, wellness and the most searched health topics.

Host:
Johanna Gomez
Award-Winning Host & Journalist

Guest:
April Tschumy, APRN, ONP-C
Metabolic Bone Specialist
Baptist Health Orthopedic Care

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Osteoporosis Explained: Risks, Screenings, and Strength Training

Transcript

SPEAKER_02 0:00

And how about working out? Exercise, absolutely. So we know that um exercises that are specific for strengthening or resistance, those are the only exercises that have been proven that can actually reverse bone loss. I was just gonna ask you if you can actually reverse this. That's absolutely. I get that question all the time. At any age. Really?

SPEAKER_00 0:20

Any age, yes. Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_03 0:32

Hi everyone, I'm your host, Joanna Gomez. Welcome back to a new episode of Baptist Health Talk, where we answer your questions on the most searched health topics. Today's episode is part of our series on infusion care, a treatment approach many people associate with cancer care, but one that plays an important role in managing a wide range of conditions, including osteoporosis. From treatment options, protecting bone health, and preventing fractures, we're focusing on infusions and injections and how these therapies work, what patients can expect, and why early treatment can make a big difference. We are joined by April Shumi, orthopedic nurse practitioner with the Bone Health and Fracture Prevention Program at Baptist Health. Thank you so much for being here, April. It's great to see you. Let's start at the top because when I think infusion care, I automatically think cancer patients, and you're like, that's not true.

SPEAKER_02 1:26

Not true, not so. Um, exactly. So it especially like the Baptist uh infusion centers, like they really focus on other treatments that are non-oncal oncological. Yeah. Um, that are non-cancer related. Right.

SPEAKER_03 1:40

But so if you have osteoporosis, obviously this is an option for you. Yes. My brain automatically goes to, I need a port in order to do this infusion. And I'm thinking of sitting there for a couple of hours. As a breast cancer patient, I had to go through that. So that's where my mind automatically goes. That's also not the case.

SPEAKER_02 2:03

No, not the case. So um some in some in uh infusions or some of the medications that are given at the infusion center can be given intravenously or IV. Um if you have a port, the port can be used and accessed, uh, but it's not necessary. Um, it's typically not uh multiple hours that you're there. And then some treatments that we prescribe for osteoporosis also are subcutaneous injections, and they can be administered at the infusion centers as well.

SPEAKER_03 2:30

Okay.

SPEAKER_02 2:30

What if I don't know if I have osteoporosis?

SPEAKER_03 2:32

Just take me back to that. Let's that's where I should have started. Let's rewind a little bit. How do we get there?

SPEAKER_02 2:38

Okay, so um most men and women they require a screening tool called a bone density, and it's a basically like a very low dose radiation x-ray. Okay. And they check certain sites of the skeleton to see what the um the quantity of bone is at that specific site, or um it can also tell you sometimes, depending on the software that's used for the for the bone density, can also tell you the quality of the bone as well. So is it like going into an MRI machine? Is it an X-ray? It's like an X-ray, yes, exactly. It's like an x ray. So it's open um, you know, for my patients who are worried about claustrophobia. No, that's not the case.

SPEAKER_03 3:15

I'm like, I would never get this done. Good to know that it's an x-ray. How old do you have to be in order to even start thinking about this?

SPEAKER_02 3:23

So um currently the guidelines they say that for women you have to be 65 and older, for men 70 and older, but there are plenty of patients who meet criteria to get screened younger. Um, you know, just to give a few examples of patients who would require screening sooner, it would be patients who um who have gone through oncology treatments, like especially like the breast cancer treatments or ovarian cancer, that they have to have uh suppression of their hormones that can induce bone loss. They should be screened earlier. Um, patients who have family history of osteoporosis or if they have a personal history of a low energy fracture, then those patients uh they should also be screened.

SPEAKER_03 4:06

Okay. So you've got injections, you've got oral, you've got infusions, they all kind of sound the same to me. Can you break it down?

SPEAKER_02 4:14

So um this is probably gonna be the easiest way to explain. Okay. So basically, this is like the phases of bone remodeling. So these cells here, these are the osteoclast, and these this whole line of cells, they, you know, they turn into the osteoclast. This side uh are the osteoblasts, which are the building cells. So when we're talking about treatments, these are the areas that we right now have uh medications that would manipulate. So we've got medications that will uh decrease the absorption of bone, which would be on this line, or there would be uh medications that increase uh the bone formation, which would be on this line. Okay. So there are medications that are specific depending on the risk fracture, the risk, the risk of fracture uh for patients um that would determine which side we work on. Okay, so why can't I just take oral medications? It's easier, I can take it at my home, I don't have to leave. Why not just do that? So again, depending on the risk of fracture. So patients who have already had, for example, a hip fracture, right? Um, they're considered a very high risk of having either another hip fracture or another fracture. Right now, the oral medications, they only work on the line that decreased the absorption of bone. So those patients that they're considered a very high risk, we would actually want to build bone at a rapid pace.

SPEAKER_03 5:33

Okay, so you mentioned the age, but what if you had cancer at a very young age? Is this something that you should really look into? Because, you know, doing chemotherapy kind of really just messes with a lot of things.

SPEAKER_02 5:48

Yes, absolutely. So um, you know, thankfully the MCI oncologists that we have here, they're actually they're on it. They're on top of it. Uh, the vast majority of the times they will order a bone density um before patients are either given um chemotherapeutics that will affect the bone, or if they know that they have to be on uh hormone therapy that will suppress uh the hormones, they will go ahead and they'll get like a baseline bone density. And that um typically helps them, you know, target their treatment. Yeah. There's a lot of side effects though.

SPEAKER_03 6:22

Can we talk about the side effects and what if patients can't tolerate these side effects? What other options do they have?

SPEAKER_02 6:28

Yeah, that is a very common question. So, I mean, like I said, there's we've got the oral medications, we've got the IV medications, and we've got the injectables that uh go subcutaneous. And each of them they have like their whole um profile of of side effects. Um, you know, do you want me to get into like the nitty-gritty of it? Yeah, you surface nitty-gritty of it. Surface nitty gritty. Okay. So as far as like the oral treatments, um they can cause like an upset stomach, things like that. Sometimes you can get some muscle aches and pains, or um what patients refer to as like flu-like symptoms. Okay. Um I have to tell you though, that you know, the majority of the side effects that patients report, most patients, they actually do tolerate these treatments quite well. Um, as far as like the injectables go, same thing. You can get a little bit of achiness, things like that. Um, some medications can cause a little bit of dizziness. Usually that's very short-lived. Right. Um, and then the IV infusion, usually it's like just like the couple of days after you get the infusion. And then you're done. And then you're done. Exactly. You can live your normal life. Oh, absolutely. And it's encouraged. Uh the only thing you're not allowed to do is fall.

SPEAKER_03 7:44

Oh, yeah. Well, you know what? You never want to fall anyhow. I highly recommend not falling. Uh walk us through a patient journey, what it's like of an infusion treatment.

SPEAKER_02 7:55

So typically, uh, you know, after the patient has been identified, uh, whether they have uh, you know, a high risk of fracture or a very high risk of fracture, which is another category that we use often in osteoporosis, that will determine what uh the course of treatment will be. So uh if it's a patient that requires uh referral to one of the infusion centers, then you know, the team over there will work on getting the authorization from insurance and whatnot. And then they will call the patient to schedule them. And depending on the treatment, so if it's IV infusion or if it's subcutaneous, then they will um that will determine the duration of time that the I was just gonna ask you how long it should take. It's about an hour give or take. Okay.

SPEAKER_03 8:39

All right. So it's it's coming for an hour once a week, once a month.

SPEAKER_02 8:45

How does it work? So depending on the treatment, right? So um the injectables, there is injectables that are once a month, there is injectables that are once every six months, so twice a year, and then the other one that's the Ivy infusion is annually.

SPEAKER_03 8:59

So I we have all these options, but can I say what I feel will work best for me, or would do we work together and come up with a plan?

SPEAKER_02 9:08

Absolutely. So as we say in in bone health, um, some medications are better than others, but something's better than nothing. And the whole goal of this is to lower the risk of fracture or lower the risk of secondary fractures or tertiary or hopefully, hopefully not more than that, right? Yeah. Um, but uh yeah, so you know, it is a conversation that you that I have with patients, absolutely. And I say, look, you know, these are the criteria, this is the criteria that you have for this specific kind of treatment. Um, if you're interested, we can try it. If patients don't tolerate it, there's always another option that we can fall back on. Uh, but it is a it is a conversation, absolutely. You know, a lot of people are talking about food, what you put in your body, working out, staying healthy.

SPEAKER_03 9:53

If you have osteoporosis and you're going through infusions, what does life look like when it comes to working out? And are there things that we should be eating that could help?

SPEAKER_02 10:03

Yeah. So obviously, you know, we want to make sure that you're getting enough calcium through your diet, specifically through the diet. Uh, we have moved away from the synthetic calcium supplements, and we're encouraging getting as much calcium as you can through your diet. Well, with a limit, obviously, right? Yeah. Because too much of anything is bad. Not as bad. But but yes, you want to try to focus on getting the right amount of calcium through your diet first. And of course, vitamin D is another uh big factor. And how about working out? Exercise, absolutely. So we know that um exercises that are specific for strengthening or resistance, those are the only exercises that have been proven that can actually reverse bone loss. I was just gonna ask you if you can actually reverse this. That's absolutely I get that question all the time. At any age. Really? Any age, yes. And it's simple by working out. You can do working out, you know, optimizing your calcium intake through food, making sure you have adequate vitamin D so that you're able to absorb that calcium, right? Um, and you want to stimulate your bones. So when when you're talking about exercise, right? Strengthening exercises, that muscle contraction is gonna what's is is gonna be what stimulates your bones to be motivated so that they can regrow and regenerate. If you're sedentary, right, your bones are not motivated to grow uh because they're not feeling the stress.

SPEAKER_03 11:26

So is this what you would tell a 30-year-old, a 40 or 50-year-old that has a family history of osteoporosis?

SPEAKER_02 11:33

Absolutely. Get in the gym. Get in the gym, exactly. I mean, safely, right? Yeah. You know, you want to make sure that, you know, if they're not somebody who has worked out consistently throughout their life, you want it to be guided at first. So maybe physical therapy would be a really good uh starting point. Um, or like, you know, just kind of like an exercise guide. Some patients they like to hire personal trainers too. That's a good option. I was gonna say it's kind of scary too, because once you've fallen and you get hurt and you have to recover, it's it's not an easy journey. It's not an easy journey. And it's yes, and it's uh it it's traumatizing for patients, absolutely. It is extremely traumatizing. Um, how do providers measure the treatment success? That's a great question. So, some medications we can do uh tracking by labs. So, like periodically we'll be checking labs to make sure that they are responding appropriately to treatment. Um, but for the most part, the gold standard is really the bone density. Okay.

SPEAKER_03 12:28

But can as a patient, would I be able to feel my bones getting stronger?

SPEAKER_02 12:33

How does that work? So that's that's actually uh an interesting question because some of the medications, like I said, that work on the area that build bone, um, you actually can get like what people describe as growing pain. Just like when you were a child and you were you had like these periods of growth spur. My 13-year-old tells me all the time she has growing pains. Yeah. So so some patients they describe that. Yeah, absolutely.

SPEAKER_03 12:57

Right. So can you feel it or can you feel it get stronger?

SPEAKER_02 13:01

Yeah, yeah. That's amazing. Some patients do, some patients they don't feel it, but then when we do the bone density, we notice improvement.

SPEAKER_03 13:07

Okay. What if there's no improvement? What does that look like? I don't want to be a Debbie Downer, but we have to ask the questions that people are searching.

SPEAKER_02 13:14

That's that is a good question. That's a valid question. Not, you know, patients are not cookie cutter, and what may work for this patient may not work for the next. So that's where, you know, you have to look at history, you have to look at um uh you have to look at the the options. And if some patients, if they don't have an appropriate response to one therapy, uh, then we can try we can try another route. You know, some patients respond really well to the anti-resorptives or the ones that affect the bone uh absorption, you write the osteoclasts. And then some patients uh they don't respond to that. So then we have to go to the bone-building drugs and vice versa.

SPEAKER_03 13:51

Yeah. A lot of pivoting, I'm assuming, happens during this, you know, process where it's not working and you try to figure out what happens. And I have to assume, and correct me if I'm wrong, that throughout time, a lot is reached a lot of research has been done on osteoporosis. Correct. And the way it was treated 15, 20 years ago is not how you guys are treating it now. That is absolutely correct.

SPEAKER_02 14:16

So um, you know, they thankfully there is a lot of research going on in the bone health world. And that's great because it's it's serving as a guide. And before we used to put everybody on oral medications first, right? And that was the first line treatment. But we discovered that the patients that were identified to be at a very high risk of having fracture or who have already fractured, um, now the gold standard is to put them on bone building drugs first. Okay. Especially if they haven't been on other like treatments before, like anti-resorptives, because then their bones are more receptive. How long are they on that? So depending on the treatment. Um, so it could be either a one-year treatment. So one one treatment uh monthly for one year, okay, or there's a daily injection uh for two years. I make a joke and I say that it's the Ozempic for bone.

SPEAKER_03 15:10

Oh, that's a good one. It's like, you know, everybody's injecting themselves already for Ozempic. Why not help your bones? That's but that's fairly new. Correct. It's fairly new. What are the side effects to that? To which one, though?

SPEAKER_02 15:22

To the injection. To the daily injection. Yeah. Um, so that one Besides just the daily injections. Yeah, just the daily injections, it it can be cumbersome, and I I totally get that for patients. Um, but for the most part, in some patients, they describe a little bit of dizziness with it. Some patients can describe um a little bit of palpitations. I always, you know, tell patients that it doesn't affect their heart structurally. At least we don't have any evidence to show that that's the case. Yeah. Um, and most patients, like as they're adapting to the treatment, you know, they might feel a little, you know, dizzy or whatever, like at the beginning. And then as as they progress through the treatment, typically they are able to overcome those side effects. Okay.

SPEAKER_03 16:03

Why is preventing fractures a major treatment goal for you guys?

SPEAKER_02 16:09

So, you know, we always say that like when you have a hip fracture, right? If we're talking about a hip fracture, that's the equivalent of like having a heart attack. And everybody knows that you want to prevent a heart attack. Correct. We even call it a hip attack, right? So it's absolutely critical because um, you know, you even now in 2026, where we are like at the top of our game with like treating hip fractures, there's still like over a 20% risk of morbidity and mortality. And a lot of patients are not able to return to function. I mean, I would say a majority of patients do not return to function. To their baseline level of functioning, exactly. So it it is a big deal from an independence standpoint. Um, you know, if we talk about vertebral fractures, you get one vertebral fracture and you're at risk for getting more, right? So um, you know, that's the goal. And the the main goal and the main focus of this is for patients to maintain their independence, right? And function. Right.

SPEAKER_03 17:08

But I also think a lot of times we don't really hear about testing, going out there, getting checked. What is your baseline if you don't know what your baseline is?

SPEAKER_02 17:18

Yeah. So like if you have risk factors that are identified that can put you at risk for having bone loss, then absolutely you should go out and get screened and get a bone dental. Isn't that the beauty of getting older? Yes, that's exactly right. And everybody loses bone. Um, you know, ideally though, the prevention starts like from like the infancy stages, right? Yeah. You want to make sure that they're that your children are getting enough calcium, right? You want to make sure that they're getting enough outdoor play because we know outdoor play is critical. Right. The jumping, falling off of the monkey bars, all that normal normal try to avoid. Exactly. All the things that you want your kids to experience, all of that is critical for, you know, for building bone density. So when you, as you're aging, right, from from your infancy into early adult years, you do something called uh called or you do something, let me see, how do I sphrase that? Uh you you you're at the point where you're trying to build your peak bone mass. Oh, right. So peak bone mass. So if you're up here. But at what, what, what level in your life do you want to achieve this? Uh about age 30. Around there, around age 30. So from the time that you're a child all the way till you're 30 years of age, majority of patients, that's where they're able to reach their pink bone mass. Okay. So once you're there, right? And especially like women, right? So one in two women can develop osteoporosis, right? So if you have a peak bone mass that's up here, once you hit menopause, which we all will, that perimenopause, you can lose up to 10% of your bone in the first five years of menopause. So if your peak bone mass is up here, then you can tolerate that loss. But if your bone, if your peak bone mass is down here and you lose that 10%, that's when you can get into the negatives and that's when you can have those higher risk of fractures.

SPEAKER_03 19:16

So is it okay, April, if I push back a little bit and say, you said at the age of 64, we should start checking our bones. But if you're a woman in her 40s and you're going through perimetopause, what a great time to see. But absolutely those 30s were back there. So I don't know my baseline.

SPEAKER_02 19:34

Yeah, exactly. No, so I mean, yeah, it it would be important to get screened early. Early. Yeah, absolutely. And like I said, there are specific um patients that do require early screening, and uh, and that would be one. Uh vitamin D. I've heard that vitamin D actually helps. How so? So you you want to get vitamin D because the vitamin D helps you absorb the calcium in your gut, right? So you want to make sure that you have adequate vitamin D levels.

SPEAKER_03 20:00

Everything is all correlated, huh?

SPEAKER_02 20:02

Everything is all correlated.

SPEAKER_03 20:03

Yep. Everything comes together. Yeah, it all comes together. And how does that vitamin D actually help, though?

SPEAKER_02 20:08

So that will help you absor absorb the calcium in your gut, and then that will help lead the calcium to your bones where it should go, right? Because that's where the storage is for calcium.

unknown 20:17

Wow.

SPEAKER_03 20:17

Uh tell me about the once the patients have gone through this journey, what what should they expect? I mean the biggest takeaway that you have for them.

SPEAKER_02 20:28

So, you know, there's a very common misconception that these medications are going to um give you a lot of side effects. And yes, I do have some patients here and there that do report side effects, but the majority of the patients, they really don't experience side effects and they tolerate these treatments quite well. And, you know, the goal really is to try to decrease the risk of fractures and maintain independence and a high level of functioning, right? Okay. So that's really what the whole purpose of all of this is.

SPEAKER_03 21:03

So I'm curious to ask you if uh you have fallen, you've had had a hip surgery, and you're on this journey right now of just trying to get yourself better. Would uh having infusions would that help?

SPEAKER_02 21:19

Absolutely. Absolutely. That's something to look into. That's an yeah. I mean, obviously there's no treatments that will lower your risk of fracture to zero. Um but the medications that we have out now, they lower the risk of fracture in the 70th and 80th percentile at this point.

SPEAKER_03 21:35

Since you're looking kind of at the future and, you know, with osteoporosis, how much it has changed to where we are now, how how bright does the future look? And science helping? And I'm assuming that AI has also a lot to do with it, with how it's kind of helping moving along people with osteoporosis.

SPEAKER_02 21:55

Yeah, you know, um the future looks really good, especially because now we know that if we're able to prevent fractures uh for patients who have a high risk with one of these bone-building drugs, we know that we can radically reduce their their risk of having another fracture or avoiding a fracture altogether, right? So in that sense, because like the table has turned and now the push is for more bone-building drugs than the bones uh than anti-resorptive agents, um, that's great because now the patients are getting a preventative treatment up front, right? Um, and as far as like AI goes, you know, yes, it is something that that we use. It is a tool. Um, it is not the ultimate, you know, deciding factor on as far as what treatment. But yeah, you know, sometimes like there's patients that they just have like bizarre clinical pictures and it and it can be used to kind of give us a little bit more clarity on the situation. Right, which we'll take.

SPEAKER_03 22:55

Yeah, exactly. Kind of we'll take any type of clarity. But when you say we're want to avoid fractures, I think great, I'm not gonna do anything. I'm just gonna hang sit on my couch.

SPEAKER_02 23:08

No, because then it's gonna make your bones worse, right? Sedentary lifestyle is is another risk factor for bone loss. So we want to avoid that as well.

SPEAKER_03 23:15

We want to avoid that as well. April, thank you so much for your time and talking to you. It really has been a pleasure and for informing all of us. Remember, viewers, be sure to hit that subscribe button on our channel to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts, so you can tune in anytime, anywhere. Be healthy. Thanks for watching.

SPEAKER_00 23:40

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