Ask the Expert: Payal Sahni, PT, MPT, DPT

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Payal Sahni, PT, MPT, DPT is the Program Director of New York State Osteoporosis Prevention and Education Program, and a medical advisor for Wellen. Dr. Sahni has extensive experience in orthopedic rehabilitation and research and specializes in osteoporosis. She regularly lectures at outreach programs organized for clinicians and patients on topics related to osteoporosis, balance, fall prevention, strength training and nutrition for good bone health.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

1) Tell us about yourself and what you do.

I am a licensed physical therapist in the State of New York. A typical day at work for me includes providing direct patient care in the orthopedic department, continuing research projects and organizing community outreach programs. The last decade of my career has been dedicated to caring for patients with osteoporosis and educating the community and other medical professionals about prevention of osteoporosis. I am a strong proponent of lifestyle changes in terms of exercise and correct nutrition for preservation of bone mass. This view of mine is not only supported by my clinical experience, but also by strong evidence from research. I believe in treating an individual as a whole and not categorizing problems based on the type of diagnosis or body part.  

2) What made you decide to focus your work on people with osteoporosis?

In 2006, I was approached by the New York State Osteoporosis Prevention and Education Program to speak on the importance of posture and body mechanics in people with low bone mass. In preparation for the talk, I started looking into research related to osteoporosis and realized how widespread the condition of low bone mass is among various age groups. I also realized the gap in treatments since for a very long time, osteopenia/osteoporosis has been studied and treated as a disease of the elderly. That point was the beginning of my clinical journey in the field of osteoporosis. 

3) For women diagnosed with osteopenia, the first question they have is understandably, “How can I reverse this?”

What are some of the lifestyle changes women with osteopenia can make to improve their chances of reversing their diagnosis and ensuring it doesn't turn into osteoporosis?

Making a lifestyle change is the most effective way to not only stabilize and improve bone mass, but also prevent bone loss. The sooner you adopt this bone-healthy way of life, the stronger your bones will be. These changes include regular strengthening and aerobic exercise and eating a well-balanced diet rich in calcium and vitamin D. More information can be found on the NYSOPEP website.

Another important factor in prevention of bone loss and fractures is in knowing your risk.

4) You’ve seen a lot of patients of a certain age who are working on improving their bone health. What would you tell younger people they can do to avoid developing osteoporosis?

Efforts to prevent bone loss and fractures later in life must begin in early and continue throughout the lifespan. The most effective of these actions are correct physical activity and eating right. Strengthening and aerobic exercise are two key components to be included in physical activity. Also making sure you consume the right amount of calcium and vitamin D daily based on your age, mainly from food sources. 

5) Are there any early physical signs of osteopenia/osteoporosis? If so, what are they?

There are no physical signs like pain, weakness, etc. that would point towards osteoporosis. However, there are some predisposing factors like small body type, scoliosis, loss of height, fractures, family history of osteoporosis, sedentary lifestyle, diabetes, rheumatoid arthritis and long-term usage of steroids, thyroid medication and some prescription antacids. 

6) What are the top three at-home exercises women with osteoporosis or osteopenia can do to prevent fractures?

The key to preventing bone loss and fractures is a combination of various exercises and a nutrient rich diet. Three effective exercises include sit to stand exercise from a chair, walking outdoors for at least 30 minutes per day and Tai Chi exercises for balance and flexibility.

7) Understandably, women with osteoporosis have a fear of falling. How do you help women overcome that fear as they continue their day-to-day activities? 

Fear of falling is real, especially in people who have fallen once. The fear of falling often times makes people reduce their activity to reduce their risk. It is helpful for people to know that participating in the right kind of physical activity, which includes strength and balance exercises, is the one and only way to overcome the fear of falling. Look for health and wellness professionals like physical therapists and personal trainers who have experience in designing exercise and nutrition programs and start your bone health journey by working with them. As your strength improves, your balance will also improve and these changes will result is reduced falls risk.

8) What do you wish more people knew about osteoporosis?

I wish more people knew we need to talk about ways to build healthy and strong bones right from the age of 9 years onwards. We can do this today for ourselves and as parents and grandparents for future generations. Osteoporosis is a pediatric disease with a geriatric manifestation. Therefore, it is never too early to talk about prevention.

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