Hello, and welcome to the Rev Up Health Podcast. Today we're going to be talking about osteoporosis and bone health. A lot of folks take this part of our body for granted, but bone health is extremely important. We hope we can shed some light on it, give you some food for thought, and leave you with ideas you can use to improve your own bone health and take it more seriously.
It's important to note that while we usually hear about osteoporosis in women, it affects men too — it's just more prevalent in women.
What Healthy Bone Actually Is
Bone is made up of different components — organic and inorganic — along with other things that make up the matrix, and collagen is an important part of that. To have healthy bone, we need strong bone mass, but we also need flexibility. Flexible bone is less likely to break, and that's really the key thing we want you to take away.
For healthy, flexible bone mass, we need an active "circus" going on: a balance of osteoblasts and osteoclasts — a buildup of bone and a breakdown of bone. When those two happen simultaneously and in balance, we get the healthiest bone, with nice flexibility and solid bone mass.
From Osteopenia to Osteoporosis
So what does it mean when we start having thinner bones? First there's osteopenia, and further along there's osteoporosis. Osteopenia is a thinning of the bone matrix — a less dense bone — compared to a young, healthy adult. It means your bone isn't as dense as it used to be. When that bone loss continues and advances, it becomes osteoporosis, which means an increased fracture risk and a loss of flexibility, so the bone becomes more rigid.
For those of you who have osteopenia — that does not mean you'll for sure develop osteoporosis. But it's good to know so you can start making lifestyle changes and work to build that bone back up. You can build bone at almost any age, and you can lose it at almost any age too. Some studies show people even in their 30s with osteoporosis — which makes sense, because your 30s is when you start losing muscle, and muscle loss is one reason we lose bone strength.
Measuring Bone Density
The gold standard for measuring bone mineral density is the DEXA scan — dual-energy X-ray absorptiometry. Bone is measured on its density, and as bone thins, your DEXA numbers get worse. They look at the T-score, which always compares you to young, optimal bone. Osteopenia is a score less than -2.5; once you get beyond -2.5, you're in the osteoporosis range, where fracture risk increases.
There is a small amount of radiation with a DEXA scan — roughly the amount you'd get flying from the west coast to the east coast, so it's very negligible. Getting one at a younger age is a good idea, because you can't plot a graph or know whether you're improving or declining without two points. You need an initial measurement and then a later one for comparison. Menopause and andropause are especially important times to check where you are and decide what to change in your lifestyle and diet.
Statistics and Clinical Impact
About 10 million Americans have osteoporosis, and another 44 million have lower bone density (osteopenia), so it's very common. General screening often starts at age 65, but we really need to think about doing it a little sooner so we have two data points to compare.
Most osteoporosis fractures occur in the hip, wrist, and spine, and that's where the more serious health implications arise. For hip fractures, roughly one in two women and one in four men will develop a fracture — again showing it's more prevalent in women. A hip fracture has a real impact on morbidity and mortality. If you're already sedentary and you have a fracture, you become even more sedentary, which can lead to problems like clots, along with frailty and sarcopenia — muscle wasting. And it takes stronger muscles to build stronger bones.
The mortality numbers are significant: about 30% of adults over 65 who suffer a hip fracture will die within the first year, and that risk roughly doubles in the next year. The older we get, the worse the outcomes.
Modern Diagnostic Tools
The DEXA scan is the gold standard — it's common, widespread, inexpensive, fast, and easy. You essentially just lie down for an X-ray. We've both had it done.
We also look at body composition, which tells us about our bone and muscle components and how dense we are. It's not as good as a DEXA scan, but it's a point of reference that shows whether you're doing something right — if you are, it improves. There are also bone turnover markers. Dr. Doug Lucas is doing a lot of work on this in his clinic, looking at P1NP-to-CTX ratios — essentially the amount of bone you build up versus the amount you break down. Those should be in balance. More studies are needed, but there's good reason to think that balance matters and that there are things we can do to improve it.
Treatment Options
For treatment, we have pharmaceutical options and bioidentical hormone replacement. The pharmaceuticals generally inhibit osteoclast activity, which slows bone breakdown. But remember, it's important to have balance — you need both buildup and breakdown for healthy, flexible bone. When you alter that, you can create more brittle bone, which may not be as healthy. It's an option, but it's something to keep in mind. These include the bisphosphonates like Fosamax and Boniva, and the SERMs (selective estrogen receptor modulators) like Evista, along with newer medications like Evenity and Prolia. Some of those are injectables, and you can't be on them forever — some can only be used for a year before moving on to something else. There are toxicities and risks associated with them, which is why it's so important to know what you can do from a lifestyle and supplement standpoint to stack the deck in your favor.
Then there's bioidentical hormone replacement. There are great studies showing this is an optimal way to improve bone health, quality, and flexibility. We're talking about testosterone, estrogen, progesterone, and even thyroid. If we can optimize our hormone levels, we can not only maintain bone but probably build it — and coupled with a proper diet and exercise routine, that really sets you up to be in good shape as you get older.
Prevention: Supplements
Everyone thinks bones need calcium, and while you do need calcium, a calcium supplement isn't really necessary. Vitamin D, however, is a great one to add, and so many people are deficient — we see people come in on the low end all the time, because we're indoor people now, not the outdoor hunters and gatherers we were 100 or 200 years ago. That's changed our bone. Interestingly, one study compared DEXA scans of old, exhumed bones to today's people and showed about a 300% difference in the components of the bone, even an increase in lead — which also affects bone.
For vitamin D, the normal range is about 30 to 100, and you want to be on the higher end. It's a fat-soluble vitamin, so you can overdo it, but it takes a lot — you'd need to be around 250 for toxicity, so being around 100 would be great. Vitamin D is very important for calcium absorption, bone health, and hormone health. Vitamins A, D, E, and K are all important for calcium deposition in the bone. And, when indicated, estradiol, progesterone, testosterone, and thyroid replacement are important too.
Prevention: Exercise
We've talked a lot about this, but lift heavy things — you can't drive that home enough. Nothing builds bone better than good, healthy muscle. When you build muscle, you stimulate and bend the bone, which helps your body repair, build up, and replace old bone.
Impact is the other piece — jumping up and down off boxes, and farmer's carries (lifting heavy things and carrying them for long distances) are great for bone health. Eccentric exercises are good too, both for muscle and for the fast-twitch (type II) muscle fibers that help you catch yourself going down stairs or when you start to fall. You build those with explosive, high-intensity interval training and heavy lifting. Any resistance training — bands, weights, even body weight — is a great start. Just do something.
Prevention: Lifestyle
Lifestyle modifications matter too. Stopping smoking and alcohol directly affects our bones, and maintaining a healthy weight is important. One tidbit people don't think about: vision and hearing correction. Make sure you can see where you're going so you don't fall, and hear when something's coming so you can get out of the way. So get your glasses, and make sure you can hear.
There are also support groups out there. It can be helpful to meet other people dealing with osteoporosis who also want and need to build bone and muscle. We've had personal dealings with elderly relatives who fell, broke a hip, and unfortunately succumbed to it, so this is not something to take lightly — it's all around us.
Key Takeaway
If you're young, you can have a fracture and still have the muscle strength to build yourself back up — but what you really want is to avoid a fracture in the first place. There's so much you can do, and you can avoid it as long as you're proactive and know where you are. The key takeaway is to be proactive: do what you can to keep the bone you have and build as much as you can. It's like banking — bank muscle and bank bone, and that gives you the best chance at a long, healthy life. And it's never too late.
If you have any questions or comments, or want to share some stories, reach out to us. Have a healthy day.
Thank you for tuning in to another episode of Rev Up Health. We hope you're leaving with some valuable insights to supercharge your health journey. Don't forget to follow or subscribe to Rev Up Health wherever you listen to your podcasts, and if you enjoyed today's episode, please leave us a rating and review. Have a topic you want us to explore? Reach out to us on our social media channels — we love hearing from our wellness community. Until next time, keep thriving, and remember: your journey to health is a journey to a better you.
The information provided in this podcast is for educational purposes only and is not intended as medical advice. The content is designed to support, not replace, the relationship that exists between a patient and their healthcare provider. Always consult with a qualified healthcare professional before making any changes to your healthcare regimen, including diet, exercise, or treatment plans. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official policy or position of Revelation Health and Well-Being.