<p><a href="https://peterattiamd.com/bonehealth/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250707-pod-bonehealth&utm_content=250707-pod-bonehealth-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250707-pod-bonehealth&utm_content=250707-pod-bonehealth-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250707-pod-bonehealth&utm_content=250707-pod-bonehealth-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>In this episode from July 2022, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it's measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods.</p> <p>While this original episode is an AMA, it is available in full to all listeners as a special rebroadcast.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Overview of bone health topics to be discussed [2:30];</li> <li>Bones 101: bone function, structure, and more [6:15];</li> <li>Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [9:30];</li> <li>The consequences of poor bone health [14:30];</li> <li>The devastating nature of hip fractures: morbidity and mortality data [18:00];</li> <li>Where fractures tend to occur in the body [23:45];</li> <li>Defining osteopenia and osteoporosis [25:30];</li> <li>Measuring BMD with DEXA and how to interpret scores [28:00];</li> <li>Variability in BMD between sexes [35:15];</li> <li>When should people have their first bone mineral density scan? [37:45];</li> <li>How BMD changes throughout the life and how it differs between men and women [40:15];</li> <li>How changes in estrogen levels (e.g., menopause) impact bone health [45:15];</li> <li>Why HRT is not considered a standard of care for postmenopausal bone loss [49:00];</li> <li>Factors determining who may be at higher risk of poor bone health [52:00];</li> <li>Common drugs that can negatively impact BMD [55:45];</li> <li>How children can optimize bone health and lay the foundation for the future [59:30];</li> <li>Types of physical activity that can positively impact bone health [1:03:30];</li> <li>How weight loss can negatively impact bone health and how exercise can counteract those effects [1:12:15];</li> <li>Nutrition and supplements for bone health [1:16:00];</li> <li>Pharmaceutical drugs prescribed for those with low BMD [1:18:45];</li> <li>Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:23:30]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Prioritize Early Bone Health
Begin focusing on bone health prevention decades before old age, as fracture-related death rises steeply after 65, especially following hip and pelvic breaks.
2. Embrace Resistance Training
To significantly improve or maintain bone mineral density (BMD), prioritize resistance training, powerlifting, and high-force impact sports that apply substantial strain to muscles and bones, as these are more effective than aerobic activities.
3. Optimize Kids’ Bone Development
For children aged 8-20, ensure adequate nutrition and engage them in physical activities that load bones, such as jumping and lifting, to help them reach their full genetic potential for BMD and avoid early smoking.
4. Essential Bone Nutrients
Prioritize daily intake of calcium (1,000-1,200 mg), vitamin D3 (800-1,000 IU), and magnesium (300-500 mg, ideally up to 1 gram) through diet and supplementation to optimize bone deposition.
5. Consider HRT for Bones
Postmenopausal women should consider bone health as a factor when evaluating Hormone Replacement Therapy (HRT), as it has been shown to decrease fracture risk without increasing cardiovascular disease risk when using topical estradiol.
6. Screen Women in 30s
Consider screening women for bone mineral density (BMD) as early as their 30s, as identifying low Z-scores at this age allows for earlier intervention and optimization before menopause.
7. Combine Weight Loss with Exercise
When losing weight, combine caloric deficit with significant exercise to help maintain or even gain bone mineral density, offsetting the potential BMD reduction associated with weight loss through diet alone.
8. Incorporate Rucking Regularly
Engage in rucking (walking with a weighted backpack) or farmer’s carries regularly, especially on varied terrain like hills, to apply mechanical stress to bones and muscles, promoting bone mineral density.
9. Avoid Youth Smoking
Avoid smoking, especially before age 16, as early smoking significantly impairs bone mineral density development, leading to worse bone health outcomes later in life even if one quits.
10. Manage Corticosteroid Effects
Be aware that corticosteroids impair bone mineralization and inhibit calcium absorption; if their use is necessary, actively work to counter their effects through other bone-supporting strategies.
11. Combat Immobility Bone Loss
During periods of immobility or bed rest, engage in any form of physical therapy that actively loads muscles, including isometric exercises or blood flow restriction (BFR) on unaffected limbs, to counteract disuse osteopenia.
12. Verify DEXA Scan Details
When getting a DEXA scan for bone health, confirm the provider offers segmental bone analysis for the left hip, right hip, and lumbar spine, as whole-body BMD alone may not be sufficient.
13. Optimize Magnesium Intake
Consider supplementing with various forms of magnesium, such as magnesium carbonate in the mornings and magnesium oxide or glycinate at night, aiming for a total supplemental intake of around one gram daily.
14. Supplement Dietary Calcium
If dietary calcium intake is insufficient, consider supplementing with calcium carbonate or calcium citrate to meet the daily requirement of 1,000-1,200 milligrams.
15. Prudent PPI Use
If taking Proton Pump Inhibitors (PPIs), ensure the drug is truly indicated and explore other strategies to mitigate the potential risk of increased osteoporotic fracture due to impaired calcium absorption.