The Second Silent Killer - Osteoporosis
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Osteoporosis Overview
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Welcome to the Clear Health Podcast. I'm Dr. Tom Rountree, a family physician, and this is the show where we turn the latest research into habits you can actually use. Today, we're talking about osteoporosis, a disease you can't feel until something breaks. This is why it's also called the second silent killer because high blood pressure is the first, but this is also something that progresses along without you knowing it.
And worldwide, roughly one in three women and one in five men over 50 will have an osteoporosis-related fracture in their remaining lifetime. And hip fracture in particular can change everything, including independence, mobility, and even life expectancy. Two studies published this year kind of challenge advice many of you have heard for decades.
One looks at the calcium and vitamin D supplements sitting in your kitchen cabinets, and the other ask which kind of exercise actually builds [00:01:00] bone. Then we'll discuss a specific plan, including exercise, nutrition, and fall prevention that you can actually start this week. Let's get into it.
How Bones Remodel
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All right, part one. What osteoporosis or what, what is this disease, right? Your skeleton is not a static frame. It's not something that is built like, you know, made out of wood or concrete. It's actually a living tissue, and that's constantly being broken down and added onto. So sometimes it gets removed, sometimes it gets built up.
And these cells that do this kind of work are called osteoclasts, which break down old bone, and osteoblasts lay down new bone. And through your 20s, you build more than you lose, and most of us reach peak bone mass around age 30. After that, the balance slowly starts tipping up, meaning it's going to [00:02:00] break down a little bit faster than it's built up.
And for women, a big problem with this is that the drop in estrogen at menopause speeds up bone loss for several years. And osteoporosis means bone has become thin. And think about like you have a sponge to clean your dishes, and if you look at that sponge, the holes are only so big. Now imagine those holes get bigger.
And as that happens, and let's say the sponge hardens up, it's gonna get really brittle, right? You'll probably be able to break it with just using your fingers and pinching them together and breaking off a piece of that sponge. Now, when the bones become thin and its internal architecture has deteriorated, it breaks under force that a healthy bone would handle.
Think about you're elderly and your grandson comes to give you a nice big hug [00:03:00] and it breaks a, like a rib. Or let's say you go to shake somebody's hand and all of a sudden you have a little bit of a wrist fracture. And so these are not normal. Now, you could also have a fall from standing height and let's say you break something like any type of bone.
That is also concern for osteoporosis. And unfortunately, besides breaking the bones, it doesn't have a lot of symptoms. So for many people, the first sign is a broken wrist, a spine, or even their hip.
Screening And Risk
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And that's why screening matters. A DEXA scan, which is kind of like a place where you, you go lay down on this, um, like this bench-looking thing, and then the scanner goes over the top and then comes back.
It helps to look and measure at your bone density. And a T-score is what you get back A T-score kind of compares you to other people [00:04:00] in your age group. So a T-score of minus 2.5 or lower defines osteoporosis. And the current US recommendations recommend screening women 65 and older and younger post-menopausal women with risk factors.
This includes things like low body weight, smoking, heavy drinking, long-term steroid use, or even if you have a parent that broke their hip. Now, in men, you should definitely ask your doctor, especially if you have those risk factors. Now, men kind of have at their peak bone density, meaning as thick as their bones can get, their bones are thicker than women when this occurs.
So in their 20s or so, we reach a age at which our bones are the thickest they can be. Now men, they get bones that are even thicker than women because their bones are longer, so they need more bone [00:05:00] to be laid down. Now, I want you to hold onto this kind of thought or this frame. A fracture takes two ingredients: a weak bone and a force, and most hip fractures happen in a fall.
So our plan has two jobs: make the bone stronger and keep you off the ground
Calcium Vitamin D Study
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Okay, let's talk about this first study. Um, we're gonna talk about calcium and vitamin D pills. Do they prevent fractures? Well, in May of this year, the BMJ published one of the largest reviews ever done on this question. Researchers led by Oliver Messé in Montreal pieced together 69 randomized controlled trials, about 154,000 adults, and they compared calcium, vitamin D, or both against a placebo, which is like sugar or no treatment.
The person took calcium or they took vitamin D or they took [00:06:00] both together, and we're comparing this against a sugar pill or no treatment. And these people were not taking prescription osteoporosis medications. So the result, vitamin D alone did nothing, for the fracture risk.
A risk ratio of one, and that's high certainty evidence from 36 trials and over 92,000 people. Calcium alone showed a small trend that wasn't statistically significant. And calcium plus vitamin D together did reach significance, about 9% relative reduction. But in absolute terms, that was like roughly one percentage point, so not even a lot.
And this is below the author's own threshold for meaningful benefit. Now, that could depend on what does the author define as a meaningful benefit. But they also found little to no effect on hip fractures, spine fractures, or falls. Now, we have to think about what kind of setting is this [00:07:00] in. These are people who lived independently and weren't at high risk of fracture.
So it does not mean you should stop your calcium and vitamin D if you've been diagnosed with osteoporosis and you're on medication that helps promote bone growth, like alendronate or denosumab. And these drugs need adequate calcium and vitamin D to work
None of these patients were on bone growth medications. And it doesn't apply to anyone with a vitamin D deficiency or to nursing home residents where the evidence was not really there for this.
So my takeaway is like a pill is not a bone strategy. For most healthy adults, the bottle in the cabinet isn't doing the heavy lifting, right? The pills do not build skills that you need in order to combat osteoporosis effectively. Whole food should be your foundation. And as you're about to hear, so is [00:08:00] actually heavy lifting.
Exercise That Builds Bone
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Now let's talk about the second study, which exercise actually builds bone? Now, this was done in Sichuan University, so not in the US. This pulled together 162 randomized trials. There were more than 10,000 adults from age 18 to 80s, and they compared 10 types of exercise, ?
What exercise do they compare? All right. So they compared, um, resistance training, like let's say lifting weights, which is one of my favorites 'cause you can just go up on it when you need it. Impact work like jumping, also a good one. Aerobic exercise, also good for the heart and blood pressure, all that good stuff.
Tai chi, good for balance. Water exercise, good if you are overweight and it's difficult to move. Vibration platforms, [00:09:00] not a fan of those, and combinations. The headline was "Structured Exercise Improve Bone Density at the Lumbar Spine and the Femoral Neck." This is where the, the top of the thigh bone, so like your large bone in your leg, it connects into the hip bone itself, okay?
It looks like a little ball with a little stick, right? Big stick. So this is right where the hip fractures happen, and the effects were small to moderate, and the femoral neck findings carried high certainty evidence. Resistance training, like I love, was effective across several sites, right? Your wrist, your lower back, your spine, your hip itself.
So, um, aerobic plus resistance training ranked highest for the spine. Tai chi was also ranked decently. , And impact plus resistance work was the leader for whole body bone density
[00:10:00] So there are three details that should shape the plan. The strongest programs tended to be supervised. So is somebody there pushing you to do the hard work? They were done at least three times a week and run for at least six months, okay? So you gotta be doing this for six months to reverse your bone growth, and it will, believe me, fix a ton of other things.
And there were no really serious exercise-related injuries. So the authors called their rankings exploratory, and they measured bone density, which is kind of more like a marker of strength and not fracture themselves. But the direction matches the well-known Lift More trial from Australia, Australia, where post-menopausal women with low bone mass did supervised heavy lifting and jumping twice a week and gained bone at the spine and hip without serious injury.[00:11:00]
So Lift More trial, check it out, look it up. It's a really good one on osteoporosis. Here's the shift, okay? We are not just going to walk and not lift anything heavy, right? This doesn't give the bone enough signal. Bone responds to load. We're gonna go up, and the load that we put on it, meaning the weight of the dumbbell, because the bone responds to that load
All right.
Bone Building Workout Plan
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Let's talk about your bone building prescription. All right? What are we gonna do? There's five pieces. One, we're gonna lift two to three days a week. We're gonna focus on big movements, movements that load the hips and spine, like a squat, a sit to stand from chair, a hip hinge like a deadlift, so like bending forward and pulling something up.
A push like a chest or overhead press. This is like the bench press or the pushing upward with the dumbbells. And a [00:12:00] pull like row. That helps us balance things out. For the first four to six weeks, do two or three sets of eight to 12 reps to learn that form. And we're doing a little bit lighter loads during this time.
Then progress toward five sets of five with a weight that feels hard by the last rep. So by the time you're on that fifth set and you're doing the last rep, that should feel pretty, pretty difficult. Now, if you could start with a physical therapist or a qualified trainer, then you will likely get more or better results.
All right. Secondly, we're gonna add impact m- on most days. Bone likes little quick jolts, okay? We're gonna do heel drops where you rise onto your toes then drop your heels firmly onto the floor, floor or stomp while you march or do small hops if you're able to. Start with like t- we're, we're thinking like 10 to 20 impacts and build to about 50 a day.
If you've had spine [00:13:00] fracture or you're high risk, stick with heel drops and get cleared by your doctor or physical therapist first, okay? Always do that. And then we're gonna train balance. Stand on one leg at the kitchen counter for 30 seconds. You know, put each shoe on. Stand in front of the bed and put your shoes on.
Don't sit down to put them on. Stand up and try and do it. I learned that one from, um, who was it? The famous martial artist guy, Bruce Lee. So that's what he always said. I remember when I was younger. Now You can also do Tai Chi two or three times a week, which covers balance and a little bit of bone together.
Now four, you're gonna protect your spine. Strengthen your back with exercises like lying face down and lifting your chest. So it's kinda like you lay down on your stomach, and then you're gonna lift your head up, okay? And then come back down. [00:14:00] If you have osteoporosis, avoid, like, repeated loaded bending and twisting, ?
Nutrition And Supplements
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Now, you're gonna eat for your bone. You're gonna get calcium from the food first, like whole food, all right? About 1,000 milligrams a day for most adults, 1,200 for women over 50 and men over 70. We're doing a cup of yogurt, glass of milk, fortified soy milk. That's about 300.
Salmon, like you can even do canned salmon, which not the best tasting, but you can do it. Calcium, set tofu, collard greens kinda fills up the gap there. , Those greens also bring vitamin K, which can help bone. , But you wanna get this from a food, not a pill. And if you take warfarin, the blood thinner, keep your intake steady, okay?
Aim for about one to 1.2 grams of protein per kilogram of body weight. So this is roughly 70, 80 grams a day. Like, let's say you weigh 150 pounds, 70 to 80 [00:15:00] grams a day So we're gonna spread this across each meal, meaning we're gonna eat some protein in the morning, say like eggs, in the afternoon like chicken, and at night like salmon.
This gives you the best protein boost. So there's several studies that show this. If you have osteoporosis or risk factors, ask for vitamin D level and then treat like that true deficiency, right? Like if you have it, then you need to take supplements to get it back in check. Now, the last couple of things are like avoiding toxins,?
This is the sixth pillar in lifestyle medicine. Keep your alcohol down, right? You don't need a ton of alcohol, , each day. We're talking if you drink, try to keep it to one to two times a week. And if you have [00:16:00] trouble, then you can look into Allen Carr's Easy Way to Quit Drinking. And the same thing goes for smoking.
Allen Carr has the same book for this. Put it on, , put it on play on your audiobook and listen to it because, you're slowly trying to change your mind, and this is a good way to do it.
Fall Proofing And Meds
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Then you're gonna fall-proof your home? Night lights, bathroom grab bars, no loose rugs. Get those guys tacked down.
There's like some, uh, sticky tape, which is like Velcro. So you put the tape on the floor, then you also put it on the on the rug on the underside, and you can Velcro it down. And then talk to your doctor about like any medications that make you drowsy or dizzy. One last thing. If your fracture risk is high, the medication is not a failure, right?
Lifestyle and medication work best together. We get on the medication, it helps treat us. We change our lifestyle at the same time, [00:17:00] and then we come off that medication
, This episode is for education, and isn't medical advice. I'm a doctor, I'm not your doctor. So talk with your own physician before starting a new exercise program or changing any medication or supplement, especially if you've been diagnosed with osteoporosis or have had a fracture.
Weekly Homework Wrap Up
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So here's your homework this week. First, if you're due for a bone density scan, schedule it. Second, calculate your calcium and protein for one , ordinary day, ? Look at what you've been eating. And then third, do some of those exercises that I talked about. Your strong bones are not gonna be luck or solely genetics.
They're built, ? One rep, one meal, and like one step at a time. All right? You can do it. And if this episode helped, please subscribe on Spotify or Apple Podcasts and share it with someone who needs it. For more visit my website, [00:18:00] drtomrowtry.com. I'm Dr. Tom Rountree.
See you next time
