Bone Health: Strengthening your Foundation
We usually don’t pay much attention to our bones. They are our silent, invisible supporters and we depend on them without giving them a second thought. But your bones are susceptible to the same harms that affect your heart, brain, liver and other organs. And they need your attention and care, too.
Most people think bone loss and osteoporosis are only concerns for older women. But bone loss happens to all of us as we age. The good news is that there’s so much you can do to ward off bone loss before it becomes a bigger problem. You are getting older every day, but you do not have to become frail or disabled.
Dr. Ashley Woods is passionate about bone health. Many of her patients – and even family members – have experienced bone loss and she has seen the devastating effects it can have on their quality of life.
Watch the video to learn more about maintaining the health of your bones:
- Discover the hidden enemies of bone health
- Learn what lifestyle changes with diet and exercise that can really make a difference in your bone strength
- Find out what supplements can help reinforce the strength of your bones and ward off bone loss
Your bones need your support to support you! Learn how to give them what they need in this webinar.
Strategies for Optimal Bone Health: A Comprehensive Guide
Maintaining strong and healthy bones is crucial for overall well-being, and understanding the intricate details of bone health can empower individuals to make informed lifestyle choices. In this comprehensive guide, we’ve delved into the essential factors influencing bone health, from nutrients and supplements to exercise recommendations and beyond.
Nutrients for Bone Health:
- Calcium: Calcium is a cornerstone for bone health, forming the structural foundation of bones. Adequate calcium intake, around 1000 to 1300 milligrams daily, is vital for maintaining bone density.
- Magnesium: Often overlooked, magnesium plays a pivotal role in over 300 metabolic processes. A deficiency in magnesium can impact osteoblast formation, contributing to lower serum calcium. Aim for 600 to 750 milligrams daily, maintaining a balanced calcium to magnesium ratio.
- Vitamin K: Essential for blood clotting and bone formation, vitamin K, particularly K2, supports optimal bone health. A daily intake of 45 milligrams is recommended for bone health.
- Protein and Collagen: Protein, at about 30% of your caloric intake, is crucial for building muscles, which, in turn, supports healthy bones. Collagen supplements may offer additional benefits, but ensure adequate protein intake from various sources.
Supplements:
- Silica: Silica, present in supplements like RegenAnew Plus™, aids in collagen formation, benefiting not only bones but also hair, skin, and nails.
- Omega-3s: Found in fish and flax seeds, omega-3s help lower inflammation, contributing to overall bone health.
- Vitamins A, C, and D: These vitamins play unique roles, from supporting osteoblast activities (vitamin A) to maintaining collagen structural integrity (vitamin C). Vitamin D aids calcium absorption, crucial for bone health.
- Zinc: Addressing common deficiencies, zinc supports thyroid function and collaborates with vitamin C to cross-link collagen fibers.
Exercise and Lifestyle Recommendations:
- Weight-Bearing Exercises: Engaging in weight-bearing exercises like bands, weights, and resistance training stimulates osteoblasts and contributes to bone strength. Ensure proper technique to prevent injuries.
- Whole Body Vibration Plates: Emerging studies suggest that regular use of vibration plates, like those around 30 Hertz, may enhance bone density and balance, offering additional benefits beyond traditional exercises.
- Jumping and Balance Training: While jumping exercises should be approached cautiously, activities like rebounding on mini trampolines and balance training can enhance overall bone health and reduce the risk of fractures.
- Stress Management: High mental stress levels can impact bone health by increasing cortisol levels, leading to decreased estrogen production. Prioritize relaxation techniques for optimal bone health.
Hormone and Estrogen Considerations:
- Estrogen’s Role: Estrogen stands as the primary hormone regulating bone mineral density, making it crucial for bone health. While hormone replacement therapy is a personalized decision, having some estrogen on board can contribute to maintaining bone density.
- Individualized Hormone Decisions: Hormone replacement therapy must be individualized, considering factors like age, cardiovascular risks, and personal health history. Consultation with a clinician is crucial for informed decisions.
Clinic Support and Supplements:
- Clinic Interventions: Clinics often recommend a holistic approach to bone health, incorporating assessments, lifestyle changes, and potential supplements based on individual needs.
- Creating Health Supplements at the Maxwell Clinic: Silica supplements like RegenAnew Plus™, among other core supplements, are frequently recommended to support bone health.
Final Thoughts:
Achieving and maintaining optimal bone health involves a holistic approach, including proper nutrition, targeted exercises, and lifestyle modifications. While supplementing with key nutrients is essential, combining it with weight-bearing exercises, stress management, and hormone considerations forms a comprehensive strategy.
Don’t get overwhelmed by the details. Understand the broader picture of bone health and take actionable steps for yourself and your loved ones. Measure key indicators, evaluate your risk, and make informed decisions in consultation with your clinician.
Remember, your bones are an integral part of your body’s foundation. Invest in their health, and enjoy the journey towards strength and vitality.
Feel free to share this information with those who might benefit from a deeper understanding of bone health. Let’s work towards a future where frailty is replaced with strength and resilience.
Are you ready to take charge of your health? Schedule your free 20-minute discovery call with our New Patient Coordinator to see how you can become a patient at MaxWell Clinic and start your healing journey today.
I’m Ashley Woods a physician here at the Maxwell clinic and I am doing a webinar today on
bone health so um welcome I want to tell you why I wanted to talk about this today is
because this is a very uh personal topic for me because I’m at increased
risk for um bone loss or osteopenia osteoporosis I have a very strong family history my
mom has osteoporosis pretty significantly my dad has not been tested but I think he probably has because he
has um poor posture and his height has been affected so I suspect he also has
osteoporosis and my father-in-law in the last year of his life fell just in his
in his home just on carpet and had a spinal conference compression fracture
um so um it affects a lot of people um and many of my patients have
osteopenia or osteoporosis and many of them do not want to take medications
um and so because of potential side effects and we’re not going into meds in
any kind of detail today because I’m talking more about bone health and what
you can do Beyond medications so let’s get started
Goals
okay their goals for our time together are to think more about our bone health
most people don’t think about their bones and to feel motivated to take action and to know why you’re taking
action and to know what to do exercise wise nutrition wise supplement wise and
to feel empowered with with those actions so bones are a bit of a dry topic
Bone Health
they’re not very sexy um when you most people don’t even think about bones
um they’re not aesthetic you know you don’t go and get BOTOX for your bones you don’t brush your bones every night
like you brush your teeth every night we just kind of ride around on them all day as our main structure and we just don’t
even think about them and they don’t usually make headlines like cardiovascular disease or cancer
um but we need to think about them um because we are all at risk for an
osteoporotic fracture as we age um and I’m throwing around terms that I
will Define later but osteoporosis is significant loss of bone density
osteopenia is on that Continuum and I have a side about that later so we’ll dig in a little bit there but unless you
have arthritis which is not what we’re talking about today um or osteoporosis or osteopenia you
probably don’t think about your bones much at all um and um why should we care I mean most
people think oh old white women get osteoporosis yeah well men get it too uh
and it’s not um it’s not just white women it’s all Races although uh white
women are increased risk and so when you look at this picture you think well I don’t want to look at like the woman
Skeleton on the right and she has a dowager hump which is the hunched back and you do see that from time to time
Loss of Independence
um here’s some other things that you probably don’t love you don’t want the dowagers hump you don’t want to have to
end up using a walker a wheelchair end up in a nursing home because you
fractured something um to be in pain from a vertebral or hip
fracture or any fracture for that matter have a loss of Independence which is a
outcome from having a fracture or just
having osteoporosis people become fearful and that’s next on the list of doing things I mean
snow skiing water skiing um activities you know playing football in
the yard with your kids things that you normally would enjoy doing people become fearful of doing
that and so they stop doing those things because they go well I have this osteoporosis and I don’t want to break a
hip so I’m not going to do those activities um so fear plays a role here too loss of
height I am a whopping 5’4 and I do not want to get shorter so most people don’t
um and then again a diagnosis of osteoporosis or osteopenia
um so this is a striking side where slide where do you want to be you want to be like the gentleman on the left or
the couple on the right um what is your Maxwell look like
Why Care
so why should I care about this well it’s estimated worldwide that one in
three women and one in five men over the age of 50 will experience an
osteoporosis fracture in their remaining lifetime um
according to the U.S Surgeon General over 10 million persons over the age of
50 have osteoporosis and over uh 43.3 million have low bone density all also
known as osteopenium in persons over the age of 60 falling is
a major cause of accidental injury accidental death is the third leading
cause of death that can be it seems sort of dramatic because cancer and heart disease are up there but that is where
this Factor factors in the average mortality after a hip fracture is 25
within a year so if you fall and and I’m not just being dramatic here if you fall
and break a hip your chances of and my chances of being in a nursing home and
subsequently dying in that nursing home within a year are about 25 those are not
good at odds that’s pretty staggering data um and man you are not
you are not off the hook with this men get osteoporosis as well your risk is not as high as women and estrogen plays
a role and we’re going to talk about that but um to put this in perspective
for um I saw a fact it’s estimated that the residual lifetime risk of experiencing
an osteoporotic fracture for men over the age of 50 is higher than a lifetime
risk of developing prostate cancer which is 11.3 percent so that’s another reason
we should all care and then parents if you’re listening to this and you have kids um you know we teach our kids to brush
their teeth because we want them to keep them um and how to care for our bones should
be equally as important important I mean we have them wear helmets when they ride bikes so they don’t break a bone
um but why not just get when we talk about teeth why not talk about bones um childhood and Adolescence is the time
that you’re building your bone um and it’s critical to optimize your
mat your Peak bone mastering this time um so it it starts in childhood so
nobody is too young to listen to or to know these facts and to listen to this
webinar um so we’re all chronologically getting older but I strongly believe how quickly
we biologically age is up to us
um so let’s talk about bones for a minute and we’re gonna get kind of sciencey here so I’ll try not to dig in
too deep but I think it’s important to understand that bones are a living tissue they support our muscles and
protect our vital organs and most people know that but they are also the main reservoir for minerals primarily calcium
and phosphorus in our body there’s other minerals and we’ll talk about those um but calcium is vital for lots of
functions in your body think your heart beating you know your muscles Contracting sending nerve signals to
your brain blood clotting teeth calcium is important has lots of
functions and if you’re not getting enough calcium in your diet or there’s problems in your gut and you can absorb
calcium guess where that comes from it comes from your big Reservoir which is Bones
so there’s a lot of reasons for people to be calcium deficient
um and when you’re trying to build bones that’s critical you know want to take from your
Bone Basics
Reservoir so we’re going to talk a little bit about some bone Basics so bones what are they made of they’re made
of collagen which is a protein matrix and that collagen is um that collagen
organic structure is is mineralized um with lots of major minerals primarily
calcium and phosphorus which form an insoluble salt called hydroxy appetite
crystals but there’s also magnesium Boron zinc that also play a role
there’s two types of bone and I kind of like to describe them as sort of a Q-tip
as a way of thinking of them there’s cortical and trabecular cortical bone is the shaft of the Q-tip or the shaft of
your leg or your femur and the trabecular bone are the sort of the fluffy ends of the Q-tip trabecular bone
is what is in your vertebral bodies um or your spine bones and cortical
bones are in your long bones and then you have the bone mirror which resides within the cortical bone
um and it’s primarily composed of blood products red cells
white cells um anyway and then then you think about well on a cellular level
there’s those cells those bone cells are called osteocytes and there’s two types
of osteocytes osteoblasts and osteoclasts and I remember this in medical school because I was like blast
blast is for building um so the osteoblast help build bones
and osteoclasts help tear down bones and it’s important to have both because your
body is constantly remodeling all this all your bone
um 2.5 of your skeleton is under construction or being remodeled at any time they’re like little tiny
construction sites if you want to think about it that way the osteoclastic phase
is about three to five weeks and the osteoblastic phase is three to five months to complete and they talk to each
other the osteoblasts sigma the osteoclast hey come in we were detecting a strain we’re going to build some new
bone we need to clear out the old less good bone and your bone is constantly turning over
all the time but that communication can get out of sync
um there’s signaling molecules that create this Symphony um or the the instructions at the
construction site um these signaling molecules tell the osteoclasts to begin the process of
clearing out the damage bone when there’s micro fractures that you don’t even know about and it stimulates the
osteoblast to build healthy bones but you got to have the raw materials to
build the healthy bones um and that’s where nutrition comes in so these cells were close together and
um and then there’s there’s quality control issues and so there there’s we’ll talk
more about that a little bit later hormones play a role here because hormones primarily estrogen is a major
signaling um factor to the osteoblast
um and our most prolific time of bone growth again is in childhood
um obviously when you’re a baby your skeleton grows because you grow into an adult-sized frame
um but the time where we increase that density and quality is from age
um about 9 10 sometimes eight to about age 20. that’s when we’re building bone
density that is a critical critical time um
and here’s the graph it shows um your your bone mass increases and you
can see how it’s a steep slope up until about age 20 and that’s when you’re
really building bone and we’re going to talk about what kids need to be doing
um to really reach their full genetic potential um if they’re not getting adequate
exercise if they’re not um eating the right diets doing things
that create oxidative stress we’ll talk about how these play out they can actually be hindering and not reaching
their full genetic potential therefore they’re starting out in the hole they’re they’re not they’ve got less bone to
lose um and then of course the slide does kind of speak to the menopause piece
here where uh specifically in women you really see a start sharp Decline and
where that starts is different for different women here on the side it’s 50 because that’s an average but I have
lots of that hit menopause before that for surgical or natural reasons so
Bone Health Continuum
healthy bone is on a Continuum you start with a healthy bone then it becomes osteopenia then it becomes osteoporosis
uh and this is all measured it’s measured by a test called a dexa scan
which stands for adult energy x-ray absorbitometry
um and basically it’s painless it’s quick it takes 10 minutes there is very
very very minimal radiation less than the chest x-ray
um and it’s not terribly expensive it is um
it’s an important test to to measure and we’ll talk about what kind of data it it
gives you um osteopenia is about a 10 bone mineral density loss and osteoporosis is about
25 but there’s actual numbers that are more specific and we’ll talk about it but again the point of this is that it
is a Continuum and where we are all on this Continuum depends on lots and lots
of different factors um family history genetics plays about a 50
Risk Factors
percent uh role here um it accounts for about 50 of the risk so
if you have a family member with osteoporosis or a random fracture that
just fell because I mean that occurred because they cough too hard or they lift the trash bag out of the rollout garbage
can um that’s abnormal they probably have osteoporosis and should be checked
um smoking dramatically increases your bone loss
um at any time that it that you have smoked and it’s actually worse for kids or preteens that are experimenting with
smoking that’s really quite detrimental um low body mass so it’s good to not be
overweight obviously you don’t want you know you don’t want extra fat Mass just to protect your bones but ironically
people that are overweight tend to have less osteoporosis because they’re doing more
sort of weight-bearing exercise every day but when an overweight person loses
a significant amount of weight that’s awesome except they’re also losing skeletal muscle mass and so you really
have to work hard um to maintain your skeletal muscle mass
best you can while you’re losing weight because you lose bone too that’s a problem certain medications classically
corticosteroids so people that have to take steroids for things like asthma or inflammatory diseases long term that’s
that’s a risk for osteoporosis um ppis which are proton pump inhibitors
that lower your stomach acid that is a risk for for osteoporosis because you may be
absorbing less nutrients so there is some data on that and I didn’t list it
on here but I think some anti-seizure medications can also be a risk factor
excessive alcohol intake um
age obviously sex female race um
African-American folks have a less of a risk but they still are at risk too as
our Mexican-American but uh Caucasians are actually at a higher risk I don’t
really know why that is um but that is what plays out in the data
um menopause so this is a big one and this is I think the reason that women
are at such increased risk is because when they hit menopause whether it’s surgical because you had a hysterectomy
or other medication induced because you’ve had breast cancer or something happening or just loss of estrogen
naturally your estrogen level plummets well estrogen is one of those hormones
that helps with cell signaling and the cell signaling is what tells you remember the orchestra on the
construction side and all that it tells the osteoblasts to to kick up their activity I put on here
sort of as a joke menopause again men not living out here low t low
testosterone men’s testosterone can decline there’s lots of reasons that
happens inappropriately earlier this is not the point of this talk but
estrogen is made from testosterone and in the body in Men in women and men do
have estrogen and so if you have low T those men also have low estrogen and
that can be a risk factor um again inflammatory diseases because they frequently require steroids
diabetes interestingly is a risk factor for osteoporosis
um also I didn’t put it on here but if you’re on if you have thyroid disease and you are on thyroid replacement you
want to make sure your threading the needle you are not symptomatic your thyroid is
replaced you’d feel awesome but you’re not over replaced because over
replacement of thyroid hormone causes um bone loss so that can be a little
tricky um oxidative stress now this was not something I learned in medical school
this was something I learned since my training with functional medicine is that oxidative stress is a major player
in bone loss and you wouldn’t know that but the more inflammatory your diet is
the higher stress level you have the more you are in a catabolic State
meaning you’re in a state of breakdown instead of a state of repair antibiotic
anabolic um that’s that that plays a huge role
and so even if you’re not in menopause and you don’t have a family history I have people that come in and I’m
concerned that they may already be losing bone due to some of these risk
factors or because they’re so so inflamed and have been for years so
we’ll work on that malnutrition malabsorption mild digestion
I had a patient that um a long time ago in her late 20s and she
already had osteoporosis she had not taken steroids she did not know her family history so I suspect that that
played a role but she had uh food inadequacy as a child
um and a lot of stress in her life and she already had osteoporosis in her 20s
um and so that speaks to that early building of bone and nutrition in the
formative years if you have problems digesting and absorbing your nutrients
well guess where some of those minerals are going to come from remember bone Reservoir they’re going to come from the
bone unless you are replacing them so making sure your gut is in order is huge
um sedentary lifestyle activity very much affects bone density
so people that are more active and have more muscle mass have better bone health
I always tell my patients for bone health women you need and I’m sorry man
not leaving you out here but women tend to not lift weights um classically more are now and that’s
awesome but you need to be doing weight-bearing exercises meaning weight training at least twice a week as a
minimum we’ll talk more about that in a minute um but being sedentary is not helpful
because it’s that stress on the bone from the muscle pulling sending signals
saying hey we need more support here creating osteoblasts signals uh and then
again not reaching your Peak skeletal growth in youth um so how do you know how do you know
Dexa Scan
where you are on that Continuum well there’s a dexa scan which we talked about briefly before uh it’s the gold
standard of bone density measurement and uh when you get an extra score you should get a segmental dexa score you
should get they measure the hip and the vertebrae and some people I don’t know why they just checked those two things
well that’s because that’s where most fractures occur in fact um most fractures occur in um the I
think 75 are in the vertebral compression fractures
um and a lot of times they’re clinically silent you don’t even know that they’re there and sometimes they’re super painful and you absolutely know that
they’re there um so anyway back to the taxes again so the dexes can painless simple 10 minutes not
expensive as far as scans go um Imaging
um most insurance companies and most and because insurance companies tend to
follow guidelines recommend you should get your first dexa scan at the age of
65. uh if you’re a woman and 70 if you’re a man kind of disagree with that I’m going
against the grain here I think you should measure to know what your Baseline is and so now there are caveats
here so if you have a lot of risk factors getting one earlier it may or may not be covered but again this is not
an expensive test you can pay cash and just have this done um and I do recommend that especially if
you’ve gone through early menopause or have a lot of risk factors anyway so
you get your get your test back and you’ve got a dexa scan report and it has a t-score and a z-score and you see a
bunch of numbers and you’re like I don’t know what this means well the t-score is you versus a normal 30 year old person
healthy 30 year old bone um where you are in relation to a
bell-shaped curve and my next slide kind of gives you a visual so you can understand this but it’s not a bell-shaped curve but you remember the
old bell shaped curve from statistics and zero is the middle it’s the median it’s it’s pretty much average compared
to a 30 year old um and so one standard deviation above
would be better and one standard deviation below would be less and so there is again a Continuum and then two
standard deviations and so on and so forth so that’s your t score Zeke score is the same thing but it’s also it’s not
comparing you to other 30 year olds if you’re 65 z-score is comparing you to
same age peers and so that’s sort of where you are with your same peer group
but osteoporosis and osteopenia is based on the t score
um you can also order a vertebral fracture assessment
um I see you but your physician can order a vertebral fracture assessment to
look for those micro fractures that you might not know that you have that’s not always necessary but it’s it’s another
way to kind of check for Quality not just quantity of bone density
um there is a computation
um called a Frac score it was developed in 2007 by the World Health Organization
as a fracture assessment tool and you can find it online if you just Google it and it takes into account other risk
factors because it’s not all about bone density it sounds like it is but it’s actually bone density is quantity but
there’s also a quality piece here like you’re turning over bone but what you’re replacing with it is a good quality bone
and how do you even look at that um so the Frac score doesn’t tell you about the quality but it does factor in
risk factors body mass index medications family history so
you don’t treat somebody just based on a t-score you can and a lot of people do
and so if your t-score is really bad like negative three or you’ve had a
fracture you’re going to have to consider some medications to get you out of the hole but
um we’re not tackling that subject today specifically we’re talking more about bone health
to the right is biomarkers well there’s several different biomarkers that you
can give you a look to see well could you be turning over bone even if your
bone mineral density is normal or normal low like are you really cranking through
the remodeling States and and what’s are you building too much are you you know there’s a lot of factors that can be
looked at in people where it’s less clear so intelio peptide is something we
measure in the urine it is a metabolite of collagen breakdown so if
you’ve got a lot of that in your urine which we see a lot when people are really inflamed and have a lot of oxidative stress it means you’re
starting to break down a lot of your osteoclasts remember those are the ones that break you down are very active
you’re turning over a lot of collagen now collagen is also in your skin hand I
can’t talk skin hair and nails so you know those those are at play as well
vitamin D levels super important um calcium levels in a serum calcium
serum calcium is pretty tightly regulated so you don’t know where that serum calcium is coming from but it’s
good to know is it too low parathyroid hormone some people have issues with that as a separate diagnosis
um osteoclasts and measures the activity of the osteoblast like how active they are
out fast comes from different tissues it comes from gut it comes from bone primarily
um and you can fractionate that you don’t have to get fancy with all these for just regular things but you can get
a lot of information just from um Regular Labs like a CRP an A1C which
has to do with um blood sugar there’s a lot of other markers that you can kind of look at to
see where is this person’s risk what what is what is their overall health
uh and then of course height I didn’t recognition that the loss of height it would be another red flag like um
Osteopenia
there’s something going on here so here here is a slide that looks at sort of
it’s not a bell-shaped curve visually but you kind of get the picture if you remember when a bell-shaped curve looks
like and and a normal is uh negative one all the way up
um most people fall between negative one and plus one but there’s also some
caveats there osteopenia would be a t-score of negative one down to negative
2.5 but negative 2.5 and greater is osteoporosis and the bigger the negative
number the worse you are
um so this is a little repetitive so I will
Factors Affecting Bone Health
go through this quickly but the factors that are affect bone health or Diet activity family history hormones
nutrients minerals and lifestyle choices and you’ll see on this slide a lot of
the different things that we’ve already talked about so um I’m not gonna break
this down in this moment because like said it’s sort of like a review of what
we’ve what I’ve already said um we’re going to get into more detail here
What Most People Think About
okay so what what is what what’s the lead things that most people think
about when they think about them so I think calcium vitamin D they might think of magnesium they might think of vitamin
K they might think of collagen or protein so we’re going to go through
each one of these very specifically starting with calcium and I list on
Calcium
these slides the food sources first because I think food needs to be first before we think of a supplement we need
to think of food and we need to think of our gut and is it healthy and are we digesting our food are we absorbing our
nutrients where are our deficiencies and that’s where you can look and see you
know how how is my diet shaping up um and when I think of calcium most
people think of dairy well around here we have a lot of people who don’t need to do dairy for lots of reasons or they
have lactose intolerance or inflammatory conditions anyway so people
that are vegetarian or vegan and they’re not getting Dairy sources
calcium can come from other things you don’t have to get it from dairy um but there there’s a lot at play here
so the food sources there’s just a few listed but you can I’m not going to read those because they you can read
um and then there’s all kinds of calcium supplements just to completely confuse everybody there’s calcium carbonate
there’s calcium citrate calcium microcrystalline hydroxyapatite complex and that is
actually my favorite because that is actually what is most representative of what your bone is mineralized with
um but again remember food first Elemental calcium per day recommendations are about 1 000 to 1200
milligrams per day and that’s Food Plus supplements not just in supplements and
again these are not person specific so these are just general recommendations um and a serving of dairy as an example
has about 300 milligrams um per serving and then the other Foods
tend to have less 100 to 200 milligrams per serving um it’s best not to
uh exceed a thousand milligrams um per day in supplemental calcium
because there is some risk associated with that there’s been some increased uh
concern about heart disease associated with supplemental uh calcium meaning
carbine calcifications in your arteries um interestingly Dairy does not increase
increase Dairy it lowers your cardiovascular health risk but again we’re not talking about Dairy as a thing
people say well what about me I have kidney stones I don’t want to supplement with calcium and they and calcium should
be advised um but not necessarily in relation to food I’m talking about supplemental so
when you’re supplementing you do need to look at the label and you look for the amount of Elemental calcium per
supplement uh as an example calcium carbonate is about 40 percent of Elemental calcium
um but it’s best to take supplemental calcium in divided doses don’t take it
all in one big handful if your dose of supplemental calcium is going to be over 500 milligrams but again I really want
you to focus on food of the choices listed here calcium carbonate is
probably the worst one that I would not use it’s poorly absorbed it is the
cheapest but it has to be taken with milk meals because it’s stomach acid dependent on absorption so if you’ve got
low stomach acid because you’re stressed or you’re on a PPI or any other number
of things you’re not going to be absorbing it so you’re kind of wasting your money and there can be some
um contamination so I would steer clear of that one
um all calcium supplementation can interfere with thyroid medicines and iron supplementation it interferes with
absorption um so be cautious there and of course um I I need to mention that if you’re
pregnant you need higher levels of calcium and again we’re not talking about specific people here just in
general these are General recommendations um next up is vitamin D
um so boom let me get my slide
Vitamin D
so vitamin D sources eggs salmon tuna sardines Dairy and mushrooms and
sunshine so Sunshine is great if you live pretty much north of Atlanta
um but but I mean sorry that’s wrong if you live south of Atlanta but north of Atlanta
you have an increased risk of not and if you’re inside if you have a you know a
job where you’re just inside all the time you don’t like being out the sun your fair skins you burn you’re always celebrated with sunscreen you’re not
making a whole lot of vitamin D vitamin D is made in your skin but you have to have about uh 10 to 20 minutes of sun on
your skin between 10 and 2 without sunscreen obviously you don’t want to burn because that goes against common
sense but and there is some genetic role with vitamin D vitamin D some people
have a hard time getting their vitamin D levels up and they’re chronically low and that is has a lot to do with with
genetics um and so you don’t have to know your genetics but you should know your
vitamin D level and so I do recommend that you test and don’t guess vitamin D uh if you’re supplementing you need
Vitamin D3 and ideally combined with vitamin K2 especially if you’re over the
age of 50 because K2 helps keep the calcium out of sauce tissue such as your
arteries and keeps it more in your bones where where it needs to be
Magnesium
um magnesium is mixed on our list um
again food sources on the left dark leafy greens beans you’ll notice there’s
some repeat repeat players here so there’s starting to be a theme of which types of figs are really good for bone
health um supplements there’s a ton of different magnesium supplements there’s magnesium gluconate
malate sorbate glycinate three and eight and they all have different roles I’m
not going to dig into that deeply but it is good for bones magnesium is one of
the most important nutrients in the body it’s involved in over 300 metabolic processes and it’s common deficiency
it and deficiency of magnesium reduces the osteoblast remember B for build
formation increases osteoplast formation so low magnesium can contribute to low
serum calcium um because it is important
um in absorption there as is the vitamin D so uh if you’re having your magnesium
measured it’s best to measure the whole blood in the red blood cells and not just a serum magnesium because that
doesn’t it’s not an adequate representation of your magnesium Stores
um daily recommendation there is about 600 to 750 milligrams a day and there is
some literature that suggests a calcium to magnesium ratio of two to one
um so uh next on our list is
uh let me go back is vitamin k
Vitamin K
um vitamin K again is important for lots of things and involved in blood quality and
blood formation and K and D work together to modulate calcium balance vitamin D helps ABS the absorption of
calcium and vitamin K prevents the loss of calcium in in the urine and again
prevents calcification in soft tissues so the minimum for just General Health
is one milligram per day for General support but optimal intake for bone
health is closer to 45 milligrams a day of K2 there is a K1 K2
and then there is some literature out there about mk7 which is a superior
supplement form of K2 caution with people on blood thinners specifically
Coumadin it affects blood clotting you have to be careful you can’t just go
about the vitamin K without without oversight there
um the other other things on this list don’t have their own side because they don’t pay is play as big of a role but I
don’t want to minimize their importance protein hormones which we’re going to talk about
in a minute um weight-bearing exercises keeping your inflammation low gut health weight
management um the protein and collagen I want to spend a little bit of time on because most
people don’t get enough protein in their diet the RDA recommends zero point
let’s see this is 0.8 grams to one point I think two grams per kilogram depending
on your activity level and your body build I think that’s woefully inadequate
um it’s really closer to one gram per pound of lean body mass
um if you like percentages protein needs to be about 30 percent of your caloric intake again this is not individualized
these are just big blanket statements so everybody has different needs but most of us need much more protein than we’re
getting um doesn’t have to be from an animal Source um protein is important for building
muscles and building muscles is important for healthy bones so um that said I’m just going to move on
from there collagen a lot of people are taking collagen supplements there is some data that that supports that
um how it’s absorbed from your gut there’s a little question about that but it’s
also another protein source so um but that’s another benefit
um again weight management we already talked about gut health we talked about and then lowering your inflammation is
huge um supporting roles these are other things that if you’re reading about bone
Supporting Roles
health you are going to come up and I’m not going to go into a lot of detail here I’m going to give you a couple of
lines about each one of them you don’t need to supplement with phosphorus because our diet in the in America is
plentiful of phosphorus um Boron helps increase estrogen levels
um so if you have a estrogen dependent cancer you need to not supplement with Boron
um but there’s a lot of good food sources grapes notes beans vegetables apples
potassium it helps lower the calcium loss in urine
um so when people who are very acidic from eating a processed diet um potassium helps lower your uh I’m
sorry helps raise your pH um of your urine and then you get less calcium loss in the urine
um but but I don’t recommend people supplement with potassium I recommend they eat lots of vegetables and less
processed food um manganese comes from beans nuts seeds
greens whole grains silica silica is actually how collagen is made it’s a
trace mineral support and it is important in developing the strong cross Links of the collagen fiber itself we
actually have a supplement here at the clinic called regeneru plus and it is a
silica supplement and it helps not only with bones but Hair Skin and Nails
um Omega-3s help lower inflammation think fish
flax seeds um vitamin A supports osteoblast activities but be cautious with high
doses because it can suppress bone growth zinc is a common deficient mineral especially
in people who over exercise or over drink it helps a conversion of T4 to T3
so it helps your thyroid and it helps with vitamin in conjunction with vitamin C to cross-link the collagen fibers
vitamin C is an antioxidant helps maintain collagen fiber structural
Integrity so now that your head is spinning let’s talk about estrogen
Estrogen
um so estrogen is the single most important hormone that regulates bone mineral
density testosterone plays a role here but keep in mind that estrogen comes from testosterone
um so when women’s estrogen drops off they their risk goes up so why not just
treat everybody with estrogen well the Women’s Health Initiative created some problems and they said no estrogen is
risky for breast cancer and yada yada and cardiovascular disease and we’re just not going to make that a
recommendation and that stands to this day um there’s a lot of caveats to that so I
will not make a broad statement of it’s good it’s bad but I’ll tell you that you
do lose less bone if you have some estrogen on board um that has to be an individualized
decision between you and your clinician but it’s worth a discussion um especially if you are just going
through menopause now if you’re 75 and you did menopause 20 years ago not
necessarily what I would choose there’s some increased cardiovascular risk there if you’re starting out 20 years out
diet as you saw in my other slides lots and lots and lots of vegetables color beans
nuts seeds um a lot of opportunity there decreasing
inflammation which those dietary things do minerals minerals minerals minerals
um important um gut health that digestion absorption
super important so if you’re having gut problems and you know you’re not getting
the nutrients in that you need to um either or that can be a huge problem
and put you at risk for osteoporosis stress how would stress bother your bones well stress mental stress is
creates an oxidative state in other words people are have
higher cortisol levels those cortisol levels decrease the sex hormone so you
decrease your estrogen when your cortisol is high so being relaxed is
better for all the reasons okay what about exercise
Exercise
well white bearing exercise is key bands weights
um if you’re new to exercise and you don’t know how to lift the weights I recommend getting a trainer just for one
or two sessions to show you the proper technique because you don’t want to go at it at the wrong way and injure a
shoulder and and cause or near cause some other problems what about whole body vibration plates there is good data
on that in fact Dr lickey here at the clinic has one in his office um and um it they I can’t tell you the
amount of time I can’t tell you the hurts what I found in the literature is mostly around 30 Hertz
um and the times are all over the place um so just I think consistency in doing
it regularly is what is important it has additional benefits Beyond just building
bone um or turning on the osteoblasts it also helps with balance because you’re
vibrating and you got to use your core strength to stay upright um so that’s important it also helps
boost your immune system and decrease your inflammation um what about jumping well jumping is a
great idea but if you have severe osteoporosis you might not need to jump because you can get a compression
fracture but there are the little mini trampolines or some people call them rebounders there are some data on that
mostly in veterans that have had some injury and they’re trying to rehab their
bones and then balance training this is like the simplest thing in the world
practicing standing on one foot while you brush your teeth and then alternating feet doing things to improve
your overall balance is key because it’s not going to improve your bone quality
or quantity but your bones just don’t crumble you usually have to have
something that has caused them to fracture now the worst your bone density
is the more likely are you are to fracture something but
sometimes it’s you know it’s just falling on carpet well what caused you to fall well you tripped over a rug
there was a cord in the way your balance is terrible so really having somebody
assess your balance and um I do happen to know that most insurances if you have
a diagnosis of osteopenia or osteoporosis most I don’t know all will cover a
physical therapy evaluation for balance training and strength training doesn’t mean you can go there as a trainer but
they can show you some things to do um so anything you can do to increase your your balance
um is is key and that has not to just to do with your core strength but also to do with how your feet touch the floor
and how your proprioception is um so those all things are super important and should be discussed with
um with your provider okay so I put this we’re coming to the end I’m sorry this has been long so I
Balance
hope your head is not spinning but I put this picture in I didn’t take it it’s just something I found online but it
reminds me of um balance and when I had the opportunity years ago to go to Paris for
the first time and I saw several little old ladies and men carrying little bags
um cotton bags of groceries from the market walking with a cane not a not a
walker on cobblestone streets and they were just getting it across the streets
and I was like I can tell they have some osteoporosis because they’re all hunched and they
look to be about 90 years old but goodness gracious they are their balance is amazing and it occurred to me that
that was probably because those are the streets that they walk on every day and so they’re used to that proprioception
that their body their brain and body and muscles have adapted to an uneven
payment um here in the states everything is paved we you know we put rails up
everything and that’s good but but practicing your balance like um as if you had a cobblestone street it
could be extremely beneficial or better yet go to Paris um okay these are some supplements that
we have at Maxwell Clinic that I frequently recommend these are sort of our core supplements that we use
um and again you don’t have to take all these supplemental things I really want
to just make some summary statements and then let you go um so here are my summary statements
don’t get all tangled up in the minutia presented here I have said a lot of words I have recommended a lot of
supplements but bottom line is I’m just telling you about the nutrients and what purpose they serve in the body so that
you understand oh I am taking this vitamin d and vitamin D does other things than just bone but I’m taking it
so that it helps my gut absorb the calcium that I’m taking in and deposit
it in the bones um because if people understand what they’re doing they’re more likely to do
it um but don’t get tangled up in the minutiae pull back and look at the big picture
um assays like think about your bone health for yourself and your kids if I’ve done nothing else today other than
to go wow I couldn’t think about my bones this is really important stuff that I have achieved my goal
um especially for your kids I wish I had known this when my kids were little I didn’t I did not know I had gone to
medical school and yet I missed this this Global message um that the the bone Hill starts really
early and you’ve got to you’ve got to get them active you got to get them out in the sunshine in nature with some
vitamin D being made by sunshine on their skin um and get them eating the good things
and that’s can be such a challenge these days um and where can you improve like I’ve
said a lot of things but where can you improve to talk to your clinician about this evaluate your risk
um and then measure with the dexa scan or a vertebral assessment which goes with the
dexa skin if that is necessary um eat well and move daily add weights and relax and
enjoy the journey because life is very short
Questions
all right I’m going to pause here and or stop here and see if I have any questions I’m also going to look hold on
and see if
okay I’m looking at the comments um
and when I asked who was who was here and why they were here we have somebody saying I was just diagnosed with
osteoporosis um I will be taking Anastrozole for five years due to cancer diagnosis and
osteoporosis runs and family absolutely need this information I have osteoporosis and do not want to to do
the Prolia shot um one of the medications uh and then we have somebody that says I have
osteopenia osteoporosis and fell and broke my pelvis in three places in July and fractured T12
eight years ago so I’m so glad you guys were here this is kind of like a bucket
of information um there’s a lot of details there’s a lot of uh finessing of what you
specifically can do and this is not individualized this was just a broad swath of all the information
um but what I’ve presented has good data and um is worth talking to your clinician
about um and I would say on these things you can measure measure them see what your inflammation is see what your vitamin D
is um and and try to try to go from there let’s see
let’s say I have questions how do you keep building bone how do sorry how do you keep the bone
building and turnover working after menopause and your hormone levels are either too low or significant
non-existent hormone replacement is not an option is not an option after 60ish
um I think that’s the hormone option is very individualized again if you’re well
past menopause you have to proceed very cautiously if at all with hormone
replacement and so doing the bone building a turnover work you know
creating that nice combination is keeping your inflammation down keeping your diet healthy with all the nutrients
that kept being repeated leafy greens beans on the slide and then measuring those things to see where you are are
you how are your osteoblasts working how are your osteoclasts working because they’re not direct measurements but they
can give you an idea of where things may weight lifting
um I mean a lot of people say oh well I’ve I run interestingly Runners don’t tend to have the highest bone density
you would think so because they pound the pavement but Runners tend to be a lot thinner I’m not encouraging weight
gain but I am encouraging muscle gain so I think muscle gain um looking into a whole body vibration
plate um and doing that regularly and so those are my recommendations if you if you
can’t do estrogen or that’s not appropriate for you for whatever reason uh and then looking into some of the
supplements the silica the silica that we have with the original new plus is excellent
um has the nice side effect of improving Hair Skin and Nails um and so um in addition to bones
uh let’s see what do you do at your clinic to help bone health how do you help losses
osteoblasts to work so the question is how do you help the osteoblasts to work at Peak efficiency pretty much all the
things that we talked about in the thing you’ve got to give them the right nutrients and you have to the blast
respond to to stressors so if you think about your
muscles being attached by tendons to the Bone and to move a bone or a joint
you’ve got to contract your muscle so if you put muscle stress on the bone it’s
signals by the osteoblast to say hey we’re building bone here let’s let’s kick up the the action
um and so it’s that stress and that’s why I keep going back to weight lifting resistant training
um walking around with um oh this was interesting my my husband has recently been interested in Rocking rucking is
where you put weighted you know weights in a backpack now don’t just everybody go out and do this because it needs you
need everybody’s different but it doesn’t have to be big weights but just adding body white and and Hiking walking
around with additional body weight I guess you could do ankle weights um if you have severe osteoporosis you need to
be cautious um but again I’m baking Global statements not specific advice to certain people
um other questions we’re almost at the end of time here
um the magnesium oxide is kind of a somebody said why do you caution about magnesium oxide supplement I’m not
cautioning people but it’s kind of the junkiest Magnesium out there on the market it’s the cheapest
um it’s what’s in um oh shoot milk of magnesia so it will it
will give you the runs if you have too much of it um but it’s not a good quality magnesium
so you might want to look at other magnesiums um do I recommend Osteo strong I think
this is going to be a question and I don’t know how to answer it
because I really feel conflicted about the data a lot of the studies that are referenced by osteos strong were studies
that the owners of I still strong did so that makes me a little look at it with a
side eye um and Osteo strong for those of you don’t know is a company it’s a franchise
that women men can go in and you in they advertise that in seven to five to seven
minutes a week you can activate your osteoblast and build bone
maybe I don’t know I and because exercise is my passion and I like going
to the gym and I like lifting weights I just don’t see that you can do the same thing in that short amount of time and
it’s basically isocentric um force on the muscles
um so it is a stress so I can see where it would work but again I’d like to see more studies there
um it’s also you know a membership model so you have to pay and you have to go and
I don’t know I’m not saying don’t do it I’m not saying do it I’m I’m kind of neutral I’m not going to pick a sack
here I just think I think I’d like to see more data is what I like to see and
does yoga count as weight bearing it compared to not doing anything yes and
it depends on the type of yoga I mean if you’re doing restorative yoga which I am all for uh where you’re just relaxing
and breathing that’s awesome but no not so much that’s not really count as much weight bearing be on your own body
weight um and so there’s other more strenuous types of Yoga that you’re doing you know
certain posturing and thing but you know certain postures and stances I would
caution you about headstands or handstands if you’re at an increased
risk of fracture but that could be um so that’s that’s less good I’m talking
about added body weight um when you look at there was a study that I looked at in regards to the best
exercise and you know the people participating in different exercises and like mixed martial arts was up there
which you know I don’t recommend that we all go practice mixed martial arts and actually football because it’s the
impact on the bone and so you’re like well you’re telling us to be careful but you also chose to exercise I’m saying exercise wisely you know
hiking with a little extra weight that’s awesome adding a 50 pound backpack if you’ve
never hiked probably not awesome you got to build up to it um so I’m
Outro
hope I’ve answered the questions and I think it is um sorry last slide I think it is time
for us to end I appreciate everybody being here and I hope you learned something and I hope you share this
information with those that you love because nobody wants to be frail we want
to be strong have a good day
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