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When we think about bone health, we often focus on calcium, vitamin D, exercise, and our DEXA scan results. But what if there’s a bigger picture we need to consider?
In Episode 189 of Stronger Bones Lifestyle, I sat down with Dr. Tom Dayspring, a physician specializing in clinical lipidology and menopause care, to explore the connection between lipids, cardiovascular health, menopause, and our bones.
This was a fascinating, in-depth conversation that challenged some of my assumptions—particularly around medication and the importance of looking at the whole person.
Your Bones Are More Than a DEXA Scan
Dr. Dayspring explained that lipids, including cholesterol and triglycerides, are found throughout the body. Cholesterol and phospholipids are important components of cell membranes, where they help cells function and communicate.
That includes the cells involved in bone remodeling.
Our bones are continually being remodeled through the work of osteoblasts, which build bone, and osteoclasts, which break it down. Healthy remodeling depends on these processes working in balance.
Bone marrow also contains a significant amount of fat tissue. Dr. Dayspring discussed how these fat cells can release inflammatory signaling molecules and how inflammation may affect the environment in which bone cells function.
This adds another dimension to the conversation about bone health: we need to consider the metabolic and inflammatory environment in which our bones are living.
Menopause Changes More Than Our Hormones
During the menopause transition, declining estrogen can affect both bone remodeling and lipid metabolism.
As Dr. Dayspring explained, some women experience increases in LDL cholesterol, total cholesterol, and ApoB, along with changes in HDL cholesterol and triglycerides. The exact pattern varies from person to person.
He also discussed how declining estrogen may contribute to insulin resistance in some women. Insulin resistance is associated with metabolic dysfunction and inflammation, which may have implications for bone health as well as cardiovascular health.
This is one reason I believe we need to stop looking at menopause, heart health, and bone health as completely separate issues. They are connected, and our care should reflect that.
Where Does Medication Fit In?
One of the most important parts of our conversation was the role of medication.
I’ve often leaned toward avoiding medication whenever possible. But Dr. Dayspring helped me better understand why medications may be appropriate for some people, depending on their individual risks, medical history, and stage of disease.
We discussed hormone therapy, raloxifene, bisphosphonates, and statins, including some of the biological pathways that have prompted researchers to investigate connections between these treatments and bone or cardiovascular health.
These medications are not interchangeable, and a potential benefit in one area does not mean a treatment is right for everyone. Decisions need to be made with a qualified healthcare professional who can explain the potential benefits, risks, and alternatives.
The message I took away was not that everyone needs medication. It was that we shouldn’t automatically rule it out, either.
Lifestyle Is Still the Foundation
Dr. Dayspring was clear that lifestyle is a crucial starting point for managing chronic disease. Nutrition, physical activity, sleep, and other daily habits matter. He also emphasized the importance of adequate protein and muscle health in supporting our bones.
He discussed a Mediterranean-style dietary pattern as a useful general framework and cautioned against replacing saturated fat with excessive refined carbohydrates.
But lifestyle and medication don’t have to be an either-or decision. Depending on a person’s circumstances, both may have a role.
Look at the Whole Picture
My biggest takeaway from this conversation is that bone health cannot be reduced to a single number, nutrient, or treatment.
Our bones are part of a larger system that includes hormones, metabolism, cardiovascular health, nutrition, and muscle function.
As women, we deserve care that considers all of these connections—and practitioners who take the time to understand our individual needs.
The goal isn’t to fear medication or embrace it blindly. It’s to become informed, ask better questions, and make decisions that support our long-term health.
Listen to Episode 189 of Stronger Bones Lifestyle to hear my full conversation with Dr. Tom Dayspring.
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Frequently Asked Questions (FAQs)
Oxalates, also known as oxalic acid, are naturally occurring compounds found in many plants, vegetables, and fruits. They are part of a plant’s defense mechanism against predators and can be found in high concentrations in foods like spinach, rhubarb, beets, nuts, chocolate, tea, and certain beans.
Regarding bone health, oxalates can bind to minerals such as calcium in the gut, forming calcium oxalate. This compound is not easily absorbed by the body, meaning the calcium that could have been utilized for bone strengthening is instead excreted. This process can potentially lead to lower calcium availability for bone health, which can be particularly concerning for individuals at risk of osteoporosis or other bone-related issues.
However, for most women, dietary oxalates do not pose a significant threat to bone health, especially if their diet is balanced with enough calcium and they do not have a history of kidney stones.
Your gut is crucial for stronger bones for several reasons:
- Nutrient Absorption: The gut is where most nutrient absorption occurs. For bones to be healthy and strong, they need a variety of nutrients, particularly calcium, phosphorus, magnesium, and vitamin D. A healthy gut efficiently absorbs these essential nutrients from your diet and facilitates their transportation to the bones.
- Gut Microbiome and Bone Health: Research has shown that the gut microbiome (the community of bacteria living in your intestines) can influence bone density. Certain gut bacteria help in producing short-chain fatty acids (SCFAs) like butyrate, which have been shown to promote bone health. SCFAs can enhance the absorption of minerals necessary for bone strength and play a role in reducing inflammation, which can negatively affect bone health.
- Hormone Regulation: The gut helps regulate hormones that are involved in bone metabolism, including insulin, thyroid hormones, and sex hormones like estrogen. For example, estrogen is vital for bone density, and gut health can influence estrogen levels through the enterohepatic circulation, where estrogens are processed in the liver and intestines.
- Reducing Inflammation: Chronic inflammation, which can stem from poor gut health, is linked to many conditions that compromise bone strength, such as osteoporosis. A healthy gut helps to reduce systemic inflammation, protecting bones from inflammatory damage.
- Immune System Modulation: The majority of the immune system is located in the gut. An imbalance in the immune system can lead to autoimmune conditions, some of which affect the bones. Maintaining gut health helps to ensure the immune system works correctly, protecting against autoimmune reactions that could impact bone health.
In essence, maintaining a healthy gut contributes significantly to stronger bones by ensuring the effective absorption of vital nutrients, regulating hormones, reducing inflammation, and supporting a healthy immune system. Therefore, a diet rich in bone-healthy nutrients, prebiotics, and probiotics, along with lifestyle factors that promote gut health, is key to maintaining strong bones.