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Shifting the Conversation From a Number on a Test to Real-World Bone Quality and Strength
When you first receive a diagnosis of osteopenia or osteoporosis, it can feel like the rug has been pulled out from under youWhen you first receive a diagnosis of osteopenia or osteoporosis, it can feel like the rug has been pulled out from under you. The immediate reaction for so many women in our community is a sudden wave of stress, anxiety, and fear. Many of us have watched a parent or grandparent experience the painful downhill trajectory that can follow a bone fracture, and naturally, we want to do everything in our power to avoid that same fate.
Conventionally, the entire medical conversation around bone health revolves around a single number: your DEXA scan score. We are conditioned to think that improving that test result is the only thing that mattersWe are conditioned to think that improving that test result is the only thing that matters. But what if I told you that focusing exclusively on that test score leaves a major blind spot?
On a recent episode of the Stronger Bones Lifestyle Podcast, I sat down with Dr. John Neustadt, a naturopathic doctor, researcher, and leading expert in integrative bone healthStronger Bones Lifestyle Podcast. He shared a statistic that completely changes the game: a bone density test by itself only predicts 44% of women with osteoporosis who will actually experience a fracture. Your DEXA scan is just one piece of a much larger, beautiful puzzle. Osteoporosis is essentially a disease of imbalance where bone breakdown is outpacing bone building. To truly fracture-proof your bones, we have to look beyond the test score and identify the root-cause factors driving bone loss in your unique bodyTo truly fracture-proof your bones, we have to look beyond the test score and identify the root-cause factors driving bone loss in your unique bodyTo truly fracture-proof your bones, we have to look beyond the test score and identify the root-cause factors driving bone loss in your unique bodyTo truly fracture-proof your bones, we have to look beyond the test score and identify the root-cause factors driving bone loss in your unique bodyTo truly fracture-proof your bones, we have to look beyond the test score and identify the root-cause factors driving bone loss in your unique body.
The Hidden Bone Drainers: Everyday Medications
One of the biggest eye-openers Dr. Neustadt shared is the massive impact of prescription medications on bone qualityOne of the biggest eye-openers Dr. Neustadt shared is the massive impact of prescription medications on bone quality. Up to 30% of post-menopausal osteoporosis cases are driven by factors other than the natural decline of estrogen. A staggering number of people are taking daily medications that actively damage bone architecture, increase fracture risk, or trigger dizziness that leads to fallsA staggering number of people are taking daily medications that actively damage bone architecture, increase fracture risk, or trigger dizziness that leads to fallsA staggering number of people are taking daily medications that actively damage bone architecture, increase fracture risk, or trigger dizziness that leads to fallsA staggering number of people are taking daily medications that actively damage bone architecture, increase fracture risk, or trigger dizziness that leads to falls.
Some of the most common culprits include:
- Proton Pump Inhibitors (PPIs) and H2 Blockers:Proton Pump Inhibitors (PPIs) and H2 Blockers: Common acid reflux medications that alter digestion and directly impair bone healthProton Pump Inhibitors (PPIs) and H2 Blockers: Common acid reflux medications that alter digestion and directly impair bone health.
- Antidepressants (SSRIs):Antidepressants (SSRIs): Because your bones actually feature serotonin receptors, these medications can over-activate osteoclasts—the cells responsible for breaking down boneAntidepressants (SSRIs): Because your bones actually feature serotonin receptors, these medications can over-activate osteoclasts—the cells responsible for breaking down boneAntidepressants (SSRIs): Because your bones actually feature serotonin receptors, these medications can over-activate osteoclasts—the cells responsible for breaking down bone.
- Blood Pressure Medications:Blood Pressure Medications: If the dosage isn’t regularly reviewed as you age, it can cause blood pressure to drop too low, resulting in dangerous falls.
Ninety-five percent of fractures occur because of a fall. Re-evaluating your medications with your doctor is a crucial, empowered step to protecting your physical freedomRe-evaluating your medications with your doctor is a crucial, empowered step to protecting your physical freedomRe-evaluating your medications with your doctor is a crucial, empowered step to protecting your physical freedom.
The Power Duo: Plants and Protein
Once we identify what might be draining your bones, we can shift our energy to building them up naturallyOnce we identify what might be draining your bones, we can shift our energy to building them up naturally. Dr. Neustadt and I both love a whole-foods, Mediterranean-style dietary pattern, which has been shown to reduce hip fracture risk by 21%Dr. Neustadt and I both love a whole-foods, Mediterranean-style dietary pattern, which has been shown to reduce hip fracture risk by 21%. To make this sustainable, simplify your plate into two daily goals: plants and proteinTo make this sustainable, simplify your plate into two daily goals: plants and protein.
First, aim for 30 grams of dietary fiber daily from whole plant foods to feed a healthy gut microbiome, which communicates directly with your bones via the gut-bone axisFirst, aim for 30 grams of dietary fiber daily from whole plant foods to feed a healthy gut microbiome, which communicates directly with your bones via the gut-bone axis. Second, focus heavily on protein. Your bones are highly protein-dependent and contain up to 200 different proteins, including collagen. Aim for a minimum of 0.6 grams of protein per pound of body weight daily to stimulate muscle and bone preservation as you age.
Your Next Step
Remember, your bones are not weak just because you hit a certain birthdayRemember, your bones are not weak just because you hit a certain birthday. You have incredible agency over your structural healthYou have incredible agency over your structural health. Start by tracking your food for just two days to see where your fiber and protein levels currently standStart by tracking your food for just two days to see where your fiber and protein levels currently stand. Be gentle with yourself, take a deep breath, and let’s take this journey one step at a timeBe gentle with yourself, take a deep breath, and let’s take this journey one step at a time.
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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.