Fracture-Proof Your Bones and Prevent Osteoporosis, with Dr. John Neustadt @NBIHealth

Hello and welcome to this episode of the Feel Freaking Amazing podcast. I'm Wendie Trubow. This is Ed Levitan, my co-host. And today, we have Dr. John Neustadt. We're super excited to talk about this because it's foundational. He is the founder and president of Nutritional Biochemistry Inc., NBI, and has published more than 100 medical articles. So, as we say in Boston, he's wicked smart. He's written 4 health and wellness books and is now a best-selling author in the field of osteoporosis, including his most recent book, Fracture Proof Your Bones: A Comprehensive Guide to Osteoporosis. John, welcome. I'm so excited to talk about this with you.

So thank you. Thank you. Well, I'm passionate about this topic, so anytime I get the opportunity to, to share the information that I've learned with people to hopefully help them improve their lives, improve their health, and frankly, with this disease, to prevent themselves from being old and in pain and not able to enjoy their life and dying at a younger age than, than we all want to.

How'd you get into this? Is this personal for you?

Extremely personal. I never thought I would be a, a bones guy. Uh, 20 years ago I was in clinical practice just starting out. I had patients coming into my clinic, uh, with various conditions as a general practice, but of course with osteoporosis as well. And like all baby docs, I was doing what I was taught and I was focusing on improving their bone mineral density. Using integrative medicine and integrative approaches, and their bone density was going up. So I was, I was happy and, and they were happy. Well, at this time, my mother-in-law also had osteoporosis. She just passed away this last year. And sorry. And she was seeing, uh, her physician and met her medical doctor and he had her on Fosamax. I was working with her a little bit. If anybody knows the dynamic of being a doctor and working with family, it's a bit tricky. So I wasn't official.

No, no. Talk about the dynamic with mother-in-laws. Oh yeah, we're familiar with that.

It's challenging.

Mother-in-laws, physicians. Yes, yes, boundaries.

Yeah, yeah. So I was, I was helping her a little bit on the side unofficially, but I was recommending some dietary supplements and, and exercise and, and lifestyle changes and, you know, all the things that are well documented in the research to, to help.

Sure.

Then she tripped on a throw rug in her house and fractured her hip. And I, I thought to myself, something's wrong with this picture because by that objective measure of that bone density test, which is almost exclusively what's tracked, she should have been protected. Her doctor told her she was protected. I thought she was protected and she thought she was protected, but she wasn't. So I started looking at the research and literature and diving into the details more about this condition. And what I found absolutely shocked me. A bone density test only predicts 44% of women with osteoporosis who will break a bone, and only 21% of men. And that's not new information. You know, since the 1990s, we've known that they predict— that test predicts less than half of people who will, who will fracture with osteoporosis.

Slow down, you gotta—

you have to dummy this down for me.

So what does that actually mean, 44% in women?

It means if you have osteoporosis and a low bone mineral density test, there's a 56% chance that you will not break a bone.

Interesting.

There's only a 44% chance that you will. That's what it means. And if you're a man with low bone density, there's a 79% chance you will not break a bone.

So it's not looking at the quality of bone necessarily, it's looking at the quantity of bone.

Correct.

And it's not giving an accurate representation of what's going to happen with that bone. Yeah.

So all tests or any recommendation is really only as valuable as it is able to predict your fracture risk or reduce your fracture risk. And the entire conversation around osteoporosis should be centered around fractures, not around the number on a test. And that's the big problem that I have with how conventionally it's being approached, how it was 20 years ago, and unfortunately how it still is being approached, which is why I wrote my book, which is why I'm so passionate about educating people about what questions they can ask their doctors to make sure they're getting the best possible recommendations and they can make the best choices for their health, and also educating them on how to create these holistic bone health programs that meet their needs to reduce their fracture risk while improving bone health.

I have a question. Can you pick me, please? Yeah. John, in the age of AI, is it not possible we just have a shitty algorithm and the algorithm needs to be updated? So this is something that the fracture risk could be more accurately determined if we get a better tool to crunch the data? Like, why is there such a disconnect between the scans that we're using and the fracture risk assessment?

That's a great question, and there's— it could take a very long time to answer that question, but I'm going to try and do it very succinctly. The challenge we have with osteoporosis is that it's a multifactorial condition. It doesn't come down to just one variable. All these— there are many different variables that conspire to work together to either reduce somebody's fracture risk or increase somebody's fracture risk. Said another way, destroy their bones or improve their bone health. AI may be able to do that. That remains to be seen. It was another tool. There are some tools like there's an online fracture risk assessment tool called FRAX that people can go and plug some data in and get an estimate of their 10-year fracture risk. But like any tool, and AI is the same, if you don't have comprehensive enough data and you don't have the relative probabilities that all that change depending on what else is on board and going on, the relative importance of one risk factor versus another, it becomes extremely difficult to create a system that is going to give an accurate picture of somebody's fractures. Now, maybe they get a more accurate picture, and I hope that's the case, but currently it's really about, I think, understanding how bone works, what bone is, and what is in your control to, to change in somebody's life. Because a lot of people also think that it's just this one-way, you know, street that we're all on, that once you hit peak bone mass— and frankly, that's what it was taught in medical schools— once you—

it still is, I think, by the way.

Yeah, yeah, you hit peak bone mass in your 20s and you're done, and then it starts to get— it's just downhill. And that's not reality. That's just not supported by the medical research or physiology. You can reverse it. You can improve bone health and improve bone density and bone strength.

Yeah. We've seen this in our practice.

Yeah.

And just like every other, from neurons that no long, like don't regenerate to everything else, bones are alive and living cells that can regenerate. And it's not a mushrooms network. Huh?

We were just talking about mushrooms with another recorder. So I'm just thinking it's like a whole mushroom network.

Yeah, well, what, what is interesting, if you look at, at mushrooms and you look at a forest floor, you look at the mycelium, all of these, these mushrooms and these fungi in, in a living ecosystem are all connected and intercommunicate and, and with everything else in the, in the area in this beautiful symbiosis that exists in our bodies as well. That happens with our bones. Our bones are not just structural. Yes, they help us walk and jump and hug our loved ones and play and, and enjoy our lives and move around, but They also produce our blood cells, our red blood cells, our white blood cells for our immune system, our platelets. They communicate with other parts of the bodies. There are melatonin receptors and serotonin receptors and leptin receptors on bone. So there's this interplay in this holistic network of hormones and interactions between different systems in the body that to me is just, it's miraculous. I mean, I fell in love with bones and what they do for us.

Yeah, I mean, isn't it amazing that we can't separate bones from the rest of our health?

Yeah, you know, the reductionist model that really took hold in medical education is powerful in some respects, but it misses the forest for the trees. That holistic integrative understanding, it is all one system. There is no discrete organ on our body that exists only and solely by itself. Yeah, perfect.

So how big of a problem are we talking about here when we're talking about osteoporosis?

Globally, it's second only to cardiovascular disease as a health problem. Every 30 seconds somewhere, someone in the world is breaking a bone because of osteoporosis. Uh, in the United States, there are about 53 million people with low bone density or at risk of osteoporosis by, by the fact of having some bone loss already. But I think that's a, a, a an underestimate. There are many people who are not being screened. In fact, over 90% of Medicare-eligible patients, which are the prime demographic to be screened for osteoporosis, aren't getting bone density tests. So I think that's a big underestimate. If you fracture a hip with osteoporosis and you're a woman, there's up to a 36% chance that you're going to be dead within a year. And if you survive, over half of those women never regain— or half of those patients never regain their full pre-fracture level of mobility. Pain-free life that they had, and many require continuing ongoing help for basic activities of daily living, like, you know, getting dressed and getting in and out of bed and going to the bathroom and those sorts of things. So it is an absolutely devastating, uh, condition, not just to somebody's personal health but to their family who has to be involved. I know when my mother-in-law fractured her hip, like, our whole life came to a stop, and we had young, young children at home, and we were having to, you know, work around them. One of us couldn't— had always be with our mother-in-law. I was rescheduling patients. My wife was taking time off work. I mean, the stress of making decisions for the— for her, as well as the financial implications of all of that, were horrible. And then you magnify that, um, times, you know, millions and millions of fractures happening all the time around the world. It is an incredibly impactful disease.

You know, it's funny, I feel like people fall into one of two categories around their bone health. Either they've had a relative who had something happen or bone loss, or it runs in their family. They're, they're aware. They are bone health aware, or they are completely bone health unaware, and it doesn't even cross their radar until I'm like, oh, have you had a bone density scan? They're like, no. And I'm like, but you're 58, you went through menopause 6 years ago, you're way overdue, girl. Like, it's just a very interesting split to me. It's not like everyone knows they should do it. Some people genuinely don't know. That their bones are critical for their health.

Yeah, and it's asymptomatic, you know, there aren't symptoms typically, so it's not like something's bothering them and, and people aren't aware. And the general practice physician is the gatekeeper. They are the ones who primarily are the— are, are recommending these screening tests and talking about bone health. And the challenges— and there are many— but one of the challenges, you know, visits are very short, and there's just— if, if all of the preventative medicine recommendations were were, were actually done during a visit. Um, it— there's— you just— there's no way. That's the visit. There we are. Yeah.

So talk to me about, besides just aging, which is its own risk factor, what are some of the top risk factors that the listeners should be aware of for bone health and osteoporosis risk?

The one that I'm most passionate about talking about these days are medications that people are on, because that is a potentially modifiable risk factor. And by the way, most risk factors are modifiable or can be, be changed. Aging, obviously we can't, but with the alternative is worse. The alternative is worse. Absolutely. But, but you can actually improve your, your, your, your biological age. Yeah. Your chronological age, we are going to get older, but your biological age, you can absolutely improve and slow that down. But with medications, it's a huge blind spot conventionally. There's so many doctors out there who are prescribing medications, they have no idea that it's destroying bone and causing fractures, and patients are unaware of it as, as well. It's not a side effect that's, that's commonly discussed, if at all. I mean, doctors know about glucocorticoids like prednisone, dexamethasone— that's commonly understood, it destroys bone. But many other medications, the most commonly prescribed medications in fact that people are taking, also destroy bones, and nobody's talking about it. So one of those are anything that elevates serotonin. So SSRIs, SNRIs, Lexapro, Prozac, those antidepressant medications, and there's about 25% of women in their, you know, I think in their 60s and older who are on those medications. They destroy bone. They activate osteoclasts. Osteoclasts are the cells in our bone that destroy old worn-out bone and break it down. And so they supercharge those. So much so that we know from a meta-analysis that for every 19 women taking an SSRI for 1 or more years, we'll expect one of them to break a bone. Wow. And, and most doctors have no clue and most patients have no clue. The other thing too are, are acid blocking medications, uh, proton pump inhibitors. You know, the first FDA warning letter went out, you know, over a decade ago about proton pump inhibitors and bone damage and fractures. And these are available over the counter, you know, Prilosec, Protonix, and they had, they have been shown to increase fracture risk, hip fracture risk, which is the most dangerous type of fracture. By about 60% when somebody's taking them for, for years at a time. And they're, and the list just goes on and on. Those are just two of, of many.

I mean, the problem is who in the general population, maybe not the populations we see, but who isn't on an SSRI and who isn't on a PPI or an antacid?

Like between that two, you've got like 80% of the population like that.

That's a It's a sad commentary on our population, but we all have apparently a Zoloft deficiency.

Right. But what's interesting is that it's shocking to me how many people are on anything that's decreasing their stomach acid in some way, and they actually don't know that those medications, because it's decreasing your acid and your acid is needed to con— to start the process of turning inactive minerals and nutrients into active, including calcium, magnesium, iron, B12, and folate. If you don't have adequate stomach acid, you cannot make those into their active forms, and then you don't get what you need, and you can get deficient. And there's your bone health, like, right there. So it's shocking to me that people aren't even aware that it can impact bone health.

And another thing that it does is it creates dysbiosis because you can't sterilize your food. And so you get this— they also increase the risk for dysbiosis. And dysbiosis is now linked to osteoporosis and bone loss through the gut-bone network and gut-bone connection. But in a really sad twist of kind of how medicine is treating this condition, what happened with the proton pump inhibitors is a real cautionary tale because you these people with bone density decreases, with osteoporosis, you know, showing up into clinics, they're on a PPI, they have bone loss. And so what does a conventionally trained physician do? What are they taught to do? Well, they're taught to prescribe a medication for low bone density. And what is the first line therapy? The oral bisphosphonates like Fosamax. Almost everybody's doing it. And so for many years, and still to today, still this day, you know, today. What happened is they're saying, okay, bisphosphonates have been studied in postmenopausal women with osteoporosis, which is what the vast majority of studies are on. Now I have a patient who has low bone density and they have— they're on a PPI, not a postmenopausal woman with osteoporosis, just on a PPI. Well, I'm going to prescribe Fosamax because that's what we do for for, you know, bone loss with women. But the mechanism of action is totally different. The mechanism of action of why women lose bone— and men too, by the way— when estrogen decreases is very different to why people lose bone from different medications, including PPIs. But they're prescribing these, these oral bisphosphonates. They're prescribing Fosamax to people like candy. And somebody decided, well, let's study this and see what happens. What they discovered was when people took Fosamax with a proton pump inhibitor, their risk of fracture actually increased compared to just taking the proton pump inhibitor alone.

Lovely.

Okay, John, there's a lot to understand.

You're just full of amazing news.

You're the bad news bear today. Usually it's me, today it's you.

Okay, but hopefully— but, but, but it's, it's, it's actually preceding a lot of good news because there are many things you can do about it that are, that are different approaches that can improve your bone, also get rid of the— most people's need to to take a PPI in the first place.

Before we go there, can you— are you comfortable talking about the mechanisms of actions that you just alluded to and the difference between the, uh, what's happening when people age versus what's happening when people are taking a medication and that leads to bone loss?

Absolutely, absolutely. So you already mentioned most of them with, with PPIs, and then I added the dysbiosis piece. So it's, it's the nutritional deficiencies that are thought to be the underlying problem with proton pump inhibitors and, and bone health. Now, more research is being done and more mechanisms of action might, might, you know, come to light, but that's what's understood so far. With estrogen, when that goes down, it is anti-inflammatory. And so you'd increase inflammation. When you have dysbiosis, you also get increased inflammation. So there's a connection there. Estrogen stimulates the, directly stimulates osteoblasts. Osteoblasts are those bone building cells. So osteoblasts and osteoclasts are— need to be in balance to maintain bone health. And when one is, you know, when osteoclasts are more active, then you get faster bone breakdown and bone, bone loss. So estrogen also, in addition to stimulating bone formation with osteoblasts, stimulates collagen production, and it also helps with increasing absorption of a specific nutrient called MK-4. In, in, or vitamin K in general, but that's converted to MK-4, which is the form that the bones use. And so that is, you know, some of the mechanisms of action by, by which both of those, you know, estrogen and PPIs work.

Okay, cool. Thank you.

All right, I think we need some good news now because—

all right, bad news bear, hit it.

Well, the good news for people with acid reflux, frankly, is that there are 5 most common foods that cause acid reflux. So just changing your diet alone can relieve somebody of that need to take that drug. And whenever we can reduce the dose of the drug or get rid of the drug altogether, everybody wins except for the pharmaceutical company. But all the—

Counting off. Count off to me. I'll keep track. I have 5 fingers, so we're good. I can count to 5.

Okay, so tomatoes, raw garlic, and raw onions.

Is that 1 or 2?

That's 1. Orange juice, coffee, chocolate, and how many I got there? 4. Spicy foods in general.

I have one more for you.

I think we should make this 6. Oh, mint. Some people with mint too. So it also can vary, but some people with mint.

Okay. I think we should add one more because there's a massive study that was done, I wanna say in Sweden, and this is one of the only studies I'll ever quote you cuz I can't remember them. But this one I remember because I was presenting on gluten and reflux and GERD. And, there's a shocking association between people with celiac disease and low stomach acid and reflux and GERD. And so, gluten can actually lead to reflux and discomfort also for people who are sensitive.

So, that's another one. [Speaker:BEN] And, I think that that can be applied to almost any food. People can react to anything. And so, experimenting I think getting rid of the most common ones and see if somebody's symptoms are alleviated is a good place to start. And if they're not, then kind of trying to identify through trial and error what that might be. But interestingly, because you mentioned celiac disease, osteoporosis can be the only symptom of celiac disease.

Yes. That's how my dad was diagnosed. Wow. Because he felt— My brothers are young and they were rollerblading and my dad fell while rollerblading and broke his hip when he was 50. And someone went, wait a minute, 50-year-old men don't break their hips. What's going on here? And they diagnosed him with osteoporosis. And then from that they went, why do 50-year-old men get osteoporosis? Because he has celiac disease. So that's actually how he was diagnosed with celiac disease, which is just just insane because he had no idea.

Well, and I, I recommend anybody, man or woman, who fractures and they're 50 years old or older, get a bone density test. That, that is the recommendation of the Bone Health and Osteoporosis Foundation. I agree with it. It's not the conventional, conventionally accepted one, so insurance may or may not cover it. Uh, but I think it's a smart thing to do. And I do recommend all women when they start going through menopause, get a baseline bone density test.

You know, but let's go back. Just, I just want to go back, uh, before we go too far with the PPIs.

Sure.

So anybody with a proton pump inhibitor, yes, food could be an issue, and yes, we want people off. And most people have to do it very, very slowly. Most people cannot just take a food out and then stop their PPIs. They have to gradually wean down. They have to gradually wean down so that if you just, a lot of people that try to get off don't do well. 'Cause if you have to wean off the food. So I just wanna, yeah, that's important.

That's, that's a good point. And that goes with a lot of medications. And I don't, I really recommend people get off medications in consultation with their physicians and, and do it. And you know, the, the, you mentioned something though about low stomach acid. And how that was creating it. That's often overlooked that it doesn't look conventionally. Somebody has heartburn and they're, the, the thinking is, well, the stomach acid's the problem, so we're just gonna get rid of the stomach acid. But there are cases where the problem is not too much stomach acid, but too little stomach acid. There's that small little lower esophageal sphincter, a little muscle at the bottom of our esophagus that keeps the contents in the stomach separate from your throat. And, and one of the signals for that to, to close and keep those contents separate is the pH, how much acid is present. So if you have some acid present but not enough to get that muscle to close, it stays open. Um, and, and so one of the things that could be done is to test somebody's stomach acid or just do a trial in consultation with a doctor, because you can get too much stomach acid when you're supplementing with it, to, to try taking some stomach acid as a supplement in a very controlled situation to see if that alleviates the symptom. But H. pylori infections also cause, um, yeah, acid reflux. So it's not just one thing, and I don't recommend people just go and start experimenting and doing these things, except for the food. You know, really, I think talking with somebody and seeing an integrative or holistic doctor, healthcare provider, is in, in everybody's best interest.

Yeah, 100%. I have a million questions, but one thing I'll say, John, is that where we are— so we work through insurance, and where we are, I can't get a DEXA unless someone has back pain or loss of height. So I'm very lucky because all my patients have either back pain or loss of height. They have a qualifying factor. But sometimes it's hard to get just a screening bone density test, but we often find other reasons where it's not actually screening, it's diagnostic. So there's a, there's a little sort of line we can walk there.

And, and the other nice part is now more and more centers are offering DEXA for a fee, which is not an extraordinary fee, that's looking not only at the bone density, but they're looking at their muscle and fat tissues and doing it all at once. So it's actually, it becomes relatively affordable Uh, yeah. So, yeah, everybody should be able to get that.

And, and I, I do think people should be getting bone density tests, but like I said towards the beginning, uh, it shouldn't be the only thing we're looking at. And even if somebody can't afford a bone density test, you can still do basically free, no-cost assessments that can give patients and clinicians an understanding of somebody's fracture risk independent of whether or not they actually have been diagnosed or not with osteoporosis.

So let's talk about that. What kind of things can we do to— since we talked about risk factors, now let's talk about diagnosing and—

Right.

Wait, wait, wait. We missed a risk factor. I think— I don't think we would be complete if we didn't add in that if you have a history of heavy metal exposure, that lead preferentially hangs out in your bones. And so if you were born before 1978, when lead paint was outlawed in the United States, or if you were born before 1975 when lead gasoline was outlawed, and I don't even know when they outlawed the lead pipes, but there are still 10 million people in the United States who have lead pipe that's bringing them water, or if you were born to someone who lived in those times, you have potentially had a lead exposure and are at risk for toxic heavy metals, which are hanging out in places you don't want it to hang out, including your bones, your brain, between your fat and your organs. So yeah, that's a risk factor.

Well, it's not necessarily a risk factor, lead itself, for osteoporosis. What happens is when somebody starts getting bone loss, because it's stored— lead is stored in the bones— this is the real danger, is that it then releases the lead into circulation where it starts depositing in, in other tissues around the body. The, the only heavy metal I'm associated— that I'm, that I'm aware of that is associated with osteoporosis risk is arsenic. Because it can, it damages the kidneys and prevents the conversion of vitamin D to active vitamin D. There may be other mechanisms, but that's the one that I know. But lead, absolutely, and other environmental toxins, huge risk factor as we age for unhealthy aging, you know, dementia, diabetes, you know, all sorts of, all sorts of problems. And where we see, you know, lead start to increase in the body in, in blood tests when there is no current exposure is in the elderly when they start losing bone and that lead then just gets released into circulation.

Okay, so now we covered that. Now we can go on to the good news stuff, but—

Well, no, now we have to figure out how to— What's the best way to monitor what you said? There are, outside of DEXA, there are screening tests. Tell us about that.

Well, look, there are all sorts of tests, laboratory tests, radiology tests that, that people can, can order and, and spend their money on. And, and some of those are very important. I, I do recommend people get them. They, they do help complete and fill out the puzzle. But physical exam, physical fitness tests, functional testing can also be used to assess somebody's, uh, risk. 95% of fractures occur because somebody falls. So there are tests that are there that people can do at home, that you can do in your office, that, that will give somebody— will give an indicator of whether or not they're at higher risk for falling. And then obviously, if they're, if if they're, you know, elderly, if they have other risk factors for bone loss, if they're frail, you know, they're just some things that you can, you can assume are happening. If their, if their skin is thin and easily tears, that's— there's one study that linked that to bone loss and osteoporosis because the, the connection there is collagen. You're losing collagen in your skin, you're probably losing it elsewhere in the body, including your bones. But the testing, one, one of them that I like is the one-legged stand test for 10 seconds. If somebody could stand on one leg for 10 seconds and then switch and do it the other legs, their risk for all-cause mortality and for falls and fractures is significantly decreased.

Eyes open or closed, does it matter? I'm going to do this when we hang up. I'm going to try. I'm in heels, so it's actually a harder test even.

Yeah, come to think of it, I don't— I'd have to review the test protocol. I don't recall. I think that it is harder if it's, you do it with, with your eyes closed. But I don't know that it's, it's required. With, then there's a sit-to-stand test at a chair of a specific height without using the armrest to put your, you know, stand up or down. You sit down and you see how, how long it takes you to, to stand up and, and, and sit down. I believe it's 15 times.

My trainer makes me do that. When we do, you know, the bar on the shoulders, he puts a box behind me. He's like, sit down on that and then get up. I call him Evil Chris because he's evil.

Yeah. Well, he's doing you a favor. Evil Chris.

I love Evil Chris. I go to Evil Chris every weekend, but I call him Evil Chris because he's really tough.

So, okay. So those are 2 good ones. And then an Australian study came out not that long ago that just asked the question, you know, can you walk? And it was a kilometer, I believe, there. You know, basically, can you walk a certain distance Um, easily, or do you have difficulty doing it? And, and walking has been shown to be incredibly helpful. Even just 7,000 to 7,500 steps per day is associated with a 50 to 70% reduction in all-cause mortality. So it doesn't have to be the 10,000 steps a day.

Damn, we need to go for more walks.

Walking's great.

Does it matter if you're wearing a weighted vest? Because weighted vests are all the rage now. Do they Do anything?

Do they do anything? The study didn't compare that. There's no study showing all-cause mortality and weighted vet walking with a weighted vest. I don't believe that exists.

Or bone health. And I know because you really have to go uphills and downhills and hiking and stress the bones in order for— you can't just stroll for 7,000 steps. That's not going to help your bone health as much as really working it.

Here's the challenge in the research with osteoporosis and bone health. In order to have a prospective clinical trial on exercise, You need about 7,000— having fractures as the endpoint, you need about 7,000 people. And so, you know, those just haven't been done for most exercises. For most exercises, there's an association, it's linked to decreased fracture risk or improved bone density, um, like tai chi or yoga, uh, those sorts of things. Uh, there are, there's There are clinical trials on high-intensity weightlifting. The LIFT MORE study is, you know, I think the earliest one that came out of that, that definitely showed an improvement in balance and strength and reduced fall risk and improved bone density. So, there's lots of things people can do and it's just a matter of what interests them.

I want to make sure people are hearing this because I think what you're saying, so please get me me, tell me if I'm right. Part of this is, yes, your bones are— if people's bones, uh, are thin, osteopenia or osteoporosis, that's a risk factor.

The—

but it's only a 44% risk factor in women. So let's say that's 50-50, just because people understand that, I think, easier. The other piece that is really important though is it's the fall risk. So is it— it's the muscles, it's the joints, it's the ability, like you said, are your muscles going to be limber? Are you going to be able to find balance? It's not just your bones, it's your whole body interacting with your bones.

Correct. Including your nervous system. That's correct. That's a great summary of it.

I just want to make sure I'm Yeah.

And, and I would, I would just to, to drive home the importance of strength, balance, and stability even more, let's compare that to the bone density test. So bone density test, as you mentioned, and as we talked about, just by itself predicts less than half of people with osteoporosis who are fractured. But a study looked at a couple variables. They looked all at bone density tests and they also looked at whether somebody was stable and steady on their feet, what their risk for falling was. When they, when their risk for falling was low, the ability of that bone density test to predict fractures went down to 5%.

Wow.

So the bit that your stability, your strength, your muscle mass, your balance is more important than your bone density test results in terms of your risk for fractures. It's amazing.

So 5%, I mean, that's nothing. I mean, that, that's for me, it's like a little bit of a two-edged sword. So on one hand, it's super important, but I don't, I still don't think people should ignore a low bone density because as we talked about, it's a holistic, it's part of your body. So on one hand, you want to make sure your muscles are strong, your balance is good, that your nervous system is good, that you don't fall, and you have to make sure your bone density doesn't keep going lower 'cause that means something is out of balance in your body.

Correct.

That, that's my, my interpretation of that.

Well, I agree with you and I think the bone density test though is also an indicator that, you know, potentially collagen is being lost and collagen is what gives bone its ultimate strength and flexibility. The minerals bind to, to the collagen. And so looking at it holistically and trying to be as strong and prevent fractures as much as we can, while it is a, you know, there's a 5%, it only predicts 5% of people who fracture when their risk of falling is low. The problem is that people's risk for falling over time is not static. It changes. you know, depending on their age, if they get sick or, you know, are in bed, if they have to have surgery and are recovering. I mean, there are lots of variables. So only focusing on, on just strength and stability, I think, is as foolish as only, only focusing on your bone mineral density test. I, I think the best approach is to focus on all of these factors at the same time.

I want to add something here that I've been sort of percolating on. I don't know if follow football, but I love football. And I was— okay, I'm the weird one. So I was reading about how— I can't remember what team it was, but they had a quarterback who was also taking jiu-jitsu. And in jiu-jitsu, there's a lot of grappling and falling, but it teaches you how to fall effectively. So they can't prevent their falls, they're going to get tackled, but how do they fall in a way where they minimize their their head injuries and their bone and their ligament tears. And, what they found, this one team, and I'm going to have to go look it up, but this one team found that when their players all took jiu-jitsu and fell effectively, their injuries were reduced significantly. So, this is going along with what you say that, well, don't fall, but also how do you fall. So, there's also benefit to learning how to fall so that when if you— I mean, I think it's inevitable in the world that you might fall in your lifetime.

We all do.

So, falling in a way that's going to minimize the damage to your bones is also a useful endeavor. So, minimizing your risk of falling, maximizing your effective falling, and maximizing your bone density are all sort of 3 separate components plus then all the functional medicine work to make sure that we improve your bone quality.

I love that. If people are willing to do that, that's great. You know, one of the, one of the challenges clinically, and I'm sure you see this all the time as well, is there are so many things people can do. And the, the question is, what are they willing and able to do? And in respect to bones, what is somebody willing to do consistently over time? Because it is, this is, didn't happen overnight and it takes years to reverse, takes years to build it back. And it's that consistent effort. That developing new healthy habits that are just incorporated into people's lives that are gonna give the long-term benefits that everybody wants.

Yeah, 100%. I think this is great. I think my only, I mean, we could probably do this for a lot longer, but my, my outstanding question, and we'll put all of your response in the show notes, is how can people find you and more, where can they find out more about you and follow you?

Thank you for the question. My website is the best place to get information. Also to look at, you know, products that I've developed around bone health, and that is nbihealth.com. My book is also available there, as well as free articles and downloads.

This is amazing.

Amazing.

This has been fascinating, and we can definitely spend a lot more time, but thank you, and thank you.

This is—

yeah, thank you for being here.

Thank you both. And I didn't cuss, not once.

You didn't cuss? No, I said shitty at one point, but that was about it. So thank you for being on this episode of the Feel Freaking Amazing podcast.

Thank you both. It was fun.