Full Transcript Medications And Bone Risk 0:00 What if I were to tell you that the 0:01 common medications that we get put on 0:03 all the time like SSRIs, PPIs, and even 0:07 things like 0:08 hypertension medications or things for 0:10 high blood pressure could increase your 0:12 risk for fracture and osteoporosis. So 0:15 today I'm joined by Dr. John Newstead 0:18 and he has a new version of his book out 0:20 called fracture proof your bones and he 0:23 has added almost a whole 'nother book of 0:26 research and we are going to go in deep 0:29 on medications and their impact to bone 0:31 turnover, things that you can do beyond 0:34 a DEXA scan to actually address not only 0:38 whether you're losing bone, but actually 0:40 be able to track your bone efforts over 0:43 time and we go into a lot of other 0:45 things about sleep and other areas of 0:48 concern that either help make or break 0:51 your efforts on building your bones. So 0:53 join me today on Menopause Mastery. 1:00 Dr. Newstead or John, welcome back. You 1:03 we were just on a few seconds ago 1:04 talking about it was back in July July 1:07 of 2024, which I don't know about you, 1:09 but I was like it felt like I just 1:10 talked to you, but that's how time 1:12 speeds up 1:13 >> [laughter] 1:13 >> as we get older. 1:15 That's what you do. So I'm glad to have 1:17 you back for sure. 1:19 >> Yeah, it's great to be here. 1:20 >> Yeah, so let I want to talk about this. 1:22 So you just recently came back out with 1:25 fracture proof your bones 1:27 and and you have added all new chapters 1:30 like it's almost double the size of the 1:32 book that you originally created. 1:33 There's so much more data.
DEXA Limits And Fracture Prediction 1:35 Um and I want to talk start off talking 1:38 about the um 1:40 the stability and the accuracy of a DEXA 1:43 scan, right? Because that's the I'm 1:45 going to air quote this gold standard 1:47 and traditional diagnostics of 1:50 osteoporosis and we're going to talk 1:51 about all those hazards, but one of the 1:53 things that I I found interesting that 1:56 you are really outlining in this book is 1:58 the striking piece of data that when 2:00 it's combined with other clinical 2:02 factors, the bone density alone as a 2:05 standalone predictive value for a 2:07 fracture can drop to about 5% 2:10 right? And so DEXA is missing so much of 2:14 that picture, you know, and mainstream 2:16 medicine is still relying on it as the 2:18 gold standard. And so like I want to 2:21 talk like I want to go in deep on what 2:22 are the things you feel like we should 2:24 be looking at. 2:26 Um I know several of them that are very 2:28 much part of our wheelhouse from our 2:30 telemedicine company and even the 2:31 clinic, but I want to really dig into 2:33 this because so many women are just 2:35 lost. 2:37 >> It is a confusing not only for consumers 2:41 and patients, but doctors are confused 2:44 too. And there there multiple studies 2:46 that have looked at that where doctors 2:48 aren't sure how to interpret the bone 2:50 density test or what conversations to 2:53 have based on those test results and 2:55 comfort they're not comfortable having 2:57 conversations around diet and lifestyle 3:00 and exercise because essentially if the 3:02 conventionally trained health care 3:04 system does not educate clinicians in 3:07 any of those areas. In fact, even today, 3:11 you know, in 2026, 3:14 this issue of clinicians not getting 3:18 physicians not getting educated in 3:21 nutrition was something that was 3:23 identified 20 years ago. That even back 3:26 then they they saw that in research in 3:29 in the gaps in medical education as a 3:32 big problem. And even today, 20 years 3:34 later, they get less than maybe half of 3:37 a semester of one class, less than 25 3:40 hours of nutrition education. So they're 3:42 just not comfortable in having that type 3:45 of conversation. And when it comes to 3:47 the bone density test, the challenge is 3:50 is that when you're looking at 3:53 somebody's T score or their Z score and 3:56 then you're trying to understand what is 3:59 the the real risk for fractures, they 4:02 typically aren't understanding 4:05 that there is not a very strong 4:08 relationship between fractures and the 4:11 bone density test result. And because of 4:15 that, they are treating that number on 4:18 the test and that's all that they're 4:20 tracking and their numbers going up and 4:22 so they're convinced they're doing a 4:23 great job and in fact, the way that many 4:26 health care systems are compensating and 4:29 tracking success are based on that 4:31 number on the test as well. So it's it 4:33 is the standard of of care. They're 4:35 following the standard of care, but 4:37 we've known 4:38 for 20 years that a bone density test 4:42 predicts less than half of women with 4:44 osteoporosis who will fracture. 4:46 Actually, it's 44%. A bone density test 4:49 only predicts 44% of women with 4:51 osteoporosis who will fracture. It's 4:53 worse for men. Only 21% 4:56 of men. 4:57 But a study then looked at 5:00 what if somebody's risk of falling was 5:03 low? Because it's not just the number on 5:06 the test, meaning your your your your 5:08 score is low and so your bones are more 5:11 brittle and you're just walking along 5:12 and suddenly your your your bones 5:14 crumble. I mean, that's not 5:17 reality. Reality is is that 95% of 5:21 fractures occur because somebody falls. 5:24 So we want to prevent people from 5:26 falling and we want to increase strength 5:28 and stability, 5:29 but at the same time we also want to 5:32 maintain bone strength and bone quality. 5:36 So the bone density test 5:38 when somebody is when their risk of 5:41 falling is low, meaning their their 5:44 stability is good. 5:47 For 5:47 >> and men under 70 years old, if we kind 5:51 of average the numbers, 5:52 >> Mhm. 5:52 >> it only predicts about 5% of them that 5:55 will fracture. So, it's even it's even 5:57 worse than, you know, a a situation 6:01 which is bad to begin with. And it 6:03 actually is even less helpful in every 6:06 organization that has looked at the data 6:08 on just the bone density test alone has 6:10 concluded that fracture risk depends on 6:12 factors largely other than bone density. 6:14 So, any conversation around bone health 6:18 and fracture prevention 6:20 it has to focus on things other than 6:23 that number on the test or they're just 6:24 really missing the mark.
FRAX Scores And Fear 6:26 >> Yeah, and you know what I have found, 6:28 you know, because I've had, you know, 6:29 Living Well Dallas for 22 years and then 6:32 Minerva, the telemedicine company, and 6:34 we have a huge relationship with several 6:36 different organizations with women you 6:38 know, who probably for the first time 6:39 getting diagnosed with osteoporosis and 6:41 really trying to understand 6:43 the landscape of what they can do 6:44 because what I've found is they'll get a 6:47 clinician that, you know, makes them do 6:49 the DEXA or has them do the DEXA or they 6:51 ask for it because they know that 6:53 they're not going to get it until 65. 6:55 And regardless of what the number comes 6:56 back, let's say it's a -1.8 on lumbar 6:59 spine all the way to -4.4, 7:02 the treatment is always the same, 7:04 right? And the fear factor that they 7:06 strike in those women are exactly the 7:09 same. 7:10 >> Yeah. 7:10 >> Exactly the same. And so, these women 7:12 are terrorized, honestly. 7:14 >> And I've seen that a lot, too. You're 7:16 absolutely correct and it's a it's a big 7:18 concern of mine and it's a big area of 7:20 frustration for two reasons. First of 7:24 all, that fear is often times misplaced. 7:26 And if you look on the bone density test 7:28 reports, and I do this with patients 7:30 because it's very helpful for them, 7:32 towards the bottom of most bone density 7:34 test reports, they give a a 10-year 7:37 fracture risk probability based on FRAX 7:41 and the data that that was 7:42 entered into the computer at the time 7:44 the test was done. 7:45 >> Mhm. 7:46 >> And so somebody's 10-year probability of 7:48 a fracture is 8% or 12%, 7:52 which I've seen often, the opposite is 7:55 also true. That means there's a 92% 7:58 chance or or an 90 and an 88% 8:01 chance that they're not going to 8:03 fracture in the next 10 years. 8:05 >> Mhm. 8:05 >> And as soon as I point that out to them, 8:07 I can sort of see their shoulders relax. 8:09 And I also have them take a couple 8:10 breaths before I even start talking and 8:12 I'm I put that bone density test in its 8:15 proper perspective, like I already did. 8:16 What is its real predictive value? 8:19 And so let's focus on things we can 8:21 control. And yes, we want to bring that 8:22 bone density test number up. We want to 8:24 improve that, of course. But it is it is 8:27 absolutely not the most important thing 8:29 when it comes to predicting fractures. 8:31 And also, there's so many things that 8:33 people can control. 8:35 >> Yeah, I don't know about you, but you 8:36 know, out of the multitude, cuz we have 8:38 a I have a DEXA in my office, right? 8:40 Like we do those all the time. We've 8:42 added other things, you know, blood 8:43 work, the bone turnover markers, and 8:45 even REIMS, you know, cuz more data is 8:47 better data, right? Is the way I look at 8:48 it. When we can interpret and sort of 8:50 extrapolate parts from it. But I you 8:53 know, I don't know how many and I would 8:55 say it's probably a handful that don't 8:57 come back with at least at least a 7% 9:00 fracture risk over a given period of 9:02 time. Regardless of the results, there's 9:04 always something there. Like there's 9:05 never a zero. Have you seen a zero? 9:08 >> No, I mean I have seen for bone density 9:11 tests, I have seen people with with out 9:14 osteo come back without osteoporosis. 9:16 >> For sure, but the frac score always has 9:18 something. 9:19 >> The frac score has something because 9:20 it's looking at age, it's looking at 9:22 family history, it's looking at various
Who Should Get Screened 9:24 various scores. And that's you know, 9:25 it's interesting that you mentioned that 9:27 because in the the recommendations for 9:29 screening for bone density tests, the 9:31 most conservative recommendations by the 9:33 US Preventive Services Task Force, as 9:35 you mentioned, 65 years old, or or you 9:38 know, or if you have a a risk factor. 9:42 >> Right. 9:42 >> You can get screened earlier. The 9:44 challenge is is that if you if you ask, 9:47 you know, 100 women, 99 of them, 9:50 probably 100, are going to have a risk 9:52 factor. And if they're not getting 9:53 screened because there's a long list of 9:55 medications, the most commonly 9:56 prescribed medications cause 9:58 osteoporosis and fractures. The SSRIs, 10:01 antidepressants do. Acid-blocking 10:03 medications, prednisone, anti-seizure 10:05 medications, there's a very long list. 10:07 Many other diseases, if they have 10:09 irritable bowel disease or any 10:11 autoimmune condition, those are risk 10:13 factors. If they've have cancer or had a 10:15 history of cancer, those are risk 10:18 factors. Not exercising and now 10:20 sedentary lifestyle, that's a risk 10:22 factor. Now we know ultra-processed food 10:23 consumption above a certain threshold is 10:26 a risk factor. And so, many more people 10:29 should be getting screened. And even 10:31 those that are that are, 10:33 you know, according to that conservative 10:35 guideline, are eligible for screening, 10:37 95% of them are not being screened. 10:40 >> I know. 10:42 You know, it's the other thing I I think 10:44 women forget, too, is what I like to 10:46 call vertically challenged, cuz I'm 10:47 barely 5'3. So, if you're vertically 10:49 challenged and you are also really, 10:51 really petite, 10:53 your chances of getting into those 10:54 higher thresholds, especially if you 10:56 didn't work out and maybe you didn't, 10:58 you know, like we weren't looking at 10:59 those things when I was 18, right? You 11:02 know, all of those things can also 11:03 contribute to a, you know, likelihood 11:07 of a bone density that may not may not 11:09 have ever gotten to its highest possible 11:11 place, cuz we weren't even thinking 11:13 about it back then.
Early Risks And Protein 11:14 >> I get to in the second edition of my 11:16 book, and the reason why I I wrote it is 11:18 because I kept getting asked questions 11:19 of of people that that I I was either 11:22 able to answer but didn't include in the 11:24 first book, or they were just excellent 11:26 questions that I did not address in the 11:27 first book. And so, I thought it was 11:29 really important to expand it. So, I go 11:31 into a lot of those issues in the second 11:32 book of what what is it that it put us 11:35 at risk factor when we're when we're 11:37 younger, like anorexia nervosa or 11:39 competitive athletes, the female athlete 11:41 triad in young women is a big risk 11:44 factor then for osteoporosis. And the 11:47 eating disorders, like I mentioned 11:48 anorexia. So, there are many things that 11:51 that I think are important to be on 11:53 people's radar. And one of the most 11:55 important things is I believe raising 11:57 awareness. 11:58 >> Yeah. 11:59 >> That there might be an issue so that 12:00 they can get the testing done because 12:02 without the data, without the knowledge, 12:05 you can't make good decisions. 12:08 >> Right. Right. And what you know, I think 12:10 you pointed out in your book, like 12:11 today's statistics are 90% 12:14 of 12:15 those who actually have a fracture were 12:18 never tested or treated prior to the 12:20 fracture, right? Like so, most of the 12:22 time that's like 12:24 This is how you found out you had 12:26 osteoporosis. It's actually cuz you 12:27 fractured. 12:28 >> Yeah, most people do not get get 12:30 screened before. In fact, the first sign 12:33 often of a problem is a fracture, which 12:34 is why I like the recommendations from 12:37 the Bone Health and Osteoporosis 12:38 Foundation. And I'm on the corporate 12:40 advisory round table for that 12:41 association, is that anyone, men or man 12:44 or woman at 50 years old, if they break 12:45 a bone, should be screened with a bone 12:48 density test. And I I think that's 12:50 appropriate. In fact, I like any woman 12:52 50 years old, I want her to get a bone 12:55 density test because I want a baseline 12:56 because she is likely to start going 12:58 through menopause soon. And at that age, 13:01 her hormones are probably already 13:02 started to decline, but she's not 13:04 symptomatic yet. And I want to get a 13:06 baseline. I want to know where she's at. 13:08 >> See, I have the feeling, you know, if we 13:10 look at some of the data coming out of 13:12 retrospective studies, you know, the the 13:14 10 million women study that came out 13:16 with the end of 2024 or early 2025, 13:19 looking at hormone replacement therapy 13:21 and cardiovascular, several different, 13:23 you know, disease states and looking 13:25 mortality rates. One of the other things 13:27 that we're starting to recognize is that 13:29 there's an acceleration of bone loss 13:31 that occurs long before the period 13:33 stops. 13:35 That it actually starting to occur as 13:37 that estrogen level is declining cuz you 13:39 can still have a cycle and have low 13:41 levels of estrogen relative to your 13:42 original levels. And so we're starting 13:44 to recognize that treatment probably 13:45 should start before that. But we don't 13:47 actually have a way to identify that, 13:49 right? You you can you can do like FSH 13:52 in the follicular phase. You can look at 13:53 luteal phasing and and things but we 13:55 don't have this bonafide hey when these 13:57 things occur the labs look like this we 14:00 need to start treating. 14:02 And I think it's you know a travesty cuz 14:04 I feel like after all these years seeing 14:07 patients come through Living Well Dallas 14:09 that we probably need to scoot that 14:11 early baseline even earlier or look at 14:14 bone turnover markers to identify if 14:16 we're starting to see particularly rapid 14:19 osteoclast activity or you know 14:22 reduction of osteoblast even too. Like 14:25 what other things can we look at to 14:27 identify maybe somebody who might be at 14:28 high risk 14:30 that it's going to accelerate in this 14:31 time period before it looks like 14:33 menopause. 14:34 >> When when we look at a bone density test 14:36 that the T score is not valid for 14:39 premenopausal women but a Z score is and 14:42 that is an under utilized variable on 14:45 that test. I mean a lot of doctors don't 14:47 even quite understand what the T score 14:49 value is or what it means and then you 14:51 ask them what's a Z score and they they 14:53 they're scratching their even more of 14:54 them are scratching their head not sure 14:56 what it means. But that's really 14:58 important to understand is a woman 15:00 losing bone relative to other women her 15:03 her age of her same her same race. And 15:05 so that's a valuable tool I believe for 15:08 that cohort of women that you're 15:09 addressing and talking about to see okay 15:11 are they are they losing bone or have 15:13 they lost bone? I think that that can be 15:15 that can be very helpful. 15:17 >> Yeah, kind of age matched early early 15:19 detection, you know. 15:20 >> Yeah, but I also think that we can just 15:22 look at simple things like what's their 15:25 dietary pattern. Because the amount of 15:28 of of protein that a person consumes, 15:31 that alone can account for 2 to 3% of 15:34 bone mineral density. There are 180 200 15:37 proteins in bone, and most people aren't 15:39 getting enough protein. And as we all 15:41 get older, the US RDA for protein is 15:44 insufficient to maintain bone mass and 15:47 muscle mass as we get older. And so just 15:50 looking at that and encouraging people, 15:52 helping them calculate and recommend 15:54 based on body weight in pounds, multiply 15:57 that 0.6. That's the minimum amount of 15:59 protein somebody should get based on on 16:01 the research. 16:03 And tracking that way, that is a very 16:05 practical way to get people involved and 16:09 help them understand what they can do 16:11 control the trajectory of this and even 16:13 change the trajectory and help to 16:15 rebuild bone and reduce fracture risk. 16:18 >> Yeah, I think that's so important. You 16:20 know, we were talking about those other 16:21 risks. I want to go back to some of 16:22 those medications. But, you know, like 16:25 you said, anorexia or bulimia, but 16:28 we also have a lot of extreme dieting in 16:30 the Gen X and Boomer groups, right? And 16:33 we just I think the vast majority of 16:36 women during those very important years 16:38 of bone growth and then particularly 16:40 into their mid-life were probably 16:42 seriously under eating protein. Cuz I 16:44 can tell you, talking to hundreds of 16:45 women a week about osteoporosis cuz I do 16:48 a lot of webinars about it, all of them 16:50 are under eating. And that's that's the 16:52 first thing they're like, "Oh my god, I 16:53 got to eat protein like it's a job." I'm 16:55 like, "Yes, you do." 16:58 >> Yeah, and it's interesting in in the 16:59 research I sometimes have come across 17:01 the the phrase that osteoporosis is a 17:05 pediatric condition with geriatric 17:07 consequences. Meaning Isn't that great? 17:11 That really struck me, too, is that 17:12 yeah, that makes sense. So, we're we're 17:13 setting the stage at a young life, you 17:16 know, in our 20s when we have get peak 17:18 bone mass occurs, if we're not taking 17:20 care of our health then 17:21 it can manifest decades later. We may 17:24 not know for decades and decades later. 17:26 And one of the concerns that I have, 17:28 besides the fact that more and more 17:30 young people, especially young women are 17:32 being put on antidepressants, and that 17:35 is a powerful bone destroyer, but also 17:38 GLP-1s. While there's no evidence that 17:41 those those medications directly damage 17:43 bone, there's no current evidence of 17:45 that. My concern is that people are 17:48 going to end up with nutritional 17:49 deficiencies. 17:51 >> Oh, they do. 17:51 >> Yeah, they get they're not eating 17:53 enough. They're not consuming enough 17:54 protein. They're not consuming enough 17:56 micronutrients, and that is going to 17:58 have devastating consequences decades 18:00 down the road that we won't even see for 18:02 a long time. 18:03 >> Oh, yeah. I mean, all you got to do is 18:04 look at the 18:06 the pictures of Demi Moore at Cannes, 18:09 right? And I forgot who it was. I I want 18:12 to say it was Vogue, but I that may be 18:14 wrong, but it was a writer that took a 18:16 picture of her and said, "Hey, look at 18:18 her toned body." We're like, "That's not 18:20 toned. That's skeletal." Right? 18:22 >> [laughter] 18:22 >> She has lost so much muscle mass 18:25 that, you know, she's a striking 18:27 example, and it she's had a long history 18:29 of of eating things over the years, but 18:32 we have an entire community of people 18:34 that are now looking at skinny talk and 18:36 all these other things where they're 18:37 using misusing these medications, and 18:40 the goal is to get as skinny as 18:42 possible. Like, I remember kind of the 18:43 heroin chic from the '90s. Do you 18:45 remember that? 18:46 >> Yeah. 18:47 >> But the the reality is is is they could 18:50 cause irreparable damage to their bone 18:52 density that may be almost impossible to 18:55 correct if they're doing that in their 18:57 growth phases or where they're have the 18:59 best opportunity to create bone. 19:02 >> Yeah, I mean, what you might be correct. 19:04 We just don't have the data of that. 19:06 We do know that at any stage of life, 19:09 you know, it is possible, and I've seen 19:10 it clinically, all the way to people in 19:12 their 80s to be able to improve their 19:14 bone density and their in their bone 19:16 health. So, a bone is a dynamic living 19:18 tissue, and as long as and it adapts to 19:20 its environment like we do, you know, 19:22 everything inside of us does. So, when 19:24 we are giving the raw materials, 19:26 creating the environment for the bone 19:28 the osteoblasts to to do their job to 19:32 create healthy, strong bone, it's going 19:34 to do that. The problem is 19:36 people aren't creating the environment 19:38 for the body and the biochemistry to do 19:40 what it wants to do to help us be as 19:42 healthy as possible. 19:44 >> Yeah, I mean, it's more so yeah, 19:46 everybody can I mean, there's studies 19:48 with women in their 70s and 80s putting 19:50 putting bone on, you know, just doing 19:52 weight training alone. I just worry so 19:54 much that 19:55 nobody's looking at it and by the time 19:57 it gets addressed, the the just sheer 19:59 volume of loss is you know, it's kind of 20:01 like, am I going to climb Everest to get 20:03 it back? Or am I going to roll over this 20:05 very short hill? Right? I'd rather roll 20:08 over a very short hill or not have it at 20:10 all than have to try and climb climb 20:11 Everest 30 years later. 20:14 >> Yeah, and I think that's that's a great 20:15 analogy and I love that, you know, 20:17 you're so focused on this as as am I. 20:20 And and I hope through your work and 20:22 through my work and many other really 20:24 amazing clinicians and and nutritionists 20:27 and health care providers out there that 20:29 are sounding the alarm on this and 20:30 really pushing for more integrative 20:32 approaches and a real a more rational, 20:34 frankly, approach and scientific based 20:37 approach to this, it will raise 20:39 awareness. Unfortunately, for any 20:42 condition, uh people tend to be 20:43 reactive. You know, they don't really do 20:46 things in terms of preventive medicine, 20:49 although preventive medicine is a great 20:51 buzzword and it's I think what we both 20:53 hope people would do. If it doesn't 20:55 hurt, if it's not a pain point, people 20:57 not tend not to notice it. I think 20:59 especially with bones because we all 21:01 just take it for granted. We're walking 21:02 around and living our lives and our 21:04 bones are must be healthy. 21:06 >> Right, exactly. Now, I want to go back
SSRIs PPIs And Polypharmacy 21:08 and and specifically cuz I think, you 21:09 know, I know most of my listeners are 21:11 aware that the loss of estrogen, the 21:13 loss of testosterone, progesterone, all 21:15 of that can contribute to 21:16 the signaling for bone building and bone 21:19 repair that will be damaged. 21:21 Tell me about the mechanism of SSRI cuz 21:24 there's an association there, for sure. 21:26 But, tell me about the mechanism cuz I 21:28 think people are going to be listening 21:29 to this and like, "Oh my god, I'm on 21:30 that or I've been on that." 21:32 >> Well, I think the the most fundamental 21:35 concept that I can say is that bone is 21:40 like the canary in the coal mine. It is 21:42 the is receiving and and actually giving 21:45 off hormones and there are receptors on 21:48 bone for many hormones. So, serotonin 21:53 receptors are on osteoclast. So, when 21:56 serotonin is artificially elevated by 21:59 the SSRIs or the SNRIs, you know, 22:02 Prozac, Lexapro, Wellbutrin, 22:05 what happens is they speed up the 22:08 osteoclast activity and help osteoclast 22:11 to live longer. And osteoclast, for your 22:14 listeners if they don't know, are the 22:16 the cells that break down old, worn-out 22:18 bone, where the other metabolically 22:21 active cells, the osteoblast, build up 22:24 new, healthy bone. And we need a 22:26 constant balance of those 22:29 for healthy bone in a process called 22:31 bone remodeling. And in fact, when bone 22:34 is healthy and remodeling is is 22:36 balanced, about every 10 years, we have 22:39 all new bone. 22:40 And osteoporosis is essentially a a 22:43 disorder or a condition of imbalance, 22:45 where the destructive forces are 22:46 winning. 22:47 And one of those destructive forces 22:49 could be an SSRI or anything that 22:52 artificially raises serotonin. And those 22:55 osteoclast then work faster, they work 22:58 longer, and bone breaks down to the 23:00 point where studies have concluded that 23:03 for every 19 women taking an SSRI for 1 23:08 to 5 years, we would now expect one of 23:10 them to fracture. 23:11 >> Oh my gosh, I have not seen that data. 23:13 Wow. 23:14 Wow. And then you add to that 23:16 perimenopause, menopause, the loss of 23:18 estrogen which drives osteoclast 23:20 activity, too. So, if you're a woman, I 23:22 would assume in menopause, right, and 23:25 not treated with hormone replacement 23:27 therapy and on an SSRI, now you've got 23:29 kind of a double whammy. 23:32 >> Yeah, and I think you have really more 23:33 of a triple or or whatever the five is, 23:36 quintuple, quint whatever whammy. 23:39 Uh because because all these things 23:41 really are not happening in in 23:43 isolation. What you have is somebody can 23:46 be on an SSRI, but then the other 23:48 category of medication, most common and 23:51 they can get it over the counter now and 23:52 are are acid blockers, proton pump 23:54 inhibitors. Those damage bone and 23:56 increase osteoporosis and fracture risk. 23:59 Um uh prednisone, 5% of postmenopausal 24:02 women are on prednisone, and that 24:04 damages bone. Then you have other 24:07 diseases where as people get older, 24:09 they're more likely to have, you know, 24:11 irritable bowel syndrome or an 24:13 autoimmune disease or ulcerative colitis 24:17 uh or have gone through cancer treatment 24:20 and are are cancer survivors. You'll all 24:22 of those also are risk factors for 24:24 osteoporosis factors. And then they're 24:26 on other medications as well. In fact, 24:28 research has shown that 94% of women, 24:31 you know, 65 and older are on a 24:34 medication that that increases their 24:36 fall risk. And 95% of fractures occur 24:39 because somebody falls. In addition to 24:42 that, 24:43 you have people who are on blood 24:45 pressure medications for decades and 24:48 they don't end up getting a a a a 24:50 medication review to make sure that the 24:53 dose of the medication that they were on 24:55 5, 10 years ago is still appropriate. As 24:58 people get older, their ability to break 25:00 down and metabolize the the medication 25:04 tends to decrease. And when that 25:06 happens, the amount of medication 25:08 they're taking ends up being too high of 25:10 a dose. So, it can drop the blood 25:12 pressure lower. And then that also then 25:15 is a risk factor for falls and 25:17 fractures. So, all of these things start 25:19 to compound and you have the highest 25:22 risk group, this postmenopausal women 25:24 with osteoporosis that just has two, 25:27 three, four, five strikes against them. 25:30 Many of them being being created by the 25:34 medical system itself with these with 25:37 the way that diseases are treated and 25:38 approached and by these medications that 25:41 doctors don't even realize are 25:43 destroying bone. There was a study that 25:45 was done that looked at the medications 25:48 women were taking, 25:49 women with osteoporosis, for the three 25:52 months before they fractured a hip and 25:54 ended up in the hospital and what they 25:56 were discharged with. 86% of those women 25:59 were on a medication that increased 26:02 osteoporosis fall and fracture risk. 26:04 Then they fractured, ended up in the 26:06 hospital, and when they were discharged, 26:08 there was no net benefit. If they were 26:09 changed and given a different 26:11 medication, they're put on a medication 26:13 that essentially kept their 26:15 high level, maybe with a different and 26:17 or a different mechanism.
System Gaps And AI Help 26:19 >> This is where our current our current 26:21 There's so many things wrong with our 26:22 current medical system. That's a That's 26:24 at least a four-day extravaganza. But I 26:27 think it's the lack of the quarterback 26:30 role. You know, like the idea is that 26:32 that internal medicine person is kind of 26:33 your quarterback. Meaning that you have 26:36 all these other players, your 26:37 specialists, your this, your that, or 26:38 whatever. 26:40 The idea was always that that internal 26:41 medicine person was going to take all 26:43 that information, 26:45 distill it down, pay attention to all 26:47 those things, and do that sort of error 26:49 check, and also help you understand what 26:51 you're getting as a patient and help you 26:54 make decisions, which is 100% not what 26:56 happens. They are the they are the 26:58 referral source and the pill pusher and 27:01 neither do they any any of these doctors 27:04 ever go through and look at what the 27:06 other physician have put you on, what 27:08 you're on today, what's being added and 27:11 what could potentially add risk 27:12 anywhere. Like that is zero. The only 27:15 place I know that happens is in the 27:16 functional and longevity world. 27:18 >> And even then that probably gets missed. 27:20 >> Look, the medical doctors and the 27:22 physicians that that I talked to, 27:24 they're all all of them that I've talked 27:26 to are very well intentioned, very well 27:28 meaning and they unfortunately are in a 27:31 system that doesn't allow for those 27:33 conversations nor do they have the 27:35 background with their education to be 27:37 able to have the more comprehensive 27:39 education. But you can just simply can't 27:41 address these things in an 8-minute 27:44 visit. In addition to that, and this is 27:46 what's in the published research, is 27:48 osteoporosis is often time not even 27:51 discussed or dealt with because there 27:52 are other things that people are coming 27:54 in with that are considered more 27:56 important like cardiovascular disease 27:58 and diabetes and so osteoporosis is 28:00 simply pushed to the side, which is why, 28:02 you know, in my book, I go chapter by 28:05 chapter and I and I talk about, you 28:07 know, which medications are causing this 28:09 problem so you can talk to your doctor, 28:11 what what about the osteoporosis 28:13 medications, your questions to ask their 28:16 doctor so they can make sure they're 28:17 getting the best possible information so 28:20 they can make the best possible choices 28:22 the patients can and then how to build a 28:25 comprehensive, you know, bone health, 28:27 integrated bone health program that 28:28 makes sense for them. You know, that is 28:30 what's missing within the conventional 28:33 system and that is something a resource 28:35 that I was passionate about trying to 28:38 provide and I hope that I've 28:39 accomplished. Many people are finding 28:41 this incredibly useful, my book for 28:45 creating this blueprint for them to be 28:47 able to see definitive results and get 28:49 them on the right path. 28:51 >> Yeah. Yeah, no, it's really it really is 28:52 the bureaucracy and the business model 28:54 of medicine that is shoehorned, you 28:57 know, physicians into a lose-lose 28:58 situation. You know, I look at it also 29:00 as a as a technology company and uh you 29:03 know, have a tech firm that's building 29:05 things. This is where I think 29:07 having having AI-driven but clinician 29:11 experience sort of pulled together where 29:14 you can have technology start to ferret 29:17 out and find these things. So, we don't 29:18 have to leave it to humans to try and 29:20 figure it out. I think there's a lot of 29:22 opportunity where at least AI can start 29:24 adding value like fact-checking across 29:27 all these medications for the multitude 29:29 of things that could be a concern 29:30 regardless of what the patient comes in 29:32 for. Just looking at it and going, 29:33 "Okay, this is a woman of this age. She 29:36 might be worried about this 29:36 cardiovascular disease, but here's the 29:38 other things we need to pay attention 29:39 to." 29:40 Um and help sort of create that sort of 29:42 landscape and it's your information, 29:45 things like you put together in the book 29:46 that helps somebody navigate it today 29:48 cuz that's not here today. Right. That's 29:50 a long time coming. So, you've got the 29:52 right thing so people can help navigate 29:53 that because I I I know for a fact 29:55 that's not what's really happening. 29:57 You know? Now, what do you What do you
Bone Turnover Markers Reality 29:59 think about things like bone turnover 30:01 markers? You know, CTX, P1NP. 30:05 What [clears throat] do you think about 30:05 those? 30:06 >> I think that they can be helpful in 30:09 guiding a conversation and making people 30:11 more aware that there's an issue and 30:13 helping to get them more involved in 30:16 their in their health in their own 30:18 health care, which is important. 30:20 Because the best results when it comes 30:23 especially to bone health and 30:25 osteoporosis occur when people are being 30:27 proactive, when they are taking the 30:29 steps to change their their habits, 30:31 their diet, their lifestyle, their 30:33 sleep, and doing those right things. And 30:35 so, testing for me, any of the testing, 30:38 REMs, DEXA, CT, BTM, bone turnover 30:42 markers, the greatest value for any of 30:45 those is to start a conversation or 30:48 continue the conversation going. The The 30:51 ability of the bone turnover markers to 30:54 predict fractures is quite limited. 30:57 Research says it's quote modest at best. 31:00 So, clinically there's not a, you know, 31:02 in terms of routine testing, I know some 31:05 doctors are are doing that and they're 31:07 they're finding it useful. The challenge 31:09 I have is is when I'm hearing from 31:11 patients or I hear lectures at 31:12 conferences where they're they're taking 31:15 the the data or the results from that 31:17 and they are 31:19 drawing conclusions about how valuable 31:23 those are clinically that just simply 31:25 don't align with what the research shows 31:28 and I'll give you an example of that. 31:31 A patient came to me and they said, "My 31:33 doctor did a CTX and NTX tests and said 31:37 the ratio, you know, was not good. I'm 31:39 losing bone quickly now. Um I'm a fast 31:42 loser." That's what she she said. 31:45 But, not to worry because I'm in 31:48 perimenopause and that will slow down 31:49 and those numbers should improve. 31:52 The reality is if you look at the 31:53 research, the ability of those bone 31:56 turnover markers to predict the rate of 31:59 bone loss is 50%. It's no better than a 32:03 coin toss. And so, that's the challenge 32:05 I have is when these bone turnover 32:07 markers are are are used and and they're 32:10 talked in a way similar to the bone 32:12 density test that simply is not aligned 32:15 with what what the research shows. 32:17 Additionally, with the bone turnover 32:18 markers is I think we have to all be 32:22 really cautious in how we interpret them 32:24 because there's so many things that can 32:25 interfere with bone turnover markers. 32:28 Even if somebody has the same if they 32:31 they do the bone turnover marker at a 32:33 different lab or even in the the lab on 32:35 a different machine or if they do it in 32:37 the winter versus the summer, or if they 32:39 broken a bone in the last 12 months, or 32:41 if they've exercised in the last 3 days, 32:43 and all of these things can change that. 32:46 And so, I think it's it's really 32:48 important, and I also believe the 32:50 premise of the bone turnover markers, 32:52 and what I see my colleagues some of my 32:54 colleagues doing, 32:56 focusing on CTX or undercarboxylated 32:59 osteocalcin or or a few of these, I 33:02 think it misses a little bit of the the 33:04 analogy of the forest for the the trees 33:06 because there are, as I mentioned, 180 33:09 to 200 proteins in bone, and many of 33:11 these bone turnover markers are 33:12 breakdown products of proteins. So, to 33:15 say, "Oh, it just boils down to one, 33:17 two, or three of these little fragments 33:18 of proteins." It just doesn't make sense 33:20 to me, 33:21 and just intuitively, but then the 33:23 research also shows that, you know, we 33:25 really need to be cautious. 33:28 >> Yeah, you know, I I've I mean, cuz we 33:29 use them as more as more so cuz, you 33:31 know, like DEXA's a long game. In order 33:33 for that very gross kind of old-school 33:36 x-ray to show anything, 18 months is 33:39 about like where you could where you 33:40 could say it's not maybe meant to 33:42 chance. Like, and that's even then I 33:44 would argue that maybe it's not. Reams 33:46 may or may not be a little bit better, 33:48 but it might help you have some 33:50 directional idea if the actions you are 33:52 taking, if you control for diurnal 33:54 changes and circadian all that stuff. 33:58 But, I always look at it, too, that you 33:59 can't just look at CTX if you don't know 34:01 what the building side's doing. Like, 34:02 I'm like, it's a math equation. You need 34:04 the negative and the positive to assess 34:05 what they're doing compared to each 34:06 other. We don't have comparative 34:08 studies. We don't, but if we're trying 34:11 to find a directional thing to say, "Are 34:12 the things that we're doing possibly 34:14 making a difference in this short time 34:16 period so we can adjust?" Maybe this is 34:18 helpful, but you know, so many of the 34:20 doctors just run like a CTX, and they're 34:22 like, "Here you go." And I'm like, 34:23 that's cuz they were told to do that 34:24 based on whether the medication was 34:26 suppressing CTX too far. 34:28 >> Yeah, and I think you're using it 34:29 exactly the right way, and in fact, that 34:31 is the way that it is recommended in 34:34 terms of how these should be implemented 34:36 in clinical practice at least 34:38 conventionally because it is recommended 34:41 to test bone turnover markers to see if 34:44 somebody is being compliant with the 34:46 treatment with the protocol and so I do 34:49 like that because you're right we really 34:51 don't test DEXAs any more frequently 34:55 than 18 to 24 months and so those bone 34:57 turnover markers you know you can retest 35:00 more frequently and it does give people 35:02 a sense of you know hey can we you know 35:04 we're we're in the we're on the right 35:06 we're in the right direction. 35:07 >> Yeah is it a clinician? 35:09 >> Yeah and there's a clinician I talked to 35:10 and I really like his his approach 35:14 Doug Lucas he's a DO I don't know if you 35:16 know Doug he's he's phenomenal. 35:18 You know he's talks about how he uses it 35:21 to see if we need to if if we need to 35:23 optimize or he needs to optimize 35:24 estrogen a little bit more if there's a 35:26 little bit more room to go up and we can 35:28 dry he can dry that CTX marker down a 35:30 little bit. 35:31 >> Yeah yeah cuz that's a direct 35:32 relationship. 35:34 You know for sure. You know 35:37 so I want to move on to cuz I have a 35:39 hundred other questions I could ask 35:40 there and I'm like behave yourself Betty 35:42 we don't have hours. 35:45 Now you you also came out with some new 35:47 information about sleep right and the 35:50 their sleep and particularly around 35:52 fracture risk not so much DEXAs but 35:54 fracture risk let's talk about that. 35:57 >> Well sleep deprivation insomnia is as 36:01 dangerous as drunk driving and we look 36:04 at some of these disasters historically 36:06 that have gone on major global disasters 36:09 like the Exxon Valdez tanker that 36:12 crashed in Alaska decades ago or the 36:15 chemical plant in I think it was Bhopal 36:18 India that exploded decades ago and 36:20 killed a lot of people. 36:23 Those both had in the research that was 36:25 done after that in the investigations, 36:28 sleep deprivation as a causative factor. 36:32 And when somebody is not getting enough 36:34 sleep, their risk for making these these 36:38 errors, both cognitive errors, you know, 36:40 poor judgment. And research has also 36:43 shown we just make poor decisions, but 36:46 also balance goes down. And so the risk 36:48 for falling goes up. And bone density 36:52 also decreases at a faster rate. We lose 36:55 bone faster. And what happens is you're 36:58 getting cortisol that's increasing 37:00 because of the stress on the body. And 37:02 cortisol, even even when it's in the 37:04 normal range, it doesn't have to be a 37:06 exogenous cortisol from a drug or 37:08 somebody with Cushing's disease that 37:10 has, you know, incredibly high cortisol 37:11 because they have a diagnosis, but even 37:14 normal cortisol in the quote-unquote 37:16 healthy range has been shown, when it's 37:17 towards the high end of normal, to 37:19 increase how fast somebody loses bone. 37:22 And so when we're sleep deprived, 37:25 cortisol is going up. And it's a 37:27 survival mechanism. But that short-term 37:29 survival mechanism is compromising our 37:32 long-term bone health, and frankly our 37:33 long-term health and long-term survival. 37:36 Because if you fracture a hip with 37:37 osteoporosis, there's up to a 36% chance 37:39 that you're going to be dead within thin 37:41 air. 37:42 >> Yeah. Yeah, which I think most people 37:44 just don't understand and don't know. 37:45 You know, now one of the things that 37:47 we've talked about, cuz you talked it 37:48 specifically around those risk factors 37:50 for fracture. We talked about some of 37:51 the medications and things like that. 37:53 But I know one of the things that I 37:55 often, you know, talk with people about 37:58 is, you know, what is your physical 38:00 ability through different, whether it's 38:02 flexibility, mobility testing, how agile 38:05 are you? Do you still have, do you still 38:08 have kind of fast twitch? Cuz I I 38:09 remember a study forever ago that looked 38:12 at the the how often a little kid trips, 38:16 you know, young middle-aged person. I 38:17 hate using middle-aged cuz I'm like, 38:18 wait a minute, I'm not middle-aged yet. 38:20 And then an older person, right? And 38:22 what they found is actually the stumble 38:25 ratio wasn't that different between the 38:26 three age groups. What was different is 38:28 the young child and the, you know, 20-30 38:31 year old caught themselves before they 38:33 fell. Right? They had fast twitch 38:35 muscle, they were able to pre-o 38:36 perception, all of those firings fired 38:38 and that the older person, I'm going to 38:40 kind of make kind of fun of it, it was, 38:42 you know, they stumble and they're like, 38:44 "My god!" Cuz the body's just slow to 38:47 respond. So, there's a physical side of 38:49 this that people ignore. It's not just 38:51 weight training. 38:52 >> Yeah, and I I love that you're bringing 38:54 this up because there are things that 38:56 people can track in themselves with 38:57 themselves and that I would do 38:58 clinically that have nothing to do with 39:01 a blood test or or running a test on a 39:03 on a machine. And one of those is the 39:06 one-legged stand test. 39:08 So, research has shown that 39:10 if people can stand on one leg for 5 39:13 seconds or even more determinant is 10 39:15 seconds, they have a lower risk of 39:18 reducing of of falls, uh you know, 39:21 fractures, uh mortality, also, you know, 39:25 being able to have a they're 39:27 if they can stand that long, they're 39:29 they have have more likely to be able to 39:31 age and be able to take care of 39:32 themselves and live independently. And 39:34 so, a study looked at 39:36 you know, people 51 to 55 39:39 and 95% of them could stand on one leg 39:42 for 10 seconds. By the time they were 71 39:45 to 77, less than half could. And those 39:48 that couldn't had an 82% increased risk 39:51 for, you know, dying and and losing 39:54 their their independence as well. And 39:57 so, that alone, just somebody can test 39:59 themselves, the grip strength. And 40:02 people can buy, you know, expensive, 40:05 there's like $400 machines we can get in 40:06 clinic to measure somebody's grip 40:08 strength, but I like to say if you just 40:10 are having a hard time opening jars, you 40:13 know, grip strength 40:15 decrease grip strength is associated 40:17 with with decrease bone density. And so 40:20 that's another indicator. Shuffling or 40:23 walking speed. So if you find that 40:25 you're walking slower, that's a risk 40:28 factor. Or somebody's telling you you're 40:29 walking slower, that's a risk factor. 40:32 And the good thing is that look, unless 40:34 you have a neurological condition, 40:36 disease where you absolutely cannot 40:38 correct this, all of these things are 40:40 correctable. You can increase your fast 40:42 twitch fibers. You can increase your 40:44 muscle mass. The study that was done the 40:46 oldest participant was 85 years old and 40:49 when they were given enough protein and 40:50 did resistance exercise, muscle mass 40:53 increased in every age group including 40:55 up to 85. 40:56 >> Yeah. 40:58 Yeah, I think you know, it's it's also I 41:00 think too is 41:02 you know, if somebody was let's say a 41:04 dancer or an athlete, right? When they 41:06 were younger, they also had depending on 41:08 the kind of things that they did, they 41:09 also had the capacity to sort of train 41:12 their body 41:13 to be better at where they are in space 41:15 and time and and those kind of things, 41:16 but everybody can do that whether it's 41:19 you know, engaging in things like actual 41:22 agility training, but even dance. Like 41:24 if we look at dance [clears throat] and 41:25 the neurological effect of dance, like 41:27 we've got Parkinson's disease studies 41:28 and all these other things, learning how 41:31 to dance can probably reduce that. 41:33 >> Well, and I think also it's about 41:35 finding out what people love to do. 41:37 >> Yeah. 41:37 >> Because I can't force somebody to do 41:39 something they don't love. This is a 41:40 long game, you know, and it's not about 41:42 doing it one time or one week or one 41:43 month. This is about finding something 41:45 you enjoy and doing it over and over and 41:47 switching when you you get bored, but 41:49 gardening, even just walking, you know, 41:51 all of these things are great. I think 41:53 there is a subset of people though 41:55 that's important to understand that like 41:57 not everybody can do these things. One 42:00 of the things that is not assessed 42:02 clinically, which is a big miss, is 42:05 people's foot health. 42:07 >> Yes. 42:07 >> So bunions, foot pain, abnormal anatomy 42:11 can keep people from doing these 42:12 activities and also has been shown 42:15 repeatedly to increase the risk for 42:18 falls and fractures. And so, I want to 42:22 make sure that people understand that. 42:24 It's not as though I expect everybody 42:26 can just go out and do these things. 42:27 It's about identifying 42:30 where the challenges are, where the 42:31 blocks are to moving forward and and and 42:35 improving your health and let's see if 42:37 we can address those those blockages and 42:40 get rid of them or minimize them. You 42:42 know, go to a podiatrist, get it get, 42:44 you know, orthotics. Those are two 42:46 possible things 42:47 that you can you can do. 42:50 Additionally, I do want to address just 42:52 briefly the concept of fear because we 42:55 talked about that initially and when we 42:57 first started. But fear itself has been 43:00 shown, fear of falling has been shown to 43:03 be predictive of people falling. And so, 43:06 everything we can do up to empower 43:08 people to not feel afraid, to help them 43:12 feel more confident, and to give them 43:15 the real information and the real help 43:18 and the real steps they can take to 43:20 reduce that fear and increase their 43:23 strength and increase their bone health 43:25 and increase their knowledge and their 43:27 confidence is going to go a long way to 43:31 helping them reduce their fracture risk, 43:33 but also everything we've been talking 43:35 about when it comes to diet, lifestyle, 43:38 sleep. When you're approaching all of 43:40 those in the way that we we discuss and 43:41 the way that's laid out in my book and 43:43 I'm sure the way that you work with your 43:45 clients and patients with, it also 43:47 reduces the risk for every other chronic 43:50 disease, heart disease, cancer, death 43:52 from cancer. I mean, all of that is 43:54 helped by these integrative approaches. 43:56 >> Yeah. Yeah, I'm glad you brought the 43:58 fear back up cuz I I would say from my 44:01 experience in the last particularly the 44:02 last few years, there's an awareness 44:04 around osteoporosis that wasn't there 44:06 before, but I think because it hasn't 44:09 been appropriately talked about, because 44:11 people haven't been given the 44:12 information like what's in your book, 44:14 I would say the fear there is probably 44:16 greater than a lot of other places. And, 44:19 you know, I have I've heard so many 44:20 women say, "Well, I used to do this, but 44:22 I'm terrified to do it now, or I'm 44:24 scared to do it now." 44:25 You know, and I'm like, "Okay, that's 44:26 not helping us, 44:27 >> [laughter] 44:28 >> you know?" That's and I'm so glad that 44:29 you brought that back up, because that's 44:31 not necessarily true that, you know, 44:34 taking all of these pieces and also 44:36 recognizing that you're empowered to be 44:38 able to do these things with or without 44:40 the medications, right? That there's a 44:42 multitude of things that you can do that 44:44 are within your control to really build 44:47 that strong, healthy bone that's 44:50 fracture proof. 44:51 >> Yep. And in fact, I would argue for most 44:53 people, most of the things are in our 44:55 control, are in their control to do. 44:58 >> Yeah. 44:58 Yeah, I would agree. Well, Dr. New said, 45:01 I'm so glad to have you on the show 45:02 again. This has been such an awesome, 45:04 awesome conversation. So, everybody, I 45:06 want to make sure that you go get this 45:08 book, right? So, if you're worried about 45:10 osteoporosis, you need to have this 45:11 book. If you're a female, you need to 45:13 have this book. If you are a male and 45:15 you think it doesn't belong in your 45:16 camp, it does, cuz you can have it, too. 45:19 Everybody needs to read this. 45:21 And it's on all the major platforms, 45:23 right? 45:24 >> Yep. Yeah, fracture proof your bones. 45:26 Yes, it's on Amazon. It's available 45:28 online. 45:29 Um, it's available on my website, 45:31 nbihealth.com. 45:32 So, there's a lot of free articles 45:34 people can get some good resources on 45:35 there as well. 45:37 >> Fantastic. Well, thank you for being on 45:38 Menopause Mastery again. This has been a 45:40 great conversation. 45:41 >> Thank you. I enjoyed it. I appreciate 45:43 it. 45:43 >> Thank you so much. And if you're 45:45 listening to Menopause Mastery and you 45:47 happen to be listening on your favorite 45:48 podcast platform, don't forget to 45:51 subscribe and leave a five-star review. 45:54 If you're watching us on YouTube, leave 45:57 a comment and subscribe so you don't 45:58 miss any wisdom, and I will be back next 46:01 week.
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