Bone density

Keeping strong, healthy bones is absolutely necessary to achieve optimal health as you go through your 40s into your 50s, 60s, 70s, and beyond.

But did you know that doctors very often give patients terrible advice when it comes to what to eat in order to have stronger bones? Now, doctors want to talk about bone density.

You'll seldom hear a doctor talk about bone strength.

The reason for this is because all the research done was paid for by drug companies trying to get an FDA-approved pill that increased bone density, because it's much easier to increase bone density with a pill than it is to increase bone strength.

So what I'd like to tell you is terrible advice that doctors give that's going to cause you to have weaker bones.

Now, some of this advice might, might, might increase your bone density, but what you really care about is bone strength.

Isn't that right? If you fall down, you want your bones to be strong enough that they don't break.

I'm gonna tell you stupid advice that doctors give in this video to their patients that actually make their bone strength worse.

100%.

I mean, as women, it's, whether we're talking about bone density, whether we're talking about muscle mass, and perhaps we see muscle mass because th- that's very visible, but what we, we don't see is the bones, our bones, and how fragile they become, starting in our ear- or, like, late 30s.

And, and even i- i- when...

if you're inactive starting as early as 30, it's slower then.

Oh, absolutely.

It shows lumbar BMD increases of 4.1% versus 2.7% for risedronate, and the adherence benefits of once yearly dosing in a chronically ill population are undeniable.

Yeah, it takes the burden off the patient, but you know, this raises a philosophical yet highly practical clinical question.

Okay.

Yes, and the data from a landmark thirty-six-month trial comparing teriparatide directly against alendronate is just staggering.

Let’s hear it.

Lumbar BMD gains were eleven percent for the teriparatide group versus 5.3% for the alendronate group.

So more than double the density gain.

years ago i was in and out of a hospital in belfast with a sick child the ward had heavy doors one day i couldn't open them i decided i was exhausted i was exhausted but that wasn't why

with the bone density loss we don't feel the loss in our bone density until you fracture a bone unfortunately it's only when we do that bone density test that we realize oh

My guest is Dr. Sandra Ramey, GP with a special interest in women's health.

Just waking up multiple times a night as well and you think, oh yep, I need to go into a wee, where it's actually awakenings of the sleep apnea that get them to wake up and then they think, okay, I'm going to go wee.

So over time, when we've got estrogen deficiency, you know, past menopause, we've got to think about our lean muscle mass.

So estrogen decline, we get muscle mass decline.

We've got the bone density loss that we have.

We also get the change in fat distribution within our body that happens with the decline in estrogen, which has implications as well with our metabolic health.

I am your host, Robin Hackney, and today we are talking about something that I think every woman should have on her radar, especially as we navigate through midlife.

And that is bone density.

And before you decide this is going to be a boring episode about osteoporosis and calcium supplements, I want you to hang with me because it's actually a really empowering conversation.

Your bones are living tissue.

They respond to what you do.

They respond to how you move, how strong you are, what you eat, and even how well you you balance.

So while we can't control every factor that affects our bone density, there is a lot we can do to support our bones.

And I talked about this in this week's newsletter, and I broke it down into four things that I thought we need to talk about here on the podcast as well.

And we do see that our patients have low bone mass, which is what you detect with DEXA.

I don't know if you want to hazard a guess as how many patients in dialysis would have a low DEXA BMD if you did a screening.

I mean, you already mentioned about 70% in...

Yeah,

So probably even more than 70%.

It was a very surprising result of that screening study.

It was a screening algorithm where they used risk factors, previous fractures, and also dexa-BMD.

But for many of the research studies that we have, we see at least 30% of patients in CKD stage 3 5 5d and post-transplant will have low dexa bmd and these are research studies so typically there will be a bit of a selected cohort so we can expect the rates to be higher in the in the real world setting so 30 to 50 percent at least is what i would expect if i screened patients on dialysis using dexa and the important thing to remember is that these patients are also the one that goes on to kidney transplantation.

And she had a clinical program in Australia called the Lift More trial.

So the BMD of the lumbar spine increased by 3%, whereas in the control group, it decreased by 1.2%.

And then in the femoral neck, it was 0.3% compared to a -1.9 in the control group, and that was in eight months.

In eight months, okay.

How do we...

I thought it was a bone density issue.

It wasn't.

It was, uh, it, it led to multiple other questions about training, recovery, nutrition.

Mm-hmm.

Um, since before anyone talked about doing those things.

And just in my most critical menopause transition, I lost 10% of my bone density.

Wow.

That is phenomenal.

It's the most effective two-drug sequence for cumulative BMD gain.

Because you are utilizing the remodeling-based anabolic terparotide to completely rebuild the trabecular microarchitecture, and then you are locking in all of that new, unmineralized matrix with the most potent antiresorptive available.

Dinosumab.

They do.

And we do have crucial male-specific data for romosuzumab from the BRIDGE trial.

The BRIDGE trial proved romosuzumab provides significant BMD gains in men, effectively mirroring the robust densitometric responses observed in women.

It provides a powerful tool for that very high-risk male who presents with a fragility fracture at age 75.