Boost Your Bone Density with These 6 Life-Changing Tips

Introduction & Importance of Bone Density

[00:00] Are you looking for ways to increase your bone density? Welcome to Talk with Docs of Dr. Bradmian. And I'm Dr. Paul Salza. I like the casual look in these chairs with backs on them. Yeah, you got puppy dog eyes this morning. We got a new puppy, right? But my wife is doing the lion's share of the work. So thank you very much for that. You're welcome. So what we're talking about today

Osteoporosis and Age-Related Bone Loss

[00:20] is ways to increase your bone density. So as orthopedic surgery we deal with this all the time, particularly on the trauma side. So we see people with broken hips or hip fractures and these are typically related to osteoporosis and the obligatory loss of bone that we see as we get older after about age 50 or so. Yeah, wrist fractures and vertebra fractures, lots of fractures occur because of

[00:40] low bone mass. Yeah and this is both in men and women. Yeah that's true and bone is funny you know because bone if you use it it's good if you don't use it you lose it. Sure and they even learned that through some of the space studies where people came back and been up in space for a long time with no gravity and they're like these guys have osteoporosis what the heck.

Wolff’s Law & Space Study Insights

[01:00] Yeah, you know how much they lose in space? It's a lot. 1% to 2% of your bone mass goes per month. Per month. And that's why I didn't become an astronaut. I don't think that's the reason. And the thing about bone that makes it respond to loading is Wolff's law. Remember Wolff's law? I knew it. Remember that long ago where bone just

[01:20] builds up when it's being loaded. If it's not being loaded, it goes away. And that's going to be an important principle in what we're going to talk about on ways to increase your bone density. Right. Yeah. So the first thing that I would say is you need to build a time machine and go back in time and increase your peak bone density. So unfortunately for anyone who's watching this video

Peak Bone Density & Early Prevention

[01:40] who's over 30 years old, your peak bone density has probably came and went. Oh, I'm running out of time. Peaks in women around 25, men around 30. I got a few years left. Yeah. So what you need to do is, for the younger people that are watching, is a healthy diet, exercise, and for women, regular periods because that helps increase the amount of estrogen in your body and that has a specific

[02:00] role in bone. So increase your peak bone density as much as you can. But now for everybody else, we're going to talk about specific strategies, evidence-based strategies that have shown ways to increase your bone density and really maintain it. And we've talked about this before. Bone is like an active living structure. So it's not like a piece of wood just sits there and doesn't do anything. It's constantly being turned over.

Bone Remodeling: Osteoblasts vs Osteoclasts

[02:20] So it's a battle in your body between bone making and bone resorbing. Right, your osteoblasts are your bone cells that make bone, your osteoclasts are your bone cells that reserve bone. So it's a living, constant turnover thing. And there are a host of factors that talk to these cells and tell them what to do. So when the scales are tipped in the favor of absorption, you lose bone density. And there are a bunch of things

[02:40] do that. So we're going to talk about how to avoid those or how to optimize those. So let's start. Here we go. Top six ways really to increase your bone density. What is number one? Number one is weight-bearing exercise. Okay. So those are things like walking, jogging, standing, those kind of things. Avoid sitting, avoid lying, avoid going up into space if you can. Okay, cancel the

#1 – Weight-Bearing Exercise & Weighted Vests

[03:00] If you signed up for the trip to Mars, think about it. Make it shorter anyway. Make it less than one month. I don't think you can. I think that's a long one-way journey. I suspect. With today's technology. But yeah, Wolf's law says if you load bone, bone will respond by making more bone. If you don't load bone, it'll go away. Thank you, Wolf.

[03:20] Right. And so, yeah, so simply walking, curing your body weight does this. And we're going to talk a little bit about the whole 10,000 steps thing where that came from in a separate video. So getting as many steps as is safe for you and is within your exercise capacity. But one thing that you can consider to adding to your weight-bearing exercise is a weighted vest. So a lot of people are like, well, I've told some people this week about

[03:40] this because we did some research. My patients are like, well what's the weight of vests? It's literally a vest that has little pockets typically that hold one pound weights. It ranges in weight typically from five to 20 pounds. You can buy them anywhere. And what this does is by putting this vest on it, it simulates you weighing more, carrying extra weight. So they've done some randomized controlled trials and in that first year wearing a weighted vest that

[04:00] somewhere in the 5 to 10% of your body weight can increase your bone density 1 to 3%. And it makes it really easy to lose weight. Look at me, I just lost 20 pounds. Easy. Yeah, so consider a weighted vest. If you're going to do that, start slowly and just be careful. Obviously, you don't want to injure yourself, but there's good scientific evidence to show weighted vests actually work.

#2 – Strength Training & Bone Stimulation

[04:20] seen people wear the weights on their ankles and the wrists as well. So weight-bearing exercise, that's number one. Number one way to keep your bone density up. Okay number two is strength training and a lot of people are like, well what the heck? How does how does strengthening my muscles affect my bones? Well your your muscles are attached to your bones by tendon and a

[04:40] pull on the bone through a principle called mechanotransduction, that signal of the pulling on the bone talks to what are called osteocytes and it tells them, hey, let's start making more bone in response to this stress. Okay, so what kind of strength training exercise are you talking about? Okay, so there are randomized controlled trials that have looked into all different kinds of exercise and I'd say the top six exercises

[05:00] are ones that are compound movements using very large muscles and multiple parts of our body. So number one would be squats and I'd say across the board this is the best exercise. It's great for your back, it's great for your lower body, both for your glutes and your quads. So squats, weighted lunges and sorry, squats can be body weight squats or you can be wearing or using dumbbells or even

[05:20] using a bar. But we will hurt if you have a meniscal tear. But yeah, as we talked about that one earlier is so weighted squats, lunges, leg press, overhead press, and rows. So bent over rows. And these are all things that really are working on our back and our poster chain and our core. Okay, and same thing, right? Bone

[05:40] wants to be loaded. If you're loading your muscles, you're loading bone because they're attached. Right. If you're thinking about gaining into strength training, I think this is really important. As we get older, it's a lot that people do cardiovascular exercise, but I think strength training is key to kind of reduce that loss of muscle that we experience as well as our loss of bone. If you are unfamiliar with some of the exercises or the techniques, please seek out a professional like your personal

#3 – Diet, Calcium, Vitamin D & Supplements

[06:00] trainer or someone at your gym or at the wire or whatever to show you how to do the exercises probably because you don't want to get injured and start slow. You could get injured if you're not careful, but those are definitely shown to help bone balance. There you go. That's number two. Number three. Next one is a balanced diet plus or minus some supplements. And now the key things in a balanced diet that we talk about for bone health or calcium

[06:20] vitamin D protein. You've heard of zinc, magnesium, and collagen. Wow, you went through all of them right down the aisle. Well, I thought we could break it down. That was the introduction. I like it. That was the introduction paragraph. Okay, I like it. Now we're going to break it down. Okay, you're at grade seven writing an essay. Calcium, vitamin D protein. Those are no-brainers, can I say? Yes, I would agree. Those are all truths. Okay, so let's talk about calcium. How much calcium should you

[06:40] yet. The daily required intake of calcium is 1500 milligrams. Yeah, so it ranges depending on your age, somewhere in that 1000 to 1500. Ideally, we've done other videos about this, you want to get it from your diet. So low fat dairy, green leafy vegetables, almonds, things like that.

[07:00] If you've already had a fracture or even been determined to have an inadequate calcium intake, Vitamin D? Calcium was tricky because we used to promote supplements that went away when it sort of found to be contributing to atherosclerosis. Remember you could get orange juice with calcium in it and that went away. I think there are still some 45 months. Yeah, but there are some issues with

[07:20] too much calcium intake. Totally agree. Check with your healthcare provider on that one. Yes. What about vitamin D? We're getting that from the sun? No, when the sun helps us get vitamin D, but where we live, we don't get enough vitamin D. Most people don't get enough vitamin D from the sun, so supplements are often recommended. However, too much vitamin D because it's fat soluble can be

[07:40] harmful. Right, so a couple things about vitamin D. Recommendation is 800 to 1,000 and as we get older our absorption gets worse and we need more so check with your doctor, potentially have your levels checked so you may need more than that. Number two is vitamin D, as you mentioned, is fat soluble. When you are taking a supplement, there have been good studies to show that if you take it with a small amount of fat, it's like a couple of nuts

[08:00] fats, even like 5g of fat, this can increase your vitamin D absorption by up to 50%. So if you're looking to get the most bang out of your vitamin D buck, have a couple nuts with it. Right. Nuts. You're nuts if you take too much vitamin D. You have to be careful. There has been some recent stuff in the news now about vitamin D toxicity. And there are lots of people that are taking 10, 15, 20,000

[08:20] And interestingly, they've done randomized controlled trials to see if hyperdosing the vitamin D increases your bone density more than meeting the normal requirements and studies have not shown this to be universally useful. So yes, proceed with caution, be sensible, everything in moderation. And vitamin D, those are measured in IU, international units as opposed to milligrams. And then the third core one was protein and we've learned more and more

[08:40] that we definitely need to meet our protein requirements for a host of reasons. As we get older, our protein requirements can increase slightly as well as our diets often get worse because a lot of people can't afford or don't cook or more animal based products that have dense sources of protein. So be aware because collagen is like the main protein in your bone. It makes it like 95%

[09:00] of your bone matrix where the calcium and the phosphate are kind of hanging onto it. So you need adequate protein to build your bone. Then you get those other ones. You get your zinc, your magnesium, your high blood pressure. Those are like the fringe beneficial ones. Okay, those are the ones when at recess they're like the last picks. Lunatic fringe. Last picks for the foot hockey game, you know, that kind of stuff. So zinc, they're

[09:20] some evidence suggests zinc, septumacin, and magnesium is the same, although magnesium has also got its other effects, sleep aid and digestive aids, which we've talked about in other videos, and then collagen. That's when I've always told people there's no evidence to take collagen. So I used to say the exact same thing. I would say for cartilage growth, I'd say there's no evidence, but there actually are some

[09:40] CTs that look at people that were taking 5 grams of collagen a day, this did increase their bone density 1 to 2% over the course of a year, particularly most of the studies are on postmenopausal women because this is a group of patients who definitely are prone to fractures in osteoporosis. So worth considering, there are some issues potentially with abnormal thyroid function because of the nature of the

[10:00] amino acids that are present in collagen. So if you are going to discuss it with your doctor, make a decision. And we're not talking about collagen for osteoarthritis. We're not even talking about osteoarthritis here. No. Osteoarthritis is inflammation in the joint as opposed to osteoporosis, which is a reduced bone mineral density and increased risk of fracture. Okay. Two different things. So number four, consistent with

#4 – Lifestyle Factors: Alcohol, Smoking, Caffeine

[10:20] with our pillars of health that we've talked about in the past with a bunch of different guests, avoiding alcohol, potentially down to zero consumption, because alcohol reduces both your estrogen and your testosterone. So these are intimately linked to bone growth and bone remodeling. So avoiding alcohol, quitting smoking because of the chronic inflammation.

[10:40] A lot of people just swept away when you see alcohol. They just swept right off our video. You should say that one for the end. I think more and more people are recognizing though that I think people know that it's not good for you per se. So I think you are grossly dialing back the amount that they drink but I think some people are willing to still accept that risk. Smoking, obviously it's not good for you for

[11:00] host of reasons, but a lot of people don't think, oh, it's back from my bones. That chronic systemic inflammation that at least two definitely has a negative effect on your bone density. And then the last one kind of asterisk is caffeine. There you go. Yeah. Can't drink alcohol, can't drink coffee. So I would not say don't have any caffeine, but beware that if you are having a meal that has calcium,

[11:20] drink the caffeine with it because it can reduce the absorption of calcium. The same goes for iron actually. So you probably should not if you're going to have like soda or something that has caffeine, maybe don't drink it with your meal, drink it either before or after. The timing is important. If you're at the bar, the rum and coke, they should rename that one to the Bone Breaker because you got your alcohol and you have your caffeine.

[11:40] being in one drink. There you go. Smoke a cigarette with that and you might as well snap your wrist on your way out. Okay, so that's four. Number five. This is a big one. This is a big one. I mean, hormone replacement therapy in postmenopausal women is controversial. We're not going to discuss that, all those controversies now. However, hormone

#5 & #6 – Hormone Therapy & Bisphosphonates

[12:00] replacement therapy has been shown to increase bone mass in postmenopausal women. And it's one of the reasons why you would consider taking hormone replacement therapy. So I'm going to talk about the controversy just to tie in a little bit. Are you? Yeah. Just because what happened in early 2000, there's one study that was arguing nowadays accepted that it was misinterpreted. The breast cancer study.

[12:20] So the health initiative, the women's health initiative is a massive study and it showed there's a slightly increased risk of breast cancer in women taking HRT versus non-HRT. People went back and reanalyzed it and said, you know what, it's probably not a real finding and that the benefit's probably outweigh. So this is definitely something worth talking to your family doctor about. But what it has shown is that once you are post-menopausal, you're losing bone at a rate

[12:40] to 1% to 2% a year. The first five years are the most aggressive loss. So HRT in the early years is certainly most important, but you can get benefit out to 10 years. So say you're three years into menopause and you're like, oh man, I missed my window. You haven't. It's worth considering because the benefits are very, very real. Unfortunately, once you stop HRT and remove that estrogen

[13:00] you will continue to lose bone at a regular rate. So you have to discuss whether or not you're going to keep taking it because the risk is lifelong. And so if you're a post-menopausal woman not taking hormone replacement therapy, you don't want to become an astronaut. No, definitely not. You do not want to be drinking a rum and coke, smoking a cigarette on the way up. No, you definitely do not. Similarly, for

[13:20] hormone replacement for men, if you are testosterone deficient or if you have low T, TRT has been shown to increase bone density. And osteoporosis is just not an issue for women. It is common in men, even up to like one in seven men. And they say that hip fractures in elderly men actually have greater

[13:40] morbidity and mortality. And we see lots of men that break their hips. There is a significant morbidity and mortality associated with hip fractures. Depending on your age and your comorbid conditions, it can be quite high, like almost 50% in one year mortality. Which is shocking to most people. And the best way to do it is keep your bones strong, keep your muscles strong,

[14:00] keep your coordination to avoid falls. And then the average person has a much lower mortality associated with hip fracture. But if you have a lot of comorbidities and you're quite advanced in age, there's a high mortality. So the take home message for number five is if you are deficient in estrogen or testosterone, it is worth the conversation with your family doctor to say, hey, am I a candidate? What are the risks? What are the benefits? Go from there.

[14:20] Okay, the last one is handkeeping with a controversy theme. Yes. Big pharma got in there and said, we want a piece of the pie. Visphosphonates. Visphosphonates in medications to take or osteoporosis. And I'd say this has been a chance from when we were first training, right? These medications have slowly evolved and we had inferior ones before.

[14:40] For example, I would say the research is unequivocal that disphosphonates work very well for increasing your bone density. So typically they're prescribed if your bone density is minus two and a half standard deviations below the norm or minus one standard deviation and you've had an insufficiency type fracture of your wrist, your hip or your back, but they definitely 100%

[15:00] However, there are some associated risks. Ironically, my favorite risk of a medication is the risk of atypical femur fracture for taking a medication that's supposed to prevent fracture. I feel like they just kind of move the fracture just a little lower down the femur. Made it a little trickier to treat.

[15:20] So that was one of the things, there was some class action lawsuits that came about from the medications that were supposed to reduce your risk of fracture. However, one of the complications associated with taking those medications was a femur fracture. You heard it right. That's what I said. So you're trying to prevent a femur fracture, proximal femur fracture, but you caused a different kind of femur fracture? Yeah, we called it atypical.

[15:40] It's atypical. It's weird. Yes, and as well as oxygen and the cost of the jaw is another one that is not super common, but obviously a big problem for the people that get it. So they've talked about how long are you on this medication, is there benefit of a drug holiday, does that help reduce the risk of these atypical complications? So definitely worth

[16:00] discussion with your doctor or your endocrinologist if you're seeing someone specifically because often they're involved. But if you have done everything in our first five and you had multiple fractures in your high risk, this is still something that can play a very important role and does for many people in reducing their risk of getting a fracture. Yeah, many people are on this and they have seen a reduced risk of fracture being on these medications. However,

[16:20] Like any treatment, like any medication, there's a risk-benefit ratio. And in the majority of the time, the risk-benefit ratio favors being on this medication for certain people. But just like taking an aspirin has a risk associated with it, a GI bleed or something like that, there's a risk with every medication. However, that was number six.

[16:40] patients to help with your osteoporosis. Wow, that's a lot. Yeah, it's a mouthful. Yeah, and as a therapeutic surgeon, this is something that's part of our daily lives. So it's important to us, it's important to our patients. And now you guys know. So if you like this video, please like it, subscribe to it, and I'll share it with someone that you know that has low blood density and is maybe not doing some of the things on our list.

[17:00] Now tell us about your fractures that you've had as a result of bone mineral density decrease. And if you like this video, please like and subscribe to our channel. And remember, you are in charge of your own health. Turns out you're in charge of your own bone mass too. We'll see you next time.