Outsmarting Osteoporosis: How to Build and Maintain Strong Bones at Any Age

What if a silent thief was stealing your bone strength right now, and you had no idea until it was too late? Osteoporosis affects millions worldwide, yet most people remain completely unaware until a seemingly minor fall results in a life-altering fracture.

Think of your bones like a bank account. During your teens and twenties, you make deposits, building peak bone mass by your early thirties. After that, the withdrawals begin. Whether you end up with strong, resilient bones or fragile ones depends on how much you deposited early on and how quickly you're making withdrawals now.

Contrary to popular belief, osteoporosis isn't just a women's health issue. While post-menopausal women face accelerated bone loss due to declining estrogen, men develop it too—often without realizing they're at risk until that first fracture occurs. I've diagnosed osteoporosis in men in their sixties who thought they were "too strong" to have bone problems, only to see them suffer life-changing fractures from minor falls.

Nutrition plays a vital role in bone health, but it's not just about milk and calcium. Adults need about 1,000-1,200mg of calcium daily, which can come from various sources including fortified plant milks, tofu, beans, nuts, seeds, and dark leafy greens. Vitamin D, protein, and other minerals all contribute to maintaining bone strength. However, if I could prescribe just one "medication" for osteoporosis, it would be resistance training. Weight-bearing exercise creates mechanical stress that stimulates bone formation more effectively than any supplement.

Ready to outsmart this silent bone thief? Start by understanding your personal risk factors, optimizing your nutrition, implementing a progressive resistance training program, and talking to your doctor about appropriate screening. Small changes today can dramatically alter your bone health trajectory and protect your independence for decades to come.

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Chapters

• 0:00 Section A

Transcript

Speaker 1: 0:10

Hey everyone, welcome to Season 2 of the Dr Jules Plant-Based Podcast, where we discuss everything from plant-based nutrition to the main pillars of lifestyle medicine. Yo Plant-Based Buddies, welcome back to another episode of the podcast. Today we're going to be talking about osteoporosis, the progressive thinning of your bones that could potentially lead to fractures and to loss of independence. Now, if there was a thief that was quietly stealing from you every single day, stealing your health, your strength, your independence, would you want to know about it? Well, most people would answer yes, but here's the twist. This thief doesn't steal your wallet, or your money or your jewelry. It steals something far more valuable the very bones that are holding you up right now.

Speaker 1: 1:06

Now here's the scary part it works in silence. There are no alarms, no pain, nothing. Most people will never feel osteoporosis until one wrong step or a tiny slip, and that changes everything. Every single year, I get a handful of patients that fall and suffer an osteoporotic fracture of a wrist, of a shoulder, of a hip, of bones that were progressively thinning over decades, without the patient even knowing it. So today we're going to talk about osteoporosis, the silent bone thief, and I'm going to show you exactly how to outsmart it, how to reduce it, prevent it and to keep you strong, whether you're 25, 55, or 85. Whether you're 25, 55, or 85.

Speaker 1: 2:08

Now, osteoporosis is the progressive thinning and weakening of your bones as you age and think of it as your skeleton, behaving a little bit like your bank account In your teens and in your 20s. You're making deposits, you're accumulating money and then you hit a peak. That peak in terms of bone density is called peak bone mass. It happens sometimes in your late 20s or early 30s and then from your 30s onward the withdrawals start and your bone density progressively goes down. Now, whether you end up with a strong, stable set of bones in your later years or fragile, fracture-prone bones will depend on two things how big your bone saving account was to begin with. So the higher your peak bone mass in young adulthood, the more reserves you have. If you build up dense, strong bones in your youth, you get more reserves for later in life. It also depends on how fast you're making withdrawals. A slow decline you may never notice and you may never live long enough to see your bone mass become dangerously low. But if you have a lot of withdrawals and you lose your bone mass progressively and quickly over the years, you could be in trouble with either osteopenia or osteoporosis later on in life. Now let's be clear Osteoporosis is not just a women's issue. Yes, after menopause they're at much higher risk because of estrogen loss, but men can get osteoporosis too, and I've diagnosed it in guys in their 60s who thought they were too strong to have bone problems. Now here's the danger If your bones are thin enough, even a fall from your own height could cause a break A wrist fracture kind of annoying no one ever plans for that but a hip fracture that can change or even end your life. Now I've seen patients who were active, independent, traveling the world, and after a hip fracture they were bedbound, dealing with blood clots, pneumonia, muscle loss, depression and some of them they never regained full independence. Now, over the years I've seen a lot of osteoporotic fractures. I've even seen one of my patients suffer a compression vertebral fracture after hitting a speed bump in her car. Her bones were so thin that even that minor trauma caused a compression fracture of her vertebrae, the bones supporting her spine, and then compressed nerves and chronic pain ensues. Osteoporosis prevention isn't just about avoiding pain, but it's about protecting your future self and your future independence.

Speaker 1: 5:28

Now there are two different flavors of osteoporosis. There's primary and secondary. Primary osteoporosis is the most common one. This is the natural type of osteoporosis that people see with aging and the one caused by changes in hormones, changes in metabolism and bone turnover as we get older. It accounts for about 95% of cases and for women it naturally accelerates after menopause. For men it's slower, but it's still real and just tends to hit them a little later on in life.

Speaker 1: 6:11

Now the other 5% of cases are what we call secondary osteoporosis, and this is when something else is causing the bone loss, like certain medication or certain specific medical conditions. We see it happening with people who use long-term medications like steroids, like prednisone, for example. We use prednisone to treat asthma attacks or COPD attacks or Crohn's or colitis, and these medications, when taken long-term, can absolutely increase bone turnover, decrease bone deposition and increase the risk of osteoporosis. We actually see that complication starting to happen very quickly, often in people that are taking this medication for more than a few months. Now.

Speaker 1: 6:55

Certain medications that reduce acid, like proton pump inhibitors, or PPIs like Omeprazole, tecta, losec, periat all these medications can also increase osteoporosis. It can impact the absorption of certain minerals like calcium, like magnesium, and unless people either compensate by adjusting with higher intake in their diets or supplementation over years and years and years, they can increase their risk of osteoporosis. Now keep in mind that a lot of people they take these medications daily without ever re-discussing them or their indication with their doctors. So doctors are so busy seeing a million people for a million different reasons and sometimes that annual medication list review that should be done is done too quickly and people are not re-evaluating whether or not they really still need these medication that they've been on for years, and some of these medications are absolutely necessary. But some of these medications are for conditions that may have resolved on their own, and then these meds like PPIs, can possibly be stopped.

Speaker 1: 8:17

Osteoporosis can also be seen with certain other hormonal issues, like an overactive thyroid or people that are taking too much Synthroid, the thyroid supplement that we use to treat hypothyroidism. Well, sometimes we just give too much and people don't get their blood checked regularly and for months or years they're on too much of a high dose. This could possibly increase their risk of osteoporosis. Even conditions where nutrient absorption is reduced, like Crohn's disease or ulcerative colitis, people that get malabsorption, like celiac disease, could possibly increase their risk of having osteoporosis later on in life, and even in some rare cases, high doses of vitamin A could speed up bone breakdown. Knowing which type of osteoporosis you have is important, but that's something that you want to leave in the hands of your doctor, because we should be looking to rule out secondary conditions before diagnosing you with primary osteoporosis. Now, the reason we want to know which type you have is because it completely changes the treatment plan. If you have secondary osteoporosis. You have to treat the underlying cause and not just the bones.

Speaker 1: 9:43

So, what about risk factors and when to screen for osteoporosis? If you're a woman over age 50, your bone mass is already declining quickly. That's why guidelines recommend DEXA scans, that's, a bone mineral density test, by age 65. Or maybe even earlier if you have risk factors like a family history of osteoporosis, a family history of pathological fractures, which are fractures caused by weak bones. If you are taking certain long-term medications that are known to cause osteoporosis, you might want to get screened earlier. If you have a lower body weight and low bone mass, low muscle mass called sarcopenia, previous fractures from small falls or other chronic illnesses that affect nutrient absorption, you want to talk to your doctor about whether or not you should get screened or screened at a younger age. Now, it's important that men don't check out, because we're not off the hook. If you've got risk factors, it's worth talking to your doctor about getting screened too. Now, the positive thing about osteoporosis is we have a lot of things that we can do with our lifestyle interventions that could possibly prevent it altogether. Whether it's nutrition, exercise, proper stress management and sleep hygiene, they all play a role in helping reduce the risk of chronic diseases like osteoporosis. Now, in terms of nutrition, we can start by busting this one myth right now it's not milk that keeps your bones strong, it's calcium. And calcium can come from milk, but it can also come from a lot of other different sources. Now, for adults, the sweet spot is about a thousand to twelve hundred milligrams of calcium per day. That could come from cow's milk, from fortified plant milks like soy milk, oat milk, almond milk, which are fortified. Tofu, beans, chickpeas, nuts and seeds. All offer significant amounts of calcium, and dark leafy greens like kale or bok choy are great sources of a ton of vitamins and minerals, which include calcium. Now, if you can't get calcium from your food, you can absolutely try to get it from supplements. These are an option, but you need to be careful. Too much calcium can actually increase risk of kidney stones and of calcium deposits building up in your arteries. That's why I prefer my patients getting calcium from food, because they don't have that peak concentration happening in your blood, because your body has its own regulation mechanisms to help downregulate calcium absorption when the body is flooded with calcium. Now, when we take concentrated sources of calcium, like high-dose supplementation, which you maybe get 500 milligrams of calcium in one pill, in one bolus, in one dose, in one bolus in one dose. The peak calcium absorption is high and some studies may suggest that that could increase the risk of kidney stones and of that excess calcium not getting shuttled directly to your bones, lingering in your blood vessels and maybe even building up and contributing to hardening of your arteries.

Speaker 1: 13:26

And then there's vitamin D the sunshine vitamin Hard to get from food, which is why deficiency is super common. Almost one in three people are low low and that's bad news for your bones. Maybe consider increasing the amount of vitamin D in your diet, considering sun exposure if appropriate for your skin type, and consider getting your levels checked and supplementing if you need it. Now I take vitamin D supplementation. You may want to consider talking about it with your doctor. Most people living in Canada and New Brunswick spending a lot of time indoors should strongly consider, and normal and even optimal levels of vitamin D are correlated and associated with lower risk of dementia and lower cardiovascular risk, reduction of risk of maybe depression and other chronic diseases. Now, a lot of these studies are observational studies, meaning that we can absolutely offer causation. It's hard to conduct a randomized, controlled trial for chronic diseases that take years to develop, so this data is the best that we have. That being said, the harms of potentially getting toxicity from excessive supplementation are super rare and it would require irresponsible supplementation. So it's a low harm, high reward type behavior taking supplementation and most people could benefit from possibly supplementing. You should definitely talk to your doctor if it's right for you.

Speaker 1: 15:11

Other than calcium and vitamin D, there are a lot of different other minerals that play a role, but the most important is probably protein. Protein is not just for muscles but for bones too, and most people, to reduce the risk of osteoporosis and sarcopenia, which is low muscle mass, should aim for maybe 1.2 to 1.6 grams per kilogram per day. Maybe 1.2 to 1.6 grams per kilogram per day. Grams per kilogram of body weight, that is. Different levels will depend on your level of exercise. Now for plant-based eaters just consider increasing the amount of tofu, lentils, tempeh, seitan beans and even whole grains, as they all contain protein, and eating a little bit of all of these foods. Well, the protein grams definitely add up.

Speaker 1: 16:10

Personally, I find it very convenient to take plant-based protein powders. So I do. I work out every single day, in fact. I do. I work out every single day, in fact. 10 minutes before recording this podcast, I just ran a 10K. I am likely going to be lifting weights tonight, so I need more protein than most and I keep my intake between 1.2 to 1.6 grams per kilogram of body weight per day. I'm not counting, I'm just aiming for about at least 20 to 30 grams of protein during all three meals and my one to two snacks per day. I know approximately after almost 12 years of being whole food plant-based, I know what that looks like. I know what that looks like.

Speaker 1: 17:03

Now people would say, jules, protein powder, that's processed food. I've probably already done like a few episodes on this. Processed is doesn't always mean bad. In fact, what determines if a food is healthy or not is outcome data, not our feelings and emotions or not. Is outcome data, not our feelings and emotions. So, even protein powder being a processed food, people who consume protein powder have lower risk of chronic disease and better body composition, and for me it's a very convenient way of hitting my protein goals. Now could I be hitting 120, 30 or 130 grams of protein per day on a whole food plant-based diet? Absolutely, I do it regularly, but I just find it all very convenient after a 10K run to put a scoop of protein powder in soy milk in frozen greens and frozen berries and chugging that down. So to each his own. This is what I do. I just want to be transparent about that. I'd say 99% of the calories I consume day in, day out are from whole, minimally processed foods which include protein powder.

Speaker 1: 18:20

Regardless if we talk about nutrition and calcium, vitamin D and protein and magnesium and strontium and other minerals. If I could prescribe only one medication for osteoporosis, it would be exercise. Now, exercise is much more potent in increasing bone density than any supplement could ever be, and specifically resistance training. Now, resistance training whether it's lifting weights or using resistance bands or just doing body weight moves like push-ups or pull-ups or squats push-ups or pull-ups or squats Resistance training is the main stimuli that stresses bones and increases the deposits of new bone. To increase bone density, now, whether it's lunges, squats, step-ups or push-ups the key is progressive overload. That means slowly increasing the challenge over time, so your bones keep adapting. This way, your bone density could increase and you could possibly compensate for the natural decline that people get after age 30 to 35. Now, other than food and exercise, a few more things you could be doing for your bones eating plenty of fruits and veggies they help reduce calcium loss and add vitamin K. Vitamin K then shuttles your calcium to direct them specifically towards bone.

Speaker 1: 19:57

Try to avoid smoking its bone. Try to avoid smoking. It's terrible for bone health, as is alcohol consumption, so try to keep your alcohol consumption at a minimum and also manage other chronic diseases so they don't rob your bone of nutrients and watch for other bone thieves like long-term steroid use, like long-term steroid use, prednisone, high-dose vitamin A supplements or unnecessary acid-reducing medication. Now some people will be scared of this and they'll want to stop their PPIs or their Tecta or their Losec or Periet or any acid-reducing medication. Talk to your doctor about this, because some people get chronic reflux, which is acid splashing up from your stomach to your esophagus, and long-term chronic erosion of the surface of the esophagus could potentially increase a condition called Barrett's esophagus, which is possibly a precancerous condition that could then lead to esophageal cancer. So it's always trade-offs. There are pros and cons of taking medication. There are pros and cons of reducing them. Just make sure to talk to your healthcare provider on whether or not you actually need them.

Speaker 1: 21:20

So basically, osteoporosis is a silent disease for a reason. You will not feel your bones weakening. Osteoporosis doesn't cause pain like arthritis. Arthritis is the wear and tear of your cartilage, whereas osteoporosis is the progressive thinning and weakening of your bones and makes them more vulnerable to fractures with minimal trauma. For a lot of people, by the time they know they have osteoporosis is because they've had a fall and they've broken a wrist or broken a vertebrae or broken a hip.

Speaker 1: 21:58

But here's the good news you could take action now. You can make small deposits in your bank account at any age. You can slow down the withdrawals. You can reduce the rate at which you lose bone density. You do that by stacking the odds in your favor and to stay strong and mobile and to keep bone mass at a maximum and lower the rate of decline, you want to make sure to have a nutritious diet that contains enough calcium, enough vitamin D, enough protein and enough of the other trace and vital minerals. But as much as nutrition is my passion and is important not as important as lifting things that are heavy.

Speaker 1: 22:45

Resistance training is the main stimuli to promote bone deposits and to increase bone density. Lift something heavy. Eat your greens. Supplement with vitamin D if recommended by your doctor, and if you're in the higher risk zone, consider booking a DEXA scan or a bone mineral density. Your doctor will tell you. Your score put you either in the osteoporosis or the osteopenia, which is simply the precursor to osteoporosis. Your bones are more fragile, but not fragile enough to put you in that danger zone. And then, with simple risk calculators and knowing your personal history and your context, we'll be able to tell you whether or not you are at low, medium or high risk of an osteoporotic fracture. Your doctor should be recommending resistance training as a first line, possibly calcium intake through diet or supplementation vitamin D protein, and then should be having a discussion about possibly taking medication. Now I have some patients that even with adequate lifestyle interventions, their bone mineral density is so low that we are still going to combine interventions and behavioral change with prescribed medication. Medications are a tool, but I'll tell you the people once they've already had compression fractures in their back, in their vertebrae that support their spine, or have had a wrist fracture or a hip fracture, it's not time to mess with osteoporosis. It should absolutely be treated with lifestyle and medication Right on.

Speaker 1: 24:43

I hope this episode has helped guide you through how to manage osteoporosis. Most importantly, how to prevent it. It is super common. We see it at the clinic regularly. It's a normal part of aging, but it doesn't mean that it needs to get so bad where you experience fractures. Most of the things that we can do for osteoporosis are related to the way we eat and the way we move and the way we live our lives. Unfortunately, we need to age and as we age, our bones age as well, but there are things we can do to help them age more gracefully, right on. Thanks so much for tuning in. We'll see you in the next episode. Peace, hey, everyone, go check out my website plantbaseddoctorjulescom to find free downloadable resources and remember that you can find me on Facebook and Instagram at Dr Jules Cormier and on YouTube at Plant Based Dr Jules.