Ep 24: Lifestyle Strategies for Bone Health

Which supplements really strengthen bones? Is walking enough to keep them strong or do you need something more? And how do you actually lower your risk of the kinds of falls that can change life overnight?

With advice coming from every direction, it's easy to waste time, money, and effort on things that don't truly make a difference. If you're over 50, post-menopausal, or simply planning to be stronger in the future, this second installment of my bone health series is packed with tools to help you take control of your bone health—starting today.

I'll share evidence-based strategies you can put into action right now, from spotting everyday habits that quietly weaken bones, to building an exercise routine proven to support bone density. We'll also cover simple, practical ways to make your home safer and reduce your risk of falls.

Tune in now for a clear, science-backed plan to protect your bones—and your independence—for years to come.

References:

https://www.thefitcollective.com (Dr. Ali Novitsky)

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Eastside Menopause & Metabolism

Audio Stamps

00:52 - Dr. Patil-Sisodia introduces lifestyle strategies for osteoporosis prevention and why bone health matters for women over 50.

02:15 - The two biggest lifestyle habits that are sabotaging your bone health (and why quitting them is crucial).

04:10 - Why calcium and vitamin D are the foundation of bone nutrition, plus the best ways to actually absorb them.

05:50 - The truth about trendy bone supplements like magnesium, vitamin K2, and strontium.

09:54 - The types of exercise that have the strongest evidence for building bone density and preventing fractures.

12:21 - New research reveals the optimal timing for combining protein meals with strength training for better bone formation.

13:21 - Fall prevention strategies that can dramatically reduce fracture risk, including simple home modifications.

15:42 - Dr. Patil-Sisodia's essential action plan for stronger bones with key strategies you can start implementing today.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:02

Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health. Welcome back to Reset Recharge. Today is the second episode of our Bone Health series, and we are going to focus on what I like to call, lifestyle strategies for osteoporosis prevention or osteoporosis treatment. Today we're going to focus on non-drug interventions, the practical day-to-day lifestyle choices that can help protect your bones for years to come. So if you're over 50, post-menopausal, or simply planning to try and be stronger in the future. This episode has lots of tools that are going to help you take control of your bone health starting today. Let's talk a little bit about why osteoporosis matters. Osteoporosis literally means porous bones, and it's a condition where the bones become fragile and more likely to fracture. While it can affect anyone, women, especially after menopause, are at a much higher risk due to hormonal challenges that are going to make bone loss happen faster. In fact, 50% of women over the age of 50 will suffer an osteoporosis related fracture in their lifetime, and these fractures can lead to pain, disability, and a significant loss of independence. But here's the good news. While we can't change our age or genetics, there's a lot we can do naturally and holistically to strengthen our bones and reduce risk. Let's start with lifestyle habits. According to the American Association of Clinical Endocrinologists or ace, there are two things that are particularly harmful to bone health. The first one is smoking. Tobacco use weakens the bone because it reduces the activity. Of the osteoblasts, which are the cells that build bone. And then the second is excessive alcohol use. Alcohol, especially if you're having more than two drinks per day, can interfere with the way that your body absorbs calcium. It can also affect balance and increase the risk of falling and falls lead to fractures. So if you are smoking, quitting is one of the most powerful things that you can do. Not just for your bones, but for your whole body. We already know that there are implications for the lungs and for the heart and for your blood vessels, so that is definitely something to consider. And if you drink, try to eliminate your intake to no more than two alcoholic beverages per day. There's actually data on breast cancer risk as well with alcohol, and it's been shown that having more than two alcoholic beverages per day will increase your breast cancer risk. So while these things may sound simple, they're pretty foundational to making sure that you have healthy bone. And changing these habits drastically can reduce fracture risk over time. If you are struggling to quit either one, you can always talk to your primary care doctor. There are so many resources out there, including things like nicotine patches or medications to help with quitting tobacco, and then there are medications and other counseling interventions that can help with cutting back on alcohol. So please know that your primary care doctor is pretty well equipped to help you with these things, and they will have a huge impact on your bone health if you're able to cut back on both of them or quit altogether. Let's talk about nutrition and how we feed our bones and make sure that they're healthy. The first thing that comes to mind when people think about bone health is calcium, and it's for a good reason. However, calcium is just one part of the nutritional puzzle. The most common recommendations you'll hear for supplementation for bone health and osteoporosis are to take calcium and vitamin D. The American Association of Clinical Endocrinologists recommends that people get about 1200 milligrams of calcium per day. For postmenopausal women and between a thousand to 2000 international units of Vitamin D three calcium is absorbed from food sources. Much better than it is from supplements. And so whenever you can get your calcium from a food source, like think dairy products, leafy greens, tofu fortified plant milks, your body will absorb it better than if you took a supplement. Vitamin D has been a hot button topic for the last few years, and it's important to know that while we can get vitamin D from diet and sun exposure, a good majority of the world, especially post-menopausal women who are older are vitamin D deficient, mostly because we just don't get enough sun exposure and then. We also are not getting enough through our diet as much as we try. So supplements are really an inexpensive, effective way to help improve your bone health. And when you take vitamin D supplements, if you take them with your calcium, you actually absorb the calcium much better. So let's talk a little bit about some other micronutrients that people bring up Frequently. In my clinic, I often have women who are asking me. About things like magnesium, vitamin K, and strontium, and there's so much information out there in the media about all the different things that you should be taking. It can get really confusing. So I want to break this down for you so you understand. Outside of calcium and vitamin D, is there anything else you need to do in terms of supplements? So let's start with magnesium. Magnesium is another mineral that's involved in bone structure and metabolism. It's actually what we call a binding co-factor for calcium, and when you don't have enough in your body, it can make it harder for your body to hold onto calcium. The good news is that most women get enough through their diet, especially if you were eating whole grains, nuts, seeds, legumes, and green vegetables. Those things are fortified with magnesium and you will have enough in your diet. Supplementation of magnesium should actually be considered in people who are magnesium deficient, and that is the only place where in the studies it's actually shown benefit. And some considerations may be in people who have malabsorption issues. People who struggle with chronic alcoholism, if there is long-term use of diuretics or proton pump inhibitors. And also patients with type two diabetes tend to be a little bit more magnesium depleted. And despite that, there's still not strong evidence that magnesium supplementation actually improves your bone mineral density or reduces fracture risk in women who have normal magnesium levels. So routine use is probably not necessary unless you have a known deficiency. Let's talk about vitamin K two next. So Vitamin K two helps regulate the calcium in the body by directing it to the bones and away from the arteries. And there are recent studies that have shown potential benefits in improving bone mineral density in the spine and forearm and reducing the levels of osteocalcin, which is a marker of bone turnover. There are some studies that even suggest a reduction in fractures, but, and this is important, that data is inconsistent and most clinical guidelines, including the American Association of Clinical Endocrinologists do not yet recommend using Vitamin K two as routine therapy. We need to do more studies. It. Looks like it's promising, especially in women who have low dietary intake or high turnover rates of Vitamin K two. But we definitely have to do more research before it becomes the standard of care. My other warning is that for people who are on things like Coumadin, otherwise known as Warfarin, which is a blood thinner, if they start taking vitamin K supplements and they're on these medications, it can actually. Impair the way that the Coumadin Warfarin is working in order to prevent blood clots. So it's important for your doctor or whoever is prescribing that for you to be aware if you are going to start Vitamin K two supplements so that they can monitor you appropriately and you don't. Mess up the way that the Coumadin is working for you. Last on my list for minerals that we should be looking at is strontium. There is a lot of buzz around strontium and for me, I'm gonna start off by saying, proceed with caution because there is some data that strontium, ranelate. At a pharmacologic dose has shown fracture reduction benefits in clinical trials. But here's the thing. It's not available in the United States as a dietary supplement. Over the counter strontium products are not supported by current guidelines, and there's no clinical evidence that the over the counter strontium actually helps bone health in women. So in short, leave this one alone, and if it ever does become available by prescription in the United States, I'll be curious to see how that gets incorporated into the guidelines. So I would hold off on that. I don't think that's something anybody should mess with on their own. So that's what you need to do for nutrients. Let's talk about movement. We all know that exercise is good for us in terms of a cardiovascular health perspective for reducing the risk of heart attack and strokes, and for reducing the risk of insulin resistance, prediabetes, and diabetes. But it is essential for bone remodeling. We need exercise in order for our bones to remodel in a healthy way and continue to remain strong. The American Association of Clinical Endocrinologists encourages lifelong participation as much as tolerated in weight-bearing exercises like walking, dancing, stair climbing. Resistance training, which has the strongest evidence for increasing your bone mineral density. And this is lifting weights, Pilates, any sort of resistance exercise, and then balance and core training like tai chi and yoga, because those actually help prevent falls. The amazing thing about any of these exercises is that they do double duty. They are strengthening your bone and they're improving your balance, which is reducing your fall risk, which is a major cause of fractures and you don't need fancy equipment. Even body weight squats, light hand weights or resistance bands can be effective. My friend, Dr. Ali Novitsky, who owns a company called the Fit Collective, has put together an amazing strength training program. She has one that is called beginner strength training, and there are three phases that you can cycle through. This program has 10 minute workouts for three days per week, and she has three phases to this program. The first of which, if you've never done strength training or exercise before you do the moves in a chair so that you don't injure yourself. The second would be. A harder move with less support. And then the third is where you're much more advanced in your strength training. There is data that shows that consistent strength training will help your bones. So if you've never done exercise, this is a really great program. I have no financial affiliation with this particular product. I just really like it. I actually have. Her version of a fitness program called Total Fitness Program, and I do recommend that to my patients as well if they've never done exercise and they're looking to do that while they're embarking on their journey for obesity, or if they're more experienced with exercise. Both programs are fabulous, and you can find them on her website, which is the fit collective.com. There is some new research that is going on right now that suggests that if you exercise after a weight maintenance meal, especially one that has protein and a weight maintenance meal is basically breakfast, lunch, or dinner that may enhance your bone forming response. So if you're eating protein and then you're exercising afterwards. You can have better bone formation and doing another strength training workout later in the day can actually provide maybe a little additional stimulus. So if you wanted to break up your strength training routine into 10 minutes in the morning and 10 minutes later on. If you do the first 10 minutes after you eat protein and then you do the second, 10 minutes later in the day, you might actually get more bone remodeling and stronger bones. And while we're still learning more about this, I think it's fascinating that nutrition and movement, when they're paired together, can work in a way that is synergistic and improving your bone strength and health. Now let's talk about the last thing on my list, which I think is an overlooked strategy. And while anyone can fall, women who have osteoporosis are especially vulnerable to fractures. And that's why fall prevention is absolutely vital to part of any bone health strategy. In my patients that come into my office, if I think they're at high fall risks, sometimes I'll even call occupational therapy or put in a referral to occupational therapy for them to go out to the house. They can come in and assess for fall hazards. I do this. More frequently with some of my older patients who may not have help at home, and they look at are there rugs that are a trip hazard? Are there cords that are getting tangled up? Is there furniture that hasn't been arranged in a way that people can move around it effectively without tripping on it? There are a lot of different things you can do to make your environment safe in order to prevent falls and prevent fractures. I have a list of a few things that you can do that can actually make your home significantly safer. Number one will be installing grab bars in the bathroom. I know this is not aesthetically pleasing and some people don't want to put it into their homes for that reason, but it will keep you safe. The next thing you can do is improve the lighting in the hallways and stairs. One of the things that happens often is that if areas are dimly lit, you may not see a step clearly. You may miss a step. You may fall. Removing loose rugs and clutter will also help prevent any falls. And then adding non-slip mats in your shower are very easy ways to make your home safer. The other thing you can do is review your medications. There are certain medications like sedatives or certain antidepressants that can make you sleepy and increase your risk of falling. So talk to your doctor about alternatives, dose adjustments, or whether you need to shift the timing of those medications to keep yourself. And then if you've already had a fall or if your balance is changing, I will oftentimes suggest physical therapy and occupational therapy so that they can work on balance training as well as a home assessment and putting together a fall prevention program that actually helps a lot of my seniors build confidence and mobility, and it helps'em feel safer in their homes. So here's your takeaway toolkit for lifestyle strategies for osteoporosis prevention. Number one, quit smoking and limit alcohol. Number two, eat smart. Make sure you're getting 1200 milligrams of calcium, either through diet or supplementation if you can't get it through diet. And then a thousand to 2000 international units of Vitamin D three. Let's talk about the other minerals. Magnesium should be considered only if you're deficient for the purposes of bone health and osteoporosis. Vitamin K two looks promising, but it's not standardized yet, and it has not been incorporated into the guidelines. Additionally, it can mess with your blood thinners, so please talk to your doctors about it in case you're considering starting it or you've already started it, especially if you're on Coumadin warfarin, which is the same thing. And then strontium. There is data that shows prescription strength can be beneficial to bone health and reduce fractures, but remember that the prescription strength is not available in the United States. And the over the counter supplements have not been proven to do the same thing. So that is one that I would recommend that you skip. And finally make sure that you are exercising for strength and balance and that you are fall proofing your environment. And making sure that your space is clear and you're going to be safe in your home. All of these strategies are safe and powerful and completely within your control. And while medications are still likely to play a role for most women, these lifestyle changes are the foundation of what are going to keep you healthy with or without the prescription. So this is something that everybody should be doing at a baseline, and then your doctors will talk to you about whether medication is indicated for you or not. So that wraps up today's episode, and our next one will be talking about all of the different osteoporosis medications that are out there and breaking them down to understand how they work and myth busting some common things that you may see on the internet about these medications. When they first came out, they got a super bad rap. Because they were not used particularly well, but we will get into that in the next episode. I appreciate you all being here. Stay strong, stay steady, and remember your bones are listening. I will see you on the next episode. Hey there. Quick announcement before you go. I've officially opened my own practice. It's called Eastside Menopause and Metabolism based right here in Redmond, Washington. I'm so grateful to be helping women navigate perimenopause, menopause, and metabolic health. It's truly some of the most fulfilling work I've ever done. If you're interested in working with me, head over to eastside mm.com. You can book a consultation and stay tuned. I'll be launching a membership program as well as an online course for those of you outside of Washington. Lots more to come, so keep listening and thank you for being here.