The Osteoporosis Approach That’s Failing Millions (And What You Can Do Instead)
If you want to stay active as you get older, you need bones you can trust.
The problem is, osteoporosis often gets noticed late. And the usual plan is mostly about slowing bone loss, not building strong bone from the ground up. That can leave you feeling stuck or even hopeless.
Let’s walk through what really matters for bone health, in plain English.
Why osteoporosis often gets ignored
Osteoporosis often does not get talked about enough.
One reason is that it mostly affects women. Another reason is that many people are not screened until their 50s or later. By then, bone loss has often been happening for years.
This is why earlier prevention matters, especially if you have risk factors.
Why osteoporosis affects women more than men
Bone is not “dead” tissue. It is always remodeling.
- Osteoclasts break down old bone.
- Osteoblasts build new bone.
In a healthy body, these stay in balance. But when menopause hits, estradiol drops fast. Estradiol helps slow bone breakdown. When estradiol drops, breakdown can speed up and building cannot keep up.
That is a big reason women are at higher risk.
Men can still have bone loss too, especially if testosterone is low since testosterone can convert into estradiol.
Nutrients that matter for bone health
Most people only think about calcium. But calcium is just one piece.
Vitamin D helps you absorb calcium
If vitamin D is low, you cannot absorb calcium well. That makes it harder to support bone strength.
“Optimal” vitamin D levels were described as:
- At least 60 for general health
- Closer to 80 when bone density is the main goal
Vitamin K2 helps calcium go to the right place
K2 is like a traffic director.
You want calcium to go into bone, not into arteries. K2 helps guide calcium toward bones.
Two forms of K2 were mentioned: MK-4 and MK-7.
K2 is not commonly tested, but it may be considered when there are confusing calcium or vitamin D results, or possible parathyroid issues.
Does thyroid or parathyroid affect bone health?
Thyroid is connected, but parathyroid plays a bigger direct role in calcium balance.
Parathyroid is a small gland near your thyroid. If it has a problem, that can affect bone mineral density.
Thyroid can matter too, especially with hyperthyroidism or if thyroid medication pushes TSH too low for years. That can lower bone mineral density over time.
Testing for bone loss
DEXA scan
A DEXA scan is a low-dose X-ray used to estimate bone mineral density.
It does not directly measure bone strength or bone quality. It is mostly a density estimate that correlates with fracture risk.
REMS (EchoLight) scan
Another option discussed is REMS, an ultrasound-based scan.
Some people like it because it avoids X-rays. It can also include a fracture-risk score described like a 10-year fracture risk style score.
The conventional medication approach (and the limits)
Conventional medicine often uses two categories of drugs:
- Anti-resorptives (like bisphosphonates such as Fosamax or alendronate)These slow bone breakdown and can reduce fracture risk, especially in the spine and hip.But they do not rebuild bone, and long-term use may suppress some bone-building activity.
- Anabolic therapiesThese aim to stimulate bone building. They are more often used when osteoporosis is severe or after fractures.
A big point here is this: meds should be personalized. Other meds you take can change the risk and the benefit.
One example shared was a large meta-analysis where people taking proton pump inhibitors (PPIs) while on a bisphosphonate had a much higher fracture risk compared to bisphosphonate alone.
Osteopenia vs osteoporosis: what’s the difference?
They are on the same spectrum.
- Osteopenia: bone density is lower than normal. It is a warning sign.
- Osteoporosis: bones are more porous and fragile, with a higher fracture risk.
A DEXA scan uses T-scores:
- Osteopenia: -1 to -2.5
- Osteoporosis: below -2.5
Common fracture sites mentioned: hip, spine, and wrist.
Is bone loss “just aging”?
Age increases risk, but age is not the only factor.
Other risk factors discussed:
- Estrogen decline after menopause
- Chronic inflammation
- High cortisol over time
- Steroid use (like prednisone)
- Nutrient deficiencies
- Sedentary lifestyle
- Genetics (some people start with thinner bones)
You cannot change your age or your genes, but you can change many other factors.
What you can do to protect your bones
Start earlier than you think
Ages 8 through the 20s were described as a key window for building strong bone foundation.
That matters later when hormones change.
Support hormones when appropriate
Estradiol was described as a major lever, especially earlier in the post-menopause window.
It was also explained that it is harder to make big gains after age 60, but earlier support can make more difference.
Get serious about protein
Protein was discussed as important for bone and muscle support.
A simple “ballpark” idea shared was:
- Weight (lbs) x 0.59 = grams of protein per day (minimum target)
Train your body with resistance
Cardio is great for your heart, but your bones also need resistance and weight-bearing.
You need to push against your bones to help maintain density.
Reduce your fall risk at home
This was a big practical point, especially for older adults:
- Remove throw rugs
- Improve lighting in hallways
- Add grab bars (bathroom, shower, near toilet)
- Remove thresholds or lips you can trip on
- Consider a physical therapist who focuses on balance and fall prevention
Watch out for medications that can raise risk
Several medication categories were discussed as risks when used long-term:
- PPIs for heartburn or reflux
- Steroids
- SSRIs and SNRIs (linked in one study discussed to higher fracture risk)
The bigger theme is root-cause care, not only symptom cover-ups.
Calcium and milk: what’s the “real real”?
Calcium can help, but the type and dose matter.
- Calcium carbonate is common but not absorbed as well.
- Calcium citrate is more absorbable.
- The body is not great at absorbing more than 500 mg at a time, so more is not always better.
Milk does have calcium, but there are many other ways to get calcium too:
- Dark leafy greens
- Nuts
- Beans and legumes
- Seeds
- Fermented dairy like yogurt or kefir may be easier to digest than straight milk for many people
Gut health and bone health
Bad gut health does not guarantee poor bone health.
But if your gut is not working well, you may absorb nutrients poorly. That can affect vitamin and mineral levels that bones need.
And if gut symptoms are being managed long-term with PPIs, that can raise bone risk too.
A real patient example (what progress can look like)
A patient case shared included a woman in her late 60s with osteoporosis and digestive issues.
The focus was long-term.
Success was not framed as a perfect scan in 3 months. It was framed as:
- Fewer falls
- Fewer fractures
- Improving risk factors step by step
Changes included:
- Switching calcium form to improve absorption
- Improving gut health
- Getting off a PPI
- Considering bioidentical hormone support
- Shifting exercise away from only cardio and toward weights, balance, and flexibility
FAQ:
1. Can you give a brief introduction, your background, how you got into functional medicine, and your experience in bone health and osteoporosis?
Dr. Rose shared she is a naturopathic physician with over 20 years in practice, seeing many people (mostly women) with osteopenia and osteoporosis, and focusing on hormones, nutrients, and inflammation.
2. In like 30 seconds or less, why do you feel like osteoporosis doesn’t get the attention it deserves?
It may get less attention because it mainly affects women, and it is often not screened for until later in life.
3. Why does osteoporosis affect more women than men? Is this lifestyle or genetic?
It is mostly hormonal. Estradiol helps slow bone breakdown. After menopause, estradiol drops and bone breakdown can speed up. Muscle loss also adds risk.
4. How do nutrients play an important role in bone health?
Calcium matters, but you also need vitamin D to absorb calcium well.
5. What are good levels you like to see for vitamin D and calcium?
Vitamin D was described as ideally at least 60, and often closer to 80 when bone density is the main goal.
6. Can you explain K2? What do you mean by K?
K2 was described as helping guide where calcium goes.
7. What does K2 actually do?
K2 helps calcium go into bone rather than arteries.
8. Is that something you test for on the initial panel?
K2 is not routinely tested.
9. When do you want to get a patient’s K2 levels?
It may be considered in special cases like confusing calcium and vitamin D results or possible parathyroid issues.
10. Does thyroid play a significant role in bone health?
Not as much as parathyroid. Thyroid issues can matter in hyperthyroidism or long-term overmedication that suppresses TSH.
11. What is parathyroid?
It is a gland near the thyroid that plays a big role in calcium balance, and can impact bone density when it has problems.
12. What is the conventional medical approach to osteoporosis and what is the functional medical approach?
Conventional care often uses DEXA for screening and medications to slow loss. A functional approach looks earlier, looks deeper, and addresses hormones, nutrients, inflammation, lifestyle, and root causes.
13. Can we dive more into conventional medications: long-term side effects, better root-cause approach, and can they be used with functional care?
Bisphosphonates reduce fracture risk but do not rebuild bone. Long-term use may suppress bone building. Other meds (like PPIs) can change risk. The approach should be personalized.
14. First off, what is the difference between osteoporosis and osteopenia, and what’s happening inside the bones?
Osteopenia is early thinning. Osteoporosis is more severe with fragile bones and higher fracture risk. They are on the same spectrum.
15. Is bone loss really just a part of getting older?
Age increases risk, but hormones, inflammation, nutrients, medications, lifestyle, and genetics also matter.
16. What’s in your control if you want strong bones as you get older?
You can work on vitamin D, calcium intake, protein, inflammation, exercise (especially resistance training), and reducing medication risks when possible.
17. Is having strong bones as simple as taking vitamin D and calcium as early as possible?
No. It is multi-factor. It includes lifestyle, gut health, stress, medication risks, and more.
18. So you’re saying stress can lead to poor bone density?
Chronic high cortisol was described as one factor that can increase risk over time.
19. What about gut health? If you have bad gut health, are you almost guaranteed to have poor bone health later?
Not guaranteed. But impaired gut health can reduce nutrient absorption, which can raise risk.
20. If someone has osteopenia or osteoporosis, is there any coming back from that?
There can be improvement, especially when addressed earlier. Hormone support, nutrients, and lifestyle were discussed as ways to help move someone out of worse ranges, with better odds before age 60.
21. How important is physical activity for staying active and your bone health?
Very important. Weight-bearing and resistance help maintain bone density, and strength and balance reduce fall risk.
22. If you did everything right, how long can you stay out of the osteoporotic window?
It depends on genetics and many factors, but starting early and addressing hormones and nutrients increases the chance of prevention.
23. Your favorite markers to look at are DEXA, vitamin D, calcium, K2, and what else?
Estradiol, testosterone (including free and bioavailable), protein intake, diet, and sometimes REMS scanning were discussed.
24. Is there anyone who shouldn’t be taking a calcium supplement?
Calcium was not described as always needed. It depends on diet and needs. Form and dosing matter.
25. What’s the real real with milk? Does milk actually give you strong bones?
Milk has calcium, but there are many other calcium sources. Some people digest fermented dairy better than straight milk, and some get digestive or inflammatory issues with milk.
26. Can you walk me through a patient case study relating to osteoporosis and bone health?
A case was shared involving a woman in her late 60s, focusing on gut health, improving absorption, getting off a PPI, considering hormone support, and shifting exercise toward weights, balance, and flexibility.
27. What do you do when conventional medicine says a vitamin D level is “too high,” but you want it higher for bone density?
It was framed as a difference of opinion, with the functional priority being optimal calcium absorption for bone and staying far from toxicity ranges.
28. Do you have anything else you want to add to this discussion today?
The take-home message was that many people feel hopeless, but they shouldn’t. There are more tools beyond the limited conventional approach.
