Osteopenia vs Osteoporosis: What Your T-Score and DEXA Scan Really Mean

Today's um exciting one. I think um osteoporosis is from at least my understanding something that isn't really well understood by patients, right? Um and we're going to be talking about the importance of bone health and because you need to have healthy bones, right? To um stay active. So that's what we're all about with functional medicine. So just a quick disclaimer, everything what we're talking about today is not medical advice. This is really just for educational purposes only. If you want functional medical advice, you can become a patient at MedMatrix. This is really just for educational purposes. I'm joined by the absolutely fantastic Dr. Rose. Dr. Rose, can you give a brief introduction kind of your background um how you got into functional medicine and um yeah, what you know, kind of your understanding of or experience in bone health and osteoporosis. Yeah. Um I'm a naturopathic physician. I've been practicing for over 20 years and um I have seen a lot of people I mostly women um I continue to see a lot of patients who come in with um a diagnosis of osteoporosis um sometimes osteopenia. we'll talk about the difference and um it is unfortunately kind of very common and um yeah I've just become really fascinated with the intersection of hormonal balance, nutrient balance, um certain you know keeping inflammation to a certain level and the different ways that we can prevent both osteopenia and osteoporosis and sometimes even reverse reverse that. So, um it is a super important topic. I think you're you're completely right that it's not well understood um among me many or most um patients and unfortunately even among a lot of medical providers. um it's just not something that's at least historically been prioritized in medical education and it's I think there's some limitations both in terms of the diagnostics um and definitely the treatment approaches. So super important topic and probably one that doesn't get quite enough um attention in my opinion. Gotcha. Well, in in like 30 seconds or less, why do you feel like osteoporosis doesn't get the attention it deserves? Um, well, this might be a little bit of a controversial subject, but maybe because it primarily affects women. Um, that that might just be part of it. Um, and other than that, I think, um, it's something that isn't screened for and detected until, um, usually women are in their 50s and older. Uh, and it's kind of caught, you know, after it's ideally this is kind of something that's addressed decades earlier. And that's just not the way that our as we have discussed frequently on this podcast. It's just that doesn't really fit into the conventional medical model. We're we do have good screening tests like the DEXA scan. We'll talk about the pros and cons of the DEXA. Um but the fact that it's not done earlier um means that these are you know kind of the lower bone mineral density again osteopenic or osteoporotic um status of a woman is not detected until it's already developed. Whereas if if we had a health care system that was really really proactive and really um invested in preventive care, we would be catching it much earlier. We would be basically be be preventing it and really um improving bone mineral density for women and men. Um and therefore when we improve bone mineral density, we're reducing a person's risk of fracture. How does why why does osteoporosis affect more women than men? Is this a um lifestyle thing or is this a genetic thing? Um it's largely hormonal. It's that estrogen, primarily estradile, which is the strongest of the three estrogens, um is um really important to um basically preventing the breakdown of bones. So there's two types of cells that we talk about. Um it's bone is not static. It's kind of this like active metabolically active tissue that's always remodeling. And the two key cell types are osteoclasts which are the resorbers. They kind of break down old or damaged bone. And then there's the osteoblasts which are the builders. So they're putting down new collagen matrix and kind of mineralizing it with calcium and other minerals. So you've got these two um types of bones and in a healthy individual um with I guess I would say optimal levels of estradiol they're kind of in balance right like the activity of the osteoclast matches the activity of the osteoblasts. When a woman um hits menopause there's a pretty abrupt drop in her estradiol. What the estradiol has been doing is kind of putting a break on the that osteoclast activity. So it's basically been helping to maintain the balance and then there's this really kind of sudden drop of that the break the break comes off the osteoclast activity and suddenly you get much more breakdown than you do building up and it's so that alone is um a a big reason why women tend to have um you know weaker weaker bones. I think there's also again this is a hormonal thing um you know and we'll talk probably a little bit more about the importance of optimal skeletal muscle mass and and muscle tissue and that's protective um and that that in addition to the actual bone mineral density that's going to help an individual maintain balance and stability and again prevent fracture when um in both women and when you see a drop in estradile and a drop in testosterone, you're going to inherently um lose some of that strength. So, um there I think for I think to answer your question basically it's it's large it's a hormone hormonal issue. Okay. What about um so all right we understand that hormones play a big role in bone health but how do nutrients play an important role in bone health? So um everybody talks about calcium. Um we need optimal calcium. We need specifically um you know some calcium forms are absorbed better than others. Um in order to get optimal absorption of calcium you need optimal levels of vitamin D. Um, so if people are deficient in vitamin D, then they're not going to get optimal absorption of calcium and that's just like a real deficit for for the building of the bones for kind of that mineralization um and therefore strength that osteoblast activity. Gotcha. Okay. What's uh what are good levels that you like to see in your patients for vitamin D and calcium? Yeah. So, the vitamin D, this just came up with in a couple um of my visits with patients today. Um there is a bit of a split um between kind of the conventional medical opinion on op what normal vitamin D is versus in functional medicine what we consider to be optimal. So for any individual, no matter the sex, no matter the age, I usually like to see um serum levels of vitamin D at least at 60. Um and in addition to the bone mineral density piece and calcium absorption, that's um helping to lower inflammation. It helps with um autoimmune tendencies, it helps with mood stabilization, um immune strength, etc. In regards to osteoporosis, bone mineral density, I'm I really would like it actually probably on the high end of that. So closer to 80. And when we see that, we see that um again there's that optimal calcium absorption. We are also I shouldn't ignore vitamin K2. Um, we're always including in our recommendations vitamin K2 because as you're getting that optimal calcium absorption, you want that to be shuttled to the bones and not to the arteries. And so that's where the vitamin K2 comes in. So can you explain K2? Like what do you mean K? So yeah, can you explain that a little more? Yep. Um, so basically there's a couple different types of K2. There's one that's um I think M4 MK4 and MK7 and when that is again basically when that is taken with um the vitamin D3 then that's that's benefiting the that's benefiting the bones because of where the where the calcium is going. Um, so people often are are taking vitamin D3, but they haven't been instructed or they just don't know enough to take the K2 with it. Okay. So, sorry, can you say that again? What is K? So, what does K2 actually do? So, K2 directs the vitamin. I think of it as like kind of like it guides where the calcium should go. So, you need a couple things. You need to get enough vitamin D that you're optimizing the absorption of calcium. And that can just be the calcium in your food. um and or if you're supplementing with an additional calcium. So, you want to kind of optimize that absorption and optimal levels of vitamin D are going to let you do that. But then once that um vitamin uh once that calcium is in the bloodstream, where does it go? Does it do you want it deposited in the arteries? Not so much. That's going to increase your risk of having a cardiovascular event. you do want it to be deposited um into the that growing bone, that matrix um of the bone. Okay. That's what K2 does. Okay. So, if you have low K2, calcium is going to go to the arteries. If you have optimal K2, it's going to go to the bones. Correct. Gotcha. Is that something that you test for on the initial panel? K2. We don't do we don't do K2. No. When do you want like what type of when do you want to get a patient's K2 levels? Um, in all honesty, it's not something I order routinely. Um, but I think if we were um, so I'm not going to go too much into this, but sometimes like if there's a parathyroid disorder, um, if there's kind of some conflicting or confusing test results in terms of calcium, in terms of D3, um, you know, and you're kind of digging a little bit deeper, then potentially we could we would order that. Okay. Um, gotcha. Does thyroid play a role in bone health? I know it's all connected, but does thyroid play a significant role in your bone health? Um, I mean, not as much as parathyroid. Parathyroid really does play a big role in terms of calcium absorption. Um, what is parathyroid? Sorry. It's a second gland that's kind of next to the thyroid. Um and so if there's an issue with the parathyroid gland then um that can um that can basically impact your bone mineral density. I actually should correct that there is an issue with thyroid if usually what it is it's actually more with hyperthyroidism. So if somebody has which is a less common um form of thyroid disease than hypothyroid which is the sluggish or the the slower functioning thyroid. So hyperthyroidism is um an autoimmune condition uh and where there's kind of like an over overactivity of the thyroid gland. when that happens or if somebody is kind of overmedicated for hypothyroidism and that one marker that we that is commonly used the TSH the thyroid stimulating hormone if that is too low so if it's kind of like because of medication it's basically been suppressed we do see that that um uh lowers bone mineral density that does kind of increase your risk of fracture that has to be going on for a there of for a while. You know, if somebody has kind of, you know, uh TSH that's too low for six 3 to six to nine months, it's not going to have a huge impact. We're talking years. Okay. Sure. Um so what is I guess like what is the conventional medical approach to osteoporosis and what is the functional medical approach to osteoporosis? Um so part part let's start a little bit with the testing as I said um you know in an ideal world I think we would maybe be doing some of this screening at an earlier age. I honestly don't know like in that insurance world I'm not sure when insurance is going to start to pay for a DEXA scan. Um but again in an ideal world if somebody is at a higher risk and we can go over what those risk factors are. I would say, you know, screen earlier than 50, earlier than certainly earlier than 60. Um the but conventional medicine uses um a DEXA scan and this is kind of a it's a form of an X-ray. There's two beams that are used um in a DEXA scan. One is looking at soft tissue and one is looking at bone. And they when they do the calculations this is a lowd dose x-ray by the way when they do the calculation the like computer basically subtracts the soft tissue absorption. So one beam is absorbed more by soft tissue the other one by bone and then the computer subtracts it and you end up with an estimate of bone mineral content. um and then they divided they basically have this formula and then they get the bone mineral density and that's expressed in grams per centime squared. So it doesn't directly measure bone strength. Um it measures bone density which they can correlate with fracture risk but again it doesn't show kind of the actual quality the architecture or any micro damage. Um, there is another test that, um, I have been researching a little bit and starting to refer people to. It's actually a form of an ultrasound as opposed to an X-ray. It's called an, uh, REM, REMS, um, echo light. Okay. And this actually, some people like it because they want to avoid X-rays. Um, the ultrasound is very safe. This gives both I believe both a bone mineral density and um what's considered to be your FRA score and that's your risk of it's like your 10ear fracture risk. Um so that's again I'm not sure how how often that's going to be covered by insurance and I know that like for us the closest place where people can go is Massachusetts. um there's a there's a clinic that offers that but um I think we are starting to see these kind of alternate ways of um screening for it. In terms of treatment, it's pretty limited in conventional medicine. Um there's two categories of medications. One is anti-resorptive. So those are the ones that you've people have maybe heard of more commonly, the bisphosphinates. Um the most well-known brand name is Fosamax. Um the generic of that is alendinate. Um and then and what that's doing is basically slowing bone slowing down the bone breakdown. So it's kind of again slowing down that osteoclast activity. Okay. I know like some medications um you like the medical team here are more critical of like hey this is kind of a maybe not a copout but it's like not the best solution here um versus some medications like hey this is actually a really good thing. So where like can we dive more into the conventional medications for osteoporosis as far as like what are the long-term side effects? Is there a better root cause approach? Can they be used in conjunction with a functional approach? Yeah, I mean the the the negative with um so a couple things. I mean I'll get into kind of how we in functional medicine here and here at MedMatrix how we like to approach it. Um you know there those bisphosphinates are often used for people who kind of have a what's considered to be like a modest decrease in bone mineral density. Um, it does reduce your the fracture risk, especially in the vertebrae and the hip. Um, it's often like what's considered to be a firstline therapy. It does not rebuild bone. Um, and it potentially with long-term use, which is often times that's the intention is like you just need to stay on this, it may actually um suppress some of that building that osteoblast activity. Um but those are the ones that we're going to see the most often. The other category is these kind of like anabolic therapies and that's more for that build and like idea is to at least stimulate osteoblast activity. These are often used when people have a history of fracture. Um they have severe osteoporosis. But um they there is part of what we do in functional medicine is we practice personalized care and it's really important to know like what are some of the other medications that um a person is on in addition to actually like what they've been on in the past. What are their risks? But for example, um they're like if your doctor is prescribing a certain osteoporosis medication, they you need to talk to their talk to them about other medications that you might be on. So, if you're on an acid block or if you're on a proton pump inhibitor, that's going to change kind of statistically um what has been shown if that if that osteoporosis medication is actually going to be effective or actually potentially put you at a higher risk of fracture. Um so there was this one sty one study that was done that um when women it was done with women um I think it was all women uh this one might have been both women and men but it was basically a metaanalysis there were almost 60,000 people in this study they were on uh what we call PPIs or proton pump inhibitors so the medications that people take to help with heartburn are gird okay and it showed that Those people while taking a bisphosphinate actually had an increased risk of fracture by 52%. Compared to people who were just taking the bisphosphinate. Okay. So it matters what other things are going into your body. Um so in terms of like the question of are there certain conventional medicines that we that we do like and that we do encourage, it's it's all individualized, right? Like maybe for one person that's what makes sense right now. um but not if that person is already on a proton pump inhibitor and they really need to be on that medication. So does that kind of answer that question? Yeah. Yeah. So um I got a bunch of questions here that I have written down. First off, what is the difference between osteoporosis and osteopenia and like what's actually go like happening inside the bones with these kind of different diagnosises? Yeah. So they're basically on the same they're conditions that are on like the same spectrum of bone loss. So osteopenia means that your bone density is lower than normal. It's like a warning sign that the bone is thinning. And then um like technically on that DEXA scan um your osteopenic if your T-core range that's how they talk about it is negative one to -2.5. Um, and so, uh, you're not really at a high risk of having a fracture. Um, and not everybody with osteopenia is necessarily going to progress to osteoporosis, but it does, you do have an increased risk. Osteoporosis on that DEXA scan um, is worse. It's like, um, greater than -2.5. So, negative -2 point. I I have people coming in and they're like, I had a negative four on a DEXA. So that's definitely osteoporotic. And that's like your bones are porous, fragile, more likely to fracture. Um so that internal architecture of the bone is relatively weak. And most common fracture sites are like hip, um the vertebral spine, um I guess wrist. I think it's wrist is mostly because that's often just what you're falling on, right? like when you're st when you're trying to stop yourself, that's what you hit. So, I think that's partly why that is a common sight. Okay. So, is bone loss really just a part of like getting older? Like you're just going to get older and your bones are just going to get more fragile. Is that is that just I mean, obviously age increases your risk, right? Now, that is not a factor that we can that's not a variable that we can change. Um in addition to aging, it's that estrogen decline, especially post-menopausal. Um other risk factors are chronic inflammation. Um another risk factor is what we call like hypercortisolism and that can be um caused by medications like steroids or gluco uh corticosteroids. So things like predinazone um uh the nutrient deficiencies which we discussed and having a sedentary lifestyle that's going to put you at higher risk. Um some of it's genetic, right? Like some people are just kind of born with thinner bones. Um but there there are the genetics you can't necessarily change and the aging you can't change, but there are factors that you can change. Okay. Okay. I guess like what I'm getting at is like what's in our control when um like let's say your mission is to live as long and strong as possible and you want to have really strong bones as you get older so you can continue to be active. Like what are all the things that you should be doing to you know make that a reality? Yeah. So, I'm a little bit on a on a personal mission to talk to my young female patients and to my the p people that I know who are parents of women um girls who girls really ages gez I mean eight to in their into their 20s right that is like a prime window of when we really we can still really there's a lot of bone building activity we and still kind of optimize levels of vitamin D and calcium absorption um and really build like a strong foundation and so that when she does get into those parameopausal years and the menopausal years if she's in a situation where she doesn't go on bio identical HRT and her estradiol drops and or she has family history and like these genetic reasons why she's at a higher risk, we've given her this gift of at least having that optimal vitamin D in optimal calcium in that that those decades of her life when it's we can really make a big difference. So um that and for those of us who are older optimizing optimizing vitamin D, optimizing calcium, optimizing protein intake, um really kind of targeting inflammation, so kind of chronic inflammation is going to play a role. um handling inflammatory conditions ideally in a way that is not does not involve um chronic use of steroids because that's going to hugely increase your risk. The other um another huge category of medications as I mentioned earlier is proton pump inhibitors. So a lot of people are on medications like omerazol, froootadine, over-the-counter prylok, pepsid, those are just the over- the-counter versions of the same medications. Um and it's I mean there's no controversy around the fact that um chronic use of those medications which really are supposed to only be prescribed for two weeks but rarely is somebody only on it for two weeks. They usually are end up just kind of staying on that. um there's a huge increase in risk of um of uh losing bone mineral density and therefore increased risk of fracture. So so in terms of preventive medicine there's things that you can do but there's also these categories of medications that we want to avoid. So we want to avoid the synthetic corticosteroids if we can. Um I talked about the PPIs and then this is an interesting one SSRI and SNRIS. So these kind of anti-depression medications. Um SSRI stands for selective serotonin reuptake inhibitor. And then there's serotonin norepinephrine reuptake inhibitor. Again, super common. Again, we've talked about this on the podcast. a lot of people coming to see us are on these medications. So there was this one study, I think it was done in Canada, it tracked patients for 10 years and it found that taking either an SSRI or an SNRI was increased with a 28 but sorry with a 68% increase in fracture risk. And the reason they think is that um when there's this kind of artificially elevated level of serotonin, which is what happens when you're on these medications, um the hormone, it kind of becomes unhealthy, at least for the bones. That elevated serotonin inhibits the osteoblasts. Those are the builders. Those are the cells that are creating bones. So, you're basically um not changing the osteoclast activity. You're still getting the the cells that are kind of breaking down the bone, but you're not matching it with the builders, the osteoblasts. Yeah. Wow. Interesting. Um, so is having strong bones as simple as like just taking a vitamin D and calcium supplement for as or I guess as early on as you can. No, these are I mean it's multiaceted, right? It's like it's it's the preventive measures like you just me like you just mentioned. It's looking it's it's it's treating gut health in ways that doesn't involve chronic PPI use. It involves dealing with mental health issues that I'm not I'm not saying that somebody should never go on an SSRI. Like there's a time and a place where people, you know, we need it's the right thing to do. But um in terms of like really looking at like practicing root cause medicine and really looking at prevention, it's this chronic use of these medications that's going to all of these compound to increase your risk of uh of osteoporosis. And so addressing emotional health, mental health in ways that um are not just relying on these SSRIs or SNRIs, addressing heartburn and um gastro esophageal reflux disorder uh in ways that it's not just using a PPI. So not these kind of like you know mask the symptom type medicines but instead like actually healing things. Um I mentioned the cortisol sorry the synthetic corticosteroids. Chronic stress is for some people and I know we've talked about this as well is chronically elevated cortisol. it's not going to be quite as damaging as like a a synthetic corticosteroid. So, you're saying stress can kind of lead to poor bone density. Again, overall, it's going to contribute to your risk of osteopenia and osteoporosis because that chronically elevated cortisol um it's basically balanced with that other hormone oxytocin. They kind of balance each other. So, so oxytocin actually benefits your bone mineral density, whereas cortisol kind of strips the bones of collagen and you want a healthy balance. So, if you don't kind of have enough of that oxytocin and you have too much chronically elevated cortisol, it's just one more thing that's going to slightly increase your risk of fracture. Wow. Okay. What about gut health? How does your gut health kind of set you up for like if you have bad gut health, are you almost guaranteed to have poor bone health later in life? Not necessarily, but how if you have impaired gut health, you probably have um some level of malabsorption, right? It's harder for you to absorb um Oh, so that's how gut health plays a role in it. primarily absorption and then your nutrient absorption of the nutrients. Y um yeah, I would say that primarily and again if you have gut health issues and you're kind of masking it with a proton pump inhibitor, you're increasing your risk of of a fracture. Okay. Sure. Um let's see here. So if you've been diagnosed like when you have patients who come in with osteoporosis and osteopenia like is there any coming back from that like can you get them back to a point where their bones are like they used to be to some extent? you can um I mean so one of the one thing that I like to do is um uh talk to to both women and men but mostly women about um getting their serum levels of estradiol up. Now, the research does unfortunately tell us that after the age of 60, that it's hard like even if I do put a woman on estradile, if she's over the age of 60, it's it's it's harder to kind of make huge gains just with that one therapy alone in her bone mineral density. It does help. It's not it's better than not. Um but if I can catch a woman before she's around the age of 60, then um we still kind of are in a good window um to you know either reverse get a woman out of that osteopenia uh category or move her from the osteoporosis to the osteopenia and then maybe eventually out of that range. Um there's really the the biggest if a woman is not on bioididentical HRT specifically that estradiol it's that 5 to 10 years postmenopausal where that's kind of where the that bone that breakdown really happens right like that break comes off of the osteoclast and there just the the rate of bone breakdown exceeds the bone building. And so if we can catch a woman before menopause or early in that 5 to 10 years right after she's menopausal, then we have a better chance of um preventing and preventing or reversing. Okay. Gotcha. And and then same with the nutrients, right? like yes, it's better to do it when somebody's younger, but it's certainly still helpful and beneficial to maintain optimal levels of nutrients. Okay. Yeah, makes sense. Um, so and I haven't even mentioned kind of the physical activity piece yet, which is huge. Sure. Let's get into it. How like how important is physical activity to um not only staying active as you get older, but your bone health? It's huge. I mean, you really need that kind of resistance. It's like you you need to kind of Yes, I think I mentioned about the mus muscular strength and um stability and balance, but you need in order to kind of um so for example, we all know the thing about like astronauts, right, that they really lose bone mineral density. There's no gravity, right? And so it's like the longer that they're up there, the worse it is for their bones. So just simply that kind of that weight on the bone. So that's why we always hear about like weight resistance and weightbearing exercises to help with bone mineral density. Cardiovascular activity um is uh cardiac work, cardio, you know, running, biking, that's all great, but you need something to push against the bones to kind of um maintain that that density. And it's and so we're all what we're talking about here is reducing your risk of fracture. So part in addition to the bone mineral density, it's especially as when people get older, it's reducing the risk of them actually falling. So if a person is osteoporotic and they fall, there's just a much higher risk of them breaking a bone as opposed to somebody who falls but is not osteoporotic. So it's also behavioral lifestyle. So we talk to our patients about removing throw rugs espec you know around the house having adequate lighting in the hallways putting grab bars um on stairwells and especially in the bathroom like a lot of falls happen in the bathroom. You want to make sure that you have a grab bar um even like next to the toilet in the shower. you want to remove kind of lips between, you know, like a threshold if there's kind of something that, you know, you could easily trip over. So, those things seem kind of they're not, again, those are kind of not talked about, but it's huge. Like, there's like kind of some things that just need to like if somebody can just come through an older person's house and like reduce those risks of actually falling, that's huge. And there's physical therapists who specialize in this and like have people do specific exercises so that um physically neurologically they are at less of a risk of falling. Sure. Do you I mean do you think if you did everything right like um obviously everyone's different but like the like how long can you realistically prolong the um you know having weak bones if you did everything oh like how long can you um stay out of that osteoporotic window. Is that what you mean? Like Yeah. I mean, again, it's looking at all these factors. I mean, yes, there is the again, there's the genetic piece, but um I think if you start young enough and you adopt enough of these measures, then um and I do I sound like a broken record, but I think the hormonal piece is really big. And that actually includes men, too. Like if men have low testosterone, testosterone um gets what we call aromatase or like converted to estradiol. So if they have low testosterone, that means they're also going to have low estradiol and that's going to um give them a higher like lower bone mineral density too. So it's not, you know, obviously women have a higher risk, but it does apply to men as well. Mhm. Um so if that kind of if we can optimize hormone levels, nutrient levels like you know early enough, I think I think there's a you know I think there's a really high chance of um preventing osteoporosis. Okay, gotcha. So your favorite markers to look at kind of like osteoporosis um are obviously the dexus scan, vitamin D, calcium, K2 and what else? What are other important estradile what are other hormones? estradile testosterone. Um, I mean, you know, as you know, in our panel, we're looking not just at total testosterone. We're looking at kind of free testosterone, bioavailable testosterone, which shows us what the body's actually tapping into, um, not just total. And I'm looking at protein intake. Um, we usually are recommending more than what the RDA is, although I'm not sure what the new specifically exactly what the new protein RDA recommendations are. I know it went up, but um you know, we're looking at ideally the the the amount of protein um kind of a ballpark figure is if you multiply um your weight in pounds times um 0.59 and that'll be the number of grams of protein you want to aim for every day. So if you weigh 140 pounds and you multiply that times 0.59, I think you end up with something like 64 65 grams of protein like at minimum. Um so that's going to be beneficial some. So yes, those are the you mentioned like the blood the the blood work that I'm looking at potentially a DEXA scan or I as I said earlier that ultrasound that um REM's scan and then lifestyle wise lifestylewise what is um somebody's diet like okay yeah and then having taking like a vitamin D um three week yeah and calcium supplement as early as possible is there anyone who shouldn't be taking a calcium ium supplement or I'm not necessarily recommending calcium a lot. I mean, I think you can take I think you definitely can take calcium. Again, a lot of it has to do with somebody's diet and how much I think they're getting through their food, but if they are taking calcium um you know, calcium carbonate is kind of the traditional form that's not really easily absorbed. Calcium citrate is absorbed more easily, but at one time we don't really the body isn't great at absorbing more than 500 milligrams at a time. So there's not really any point in overloading on the uh the calcium. Gotcha. Yeah. I forgot what episode we I think we talked about this in the deficiencies podcast. Um but milk. Okay. Because we're we had I had to bring it up because we're doing a podcast about bone health and osteoporosis. So what's the for those who haven't watched our deficiencies episode? Um what's the what's the real real with milk? Is milk actually going to give you strong bones or no? So, um, yes, dairy is relatively high in calcium, um, but there's so many other ways to get calcium. So, dark leafy greens, um, nuts and legumes or beans, seeds, um, and oftentimes, and and there's different forms of dairy, right? So, for a lot of us, like a fermented form of dairy, whether it's yogurt or kefir or um certain types of cheeses, our body handles that better. We digest it better. And then you're still getting the calcium. Milk is um often harder to digest for people. And I I think as I said on that other podcast, there's a little bit of a generational divide. I think that that marketing campaign that happened however many decades ago really worked. And so I have patients in their 70s and 80s who are, you know, continue to drink a glass of milk with every meal sometimes with the idea that it's like, you know, for their bones. And I think you can get optimal calcium without the somewhat inflammatory and inflammatory side effects, the digestive side effects that that many people do from just drinking straight up milk. Gotcha. Heard. Okay. Um let's see here. Can you walk me through a patient case study that you did with um relating to osteoporosis, bone health, etc.? I can. Yeah. Um so this is somebody that I'm working with currently. Now the one thing I do want to point out is that as I think it's become evident unlike some of the conditions that we are treating um at MedMatrix or in functional medicine in general where we can kind of um gauge the success of our treatments relatively quickly um you know by how the person feels three months later, six months later. Things like bone mineral density like this this is we're in this for the for the long haul, right? Um, people aren't getting DEXA scans every three months. They shouldn't. Um, so just to have that kind of caveat that, you know, I'm working with people for a long time and sometimes success simply means they haven't fallen or they fell and they didn't break something. Um, this case is a woman that I'm working with right now. Um she is 68. She came to me originally for um primarily digestive issues. So chronic uh heartburn, chronic uh gastroosophageal reflux disease, gird. Um in addition, she has known for a while that she has osteoporosis. So she came to me um taking a merizole um which again is one of those proton pump inhibitors again had been on it for quite a long time was also on um I think she's still on um alend uh elen alendrenate which is a bisphosphinate one of the more common ones trade name is fosmax the again she's been on that for a long time but her la her most recent DEXA scan did not show any improvement. I don't remember what exactly what her T-core is, but it's in the osteoporosis uh window, not osteopenic. Um so her um at her first visit, I saw on her blood work that she was deficient in vitamin D. I put her on a decent um amount. I might have just started her even on just 5,000 IUs, which is in my opinion not a lot. 5,000 IUs of D3 with K2. Um, we started working on her gut health. Um, she saw her primary care provider who either tested her vitamin D or she I think they tested her vitamin D and it was uh came back at 33 and they told her that that was too high and they wanted her to stop her D3 supplement. Um, so again, it's just a difference of opinion. Um, you know, we don't really see people getting tox into toxicity levels until it's like around 150, but conventional medicine feels like anything like 33 is too high, but for her bone mineral density, I wanted her to be like at 80. Um, so what are you doing? Just curious, like I'm sorry to interrupt the story, but like what do you do in that scenario? Because like I say exactly what I just said to you. I say this is a difference of opinion. I say I am prioritizing your bone mineral density and um what this is what we see for optimal calcium absorption is that we want to get keep your vitamin D elevated and we are a long ways away in my opinion from what I have read and what I have learned we are a long ways away from toxic levels. Man that sucks for the patient because then they're like kind of between us torn. Exactly right. Yeah. Yeah. So a little bit of she does this for her. She does have a couple um hit like there's been a couple fractures I think in the wrist. So um we um I changed the form of her calcium to calcium citrate because it's more absorbable. Um again I can I've been like optimizing her gut health. So um she has been able kind of on her own to get off of that proton pump inhibitor. So right there right there she's lowered her risk. right? I mean, it'll take a little while, but basically just by being off of that, she no longer has that compounded risk. Um, and so with Yeah. So, she was able to do that with some neutrauticals. Um, and I did start her on some bio identical HRT. Again, she is a little bit older like the, you know, how much are we going to gain? We are going to get some gains from that. Not as much as we would if she were 10 years younger, but it's still better than not at all. and it's still safe and I I feel like the benefits outweigh any kind of risks for her. Um, and then we might be consider I might be considering kind of some additional hormonal balancing um to to just again continue to optimize that musc that musc like the skeletal muscle mass as well as the bone mineral density. So, she's really exercise-wise she's uh maybe unknowingly been focusing on cardio. Um, but I'm also trying to help her incorporate more weights and more of an emphasis on balance and flexibility. Awesome. Yeah. So, again, I don't have like I don't have a Oh, look. Her DEXA scan is now amazing, but I think we're going in the right direction. Yeah. I mean, what's awesome, she got off the um the PPIs. Yeah. Yeah. That's pretty cool. I what I'm going to do right now for patients who are joining is put a link in the comments on YouTube um where you can actually book a free discovery call as a new patient. Um we really appreciate we love when patients do the work and educate themselves. Patients who are more educated about these things and their health definitely see better outcomes. So um yeah, click the link below. You can book a free discovery call if you're looking to work with us as a patient. We do accept a limited amount of patients per week. So uh if you're interested, make sure you click it, book it. We'll leave it up for a couple more seconds here. Um, with that said, Dr. Rose, do you have anything else that you want to add to kind of this discussion today? I guess if I had one kind of take-home message for people, it would just be circling back to the beginning, I just think that unfortunately there's just been some real limitations in conventional medicine in terms of treatments and um there is there is a lot that we can do in kind of a holistic way, you know, whether it's in lie of or in addition to some of these pharmaceuticals. And so I oftentimes have people coming in with osteoporosis and they just feel a little hopeless. Um, and they really they really shouldn't. There's there's there's other tools out there that that do make a difference. Yeah. And thank you guys for saying thanks. We appreciate you. It's always fun having the live audience. So that said, we'll uh see you guys in the next one. Thank you.