423: How to Strengthen Bones: Your Gut, Osteoporosis + DEXA Scan Problems w/ Dr. John Neustadt

This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!

Take $10 off your next order! Use promo code QUELL10 at check out — Get started HERE!

– – –

Most people never think about their bones…until something breaks.

That's what makes osteoporosis so dangerous. Bone loss happens quietly over many years, often without pain or warning. By the time you learn there's a problem, you're already dealing with a fracture that changes how easily you move, exercise, and enjoy everyday life.

What's even more surprising is that osteoporosis isn't simply an unavoidable part of getting older. While age and menopause certainly influence bone health, they're only one piece of a much bigger picture. Certain medications, chronic inflammation, nutrition, exercise habits, and even digestive health may all influence how to strengthen bones, or end up with significant bone loss.

The encouraging news is that your bones are living tissue. This means your daily choices can influence whether your bones become stronger or weaker over time, as you will see.

My guest, Dr. John Neustadt, ND, is a Bastyr University graduate and #1 Amazon best-selling author of Fracture-Proof Your Bones, now in its expanded 2nd edition.

Recognized internationally as an expert in integrative and functional medicine with a deep focus on osteoporosis and fracture prevention, and as one of the top ten cited authors in the world for his work, Dr. Neustadt has published 100+ medical articles, was editor of the textbook Laboratory Evaluations for Integrative and Functional Medicine, and is on the Corporate Advisory Roundtable for the Bone Health & Osteoporosis Foundation.

In this episode, you'll discover why relying on a single bone density scan (aka. DEXA scan) may not tell the whole story. You'll also learn why protecting your bones starts long before osteoporosis is ever diagnosed.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In This Episode:

• Why osteoporosis develops silently for years before symptoms appear
• The surprising reason bone loss isn't an inevitable part of aging
• Why menopause creates one of the fastest periods of bone loss—and what to do about it
• Medications that may increase your fracture risk, including antidepressants, acid blockers, and steroids
• How gut health and chronic inflammation can contribute to weaker bones
• Why improving your DEXA score doesn't always mean your fracture risk has improved
• The overlooked role that protein and collagen play in maintaining strong bones
• How height loss and thinning skin could indicate declining bone health
• How to strengthen bones: The best types of exercise for improving both bone strength and balance
• Why getting enough calcium matters—but taking more isn't always better

Quotes

“For every 19 women taking {an SSRI} for more than a year, we'll expect one to fracture. That’s 20%.”

“In up to 30% of cases of postmenopausal bone loss, the loss of bone is caused by things other than just the decrease in estrogen.”

Links

Find Dr. Neustadt online | Facebook | YouTube | LinkedIn

Get Dr. Neustadt’s incredible book → Fracture-Proof Your Bones

Healthy Skin Show ep. 411: Why Do I Suddenly Have High Cholesterol In Menopause? (And How Do You Fix It Naturally?) w/ Dr. Eve Henry

Healthy Skin Show ep.393: TRUE or FALSE: Is Milk Bad For You? w/ Dr. Bill Schindler

423: How to Strengthen Bones: Your Gut, Osteoporosis + DEXA Scan Problems w/ Dr. John Neustadt {FULL TRANSCRIPT}

Jennifer Fugo (00:19.288)

Dr. Neustadt, I am so excited to have you here on the Healthy Skin Show so we can dive into the complexities of osteoporosis, osteopenia, and all the different things that I really, truly believe that people need to know about what's going on with their bone health, that oftentimes they don't know until it's too late, including how to strengthen bones. Welcome to the show.

Dr. John Neustadt (00:44.585)

Thank you. I'm excited to be here. It's gonna be a great conversation.

Jennifer Fugo (00:48.332)

Yeah, I think one of the biggest struggles, as I was kind of poking around online, was this idea, a lot of people don't realize that, they think osteoporosis just sort of happens. Because that's sort of how it happens in your health history, right? All of a sudden your doctor's like, oh, you need a DEXA scan, or something happens. But is this something that happens with your bones, or is there maybe a trajectory of a point when you're building bones and then you start to lose bone that people need to know about?

Dr. John Neustadt (01:23.145)

Well, both are possible, but also it's important to understand that it's not inevitable. When I was in medical school, we were taught as if it were the gospel that once you hit peak bone density in your twenties for both men and women, it's a one-way downhill street from there, losing bone at about half to 1% per year. But bone is a living tissue, so we can create the environment within our bodies. We can provide the raw materials, we can identify hidden causes of bone loss and deal with those, and bone can actually become stronger, and we can improve bone density. But it does happen, typically, it can happen gradually over many, many years, and there are no symptoms, usually, when it comes to bone loss. And so it's a surprise to people. Oftentimes the first symptom or sign of osteoporosis is somebody breaking a bone. But it is typically a condition that is gradually developing over many years or decades, with a couple of exceptions.

So, one exception is that for women who go through menopause, during menopause and for the 10 years after is where the fastest rate of bone loss occurs. And so that's a bit of a cliff where you can really start getting rapid bone loss, and people should be getting bone density tests. I prefer when they start going through menopause or ideally when women turn fifty, as a general rule, I'd like to get a baseline, and that is more conservative than the official recommendations, which are you wait until somebody's sixty-five, a woman's sixty-five. The caveat to that is it says, or if she has risk factors, and pretty much almost everybody I know has risk factors. So you can talk to your doctor and advocate for that, and hopefully get insurance to pay for it. But I like to do it at 50 years old. Especially if somebody breaks a bone who's 50 years or older, they should be getting a bone density test.

But where can it happen younger, where it's also rapid and very dangerous? And that is medications. There is a long list of medications that damage bone, cause osteoporosis, and increase fall and fracture risk, and most doctors aren't aware of them. And so understanding those medications and what they are is really important at a younger age, but really at any age, to understand your risks so you can take appropriate steps.

Jennifer Fugo (04:02.22)

What would some of those medications be?

Dr. John Neustadt (04:06.015)

The most commonly prescribed medications, unfortunately, are on that list. One is prednisone, or the glucocorticoids, and most physicians or doctors, they're aware of that, that's commonly known. Prednisone is an example of that powerful anti-inflammatory medicine, they're used in autoimmune diseases, and they destroy bone. But a couple other medications that are at the top of the list in terms of how frequently they're prescribed, doctors aren't aware of them.

One are the antidepressants. Anything that artificially increases serotonin, the category of antidepressants are selective serotonin reuptake inhibitors, it's SSRIs. There's also SNRIs, serotonin norepinephrine reuptake inhibitors, Lexapro, Prozac, those are some of the names that they go by. There are serotonin receptors on bone. There are two primary metabolically active cells in bone, the osteoblasts build up new, fresh, healthy bone, and osteoclasts break down old, worn-out bone in a process called bone remodeling, which we need. About every 10 years, your bone is totally new and fresh because you have this turnover that's happening. When you give these medications that artificially increase serotonin, well, there are serotonin receptors on the bone breakdown cells, the osteoclasts. The serotonin binds to the osteoclasts and increases their activity, so bone begins to break down faster than it's created. Most people think of serotonin just for mood and affecting the brain and how somebody feels, but there are serotonin receptors throughout the body, and bone is no exception. And what the research shows is, for every 19 women taking one of these medications for more than a year, one to five years was the study, we'll expect one to fracture. So almost 20%. It's incredible. And most doctors aren't aware of that. Most patients aren't aware of that.

Jennifer Fugo (06:10.314)

Oh my gosh. And are these women in the menopausal phase, or is this just across the board, it doesn't matter the age?

Dr. John Neustadt (06:20.733)

Didn't matter the age. Yeah, did not matter the age or the dose, interestingly. Usually the story with the medications is the greater the dose, the longer the duration, the greater the risk. This was just if somebody was taking it.

Jennifer Fugo (06:32.672)

Oh, wow. That is crazy. I was gonna ask you too about like GERD and heartburn medication, isn't that also somewhat problematic? I feel like that's one of the known risk factors that might even be in the safety information.

Dr. John Neustadt (06:50.919)

That's a great question. That's where I was gonna go to next. Absolutely. In fact, this is not new information. The first warning letter from the FDA about these medications was released in 2010, showing that people taking a proton pump inhibitor to block acid can have an increased risk for bone loss and fractures. And more research has been done since then, it's only strengthened the data. And now that we know it's a very dangerous situation, these were never approved for being taken for years at a time. And yet they're available over the counter now, people are on them for years and with no plan on getting them off of them or how to deal with it. And it's silently destroying bone and increasing not only fracture risk, but the most dangerous type of fracture, which are hip fractures. So that's something also to be aware of.

And 50% of those medication prescriptions for acid blockers are because of acid reflux. And frankly, there are some fairly simple ways that people can deal with acid reflux, often with dietary changes where they may not need the medication, or perhaps can lower the dose or the frequency.

Jennifer Fugo (08:02.872)

Do you know why, what is the mechanism that might cause someone, from taking these medications, to develop osteoporosis? Is that known?

Dr. John Neustadt (08:12.447)

Yeah. So each medication has a different mechanism of action of how it affects bone. I already mentioned the SSRIs. There is then the acid blockers. So what they do is they can cause a dysbiosis in the intestines, and they also cause decrease in some vitamin and mineral levels, so they can create deficiencies. The immune activation in the gut that is caused by these acid-blocking medications, because of the dysbiosis they create, then creates these inflammatory molecules that pass through the wall of the lining of the intestine and enter the bloodstream. Those travel throughout the body, but they do go to bone as well, where they again directly activate the osteoclasts to destroy more bone. That chronic inflammation component is very dangerous, not just to bone, but to overall health.

And the story is very similar when it comes down to what's actually happening with bone, with everything. Osteoporosis and bone loss is essentially a condition of imbalance where the destructive forces are winning. And we need to try and rebalance that system. And so that's one of the ways in which the proton pump inhibitors create problems. Another way is that because digestion is decreased, you get undigested food particles going down into the intestines, and that further stimulates an immune activation. That can, over time, damage the lining of the intestine, cause leaky gut, and cause these larger particles of food that shouldn't be passing through the lining of the intestine to get through there, which further causes even more immune activation. And that then also predisposes people to malabsorption and decrease in nutritional status, which then also contributes to bone loss.

Jennifer Fugo (10:10.542)

It does, it creates a mess in one area that then, I think of it like a train wreck, it starts one spot and it continues to affect different areas of the body. We oftentimes think that inflammation just stays in the location that it started or where the problem originates, but that's oftentimes not how this works. And that also goes for skin issues. So if anybody here has listened to me talk about how what is happening within the GI tract and other areas creates cytokines that then flood out into the system, it's a similar effect, and it doesn't just impact the skin. We start to see that impact in other areas.

I did want to ask, because you've mentioned women a number of times, but I know a man who is, I think, in his 60s, maybe early 70s, who has osteoporosis. So how frequently do you see osteoporosis in men? Because they're not necessarily not gonna end up with osteoporosis. I think it is something that men should be aware of.

Dr. John Neustadt (11:20.667)

Absolutely, it happens, but it is a minority of the cases. What the literature supports and says right now is that 20% of the cases are in men, 80% are in women, which is why the vast majority of the research has been in women. And within that demographic, postmenopausal women are at the greatest risk, and so that's also where the majority of the research has gone, specifically within that demographic.

For men, though, definitely it can happen, for various reasons. Like women, a decrease in hormones, sex steroids, can cause that, that's very common. So when testosterone declines in men, that is a risk factor for bone loss and osteoporosis, but it's not the testosterone by itself that's doing the work. And this is really important because when a man has bone loss, oftentimes the testosterone doesn't even get tested, unfortunately, by the doctor. But even when they do test it, what they frequently miss is they don't also test a man's estradiol. So men also have estrogen, and estradiol in men, just like in women, is what's responsible for building up and maintaining healthy, strong bones. And so testosterone is converted into estradiol in the body. So when a man gets on testosterone replacement therapy, you want to also be monitoring the estradiol to make sure that it is in a healthy range to help rebuild and maintain that bone strength.

But it's important to say right now that another challenge with not just men, but with women, is that if testosterone's low, if it is tested, or estrogen's low, or a woman's peri- or postmenopausal and they have bone loss, oftentimes the doctor will just simply assume that, well, that's the reason. I found it, we're done. But the reality is that in up to 30% of cases of postmenopausal bone loss, the loss of bone is caused by things other than just the decrease in estrogen. Similarly, in men, when testosterone is low and they have bone loss, up to 50% of cases are due to things other than just the low testosterone. And so looking more broadly, identifying potential medication involvement, looking at diet, looking at lifestyle, looking at this more holistically is really what needs to be done to fully evaluate and identify potential underlying causes so we can create programs for people to get the greatest benefits.

Jennifer Fugo (13:52.78)

Now, one of the things that I really appreciated about you when we've spoken before the podcast that you had shared with me, because I thought the DEXA scan is like the end-all, be-all.

Dr. John Neustadt (14:06.654)

Right.

Jennifer Fugo (14:22.805)

You know, we get this report that has like a T-score and a Z-score, and I have seen cases presented by different holistic practitioners where they've been able to show an improvement in the DEXA scan. So I would love your take on whether we should put 100% confidence in the results of the DEXA scan, or are there other pieces to this that we need to consider, and should consider, that perhaps might be glossed over when it comes to how well our bones are doing?

Dr. John Neustadt (14:45.745)

A bone density test is important to get. I do like them, they're the gold standard, but they need to be taken with a grain of salt. And it's important to understand the limitations of the test and put the test in its proper perspective. Unfortunately, almost exclusively, the clinical conversation with doctors and patients is centered on the bone density test results and what they can do to improve the bone density test, and then the bone density goes up and everybody thinks they're protected and they're happy. That's just not supported by the research. That's not the case. A bone density test only predicts 44% of women with osteoporosis who will fracture and only 21% of men. And this is not new, that study came out in 2008, and even since the 1990s we've known that bone density predicts less than half of women with osteoporosis who will fracture.

Jennifer Fugo (15:39.757)

Oh my gosh.

Dr. John Neustadt (15:40.84)

Yeah, it's quite limited, and every medical organization that's looked at this has correctly concluded that fracture risk depends on factors largely other than bone density. And that's where part of my passion lies around this issue, is reframing this discussion. Let's not focus on test numbers, let's focus on fractures. Every question to me has to be centered on how well does this test predict fractures, and how well does any recommendation maintain bone strength and reduce fracture risk. And so looking at the bone density test, seeing the numbers going up, is just one piece and a small piece, relatively small piece, of a much larger puzzle that needs to be considered.

Jennifer Fugo (16:23.572)

One thing that was really interesting is my mother is in her later 70s, and my first real experience with osteoporosis and a fracture was, I think it was 2021, she was out visiting my sister, folding laundry at the washer dryer, and turned, and she got an insufficiency fracture in the bones that are right under the kneecap. And she was in a lot of pain. She was still able to walk, but we had never been told that there was an issue like this.

Can you talk a little bit about what an insufficiency fracture is versus maybe, like you mentioned, the bigger risk fracture is like a hip fracture? And what are some other things that we should be screening for that could help us? Like you said, the DEXA scan's great, but it shouldn't be the only thing that we look at.

Dr. John Neustadt (17:26.783)

Those are great questions. So a hip fracture can be an insufficiency fracture, and insufficiency fractures can also be referred to as a fragility fracture. And it just means your bones are weaker and they broke. It could be anywhere in the body. The situation with your mom is, your mother or mother-in-law?

Jennifer Fugo (17:49.815)

My mother.

Dr. John Neustadt (17:55.092)

Your mother, unfortunately, is the common way that people find out. They break a bone, and then they learn that they have osteoporosis because they're not getting screened, which is why bone density tests are so important to be getting. What else should be screened for, though, importantly, 95% of fractures occur because somebody falls. Now, your mother was a little bit of an outlier, she didn't fall, and she did fracture. But gait and mobility, how steady somebody is on their feet, is the most consistent predictor of falls and fractures, better than bone density test results. And in fact, a study came out and showed that when somebody's risk for falling was low, meaning they were stable and strong on their feet, a bone density test for women under 70 years old and men only predicted about 5% of them who will fracture. So it's really that strength and stability, that mobility component that's important. And once you fracture a bone, as you pointed out, it is oftentimes the lead up, what then makes it so somebody for years, or even the rest of their life, is in chronic pain and has decreased mobility. So obviously it's something we want to evaluate for and want to reduce.

If you're looking for what is bone strength, there are two ways to think about this. One is bone strength, and the other is strength and stability, fall risk. So when we're looking at bone strength, unfortunately, there's not any one test that can determine bone strength accurately. Again, the DEXA test is the gold standard. There are other technologies that have come out, but none of them have shown to be superior to the limited efficacy of the bone density test. So I'm still a big fan of that. But what can predict in my mind, and what the research shows, bone strength, and maybe the trajectory that that is on, are the medications that somebody's taking, what their dietary intake is, because bone is a complex tissue like all tissues in the body.

So the bone density test only measures the mineral component of the bone, like calcium in bone. That's what gives bone its hardness. But there's a whole non-mineral part of bone that is crucial, which explains why the bone density test that only measures minerals is not very good at predicting fractures. It's the proteins in bone that are important for the strength and the quality of the bone. There are 180 to 200 different proteins in bone, in addition to bone collagen. Bone collagen is the major structural protein in bone, and as you know from skin, also in skin, it's throughout our body. And that gives bone its flexibility and its ultimate strength.

We can produce collagen from protein that we consume, that we get from our diet and dietary supplements. Research has shown that just the amount of protein that somebody consumes can account for 2 to 3% of bone mineral density because the minerals then bind to that scaffolding that the protein then creates. So making sure that somebody's protein intake is sufficient, I always do a dietary intake to look at that. And the relationship with the skin, I think, is very fascinating. There's a study that came out decades ago, there's only been one that's done, that has shown that if somebody's skin is thin and tears easily, that that can be an indication that they've lost bone density.

Jennifer Fugo (21:35.938)

Wow.

Dr. John Neustadt (21:46.28)

Because it's collagen, it's the connective tissue. And what is oftentimes what we see on the skin is a mirror and a reflection of what's going on inside of our body. And so that can be another indication, just looking at things like that, that they're losing bone density. If somebody's developing a dowager's hump, that is a bit of a hump in their upper back, that can be an indication. If they've lost height over the last couple years, if they're losing teeth, all of those things are indicators of bone loss. And then I also like to, of course, look at exercise, whether they have a sedentary lifestyle, that can help prevent bone loss. Things like that, in terms of questions to be asked and to look at, are important to understand what is somebody's risk for losing bone.

Jennifer Fugo (22:27.244)

I wanted to ask you about exercise because I do think this is a great question. Is there certain types of exercise that is better to help stabilize or maybe improve bone strength versus others? I know a lot of times people will just walk. My understanding was it was always weight-bearing, resistance training, is that the case, for how to strengthen bones? And how big of an impact does that have on your bones and either staying stable or avoiding osteopenia and osteoporosis?

Dr. John Neustadt (23:06.719)

So resistance exercises have been shown to improve bone density and reduce fall risk. There's a study that came out, the LIFTMOR study, they've done multiple of those trials now. Very clearly, high-intensity lifting, resistance training, you've got to do it safely, though, it can be very dangerous if you're not, it has to be under the guidance of somebody, a professional, to learn the technique that's going to be safe for you, has been shown to improve bone density and reduce falls and fracture risk. And one of the great things about resistance exercise is it improves strength and balance, so you're also decreasing fall risk.

But that's not the only thing that's been shown to reduce the risk of falling. There aren't a lot of prospective clinical trials out there on exercise with the results being fall and fracture risk, just because you need such a large group of people to do it and it has to be done in a controlled environment. But what we know, there are a lot of associations out there in the research between people's activity levels and what they do and their fracture risk. I'm really looking ultimately at fractures, what's decreasing fractures. Because if I say to somebody, you have to go lift weights, but that's not interesting to them, they haven't exercised in 20 years, and they're sitting on the couch, and they're overweight, and they just have no desire to go in a gym, they love to be outside more. I like to meet people where they're at.

So what does the research say about that? What does it support about meeting people where they're at? Well, there's a lot of support for that. Just walking 7,000 to 7,500 steps a day, not even this 10,000-step-a-day recommendation that's out there that, by the way, was created by a Japanese watch company to sell more watches. It was just invented out of whole cloth without any support.

Jennifer Fugo (24:53.816)

Oh, wow, gosh.

Dr. John Neustadt (24:58.375)

What we know is that for 7,000 and 7,500 steps per day, on average, it's associated with a 50 to 70% reduction in all-cause mortality.

Jennifer Fugo (25:06.668)

Wow.

Dr. John Neustadt (25:28.061)

That's all causes. That would include osteoporosis. So just getting up and walking, and exercise is cumulative, so it doesn't have to be all at once. Park a few rows further from the grocery store, take the stairs instead of the escalator, it all adds up. Gardening can be phenomenal. Balance exercises that also include strength. Yoga, Tai Chi, those have great research, but again, done safely. There are lots of options.

Jennifer Fugo (25:33.079)

And obviously we want to eat calcium-rich foods. Some people are still taking what I would consider probably high doses of supplemental calcium. Do you have any thoughts, because I think people would want to know, but do you have any thoughts on the idea that you can just supplement with calcium and that's gonna fix your bones or help them stay strong?

Dr. John Neustadt (26:02.419)

This is a great question. The whole topic of calcium is a big topic. So I'm gonna try and just be very succinct so I don't go off on tangents because I'm very passionate about this. First and foremost, people should get their nutrients from diet, not dietary supplements, not pills and powders, when possible. Now, if there's research, good clinical trials, supporting taking supplemental nutrients for their health benefits, and you can't get it, for whatever reason, from diet, then that's a good argument to use dietary supplements. I am a proponent of using dietary supplements as the FDA intended, which is as a supplement to a healthy diet.

The recommendation is always to get calcium from food. You don't have to eat dairy to get enough calcium from food, there are excellent non-dairy sources of calcium. The average American woman consumes about 800 milligrams of calcium in her diet. So if they're just eating average and getting a dietary supplement that has 400 milligrams of calcium extra is an appropriate choice and it's still well within safety limits of supplemental calcium. There are clinical trials out there with calcium showing that it can maintain bone strength. Clinical trials showed about an 18 to 23% reduction in fractures. Some of them were in the elderly who were in nursing home facilities, so overall the strength for taking supplemental calcium is not phenomenal, but it is there, and it is supported.

I think that taking it more to make sure you're getting enough and getting in that adequate USRDA range is the best argument for doing that. Because calcium really is just a supportive nutrient. I think it's been overemphasized in that supplemental form of calcium, that people are taking 1,200, 1,500 milligrams of calcium as a dietary supplement. That is not supported. And I recommend against that because the recommendations from the Bone Health and Osteoporosis Foundation and the American College of Preventive Cardiology currently state that people should not consume more than 2,000 to 2,500 milligrams of calcium per day, or there are some very serious safety concerns. And if you're already getting 1,200, 1,500 milligrams from a supplement plus your diet, you're already into that sort of red zone that I'd be very concerned about.

Jennifer Fugo (28:36.972)

Yeah. And I also know, too, that I remember from a family member who had calcification around one of their heart, the aortic valve, that one of the things that the surgeon, after replacing that valve, had stated is you gotta be careful with how much supplemental calcium you take because we don't want it to end up getting deposited in that area. There was worry about that of like, is it possible the calcium is gonna get deposited in places it's not supposed to because we're just flooding the system without other nutrients that are commonly found in food alongside with calcium in order to make sure that it goes to where it's supposed to.

Dr. John Neustadt (29:25.875)

So the debate around calcium and calcifications, coronary artery or valvular calcifications, is an interesting one and it's ongoing. And there's conflicting research out there and conflicting conclusions. In high-risk populations like the person you just mentioned, that may be a good recommendation. For general population, my understanding, my reading of the research right now, it's just too early to conclude one way or the other.

But I do think that again, the recommendation has always been the same for me, even before this research came out, get it from food primarily. And getting some supplemental calcium, 400 milligrams per day is considered safe. There are clinical trials, actually, up to 1,000 milligrams per day showing that it's safe, so there are also studies out there saying that it is safe. In terms of cardiac events, heart attacks, for example. So there it's not just this clear-cut picture, but again, understand hopefully what your dietary contribution is, and try and aim for the appropriate amount, which for most people is going to be far less than 1,000 milligrams per day as a supplement.

Jennifer Fugo (30:38.04)

Well, one thing that I want to mention to everybody, you have a great book called Fracture-Proof Your Bones. And I assume you go through all of this, from looking at the different risk factors, different things that maybe somebody needs to ask their doctor about, looking at their medications, their diet. Is it a pretty comprehensive book that people, I know it's available on Amazon, but is that a good resource for people if this kind of conversation really speaks to them, that would be like a good next step?

Dr. John Neustadt (31:07.455)

It's a phenomenal resource. And in fact, people are telling me that they're taking it with them to their doctor's appointments. Not only is it giving them questions to ask their doctors to make sure they're getting the best possible information and so they can make the best possible decision for their care, but there are take action sections at the end of chapters in the book where they can write the answers down to those questions. There's also a free workbook with those questions on my website that people can download and take notes in that. And giving the questions to ask the doctor, because that's one of the most challenging things for people to understand, and then describing in the book, why. What is the reason behind these questions? What does the research show in terms of osteoporosis medications, how they work, which ones work? What to ask, questions, and make sure you're getting the best possible advice, looking at the risk and benefit analysis and how to evaluate that, looking at the medications that cause bone loss and getting a medication review.

But then beyond that, it walks people through, chapter by chapter, how to create holistic bone health programs that make sense for them. Because unfortunately, doctors aren't educated in this. They're not educated, especially conventionally trained doctors, in these holistic approaches, what the research supports, in terms of bone health. But in addition to that, multiple studies have come out and shown that with bone health in general, osteoporosis in general, most doctors are confused. They're not sure how to interpret the test results, they're not sure which medications, they are uncomfortable having conversations around diet, lifestyle, and exercise because it's not part of their formal education and training, and frankly, they don't have time in very short office appointments. So this fills that gap. This provides a resource for people. I've even had doctors tell me they prescribe the book to their patients, and they tell them this is what we're going to do.

Jennifer Fugo (33:15.48)

Well, I love that you've created this resource for people, and especially it's something that helps someone advocate for themselves. Because it's one thing to listen to podcasts and watch YouTube shows and absorb information, but if you don't actually do anything with it and it doesn't change the trajectory of what you're choosing to do and how you have these conversations, and they really are crucial conversations. Because it could change the direction by which and the choices by which your doctor and the patient make a decision, right? And that could spell either a recipe for disaster, no improvement, or getting worse. And so I really appreciate you for doing this. And how can people find you and learn more about your work?

Dr. John Neustadt (34:03.171)

Nbihealth.com is my website, that's probably the best way to do it. Nbihealth.com.

Jennifer Fugo (34:10.346)

Awesome. Well, thank you so much for being here. I really appreciate you. I love this conversation because a lot of the stats you share are shocking, but we need to know them because I think sometimes that's the thing that makes you realize, oh, I shouldn't be waiting on this, I actually have to address this now. Because it's a cumulative thing that we can't just wait until, like you said, the bone breaks.

Dr. John Neustadt (34:34.015)

Absolutely.

Jennifer Fugo (34:35.34)

Or you fall. And then all of a sudden we're like, how do we fix this? It really is now when it starts. So thank you so much for being here.

Dr. John Neustadt (34:40.477)

You're welcome. And that's exactly why I titled my book Fracture-Proof Your Bones.

Jennifer Fugo (34:45.494)

Yeah. Awesome. Well, thank you so much, Dr. Neustadt, for talking about how to strengthen bones. I hope that you'll be back sometime, and I really appreciate you for doing all this work and being here today.

Dr. John Neustadt (34:54.793)

Thank you.

Frequently Asked Questions on How To Strengthen Bones

Can osteoporosis be prevented?

While there are no guarantees, osteoporosis is not simply an inevitable part of aging. Supporting bone health through nutrition, exercise, identifying hidden causes of bone loss, and reducing fall risk may help protect your bones over time.

Is a DEXA scan enough to determine fracture risk?

No. Dr. Neustadt explains that a DEXA scan is still considered the gold standard for measuring bone density, but fracture risk depends on many factors beyond bone density alone, including balance, mobility, medications, nutrition, and overall bone quality.

Which medications may increase the risk of osteoporosis?

Several commonly prescribed medications have been associated with bone loss, including long-term prednisone, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and proton pump inhibitors (PPIs) used to treat acid reflux.

Does everyone eventually develop osteoporosis?

No. Although bone loss becomes more common with age, especially after menopause, bone is constantly remodeling and can respond positively when underlying contributors to bone loss are addressed.

What type of exercise is best for stronger bones?

Knowing how to strengthen bones is important! Resistance training has been shown to improve bone density while also reducing fall risk. Walking, gardening, yoga, Tai Chi, and other activities that improve balance and strength are valuable ways to support long-term bone health.

Is taking more calcium always better?

Not necessarily. Dr. Neustadt recommends getting calcium primarily from food whenever possible and cautions against relying on high-dose calcium supplements without understanding your total daily intake.