#35: Let’s talk bones: A chat on outsmarting osteoporosis

Michael Dermansky

Hi everyone, and welcome to the show that helps you become more confident in your body so you can keep doing things you love. My name is Michael Dermansky, I’m Senior Physiotherapist at MD Health. I’ve got a special guest with me today. I’ve got Caitlin Smith from Osteostrong, welcome to the show.

Caitlin Smith

Hi, it’s so great to be here.

Michael Dermansky

Well, it’s really good to talk to you today because I wanted to talk about a topic we we see a lot of and it’s important one to discuss as well is osteoporosis. And this is a space you’ve been working for quite a quite a few years now. years, is that right?

Caitlin Smith

Yeah, absolutely.

Michael Dermansky

wanted to start talking about, guess, with now you’ve been working about six years in the space of osteoporosis. After working with clients,

who are only reduced to risk of osteoporosis. What can be done now? Because it’s a very different game now than it was 20 years ago. We know a lot more about it too. And there are actually things that can be done about it where it’s not just a losing game than it was quite a long time ago.

Caitlin Smith

Absolutely Michael and it’s so exciting to know now that there is possibility for the bone health space. We used to think that it was just an inevitable condition that you would actually get. Whereas now we know that we can do one of three things. We can either slow the rate of loss, we can stop the rate of loss or we can actually reverse it completely, which is an incredibly exciting opportunity for our community,also in the preventative medicine space.

Michael Dermansky

That’s a big deal. again, 20 years ago, it was like we can reduce, can maybe maybe maybe reduce the rate of decline to some degree, but we’re not going to eventually stop this as well. But the fact that you can reduce stop that or some does see regeneration as well. It’s just it’s amazing stuff as well. I mean, the medication has changed. What we know about it has changed as well. So what do you know about this space as well, and things that people can do to prevent or minimize the risk of osteoporosis?

and to improve the regeneration. What are the signs that you’re aware of?

Caitlin Smith

Well, it’s an incredibly multifactorial component. And the more that we learn about the skeleton, the more that we’re able to really dig deep into the reasonings why someone loses more bone density or less. We know that there is significant hormonal interactions as well as the bones themselves need to have a specific amount of load put on them in order to adapt.

We also know that medications and lifestyle considerations are a huge part of our capacity to be able to alter someone’s trajectory of bone regeneration or preventing that bone loss. As well as our nutrition and supplement profiles, we know that the gut plays an incredible part of the opportunity to build bone through that gut -brain axis and when we don’t have adequate capacity to absorb our micronutrients that really does hinder someone’s capacity to build their bone density in the way that we’re designed to.

Michael Dermansky

Well, let’s go through those four things you just talked about because there’s some really big things you said. Number one was hormonal. Tell me about that in more detail.

Caitlin Smith

Absolutely. So we know that we build most of our bone between the ages of 13 and 19. And then most of us peak our bone mass between the ages of 25 to 30. And then if you’re a female, we lose bone density about 2 % per year. And for men, it’s about 1 % per year after the fact. But women actually go through their period of life of menopause in which we know that estrogen plays such a significant component in our bone health. And so that reduction in estrogen actually really is hugely detrimental to our capacity to maintain our bone health. And so with the depletion of estrogen and also other hormonal factors, we know that that is unfortunately going to impact on someone’s capacity to maintain their bone mass during that time. The other consideration around our hormones is our thyroid. So a lot of times we might have some increased reduction for our clients in bone health and it’s through our exploration and our working holistically where we actually refer out to other practitioners to look at well what are the other interactions that could be hindering someone’s capacity to build bone in the way that the biology of the brain and the body is designed to do. And so through that exploration we know that when the thyroid is not working in the way that it’s supposed to, then that impacts on the hormonal interactions that we have with our musculoskeletal system.

Michael Dermansky

So I mean, it’s interesting to see a thyroid as well because people may start off with a normal thyroid as well. And as they get older, it starts functioning less and not even being aware of it that’s actually changing as well.

Caitlin Smith

absolutely. we’re finding that these interactions between the different parts of the body is really crucial to providing that musculoskeletal strength and that overall picture. And it’s interesting when we do go through those aging process that a lot of this is not necessarily considered, but there are ways forward in order to be able to screen for these things.

Michael Dermansky

it’s really important that you get tested for blood tests as well, like looking for your estrogen levels as well. And, you know, this wasn’t on my radar either till today, looking at thyroid levels as well and how effective your thyroid is at producing

Caitlin Smith

Absolutely, and it’s interesting because typically there are certain blood tests that are screened for via your GP or your integrative GP, but there are extra tests that give us more information about whether or not how effective your thyroid is working and that communication. So it’s called your Free T3 and Free T4. It’s a secondary test that goes, so most tests, they’ll test your

Michael Dermansky

What are those tests?

Caitlin Smith

TSH levels, which is one indicator, but we actually want to know more than that. We want to know what’s happening at your thyroid and your parathyroid, because that’s typically what one of the major conditions that parathyroidism is one of those major conditions that we find where people are less likely to build their bone density. And once we get that sorted out and we improve our functionality of our thyroid and a number of other conditions, then we can actually start to change that trajectory of bone loss.

Michael Dermansky

So, thyroxine is a more commonly known hormone as well, it affects your overall metabolism. So without it, you can’t function, you can’t live without a thyroid. But I’m not sure if everyone’s aware of what the parathyroid gland does as well, which sits on top of those two small things that sit on top of the thyroid. Do you wanna tell everyone what that actually does, what parathyroid’s hormone does?

Caitlin Smith

It’s just another little organ that works concurrently with your thyroid and it’s always interesting information in, information out and it works concurrently with the brain around maintaining our different levels of our hormones and how those hormones interact with a number of other systems of our body.

Michael Dermansky

And so then you also mentioned about, we’ll go into this more detail now too about strength training. So we talked about strength training is important for osteoporosis. What different type, what makes a difference? I lift small weights and, you know, two, three kilos. Is that going to make a difference as well? do a class as well. Does that make a difference?

Caitlin Smith

Yeah, so when we talk about the pillars of bone and muscle health with aging, there’s a number of different components of strength training that you actually need in order for us to create that ideal environment or for strength. There is a definite place for small levels of weight. So exercise things like Pilates and yoga and other maybe strength -based classes. We know that resistance -based training is important to maintain our neurological connection to our muscles as well as our muscle health. But from a bone density perspective, there was a beautiful study that was established in 2012 where we identified that we need high levels of load to our bones to create that stimulus for the brain to create the adaptations to build further bone. So in the past, there’s been two major populations that do that really effectively, powerlifters and our gymnasts. But unfortunately, both of them come with a lot of risk of injury. And so we need another solution to be able to put high levels of load on our bodies in a safe, secure and measurable way.

Michael Dermansky

what I’m hearing as well is that you need you need heavier stuff through your bone. Your bones need compression forces in order to be able to know how to put down more bone. mean, you know, bones dynamic, it doesn’t stay still. It’s always changing. And it responds to what you ask it to do. You put load through it, it will get better. You don’t put load on it. It will adapt to exactly that too. If you look at the cut version of a bone, you see bone lines are all on lines of stress. So where you put load, you’ll see bony lines there too. And as people get older, they take less weight off it too. Those lines become less and they’re not as strong. They don’t take the compression as well. So bone loves a degree of compression because it says, I know what to do. I’m going to put bone down in this direction because that’s where you’re asking me to put

Caitlin Smith

Absolutely, and that’s where we love both not only a fun word called trabecular bone, which is our spongy bone, but also our cortical bone, which is the outer layer. That spongy bone is really important because it’s full of those that capacity to build a denser, more healthier bone. And you’re right, Michael, absolutely. If you don’t use it, you lose it. And so then when we move into this deconditioning cycle, if you have less bone density, well, your muscles will only be as strong as your skeleton.

So when you have less bone density and less bone strength, which is just as important, you’re less likely to be able to achieve the maximum strength from a muscular perspective. And then that then starts that cascade of degeneration and potentially puts our population at a higher risk of falls and fractures.

Michael Dermansky

So that’s a, that’s a very interesting cycle because you need, you know, you need muscle strength to be able to then utilize your skeleton. need good bone density to be able to utilize your muscular system as well. And so, you know, just letting things go and think, I’m okay. I’m getting older. It’s not okay. Cause it affects your everyday function. Like to have the best life you possibly can. You need a good bone system. need a good muscular system as well to be able to take advantage of that system as well. Cause you want to be able to healthy life through all of your ages and we know that makes a difference.

Caitlin Smith

it’s really fascinating. think gone are the days where people are just like, I’ve got my dad’s knees or I’m just getting older. We now know that you can change your life and change what you want to do on a daily basis because your brain is so ready to adapt in a really positive way. And those adaptations, we are signaled all the time. I think there’s over 300 adaptations that happen on a daily basis, if not more.

And so absolutely, we don’t want to be sedentary because that loss of bone density, that loss of bone strength also then potentially means that we have loss of muscle strength and loss of muscle mass, which actually leads us into a condition called sarcopenia.

And sarcopenia is actually now, it’s actually a precursor to a lot of bone health conditions. And they’re doing a lot of research in this space at the moment. They’re looking at creating a proper assessment around psychopenia and looking at ways to actually improve someone’s muscular health so that it actually can maintain its strength and integrity so that we can continue to improve our bone health as well.

Michael Dermansky

And I guess the next message I was gonna ask about as well, when is the best time to start or at least when the other, what are the benefits of strength training or loading your bones at different ages? I mean, I have a very strong opinion about this and I’ll share my opinion as well, but from your point of view, when do you start and when is it too, is it ever too late?

Caitlin Smith

I am 100 % passionate about this question, Michael. Absolutely. So the word is that it is never, never, never, ever too late. It’s just about choosing the right type of exercise and strength training for you based on your current circumstances and also where you are in your life. So we have a beautiful gentleman. He’s 91 years old in one of our centers and we’ve worked with young people as young as eight.

So I’m really about proactive and preventative medicine. I’m about living your best life every single day. And so if I could get the youth of today to be loading their bodies in a safe, slow and measurable way under guidance, I think that that is absolutely going to set our bone bank up for success so that we can actually, if we are going to hit that peak bone mass and we start to decline, we’re starting from a much, much, much higher capacity so that when if and when we don’t load our bodies down the track we’re not actually even getting to the fracture threshold or even into the realms of osteoporosis. Because 40, 50, 60 years ago, osteoporosis was not as prevalent because of all of the lifestyle factors that have changed, where we are in our society today, our food, where our food comes from, our ability to absorb micronutrients, everything I said before. I would absolutely love our youth and our young population to be strength training a lot

Michael Dermansky

funny you say that to me because we obviously see people for strength training as well. the amazing and interesting thing that I’ve seen over the years is that people start doing strength training in their 40s and 50s, but often neglected in their 20s and 30s, particularly young women, because life gets busy, life gets, you know, hectic and everyone else’s priority is somewhat is your priority. And then we realize we see a lot of young weak women who don’t have the strength in their bones. They don’t have good muscle strength as well. And their life is so much harder than it should be.

Caitlin Smith

Yeah, absolutely. And we know now that secondary osteoporosis postpartum, so after a woman has a child, is becoming more prevalent as well. It’s a bit of a silent condition. They don’t talk about it as much as they need to right now. But if you think about the baby, your whole focus is to create this beautiful human inside of you. And so a lot of the micronutrients are translated into that child. So after childbirth, then the mother is then potentially breastfeeding. She’s not necessarily getting the sleep that she requires. She may or may not be actually able to do strength training or it’s not on her focus because as you said, all of her priority comes on looking after this new little human. And so we do run the risk of that depletion and we run the risk of fractures and injuries. And it’s really important that we’re supporting our new mums and ensuring that they’re actually able to safely be able to start loading their bones and their muscles as soon as they’re clear for exercise postpartum so that we can actually help us to be as strong as possible to be able to give to our little people.

Michael Dermansky

Well, it’s amazing. Not everyone realize how much bone density you lose during breastfeeding as well because your body do everything to support your child. And so that means that your bones are sacrificed. You don’t have a choice. It’s getting taken from your bones and being given to your child who needs it. But it also means that your calcium requirements are much higher than they usually were because it’s coming from somewhere. So it’s really important to have the nutritional support postpartum because it’s coming from somewhere. You need to be able to replenish

Caitlin Smith

And even if I’m a big believer, if you’re planning to have another child, start doing something beforehand. So if you can get into an osteostrong center or do some heavy lifting and do some osteogenic loading exercises, which then stimulates your brain to build that bone bank, you’re going to then support your structure so that then you can carry your next child as well, which is really

Michael Dermansky

So it’s funny to say that too, because it’s really important to do strength training before or before you have hopefully before you get pregnant too, because you can increase your weight to load.

And you can continue doing lifting during your pregnancy. You just don’t want to be starting during pregnancy. So if you’ve done the pre -work before, and there is no good reason why you can’t continue doing strength training during your pregnancy as well. It’s just that you want to get started early so that you can maintain that level of load during your pregnancy. Because if you get to 20 weeks and I think it’s a good time to start doing strength training it’s too late you’ve left it too late, you got to wait till afterwards then. So the earlier the better. And that means you can continue on and set yourself up success later. And you can start exercising usually with the Cesar six weeks after after after pregnancy, after having had the baby with the natural varies, most of the time six weeks, no questions asked. It’s sometimes it’s okay, three to four weeks, but you need to have an efficiency clearance and to make sure it’s safe enough as well. But all the other cases,

Caitlin Smith

Absolutely.

Michael Dermansky

is six weeks after the childbirth, it’s usually safe to exercise. It’s rare occasion, it’s not.

Caitlin Smith

Absolutely. yeah, as long as you’re working with a health professional that you feel safe with and you’re able to have an open communication. And I believe in holistic health care. So your health care team talking to one another to close the loop on client communication. Absolutely. There is that opportunity now. We are really past the idea that we can’t exercise. We just need to do it safely with the right guidance.

Michael Dermansky

And so I guess on the supportive side as well, strength training we’ve talked about, we’ve talked about checking your hormone shift as well to make sure estrogen levels and your thyroid levels are normal as well. What else? What else should people be doing to minimize their risk of osteoporosis or managing it if they know it’s there?

Caitlin Smith

So again, coming back to that preventative space, really exploring all of the different facets. We know that bone health, there are specific almost checkpoints that you should go through. I’m a big believer on getting your annual blood tests done by your GP and looking at the key micronutrients that we need, things like calcium, vitamin D3, vitamin K2, our magnesium, a really good quality magnesium that’s going to support your bone density is very important as well as for your muscles. Looking at our zinc, our iron, our omega -3s and 6s and our collagen, but also as well as that is our protein intake. So ensuring that we’re getting the right amount of protein throughout the day, not only in one meal, because that doesn’t work, but ensuring that that’s also going to then support our muscular skeletal development and ensuring that we’re able to continue doing and then there’s a number of other things too, ensuring that we’re looking at our balance, we’re looking at our strength and our bone density to minimise that falls and fracture prevention. There’s a number of healthcare practitioners out there that we can actually lean on for these things. We know that from an osteostrong perspective, we work really closely with a number of integrative GPs who understand the holistic element of bone health and are able to triage and support the different components that need to be assessed. We work with endocrinologists who are the key primary provider of medication when it comes to conditions like osteoporosis. We know that we need to work concurrently with the allied health community, our exercise physiologists, our physiotherapists, any potential provider of exercise prescription, strength and conditioning.

And those side of things are very important to create similarities and to ensure that our communication is the same across anyone’s healthcare team. And then we’ve got our nutrition and supplement side of things. So working with a really well -rounded, either nutritionist or naturopath or someone that’s going to be able to explore gut health and metabolism is going to really set you up for success to reduce the risk of osteoporosis

Michael Dermansky

Do know much about which medications are available when people do have osteoporosis? What the usual thing you’re seeing out there now is?

Caitlin Smith

There’s a number of medications that are typically still prescribed. most healthcare practitioners that prescribe the medication have a treatment plan and almost a plan for you as an individual, depending on your DEXA scan. So DEXA still is the standard for most bone density testing. There is a new technology out there that is really positive and it’s got an number of different screening protocols. It’s called Ecolite. It’s come out of the Italian Research Council. So through that protocol, allows us to then, the endocrinologist, sorry, will then determine which medication is best suited. The challenge with the medications is their physiology and how they actually work on the bone themselves. And so for me, it’s not a one size fits all. need to look at the individual, how they’re going to take on the medication, whether or not there’s any potential side effects, and whether or not that is the best opportunity for them at this time. I’m neither here, prone or against medication. think that medication has its place depending on the falls and fracture risk of the individual and also what else is going on in their space. And so that’s why it’s really important to find a healthcare practitioner that you trust so that you can have these open conversations because when you’re undertaking any treatment protocol, it’s really, really important that you still have agency over your own health and wellbeing and that you feel that you are educated and supported enough to be able to say yay or nay to the suggestions that are made to

Michael Dermansky

And again, I guess on a different side as well. Is this only a female problem? This osteoporosis. Well, well, I’ve hit a very important topic here. Tell me about it. Go for it.

Caitlin Smith

So men, I’d like to say males that it used to be considered just a female issue, but it is absolutely not. as of the, because of the challenges that I’ve said before, our food, our nutrition, our gut health, conditions like celiac disease and irritable bowel, their prevalence is getting higher and higher. It’s not quite even now, but definitely the rates of osteoporosis are on the rise for men as well. You still go through the natural declining process of bone loss. It’s less than women, but over the age of 60, two thirds of women will have a osteoporotic fracture, whereas over the age of 60, one third of men in Australia will have an osteoporotic fracture. But interestingly, men actually account for 30 % of all fractures with osteoporosis and osteopenia, which is low bone density, which is still a consideration. So men, it’s really important that you still go and get your health checks as well. We wanna keep you as strong as possible too. Falls and fractures are something that really can be avoided. And it’s very important for us to ensure that your balance system’s working, you’re looking at your lifestyle and you’re actually improving your opportunity to extend your health span as well into the

Michael Dermansky

Yeah, well, mean, the numbers are pretty clear. know, yes, it’s not as high as women, but one third that’s I don’t want to be that one third. I want to be the one that has a better life out of that too.

Caitlin Smith

Absolutely, I agree. And it’s, I think it’s one of those things that with the musculoskeletal system, you can’t see it. So we don’t know how strong we are, nor do we know how strong that we can become from with our skeleton. So have that assessment, explore how your bones are working for you and look at ways to get stronger for longer in the future.

Michael Dermansky

Yeah, I mean, as you said, extra scans of the test done and then you should done the once every two years even they’d be done, it wouldn’t be done any more than more than that. And the changes are very slow. So you’re not gonna get a scan done today and six months later, or is it better? It’s not it’s too not a timeframe, but you’ve talked about a few other options. So having regular blood tests done on a yearly basis, we can get your calcium level, your magnesium level, calcium level, your thyroid levels, all that stuff, indicators that of things that we can do right now to make a difference and really seeing whether we’re doing the smart health things as well to improve our musculoskeletal and bone system.

Caitlin Smith

I think it’s one day at a time. I think it’s about looking at what we’re putting into our body, how we’re looking at our stress levels as well. I we haven’t even touched base on that, Michael, but cortisol levels and stress is one of the biggest issues in our modern day society. And that unfortunately is really, really bad for bone density.

Michael Dermansky

Right, okay, see that’s not even, I wasn’t even on my radar to talk about that to you because I didn’t put two and two together, but that makes a lot of sense.

Caitlin Smith

Absolutely, because the more cortisol we have, the more inflammation, the more inflammation, it means that our body then is resourced in a way that is trying to survive, not thrive. And we all need cortisol. It’s important. It’s an amazing hormone that we need. But it also means that in excess, it actually has a detrimental mental effect on our bodies.

Michael Dermansky

Yeah, absolutely. So yeah, and it makes a difference in the musculoskeletal system as well because cortisol is quite a catabolic steroid. You need it at a certain time when there’s levels of stress, but if it’s there all the time, it breaks muscles down, it breaks down bone. It does the opposite of what we need it to do.

high levels of that in a long period of time does make it a negative impact versus important, what we talked about in terms of the important chemicals and elements that we need to have to be able to good bone density in the long

any last thoughts before we finish up today?

Caitlin Smith

I just think everyone has the opportunity to change their health trajectory every single day. Even if it’s not bone health related and from another angle, the choices that you have are right there in front of you. I get that it might be scary. I get that it might create fear within you. But this is the difference between you living a life that is fulfilling and exciting and free of fractures as opposed to one full of fear. So take the risk, take the step forward and start to explore an opportunity for a better wellness.

Michael Dermansky

I couldn’t agree with you more. you know, having worked in a space for about 20 years now to, you know, 20 years ago, would have been, these things are inevitable and they’re not. You can have a better life. You can have the life that you deserve. And so much of it scarily come down to choice.

You can choose to have a great life. You can choose not to by the work that you do, by the decisions that you make. That’s the great, that’s the agency talks about. These are the things that we have a choice about and we have the outcome of those choices too. We can make a better choice over time to live a healthier life. Okay, thank you very much for your time. It’s been a great conversation and some really very important health points to tell the listeners that they can actually make a big difference in their life.

Caitlin Smith

Thank you so much for having me, Michael. It’s been an absolute pleasure spending time with you today.

Michael Dermansky

Great, thanks