Navigating bone health: early life influences and advanced strategies for improvement and injury prevention (#214 rebroadcast)

The podcast delves into the critical importance of bone health and its significant impact on quality of life and mortality, especially in older adults.

Bone Health Affects Quality of Life and Mortality In Older Adults

Peter Attia stresses the importance of bone health throughout life, not just in later years. Citing CDC data, he highlights that falls are a leading cause of mortality for individuals over 65.

Fractures, Especially Hip and Pelvic, May Lead To Over 40% Mortality Within a Year For the Oldest Adults

Attia points to the steep rise in fracture-related deaths after the age of 65, with hip and pelvic fractures being particularly dangerous. The immobility these fractures can cause is a key factor in the subsequent high death rates. He notes that for those aged 90 or above, there is a shocking 40% mortality rate within a year of a hip fracture. Even for those over 80 or 85, the mortality rate within a year after a hip fracture hovers around one-third.

Peter Attia references multiple studies to underscore the severity of hip fractures' impact. One study found that 25% of people aged 65 or older died within six months of suffering a hip fracture. Another reported a one-year postoperative mortality rate of just over 27% for hip fractures.

Poor Bone Health Raises Death Risk From Falls With Age

The risk of mortality from a hip fracture increases with age, with notable risk beginning in the seventies. Attia discusses a large study following participants aged 60 and older fo ...

The episode explores the dynamic nature of bones and how bone health evolves from youth to old age, including differences between sexes and the impact of various factors on bone mineral density (BMD).

Bones Are Dynamic Organs With Complex Tissue Interplay

Peter Attia underscores that bones are living tissue, not only providing structure but also vital for manufacturing blood cells and storing minerals. Bones consist of two types of bone–cortical or compact bone, and trabecular or spongy bone–each with different levels of vascularization. These structures are in a state of constant remodeling, thanks to the actions of osteoblasts building the bone and osteoclasts breaking it down, thus maintaining calcium balance.

Bone Formation and Breakdown: Osteoblasts, Osteoclasts, Calcium, Vitamin D, Parathyroid Hormone Regulation

Bone is a matrix comprised mostly of minerals (50 to 70 percent), predominantly calcium, and organic matter (20 to 40 percent), and it undergoes a continuous remodeling process. This constant turnover is responsible for maintaining the skeletal system, which can be completely renewed over a decade. Calcium homeostasis is largely dictated by bone, which serves as a vast reservoir for the mineral, crucial for a variety of cellular activities. Vitamin D facilitates the gut’s capacity to absorb calcium. Parathyroid hormone regulates calcium levels, releasing it from bone when necessary and activating vitamin D to increase dietary calcium absorption.

Factors such as corticosteroids, which can favor bone reabsorption, and [restricted term], which may lead to increased catabolism of vitamin D, impacting calcium absorption negatively, were noted. Moreover, disuse osteopenia, a condition of high bone resorption and low bone formation due to lack of mechanical loading, was described to elucidate the adaptive nature of bone to its environment and use.

Bone Mineral Density Rises In Youth, Declines In Adulthood

Bone Density Declines Around Menopause Due to Estrogen Loss

The episode highlights the significant increase in BMD from childhood to the early 20s. BMD typically peaks around 30 years old and remains stable until mid-life, after which it gradually decreases. Women experience a steeper decline in bone density at menopause due to estrogen loss, which can escalate to 3-7% annually, implicating the importance of maximizing bone mass before this period. Estrogen's role in postmenopausal bone health is ...

To optimize bone health, nutrition and physical activity play critical roles. Peter Attia highlights the micronutrient essentials and exercise types best for bone density.

Calcium, Vitamin D, and Magnesium Intake Critical for Bone Density

Diet Provides Nutrients, Supplementation May Be Needed

Peter Attia emphasizes that calcium, vitamin D (specifically D3), and magnesium are vital for bone health. Recommended daily amounts stand at calcium 1,000 to 1,200 milligrams, vitamin D 800 to 1,000 International Units, and magnesium 300 to 500 milligrams. These can be sourced through diet or supplements, with calcium carbonate or calcium citrate and various magnesium forms being supplementary options.

Vitamin D3 is particularly noted for its role in dietary calcium absorption. Attia alerts that obtaining enough magnesium from diet alone can be challenging, and confesses his own use of supplements to meet daily requirements. He also acknowledges that people, especially on plant-based diets, may need to seek alternative sources for calcium intake.

High-Impact Activities Best For Boosting Bone Density

Resistance, Plyometrics, and High-Force Sports Surpass Aerobic Activities

Peter Attia believes that activities imposing bone load are key to maintaining bone health – citing sports like football and MMA for their benefits to bone mineral density (BMD). While muscle force on bone signals an increase in bone density, resistance training and powerlifting are highly effective, especially in post-menopausal women.

Running, contrary to common beliefs, has not shown a significant impact on BMD, potentially confounded by low body weight in elite runners. For children, Attia underscores the importance of engaging in more powerful physical activities like jumping and lifting heaviness.

Attia praises rucking and weighted uphill walking as beneficial for bone loading without risking the knees. Low-weight, low-impact activities like walking, swimming, and cycling are comparatively less beneficial to BMD unless intensified by extra strain, such as uphill treks with added weight. However, high-impact, ...

Discussions with Peter Attia highlight the role pharmacological treatments play in managing bone health, emphasizing bisphosphonates and the need for specialized care when considering drug interventions.

Bisphosphonates Slow Bone Reabsorption, Boost Density in Osteoporosis

Peter Attia describes bisphosphonates as a drug class that strengthens bones by slowing osteoclast activity, which removes bone tissue. Attia notes that these drugs can increase bone mineral density (BMD) by 4% to 6% in critical areas such as the femoral neck, hip, and lumbar spine, subsequently reducing the risk of fractures.

Drugs Boost Bone Density 4-6%, Reduce Fracture Risk, Limited To 5 Years

However, the usage of bisphosphonates, such as [restricted term], [restricted term], and [restricted term], is typically capped at around five years due to diminishing benefits and potential side effects. Despite discontinuation, the benefits appear to persist.

Attia discusses a mouse study that demonstrated bisphosphonates' ability to maintain bone density during periods of immobility. In the study, mice given botulatoxin to paralyze their legs were also treated with a bisphosphonate, which helped them maintain bone density similar to that of the control group, unlike the untreated group that experienced a decrease. Although the findings come from a mouse model, they imply that bisphosphonates could be beneficial for maintaining BMD, especially during immobilization periods which could be crucial for bedridden patients or the elderly.

Other Drug Classes Show Promise

Attia brings up monoclonal antibodies and synthetic parathyroid hormone as two other drug classes. However, he concedes he does not have extensive experience with these treatments. It's noted that such matters should be referred to endocrinologists, who specialize in this area.

Consult Bone Health Specialist Before Pharmacological Interventions

Drugs are seen as the last line of defense for bone health issues, with lifestyle changes often recommended first. However, pharmacologic options become crucial when lifestyle adjustments are insufficient or during challenges such as bed rest or injury. Attia mentions the increased risk of bone density loss associated with high exposure to certain drugs like corticosteroids, which are known to significantly reduce BMD and increase fracture risk with ...