Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week I got to enjoy a conversation with Dr. Doug Lucas (Stanford trained orthopedic surgeon turned integrative medical doctor) about his new book called The Osteoporosis Breakthrough.
Dr. Lucas is the founder/CEO of Optimal Bone Health and creator of The 4R Bone Optimization Method. His obsession with treating bone health through a holistic approach and health optimization is captivating. In this Note, I will touch on his book, along with some highlights of our conversation.
Let’s get started…
The Osteoporosis Breakthrough
The Osteoporosis Breakthrough by Doug Lucas, DO, FAAMM is a MUST READ for anyone who has an osteopenia or osteoporosis diagnosis. Patients often come to me saying they’ve got osteopenia or osteoporosis, what do I do? For one thing, the diagnosis of osteopenia for any menopausal woman is normal. They should not freak out about this diagnosis. A lot of times, what I see is their doctor wants to immediately put them on calcium supplements (which I don’t agree with), or start a bisphosphonate, which is a class of drugs that can have terrible side effects.
Whether you are newly diagnosed and wondering what to do medication wise, or in treatment and struggling to get results, The Osteoporosis Breakthrough is a good place to start.
Screening For Osteoporosis
Who is at risk for osteoporosis? When should you start screening? Should you get a DEXA?
These were the first questions I had for Dr. Lucas. Most people have heard of a DEXA scan. The DEXA scan is a low radiation X-Ray that tells you about your bone density and potentially body composition. The recommendations for getting a DEXA scan is not until 65 for women and 70 for men. Dr. Lucas says this is WAY too late. “If you want to reverse osteoporosis or prevent it, you have to know way before then.”
He mentioned we should know our bone density in our early adulthood (20’s and 30’s). “Know what your peak bone mineral density is because that’s going to dictate how careful you need to be around some of these things that are going to end up causing bone loss over time.”
The reality is most will not get a DEXA at this young of an age. For women, a really good time to start is around perimenopausal time (mid forties). Just like a screening colonoscopy, I think all women should start at 45. You also need to start thinking about hormones. Remember, estrogen is the last one to drop out, so you need to start thinking about this before that happens. Also remember, it’s never too late!
Many women are scared of estrogen. This has to do with the fallacies of the WHI study. It’s all about weighing the risks versus the benefits. And believe me, the benefits usually outweigh the risks. “When estrogen starts dropping, that’s when bone loss is accelerated. This is predictable. Of course it is natural to lose estrogen, but what happens as a result of that natural process is totally predictable.” – Dr. Lucas
I love this quote from Dr. Lucas in regards to estrogen. “If you have significant osteoporosis and are at risk for fracture, let’s worry about the devil you know, versus the small percentage of the devil you don’t know.”
As you age, your body declines. If you aren’t able to see as well as you used to, would you not use eye glasses? If you are losing hearing, would you not use a hearing aid? Same thing with hormones. Just make sure you see a doctor who knows a lot about hormones.
Here are some statistics that really blew my mind: There is a 30% mortality rate overall if a woman gets a hip fracture; 25% if it’s treated; and 90% one year mortality rate if it’s not treated. But the statistic that really bothers Dr. Lucas is: One-third of patients with hip fractures NEVER recover independence. It’s a life ender, or a life changer.
Osteoporosis In Men
“We are underselling both the prevalence of osteoporosis in men, and underestimating how many men are going to have this problem. Low testosterone is everywhere. It’s so common in men.” – Dr. Lucas
In men, if you have Low T, you have low estrogen. Men need estrogen for a lot of things, bone health is one of them. Men are less likely to have a fracture as women, but disproportionately more likely to die from a hip fracture and to lose independence from a hip fracture. You have to check estradiol levels in men. I do this every time I check their testosterone levels. Note: I follow both levels. Men need an adequate amount of estrogen, not just for the bones, but for protection of their heart and brain as well.
Natural Ways To Keep Your Bones Intact
Dr. Lucas starts with what he calls the “optimization pyramid”: Nutrition, Exercise, Sleep, Stress/Spiritual Connection. Nutrition is key. Transitioning patients into an adequate animal protein diet (with limited amounts of sugar, sodium, and fat) is intense, but necessary before going to the exercise component.
“For exercise, walking is not enough. It’s good, but not enough. You have to start doing resistance training. You have to load the bones. You need to build muscle mass and make that anabolic switch. After this, it’s targeted supplementation, hormones, then peptides, etc. And lastly drugs. By the time we get there, we often don’t need them.” – Dr. Lucas
Don’t get injured. This is his number one rule for his patients. It takes too long to recover. One major thing I learned from Dr. Brett Osborn is to build muscles from the capsule out, meaning your joints, tendons, and ligaments. Otherwise, your muscles aren’t going to respond and you’re going to get hurt.
People with osteoporosis are scared to lift weights. This mentality is not going to make you better. It’s going to make you worse. As we have said in previous Notes, work on your deadlift. Be able to get out of a chair, or up out of the floor without using your arms. “Sarcopenia (loss of muscle), osteoporosis, and inability to protect yourself in a fall is a great combination for a hip fracture.” – Dr. Lucas
Medications For Osteoporosis
I haven’t been fond of the bisphosphonates since they came out, for many reasons. I asked Dr. Lucas for his thoughts on the subject. “When to get on medications is all about fracture risk. Knowing why you’re losing bone is so important.” – Dr. Lucas
He mentioned the DEXA Scan in the podcast, as well as two biomarkers he really looks at: CTX and P1NP. CTX tells you if you’re rapidly losing bone. This is for osteoclast function. P1NP: Are you not building bone? This is for osteoblast function.
If you monitor these over time, it can be a good substitute for a DEXA scan, which doesn’t change very rapidly. That’s the thing about the DEXA scan, you wouldn’t want to get one more than once a year, because it’s slow to show change. These biomarkers are good for telling if you’re heading in the right direction. Note: A DEXA scan is recommended yearly at the minimum.
“For me, if I’m considering drug therapy, I want to know if you are rapidly losing bone or are you just not building bone. Bisphosphonates are drugs that will slow down bone loss. If you’re not rapidly losing bone and on bisphosphonates, you’re not going to get any better.” – Dr. Lucas
Dr. Lucas also mentioned that Bisphosphonates squash bone metabolism. If you crush bone metabolism, you’re going to end up with complications. They are not common, but common enough that he really doesn’t like the drugs. Possible side effects of bisphosphonates:
Osteonecrosis of the jaw.
Atypical femur fracture, which means you’re essentially not able to turn over bone.
What he sees mostly in his practice is people who are just not building bone. And if they are on bisphosphonates, their P1NP may be zero. “If someone is at high fracture risk, use an anabolic: FORTEO and TYMLOS. They don’t squash bone metabolism, and they really elevate the bone building side. The risk ratio is beneficial for those drugs, but you can only use them for a short period of time (2 years). You have to have a plan on the other side. You can use these medications to help people get to the other side, then you may have to go to bisphosphonates in severe cases. You still need to build a solid plan around it.” – Dr. Lucas
Does this mean you should never use a bisphosphonate? No. Women with breast cancer on anti hormone drugs may have to be on them. Their estrogen levels are going to zero, so they may need some of these medications. Remember, medicine is as much an art as it is a science. Everyone is different. Dr. Lucas customizes a bone optimization plan for each individual case.
Final Thoughts
What patients are looking for is answers. Answers to questions like:
Why am I experiencing bone loss? Where did my skeleton go?
How do I stop or reverse those causes of bone loss?
Is there something I could do naturally to help improve my bone?
That’s exactly what Dr. Lucas and his staff do at OPTIMAL BONE HEALTH (OBH). They answer those questions, then create an individualized program to improve your bone health. The Osteoporosis Breakthrough is his kickstart guide/book for anyone recently diagnosed with osteopenia or osteoporosis. It goes over hormones, exercise, supplements, drugs, and his overall approach. For women close to being in menopause, or in menopause, please check this book out. It’s awesome.
Stay educated. Stay healthy.
Till next week.
