This podcast is for you, the Modern Man. I'm Dr Anne

Truong, your host. I'm an intimate health medical doctor

and best selling author of the book, Erectile Dysfunction Fix.

I'll do a deep dive into sexual health and performance and how

it affects men of all ages and backgrounds. So let's get

started, and be sure to visit my website at

sexualhealthformenpodcast.com for more information and

resources from the show. See you on the inside.

Hello there, Modern Man. In this episode, we have Dr Doug. He is

an orthopedic surgeon and the expert in bone health and

probably everything orthopedic. And I'm glad to have him on this

show, because we're going to dive into why you should care

about bone health as a man. And this is not just a problem about

women issues, and we're going to see how that is related to your

sex life, because you will find out a very interesting

connection between your bone and your sex life. And we're going

to dive all into that today with Dr Doug. So welcome. Dr Doug.

Awesome. Thanks for having me. Looking forward to

it.

Okay, so let's just dive into it. So what is bone

health and what happened as we age? Why should we care about

bone health?

Great, great question. And I'm so glad to get

this in front of an audience of men, or at least mostly men,

because we don't talk about this with men ever anywhere. It's

never brought up until a man is in his 80s, 90s, and he's had a

hip fracture. And we think about bone health, or osteoporosis as

a woman's problem women as they go through menopause. And yeah,

that's true, but the way that I look at bone health now is that

bone health is really a biomarker of health span for all

adults, if you're losing bone, something's wrong. And the cool

thing about bone is it gives us a clue. It tells us a story,

because we can use blood testing, we can use imaging, we

can tell what's happening in our bones, and it can tell us if we

need to look deeper at some of the things that we're going to

talk about, like hormone levels or lifestyle or potentially gut

health, nutrition, etc. So I think that we should all be

looking at bone. We should be imaging it in young adults,

including men, and then if we're losing bone, looking to figure

out why.

Okay, so let's kind of backtrack a little bit. I

love what you just said, that it's a biomarker for health

spans. Essentially, bone health is something you should care

about, because it's a marker for your health. So why should young

men care about that?

Yeah, so there's, I would say, three main reasons we

could go through. One is that we develop our bone as we go

through adolescence and childhood and young adulthood.

We this that time period is critical for developing your

what's called peak bone mass, or the amount of bone that you're

going to have for the rest of your adult life. We don't talk

to children about this. We only talk to parents about this to

catch adults in the early adult life and say, Look, you need to

know if you did a good job there or not. And a lot of people

didn't for various reasons. They might not have good bone density

out of the gate, and that's something that you're going to

want to want to know, because it's going to change how you

treat yourself and what kind of things you involve yourself in

over time. So number one is we need to know peak bone mass

because we want to know what we need to do over time. Number two

is low bone mass is associated with fracture. Now, again, most

people think, oh, hip fracture or hip holder peak. I don't need

to worry about this. Not really true. As a practicing orthopedic

surgeon, I can tell you that we see fragility fractures in the

younger and younger adult population. I'm talking 60s,

50s, 40s, 30s, and this includes both men and women. I think

we're facing an epidemic of poor bone mass that we don't know

because we're not screening. But in my orthopedic practice, and

in my current practice, specializing in osteoporosis

reversal, we see young people that either never had good bone

mass or lost their bone quickly as they aged and then had a

problem very quickly. What sucks about that from men is that we

don't know. We're not screened. And if you have a hip fracture,

it's life changing or life ending. If you have a spine

fracture, it's definitely lifestyle changing, probably not

life ending, but it'll change the way that you live your life,

and it might change your independence. And that's a huge

deal. Nobody wants that, and we don't even think about that

until we start thinking about older men, 80s, 90s and above.

But it actually is happening much younger, and if you want to

prevent fractures later, you need to start younger.

Okay, so why are we seeing more bone, fragile bone,

in younger men now? What the heck is going on?

Yeah, I look at again, bone as a biomarker of

health span. So when you think about, why would we see bone go

down? Well, bone can decrease for a lot of reasons, I would

say some big. Ones that play right now would be poor diet,

and these are your stainless same lifestyle pillars, poor

diet, wrong exercise or lack of exercise, poor sleep, which is

rampant in our especially young adult culture, and then stress,

unmitigated stress and not knowing how to handle stress,

those four lifestyle things are going to have a huge impact on

bone health because of excess cortisol, immune system

dysfunction, all the things that go along with that that are

going to affect everything else, including your sex life. But I

think in addition to that, what we're not also doing for our

young adult men is checking testosterone levels adequately.

Every guy should know what their testosterone levels are. They

should know total, they should know free, and if they have low

testosterone, have plan to fix it, because big hormone

optimization is a huge part of bone health, and one of the main

reasons we see people lose bone for is because their hormones

aren't optimized.

Okay, so it all come down to hormone. That's one

of my passion as well. That's where we see the intersection

between sexual vitality and sexual health with bone. Now, so

you're saying that bone is dependent upon diet and

exercise, sleep and stress, right? Which is kind of like the

pillars for a lot of conditions. So and you open up my eyes on

like, "Oh my god. Bone? Can bone health and bone density can

correlate with cardiovascular disease, can correlate with

diabetic, diabetes, and now your sex life?" So that was a big

revelation there. I haven't thought about it honestly like

that. So that's why I was very interested in having you on the

show, to find the connection. So we know, "Hey, your diet, your

exercise, sleep and stress." And you also said that if you have

fragile bones that is not dense, then you're at risk to having

fractures which we don't want. And as an orthopedic surgeon,

let's just kind of dive into a little bit about so why is it

not good when you have a fracture in the hip or a

fracture in your spine, like in the vertebrae? What are the kind

of like sequela?

Yeah, so when you look at, I mean, most people

think of fractures. They think of like a leg fracture, and even

like a thigh, like the leg bone fracture, the thigh fracture,

the femur fracture, and those things heal pretty well. Ankle

fractures, assuming they're put together, they heal pretty well.

Hip fractures, though, are pretty crummy injuries. They do

heal usually, but they don't heal very well. The function of

the hip joint is very sensitive to alignment of the bone when we

line that thing up on the operating table, and we put the

instrumentation in it. There's really no way to know precisely

what that alignment looks like. We put it close, and that's as

good as you're going to get. But close when it comes to function

of the hip joint, especially in a younger adult, close isn't

good enough. It needs to be perfect. So while there are some

surgical things you can do, and there's people that talk about

the different type of surgery for young that's a different

discussion. What I'm saying is we want to avoid that pretty

much at all cost. We want to know what's happening with our

bone density. If we get to the point where we had a hip

fracture, you've been losing bone for a long time. So we want

to know before that occurs. Spine a little less obvious. So

spine happens earlier. Spine is mostly if you have a spine

fracture, it's mostly going to be associated with pain. If you

have enough collapse of the bone, you can actually get

deformity. You imagine you have that, what's called dowagers

hump, that hump of their upper back, yeah, that's for multiple

vertebral fractures. And I've seen this in men in their 40s.

They start getting deformity in their spine because they're

fracturing. So we want to avoid these things, because our

skeleton is our structure, and unlike the things those people

think about wrist, like ankle, some of these things, when they

break, they don't go back together very well. So the spine

especially doesn't go back together. It sort of stays where

it lands.

So what are the consequences or quality of life

changes if you have a hip fracture from having poor bone

health? What does that mean for somebody after they have a hip

fracture? I assume that they probably have, like a metal in

there, an internal fixation right, a metal bar in there,

rather than a total hip replacement. So what quality of

life changes would they expect to see if they have that

procedure?

If you look at the overall statistics, if you just

generalize this across both men and women, it's actually worse

for men, but if you generalize it across men and women, about a

third of patients after a hip fracture die within a year, a

third lose independence. Yeah, they lose independence

completely. Only a third regain independence. And I can tell

you, my clinical experience is that they they didn't get back

to where they were. They were just independent. So they meet

that criteria. It's not that necessarily, the surgery and the

fixation that's the issue. I think it's the the deformity,

the healing, the change in alignment, and the impact that

it has, especially on an older and. Individual of being

essentially bedridden until you heal, until you can get up and

walk. So that's why, when we fix it, we do want people to be able

to weight bear. So doing like a partial or sometimes even a

total hip replacement is a thing. It's a much bigger

surgery. So it just depends on the person we want to get people

up and moving, but that time down can be a really big problem

for especially older individuals.

Okay, so Wow, when you said a third of, so if you

get a hip fracture and you get surgery, a third of you can die.

Die, death, die. Did they die from the surgical complication?

Or they die like blood clot or like pulmonary embolism,

immobilization?

Or UTI, the things that kill people when you lay in

bed for more than a couple of days, okay?

So like pulmonary embolism, urinary traction,

sepsis from the UTI or infection in the blood. So a third die, a

third lose independence, meaning you don't walk the same. We all

know about the lurch. Once you have a hip fracture, right? They

walk with a lurch and lean to one side. So when you say

independence, can you kind of clarify what that mean? Would

they lose their independence?

Yeah, and this is lost on younger individuals,

right? Because that's a mid 40s guy. I'm not thinking, oh,

something's going to happen where I'm not going to be able

to take care of myself. That's usually not in our like in our

vision of what's going to happen in our health. But what we mean

loss of independence. That means you can't take care of yourself

anymore. It means you need to go live in a in a nursing home or

some kind of assisted living facility, or you need some kind

of live in care. It is a very different way of living than

most of us, young, healthy, productive adults view our life

right now.

Does that shorten your lifespan? Has there been a

study that looked at hip fracture and the longevity after

hip fracture compared to somebody that doesn't fracture?

For sure. Yeah, it's hip fracture is a it is a sign

that something's been going on for a long time now, most hip

fractures, again, do happen in older individuals. So this we

have to look at the data. If we look at all the people with hip

fractures, I'd be biased towards an older population. But even in

a younger population, those things still hold true, where,

if you're breaking your hip, unless it was truly traumatic,

meaning like you got in a car accident and you broke your hip

at a high velocity, if you had a fragility fraction medically,

it's been wrong for a long time.

Okay, gotcha All right. So that's pretty

striking. But then you also said it's actually worse than men

compared to women. Why is that?

I think, for two reasons. One is that the average

age of hip fracture, it's older in men. So it's an older

population to begin with, but they also tend to be sicker,

because for men to lose enough bone to have a hip fracture,

again, there's something was wrong for a very long period of

time, because men start with higher bone density and quality

than do women on average. So they have more to lose before

they get to that point where a hip fracture is going to occur.

Gotcha. Okay? So I always want to kind of dive into

what's the consequences? That's why you need to change. Because

if you have a hip fracture, 33% of the time you may die, which

is not good. You don't want that again for the show. That's

pretty bad. And then lose independence, meaning you're

going to be in a nursing home or assisted living and not be

independent. So we know that the diet, exercise, sleep and stress

of bone health. So what can men do to preserve their bone

density? Because, like you said, men have more density than women

to start out with, which is good, but they lose bone density

the same way. So what can they do to preserve their strong

bones?

Yeah, so the same concept to preserve bone as it

is to rebuild bone. So if somebody's listening to this

that has osteoporosis, it's the same thing, you just have a

different starting point. So to preserve back and talk about

those four pillars, we don't need to dig into sleep. I think

that's relatively obvious. You've probably nailed that

home. Same thing with stress. We know that we all need to deal

with stress better. Same thing. But when it comes to nutrition

and exercise, there's some very specific things here. So from a

nutrition perspective, and I don't know anything Anne about

your thoughts on about your thoughts on food, so we'll see

if this is consistent with what you say or not. But from a food

perspective, if we want to maintain or especially if we

want to build bone, we have to do the same things that we would

do if we were going to build muscle, and that's to eat a

protein forward diet. My preference is animals is a team.

Because of compatibility from animal to animal, you need less

protein, grams of protein per pound if you're using animal

than plant, and there's less potential challenges of

consuming that much plant protein. So my preference is

animal protein. We start our patients at around one gram per

pound of ideal body weight, and then we can titrate up or down

based off of their individual needs. Some people are

significant. Higher some people don't eat quite that much, but

one gram per pounds are a good starting point for us. If, as

long as you're hitting that, the rest of the diet can be really

generally just described as, to me, an anti inflammatory diet

that fits your needs, and that could be higher carbohydrate or

lower carbohydrate. It just depends on how active you are

and what your metabolic function is like. I don't like to get

into the details and tell people that they can't eat this or

can't eat that. My preference is protein forward from animal

sources. Fill in the rest as you need, and working with a

dietitian probably to help you do that. So that's the diet

side. The exercise side is really clear. You can imagine,

if you want to build muscle, it's going to be the same thing

as building bone. If you want to build muscle, what do you do?

You do resistance training. So you need to do high intensity

training if you want to maintain bone, if you want to build bone,

if you want to maintain muscle or build muscle, doing that

safely in a way that you don't get injured is really important.

Most men, at least that I've worked with, are already doing

that to some extent, but there's a lot of confusion as to how

much cardio should I do, and how much time should I spend working

on my cardiovascular fitness? What if I want to lose weight?

What if I want to get shredded? Whatever it is, we can't let the

resistance training go. It's so critical to both muscle and

bone. And then the third piece of that is impact. Most people,

most humans, are not doing impact because it potentially

hurts. We run away from things that hurt. So we need impact,

though, to stimulate our bone if you look at athletes that have

the best bone density, gonna be athletes that have some kind of

impact. And I'm not talking running impact, I'm talking like

gymnastics impact, right? Like you watch those athletes hit the

mat. They're hitting that with some force. Running is not

impact. Walking is not impact. We need to generate over four

multiples of body weight, which is going to be somewhere between

three and five G's of gravity that you need to generate

through your bones, and it has to happen quickly. So we need

some kind of impact, and that can be from specific exercises

or modalities. There's way to simulate that, but we need

something like that in order to really stimulate our bone. But

if you can do those two things primarily, then you're going to

be able to maintain or grow bone almost regardless of your

starting point, as long as you have other things optimized as

well.

Well, what? What type of impact are you talking

about? Like you said three to five genes, but walking is not

one of it. I always thought that walking was a fact, and you

said, not even running. What type of activities does that

fall?

So let me just talk about walking or running first.

So when you look at the the studies on what impact, quote,

unquote, impact is, as you're walking, it's going to

essentially float around 1g or one one amount of gravity,

acceleration of gravity. So if you're just standing, that's 1g

if you're walking, your body is experiencing a range of 0.8 to

1.2 so you're kind of just fluctuating around that 1g it's

not enough. Running is going to be a little bit higher, but not

like you might think, because most people that run are

efficient runners, and they don't strike the ground very

hard. Otherwise they wouldn't be able to run very long. So if

you're an efficient runner, you're not really seeing much

impact either. Also, if your body is running a lot, if you're

a long distance runner, your brain is telling your body to

shed weight, to shed muscle, to shed bone, because it knows that

it needs to be lightweight. So runners are strongly associated

long distance especially with low bone density. For other

reasons too, dietary in nature, that's what there isn't enough

when I'm talking about impact, some of the simplest things that

have been studied would be like a heel drop. So I don't know if

you ever seen people do this, but essentially, kind of rise up

on your toes, and then you drop down on your heels with your

knees maybe a little bit bent. You can generate over five

multiples of body weight by doing that. And anybody who's

sitting at home and thinks that they're going to stand up and do

this, please start carefully, because you'll be surprised how

much force you can generate when you do that. But for us, can

stimulate bone growth. And you see that in literature, there's

also lots of people who are doing different types of jumping

exercises, so like box jumps, Plyometrics, assisted hanging

drops, all these kinds of things that we can help to stimulate

but they have to be done under the right supervision and under

the right direction and form, otherwise you can definitely

hurt yourself. That's why we avoid it in the first place.

Gotcha, what about trampoline?

Yeah, I get this question a lot. Usually people

in the osteoporosis kidney will say the word rebounder, but

that's just a little trampoline. And so the rebounding does not

show improvement of bone mineral density, which is logical for

me, but maybe not for others, because if you think about

what's happening on a trampoline, you're going up and

down, and you're generating force. Your muscles are firing.

That's why it's like, it'll make you out of breath, but it's not

happening fast enough to be impact. So if you compare it to

say, like, whole body vibration, if like the company power plate,

and those devices move up and down, right? So if you think

about how quickly they're moving up and down, 30 to 40 hertz,

which is times per second, versus on a trampoline, where

it's like one 1000 maybe you're getting two repetitions in per

second if you're doing a small jump, but whole body vibration.

Which we know does also generate that kind of acceleration in

three to five GS, 30 to 40 times per second, but only two to

three millimeters, so very small displacement.

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Okay, so if you're looking to build bone density or a stronger

bone rebounder, is probably not the way, definitely not

swimming, right? Because no impact, or even walking, because

when, when I was undergoing training. They said for

treatment for osteoporosis, ladies go walk, weight bearing

exercises, you know. So is that just a waste of time?

Can we, yeah, can we get rid of the term weight

bearing exercise? I was actually just prepping for some some

scripts that I'm recording today, and I was looking at some

exercise studies, and they basically said that the control

group continued on with weight bearing exercise. And I was

like, okay, okay, if we're walking, you're weight bearing.

So do we really need to use the term weight bearing exercise?

Isn't all exercise weight bearing, unless you're talking

about swimming, like, can't we just say walking? So I don't

like this idea of weight bearing exercise as a treatment for

osteoporosis, because we know it's not enough. And so I think,

yes, is this a waste of breath? Yes, absolutely. We need to be

more specific, and we also need to be more aggressive. Doctors

just tend to not want to put patients at risk. That's that's

our bias. Let's keep them from fracturing. So we tell them, Oh

yeah, take calcium and vitamin D, do some weight bearing

exercise, and you'll be good. But what they actually mean is,

take calcium, vitamin D, do some weight bearing exercise, take

this drug, and you'll be good, because it's really the only

tool they have.

To clarify. Do more high intensity interval

exercises, do resistance training and do more of 3g to 5g

impact exercises, and you were talking about the heel lift and

plyometric more in a supervised setting. But what is there

people to do? What if they're not in a setting where they can

be supervised? What can they do at home?

How to do it? The reason why I'm so careful with

the way I say that is that you can't hurt yourself if you just

walk into your gym and start jumping off of stuff, right? If

you walk out to your garage and you start jumping off of your

car like you're going to probably hurt yourself. So you

need to learn how to do it. But then once you learn how to do

it, you can totally do it at home. So I would recommend, if

somebody it truly does have osteoporosis, they figure out

how to do it. If you don't have osteoporosis and you've been

screened, which we need to talk about, but if you don't have it

and you're just trying to optimize your bones or maintain

bone density, then a lot of these things are probably going

to be safe. I would still make sure how to do it, but you can

do almost all of this at home. You do not need a fancy gym. You

don't necessarily need fancy equipment, either, but some of

the modalities become really helpful, like a power plate, for

example, which you can also do at home. It's just a, it's a an

investment, right?

Exactly. So let's talk about, how do you have

osteoporosis or not?

Yeah. So everybody has heard of usually, DEXA is

essentially an x ray that's made specifically for bone density,

and this has been around since the mid 1990s and DEXA looks at

your publicity, potentially a software add on to look at

quality, but for the most part, we're talking bone density, but

that's only half of the equation of fragility, meaning that when

we look at fracture risk, density is only part of the

equation. So we're starting out by really only knowing part of

the equation for most people anyway, which is a problem. Plus

the other issues with DEXA is that there's quite a bit of

variation from scan to scan. Most even manufacturers would

say between four and 5% variation, they can't tell a

change that's less than that, which is a problem, because if

you look at most of these interventions for bone health,

they're usually looking at the like one 2% change over 12

months. So we can't actually say that any of these tools are

going to be effect more so than chance or statistical error. The

Dex is a problem. We need a better imaging mode. Not going

to get away from Dex anytime soon, because it's globally

available. Everybody has access to one. It's relatively

inexpensive, even if your insurance won't pay for it. So

we're not going to get away from it. But there are other choices,

the other imaging modality that is becoming more so globally

than in the US, but it's catching traction here. Or two

is a device from a company called Echo light, and it's a

rems device. Rems is an acronym, but it's basically an

ultrasound. So the same ultrasound device that you saw

at your wife's OB GYN appointment, when they looked at

the baby through the belly, same looking thing, just slightly

different, and has an algorithm behind it that can look at bone

what's great about this device is that it's going to tell you

about your bone density, give you a t score, just like a DEXA,

but it's also going to tell you about bone quality, and then

give you a fragility score. This is really important, because

depending on your bone density and your your ethnic background

and your height, DEXA can skew people one direction or another

based off of the population of interest. So we find especially

for and this would be for men too, for shorter men that are

smaller frame smaller men, your T scores are probably going to

look worse on DEXA than they really are. And if you were to

then go get a rems your fragility score, I find

oftentimes these men have low bone density, but good bone

quality, and that's going to change the way that you decide

what to do, certainly around drug treatment, if your doctor

says, Oh my gosh, you have osteoporosis, but your fragility

score is good. Now your doctor doesn't know what that means,

but people ask me this all the time, well, if I have good

fragility, I have good bone quality, but my t score is low,

what do I do? Well, we still work on it, but maybe we give

ourselves a little bit of grace to do this naturally, first, to

make sure we can do this naturally without drugs. There's

a time and a place for drugs, but I like to avoid them

whenever we can. So that's how we screen. The second part of

that is, when do we screen? And again, I would propose,

especially if we have access to this ultrasound device, screen

every young adult possible, because we need to know our

starting point.

Hi, what is the name of the test? R, E, yeah.

R, E, M, S, it's Yeah, radiographic, Echo,

something multi spectrometry, but it the REMS device is what

people call it, in the CO light, and that's E, C, H, O, L, i, t,

e, so echo, light rams, and it's an ultrasound device. And when

we talk about resources, I'll tell people how they can find

this.

Right now, is this covered by insurance or no? No,

not

right now. Of course, the company wants it to

be. But right now, the people who are buying this device and

putting it out there to the public, these are entrepreneurs

who have access to one of the like the franchises that help

with bone density, like osteo strong and bio density. So these

owners that have a large population of people with bone

health challenges, and they want to have another screening

modality. So that's how they're getting out there. But those

people are buying a device right now. This device is 70 or

$80,000 so they need to make money back. This is going to be

a cash pay thing for the foreseeable future.

Gotcha. So if you want to get that test done, you

would have to go to these facility that has it and then

pay cash for it, which is what, what's the range for? For $200

to $300. Okay, well, $200 to $300 to invest in your health

and to know where you're at. It's kind of like the CT

coronary scan that I recommend. Calcium coronary scan for

cardiovascular health. Insurance doesn't cover that, and it

ranging from $100 to $200. It's good to have as a baseline, at

least what your start at, so that way what you need to head

to. I'm glad we talked about that as an alternative. So what

the DEXA is, even though it's covered by insurance, there's a

4% variability in it. So what you're saying is that, let's

say, if you get a T-score of like 14% and the goal is to

increase by 2% or something, the next time you do a test, there's

a plus or minus 4%.

We don't, we don't know that's right. So I was just

doing a patient example that I'm scripting for today, and

fortunately, she grew by 20% right? So in this example, what

I'm saying is, look, she had such an improvement in assist

with her spine. She had a 20% improvement in B and B in her

spine between her two scans, which were almost two years

apart. So we can say confidently that this was an actual increase

in bone marrow density, because it was over that 5% mark. When

it's under that 5% mark, we can take a positive, like a two or

3% increase. We can take that as a sign that things are probably

going well. I don't really know, and that's why this is a long

game. So we have to keep scanning, keep testing, keep

retesting. I have this framework, and the third R is

retest, make sure you're headed in the right direction. Because

we can't just choose a modality or choose a supplement or take a

drug or whatever and stick our head in the sand. We need to

keep finding out if we're improving over time, because 2%

plus 2% plus 2% if you keep getting that 2% improvement,

then yes, it's real eventually, but it's going to take two,

three years or more.

So that brings me to the next question. Let's kind

of backtrack and say, how many years does it take to get to a

point of decreased bone density? So there's two terms that is

used by doctors osteopenia, and then osteoporosis. Says the

first part of the question is, how many of years does it take

to get to osteopenia? And then, what is it? And then, what is

osteoporosis? And then I'll ask you the follow up question,

which is, how, how long does it take to return, to reverse back

from osteoporosis?

To reverse osteoporosis as it were. Yeah,

we'll talk about why that's not a great term. So how long does

it take? It depends on your starting point. So think of it

like this. Can we reach peak bone mineral density for a man,

especially like black men, have even more dense bones than

Caucasian men. Let's use that as an example. So black male in his

early 20s is going to have one of the highest bone densities of

any population if he reaches peak bone mass, then he has a

long way to go before he would ever hit osteoporosis, because

he has so he has such dense bone that it's going to take a long

time for him to get there. So he's got a huge safety margin

there. But we don't know what that starting point is for most

men, so we don't, we can't say that it's going to be, how many

years is it going to take? Under what circumstances? We can't

really say that unless we know what your starting point is. I

also see men that lose bone very quickly. I was thought about guy

patients. They have numbers going back for for years. I mean

decades where they have t score after t score after t score. And

I've seen them lose 5% 10% over the course of two years, it

doesn't take long, even if you had a good starting point for

your losing bone that quickly, we really don't know, and that's

why we really do need to screen on a regular basis, so that we

know what's happening with our bones, because it's hard we

don't know. And I think because we're not screening for the

things that can cause you to lose bone, and some of them are

hard to screen for, hard to have a conversation about, we have to

use the screening modalities, because there's really no other

way to know.

Okay, so it can take. So if you start out good

density, it could take maybe decades. But if you may not

start out with good density, you said it could even take a couple

years to decrease the density. So what's osteopenia and what's

osteoporosis?

So osteoporosis is the medical diagnosis. It's the

ICD-10 code that you would use for poor bone quality, and you

call it osteoporosis, and it's just defined. It's actually

defined by the DEXA, which is kind of annoying, because it's

not really a good definition. So when the DEXA was brought

forward in the mid 90s, the there had to be a an objective

criteria that could be used for pharmacologic recommendations.

So this is how this whole system is tied together. So a t score

of negative 2.5 meaning two and a half standard deviations below

the mean for sex and ethnicity, is the definition of

osteoporosis. But every manufacturer has a different

database. Every ethnicity is different, gender is different.

So it gets really confusing really fast, but in general,

that's the major criteria to the t score across everybody.

Unfortunately, like I said earlier, people that are at the

extremes of the bell curve are going to probably not be

temporarily. And we see this in our thin, Caucasian and Asian

women that have a smaller bone frame, they will generally come

out with a lower t score. Generally, they're just

comparing it to kind of like the wrong bell curve, if you will.

So osteoporosis is the diagnosis. Now, osteopenia is a

term that that was coined to be somewhere in between what they

consider negative one and negative 2.5 on that scale of t

score. But it's not a diagnosis. And I hear this all the time,

and it's really frustrating, is people will say, Oh my gosh, I

got diagnosed with osteopenia, and my doctor recommended that I

go on a drug. Drug A little crazy, because osteopenia A is

not a diagnosis. There's no ICD code for that, and B, the

recommendations for drug therapy generally should not include

people with osteopenia unless they're rapidly losing bone for

another reason. So I hear this all the time, and I think this

is a misunderstanding from doctors and a reason why they

actually are changing that term. So osteopenia is a term that she

needs to go away. We need to stop using that term, and we

just want to call it low bone density. So we're going to say

you have low bone density, and then if you have low enough bone

density, then you have osteoporosis. We need to get rid

of the term osteopenia, because I think people are they, they

look at them as the same thing, and they're not osteopenia might

not be an issue at all. For example, I have osteopenia. I've

had osteopenia my entire my t score is about negative 1.1 so I

meet the diagnostic criteria. If there were any for low bone

mass, I have osteopenia. But I know that it's been that way

since my early adult life, because I had a DEXA done. I was

a research participant in a study, and they did they did

Dex, I did deck body comp, but they had a t score on there, and

I know that I had low bone density. Then I think it was

because of my diet growing up and lack of activity, and that's

a whole other conversation. So should I go on a drug because I

have osteopenia? Of course not. My bone is getting more dense.

It's getting stronger as I age, which is why I. We don't have to

accept that bone loss is a part of a part of it, because we

prove that wrong over and over and over again. So I hope that

helps to explain it. Osteopenia needs to go away. Low bone mass

is lower than one standard deviation. Osteoporosis is lower

than two and a half standard deviations.

Okay, so then, Can we reverse it? You said, No, you

can't reverse it. Let's clarify that. So what can we do? Or your

SOL?

So most doctors will tell a patient when they get a

diagnosis of osteoporosis that they cannot reverse it, just

like so many chronic diseases that you and I are trained on,

and diabetes, the same thing I was training diabetes as a

progressive disease, you'll only get worse. Take more drugs, then

you're going to go on insulin, then you're going to get your

going to get your legs cut off, and then you're going to die.

That was sort of what I was trained with. Diabetes is

diabetes like cutting off thing. Osteoporosis is viewed the same

way. You're not going to reverse this thing. The only thing we

can do is slow down bone loss and hopefully prevent a fracture

over time, and we're going to have to use these drugs. That's

the way that we're trained around this. As an orthopedic

surgeon, that was my understanding of the disease.

But what I can tell you now, we've been running a program

where we help people reverse osteoporosis naturally. For the

last four years, we've been dialing it in. And what I can

tell you is that if you have the ability to eat the diet, do the

exercise, optimize hormones, especially, but not always. But

if you can do those three things, the vast majority of our

patients are seeing improvement in bone turnover markers and

imaging within 12 months. I really look forward to getting

data on the 24 month and 36 month follow ups, because what

we're seeing is like that case I shared earlier. We're seeing

these massive increases in bone mineral density, 1015, 20% and

this is all through diet, lifestyle and hormones. If

people are candidates for hormones, you can do it without

hormones too. It's just slower. So absolutely it can be reversed

if you have the capacity to do things that we need to do, which

is exercise, the sleep study, the right diet, and then

optimizing hormones helps. So absolutely it's reversible. And

I can't say that loud enough.

Okay, so that's good to know. So what hormone

are you talking about that is effective?

Yeah, so most of our patients are women, so we're

talking about men. So replacement therapy for women,

that's estrogen, progesterone, testosterone is if needed for

men, we're much easier for men. We're just talking about tea.

We're talking about testosterone because we don't make estrogen

outside of our testosterone. So we just need to optimize our

testosterone, not really talking about thyroid here, but if we

optimize our testosterone, you're going to have optimized

estradiol. The balance between those two hormones is going to

be more than enough to keep your bone healthy and keep the

stimulus to turn over bone going low testosterone. Talk about

enough subclinical low testosterone is a problem, even

if it doesn't lead to sexual dysfunction yet. And this is a

big takeaway for your audience, which is that for guys that have

like, like, maybe it's a little different, maybe my performance

isn't as good, your bones are going to tell you before your

penis, is going to tell you that something's wrong with your

hormones. So we can cut that short, and we can prevent that

from happening by looking at hormones earlier.

Okay, great, so that's what I was going to ask

you. What's the connection of bone and the sex? It's the

hormone, but it's also, you said, the diet, and of course,

you know, eating clean and more high protein and exercise. All

that increases testosterone, and then all that also decrease

inflammation, which then is also improved cardiovascular health

or blood vessel health. Which for sexual health, that's the

pivotal change that you need to get more blood flow to the penis

for that's where the connection between the bone hell and then

the sexual health. So, but what you did said earlier, I wanted

to clarify, was that you said that the bone changes may show

up even earlier than the sexual change?

Yeah. So let me clarify that. So what I mean is

that if you were known quality and density, let's say using

that rems device. So if you're looking at an ultrasound of the

bone, and you look at it over the course of a couple years,

and you're losing bone, I would want to know a lot of things.

But one of those things is I want to know what's happening

with your hormones. That's going to happen before you would reach

a point where you would have the clinical manifestation, or you

would notice erectile dysfunction or decreased

performance, decreased libido, et cetera, because I have lots

of patients that have moderate testosterone, they have low

estradiol, because they don't have enough testosterone, but

they don't have any symptoms, or at least they're not telling me

that they have any symptoms of erectile dysfunction or low

libido. So your bones are going to tell you before your penis

tells you.

That's very interesting to know. Now I

wonder whether I need to order the REM, the echo REM test, that

correspond with my workup as well. Haven't thought about

that, but that makes sense to me, as in Hormonal Health,

because when we do blood work, we look at thyroid. And pro

Latin and the hypothalamus hormone as well. So why not

check that? Very interesting. So any last minute tips that you

can give to our audience after this very insightful episode,

and I can tell I've learned something as well too. So I hope

that our listeners have some takeaway from this, but what

advice can you give to our listeners at this point and how

they can take care of their bones as they age?

Yeah, this is one of those areas in healthcare that's

tough for men, because as men, we generally don't ask for help.

We generally don't pursue things that aren't put in front of us.

It's just how we're wired, and that's not wrong. It's just who

we are, and that's okay. So what we need to do is understand that

the things that I just talked about are relevant. They're

important. They're going to have an impact on your life, on your

life style, on your lifespan, on your health span. I would

encourage you to know what's happening with your bones. Add

things that you want to check on a regular basis. If your doctor

cares about cholesterol, Fine, let's add bone mineral density

and bone quality to that list as well, and then track it over

time. You've got to be an advocate for yourself here,

because your doctor is not going to talk to you about your bone

health, but if you use this as a tool, it'll help you to know if

something is with your diet, with your lifestyle, with your

hormones, and you can it can help you to put together that

big picture. So that's the big takeaway here.

Well, yeah, that's good to know. And then one point

I wanted to kind of a minor point I want to find out, is

that estrogen men also need estrogen too. Estrogen is just

not for women, even though men have a lot higher testosterone

than women. But estrogen actually plays a role also in

your bone health, but it also plays a role in your libido,

desire. Estrogen is important for that. So it's important to

keep it in kind of somewhat above 30 level. On the blood

test, bloody 30, I try to keep around 30 to 60 level. So it's

good to have some estrogen, but not too good to have too much

estrogen. So that's the beauty of being in clinical practice,

is to be able to see patient and be able to customize the

treatment plans. And I'm sure that's what you do all the time

in your program with your patients. So tell our viewers

how they can find out about your program and how to work with

Yes, you basically have, we have two types of

you.

programs. So one is Comprehensive Bone Health

Program, which is, if you have osteoporosis and you want to

reverse this naturally, then this is the way to do it,

because this is the lifestyle optimization. We look at the

diet, we look at gut health, we do all the things, and it really

works, but it's work. So if you want, if you want to work with

somebody to do it, that program is the company called Optimal

Human Health, and that's optimalhumanhealth.com lots of

information on that website. That's the way to get help to do

it, for us to hold your hand as we walk you through. But what we

found is that so many people, if they just have the right

information. Can do this on their own. So yes, I love the

practice, and yes, we're helping people, and we kind of sort of

run at capacity, but the community is where we put as

much information as possible at the fingertips of people that

want to improve their bone health or learn about hormone

health. We have a lot of that content there too. So that's

called the Osteo Collective, and the website for that is just

osteoccollective.com and this is a low cost monthly membership

where you can go in, where there's weekly Q and A's,

there's research libraries, there's all the material that

you could ever need to learn how to improve your bone health, and

all the resources to do it. You can get labs through there. You

can actually potentially work with our nutritionist to do gut

health and or do all these things. So the Osteo Collective

is the way where most people I view in the future are going to

get this information and do it themselves, because they don't

necessarily need the full program. You have both options

for people that need each one.

Okay, great. So there's two type of program. One

is a more in a group. Another one is little little bit more

intensive, which is the other one, the Optimum. Okay, great.

So I believe you have an eBook for our audience as well?

I do behind my head here for those watching this on

video, yeah, so the Osteoporosis Breakthrough is an ebook that

we're happy to give all your listeners. So we'll make sure

you have that link and you can download the eBook. I go through

in here, some of the big players that we didn't get to today,

about the confusion and the myths and mistakes that we see

people with that are going through the bone health journey.

So it's a quick read, easy enough to read through an eBook.

So happy to give that to all your listeners.

Oh, great. So we'll put that link and description,

so make sure that you check out the prescription for the

episode. So having said that, thank you, Dr Doug, for your

time and your expertise and teaching us about the connection

between bone health and your sex life and why men, you need to

know about this, because you will have osteoporosis too if

you don't take care of your bones.

Okay, Modern Man, you are not alone and you don't have to

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