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

**Peter Attia** (0:11)
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Welcome to a special episode of The Drive. This week, we are re-broadcasting our in-depth AMA, which was AMA 37, on bone health. It was released to subscribers initially, but we're opening this one up to everybody so that those of you who are not subscribers might get a sense of what the AMAs are all about. In this episode, we discuss why fracture-related death rises steeply after the age of 65, especially following hip and pelvic breaks, and why prevention must start decades earlier, what bone mineral density is, and how DEXA scans measure it, and how to read a T score and Z score, how bone changes with age in men and women, the outsize effects of menopause and estrogen loss, and the role of vitamin D, calcium, parathyroid hormone, and magnesium in bone turnover, the difference between healthy bone, osteopenia, and osteoporosis, and when each diagnosis is made, major risk factors for low BMD, when to start screening sooner than most guidelines suggest, and how often to repeat DEXA, which type of exercises best improve or preserve BMD, nutritional priorities for bone, how weight loss without resistance training accelerates bone loss, and why combining diet with heavy load exercise can offset it, pharmacologic options when lifestyle options are not enough, and strategies to minimize bone loss during bed rest or injury. So without further delay, I hope you enjoy this re-broadcast of the Bone Health AMA.

**Nick** (2:43)
All right, Peter, welcome to another AMA. How you doing?

**Peter Attia** (2:47)
Doing well, man. The final seven episodes of Ozark dropped tonight. We're recording this April 29th. Interesting date for two reasons, by the way. The other thing that occurred to me this morning is that the days and dates in this year, 2022, were the same as they were in 1994 So I was like, oh my God, today is Friday, April 29th, which is the same as it was in 94 So on Friday, April 29th in 1994 was the practice day at Imola. And that's when Rubens Baricella had that horrible, horrible accident. We can link to the accident where he basically hit the chicane and launched into a barrier and amazingly, only escaped with a concussion and a broken nose. The following day, which is the same day as tomorrow will be, which was Saturday, April 30th, was when Roland Ratzenberger was killed, which made it the first fatality in Formula One in 12 years. The last one being Gilles Villeneuve in 1982 And then of course, Sunday, May 1st, which will be the same this year, was when Senna died.

**Nick** (3:54)
All in 1994

**Peter Attia** (3:55)
Yeah, I was at the same race. You had these three horrible accidents resulting in two fatalities in one weekend. But again, to think it's the exact same days this year as it was 28 years ago, I didn't notice that until today.

**Nick** (4:09)
This is really off topic, but do you still have the skill that you had back in the day where you can remember what day, like day of the week a date was?

**Peter Attia** (4:18)
Only if I can peg it to something, but not as profound as it used to be.

**Nick** (4:22)
I remember in meetings, we used to just throw out random dates and then we would fact check it. I feel like we wasted a lot of time doing that.

**Peter Attia** (4:29)
Someone would tell me their birthday and I would tell them what day of the week they were born on.

**Nick** (4:33)
On the complete opposite end of that, what we're going to talk about today is the topic that we get asked about a lot. And we've gotten a lot of questions that have come in, but we've never really dove really deep into it, which is what we're going to do today. And it's kind of all things, bone health, bone mineral density, osteopenia, osteoporosis, things of that nature. And I know this is something that you work a lot with in your patients, and I know it's something that's of really big interest for people. And so our hope is that we can go through this episode and focus on why is this important? So why should people care about this? People listening right now, there'll be a subsection of them that are going to be super interested, and there'll be probably another subsection who are maybe younger. They've never really thought about their bone health, and they might not think it really applies to them. But our hope is in the beginning at least, we'll walk through why they should care about this and why they should focus on it early on in life. And then from there, we'll talk about how bone health changes as people age, the differences between sexism in men and women. And then we'll also focus on things on how people can improve or help their bone health become better from physical activity to nutrition, supplements, drugs and more. And then if all that goes well and we still have time, which is always 50-50 on how these AMAs go, we'll also focus a little bit on people dealing with acute injuries and how they need to think about this, which I know is something that you're interested in given your recent shoulder surgery and now you're not as active in one side of your upper body as you used to be. All that said, I think before we start going through those questions, it's going to be helpful to set the stage a little bit, just so everyone is on the same page and the definitions and what we're talking about. So, why don't we start with what are some of the types of bones we'll be referring to? Because at least for myself coming into this, I just kind of think of bone as a bone and I don't really think much more beyond that. So, why don't you dive into that a little bit?