Bone Health

Connie: Osteoporosis is where your bones have deteriorated to the point that you're vulnerable to fracture. When that happens often, you're becoming internalized because you're not more bone to get out with family and friends. So you're falling in, love goes down, you're in pain, and that can lead to death.

Brent: Welcome to death. I am your host, Brent Franson. Today we speak with Doctor Connie Weaver about Bono. Doctor Weaver is a distinguished research professor at San Diego State University. Previously, she was at Purdue. She has spent her career studying nutrition and bone health. It's a topic that really matters for everybody. There's a misconception in bone health that it only matter.

Brent: The degradation of the health of our bones only matters for women as they age. It matters for everybody. It matters what we do up and through puberty. It matters what we do between puberty and our 50s and 60s. And it matters just as much for men and women. It's a topic that's not discussed enough, so I'm glad that we had such a good guest on to give us all the highlights.

Brent: She's a great guest. I hope you enjoy.

Brent: Doctor Connie Weaver, welcome to the show.

Connie: Thank you.

Brent: So today we're going to talk about bones and bone health. This is going to be I'm definitely going to be way outside of my comfort zone here, because I've spent just very little time in my life thinking about bones. As I prepared for this conversation, I've been more and more curious, and I've been reminding why it wasn't hard to remind myself that, oh, bones really matter.

Brent: But before we get into it, can you just give us a sense of your bio and how you've come to, you know, being at being a leading expert in bone health?

Connie: So I, trained in nutrition and food science and got into appreciating minerals and studying mineral metabolism in my PhD in the 80s. The public was becoming aware, and there were a lot of conversations in women's magazines and whatnot about calcium. And, maybe calcium is more important than we thought it was. And this notion that osteoporosis, which is the disease where you have bone fractures later in life, that it actually starts early in life.

Connie: So it's even been called the pediatric disease because you lay the foundation while you're young and growing and build bones to protect you against fracture later. So it wasn't a very big jump for me to go from the minerals I had been studying, like iron and zinc, to think of calcium because it was becoming a thing, you know, and interested.

Connie: And I got more money from my grant applications, mostly federally, for studying calcium and bone. And so I've been in that area for a very long time. That's my primary area since then. So I had a career at Purdue University. I retired, but I wanted to do more research and my husband wanted a sailboat. So San Diego State University addressed both of our interests.

Connie: So I continue to study nutrition and bone health here.

Brent: Okay, awesome. And that sounds like, you know, no knock on Purdue. But, you know, San Diego's not not a bad place, I think.

Connie: It's a lovely place. Thank you.

Brent: So will you give us the basics of what are bones and what do they do outside of just, I don't know, supporting all of the soft tissue.

Connie: You're right that they're a support. Structural support. But they can't be so strong and solid that you're like a tree. You have to be mobile. So they have to be lightweight. And that sense sets up the problem. You have to have enough bone to be mobile, but also strong enough that if you lose bone later in life, you're not vulnerable to fracture.

Connie: So the other big function of bones is it's a reservoir for the nutrients, especially the minerals that you need for all your life processes. Calcium being the most dominant. But all these minerals that are involved, like magnesium and phosphorus and so forth. So if you don't get those regularly in your diet, those minerals, you can't make them. So the only recourse your body has to keep you alive is to draw those minerals out of your bones, to keep your blood levels that nourish all your organs intact.

Brent: So are you saying that basically, there's not a great way for the body to store calcium other than in the bones? And so there's calcium in the bones for reasons related just to the structural integrity of the bone, but also just as a, as a place to store calcium for other uses.

Connie: It has a bank. In fact, calcium is about the only nutrient where the reserve is functional. So calcium is a constant portion of bone. So if you have more calcium in your body, because over 99% of this in the bone, it means you have more bone. It's not hanging around some other place outside of the bone, because only like less than 1% of your calcium is in your soft tissue.

Connie: Now that's life critical. That 1% and the rest of us in bone. And you want to build as much bone as you can within your genetic potential to protect against fracture and to have as a reservoir.

Brent: But like something like magnesium that is purely stored in the bone and doesn't have any function related to the bone itself.

Connie: No, that's not true. Magnesium 60% of your body's magnesium is in the bone, unlike the 99% of calcium. So magnesium is more commonly, in your soft tissues, your muscles and so forth than calcium. But it serves a purpose in the bone to improve quality of bone. So if you think of crystal and foods like ice cream or, fudge candy, you don't want those crystals to be too big so you can detect them on your tongue.

Connie: You know, when ice cream is too long in the freezer and you feel those gritty crystals on there, you don't like that? Well, bone doesn't like really large crystals either, because they become brittle. And so magnesium gets in there and kind of messes up large crystal formation. So it keeps the crystals small and gives you a better quality bone.

Connie: So you need the magnesium for the bone quality.

Brent: But are there are there nutrients in the bone that are stored in bone but totally unrelated to any bone function or structural integrity?

Connie: Think of it this way bone is a living tissue. So like every other organ in your body, every single essential nutrient has to be present to build the bone. And so it's there as well.

Brent: When I think of something like bone and storage, I want to think of a location that it's stormed and stored, and I start thinking about the center of the bone, and then I'm asking myself, like, what is bone marrow? But it sounds like, no, that's that's a gross, oversimplified simplification. It's stored in the bone in that it's part of the composite of the bone.

Brent: It's able to go in and out of the bone with relative ease. You don't need to think about a bone like you would pick up as this hard object that would need, like where you'd be looking for where it was stored, is that.

Connie: It's a it's a dynamic tissue. So when you're building bone you lay down these protein fibers and then the minerals are in deposited within it to give it the structural strength. You have the hollow or mostly hollow inside. That's what gives you the mobility. We were talking about earlier is keeps it light enough. Because if it were solid, then you'd be like a tree.

Connie: You couldn't really pick up your legs and move.

Brent: You'd be too heavy. And then and then what is bone marrow? So there is something in this in the center of the bone, right?

Connie: So bone marrow has a lot of the blood vessels that carry the nutrients from your blood to the bone. It has fat too. And that's been a subject of a lot of research worrying about that fat. If you have, you need a little fat. But if we get too much like our propensity to become obese, then that seems to be damaging.

Connie: The quality of bones also.

Brent: And it's the fat and bone marrow. That's why, like my grandma loved to suck out the bone marrow of the bones at dinner because there's there's fat in there. And should the not taste good?

Connie: Absolutely.

Brent: How do we measure the health of a bone outside of just, I don't know, like, are you getting enough calcium?

Connie: So the main way is through some sort of imaging, the most common being dual energy X-ray absorption geometry or Dexa. It's really useful if, especially as you age, you get Dexa scans every couple of years to make sure that you're not sliding down and decreasing. So there's two stages in your life span that's really critical to prevent osteoporosis.

Connie: One is during puberty or growth, or you're really growing up in high and consolidating your bones. You want to get to a peak bone mass that's as high as you can within your genetic potential. That's really the most productive. All of us spend very much time, not nearly enough time on that because the medical environment is to treat problems after you have them, not prevention like, nutritionists and exercise.

Connie: The second period is once you have that peak bone mass to hold on to it as much as you can as long as you can. And that's where most of the research in the treatments are targeted, because you missed the opportunity during growth and now you're just trying to hold on to it. And remember, osteoporosis has no cure.

Connie: It's just got treatments to try to slow down okay.

Brent: So let's let's let's come to osteoporosis. But let's I want to understand the puberty piece first which is okay I've got young kids. They're all prepubescent and all right I'm talking to you. And I want to make sure that they've got as much bone density as they can by the time they're in their 20s or something. You'll tell me what that is.

Brent: What what what am I doing? Like, what do I do differently than the average parent to set up my kids for good bone health?

Connie: Something like 60 to 80% of your bone mass is determined by your genes. What you can't change who your parents are, but that 20 to 40% that's influenced by lifespan is enough to really protect bones throughout your life. So it comes down to diet and exercise. We know more about some aspects of diet and exercise than others. The standard, nutrients that is in therapy later in life for treatment or calcium and vitamin D, well, that's also important during growth.

Connie: Make sure you have the raw materials of calcium. Bone mineral is also made up of phosphorus and magnesium. Phosphorus kids usually get plenty of, but many cesium comes from dark green vegetables and nuts and whole grains. And too many kids ignore that calcium. Like 70% of your dietary calcium comes from dairy products. So if you eliminate dairy products, there's practically little way of getting enough calcium unless you go to supplements.

Connie: And all the policy makers say food first, which is mostly dairy products, because they have all these other bioactive constituents that can be good for bone and other organs. So make sure you get the dietary Guidelines recommendations worth of dairy products. Three servings. That's the easiest thing you can do. If not, you have to do a lot of work to figure out how to get all those nutrients that you're missing out within dairy in supplements.

Connie: The problem is, it only comes with whatever they put in the supplements. So you make enough calcium. But what about that magnesium in vitamins and other minerals and bioactive that you're missing out. So that's the easiest thing for diet but also weight bearing exercise is really important in building bone mass.

Brent: I'm 64 and I'm like the tallest person in my extended family. I drank an absurd amount of milk as a kid. Like, there you go, diculous amount of whole milk. And I've always wondered, I wonder if I'm tall because of all of the milk. Is that an absurd hypothesis, or is it? Can there be some connection?

Connie: If you look at countries where there's extremes in dairy or calcium intake, yes, you can see it. So take Africa. If you look at people that are dairy herders or in a daring community like the canyons, they're very tall. If you look in groups that don't consume dairy like pygmies, you know, they're very short. So dairy really tracks in developing countries.

Connie: I mean, height is associated with dairy consumption, but you don't you miss it a lot in Western societies because you have enough not to be completely standard.

Brent: Weight bearing exercise. How do you think about that? For a 12 year old, it's like they're doing body weight stuff. And I assume you're not saying, hey, like, let's get all like ten and 12 year olds weightlifting.

Connie: Almost all of the randomized, randomized controlled trials, which are the gold standard, study designs use jumping of some sort. And so we really don't have evidence either in young or old people directly comparing different types of exercise. But in children, pubertal children, what always shows up, even if it's not a randomized controlled trial like observational or something is dynamic.

Connie: So soccer basketball, where you're shifting and turning on your weights that always comes up as the highest association with higher bone mass.

Brent: And then so it sounds like I'm basically making deposits into the bone for some period. And I want to maximize my deposits into the bone through consumption of dairy, through these shifting exercises. And then at some point, the bone bank, for lack of a better term, stops accepting deposits. And so the max bone density that I have at that time matters, because then I'm on a slow downward trajectory from that point.

Brent: Is that right? Please correct that if that's wrong and if it is right, at what age does that happen?

Connie: Don't forget bone is, dynamic tissue. So it never stops accepting nutrients, but it's the balance of formation versus resorption or drying out in the bone. But you go from a positive balance where you have more formation and resorption at the peak bone mass, and then you're hopeful in bail to be in balance. So you're not losing for a while in adulthood, but then you really get an imbalance.

Connie: Women at menopause, that's the big place. And men more slowly. So they're gradually losing bone. And you're trying to counter that as much as you can. When the peak happens, it varies with genetic programing a bit, but on average it also depends on the bone site. So in our studies, bone stopped growing in the hip at age 16.

Connie: And you, took longer for some of the other sites. The slowest one to stop is the spine. It's malleable into the 30s or so, but the hip is the worse fracture you can have because you lose your mobility and it's so painful and whatnot. So you're kind of old in terms of bones when you're 16. Then after that, that's not part of our medical environment to see these young kids and get them on a tract and build bone very often.

Connie: One of the tidbit that you might be interested in is we did a randomized controlled trial of exercise in young women, 19 to 31. And so we recruited sedentary women and assigned them to exercise or not. We expected the bones to be stable in the control group but improve in the exercise group. And that's not what we saw.

Connie: Those 19 to 31 year olds were already losing bone. We didn't assign them to the exercise group. And so the exercise prevented the loss during that young age, young adult age. But they were losing bone already if they weren't exercising.

Brent: All right. So obviously like, you know, we have so many of the conversations that we have are like, hey, diet and exercise, you know, sleep, diet and exercise really, really matter. But this seems to accelerate in menopause. I mean, does it start to accelerate in perimenopause for women and then accelerate even further in menopause? And why is that?

Connie: Well, that's likely what you say. But usually studies you either recruit them pre menopause during menopausal post menopause there. And the perimenopause is very poorly studied. So it's harder to know.

Brent: So obviously there's a relationship it seems between hormones and bone health. And so what is it about hormonal changes in menopausal women that are contributing to accelerated, viral bone degradation? However you would say it.

Connie: So it's mostly about estrogen with women. So estrogen before menopause really suppresses that bone withdrawal, that resorption that we were talking about. So then the estrogen goes away and bone resorption goes wild. It really accelerates the withdrawals. And so for the next five years you have a dramatic drop okay.

Brent: And it does hormone replacement therapy slow this or change it. Is it helpful.

Connie: So at one point in my life or career, we thought every postmenopausal women should go on hormone replacement therapy to help avoid bone loss. But then the Women's Health Initiative reported in 2002 that there was a slight increase in risk of, cardiovascular events and stroke. So everybody stopped recommending hormone replacement therapy. So giving estrogen is really effective, but nobody recommends it anymore.

Brent: So I had thought a couple of things about that study. One was that it was an increase in risk of breast cancer and not cardiovascular issues. Although we could be I could be mixing up the study. And then two, I thought that study was debunked. I thought somebody had come along and said there was some evidence to suggest after the damage had been done, that actually the study wasn't legit and there's not an increase in incidence of breast cancer.

Brent: And in women who are on HRT.

Connie: You're getting into cancer. And that's not my expertise, so I can't address that. But generally, the Women's Health Initiative has been considered to be really valuable. It's the largest randomized controlled trial, in the history of the world and recognized at the time it was funded. Pretty much all the research for preventing chronic disease was in men. So this is NIH is huge investment to try to catch up a bit with women.

Connie: You know, the philosophy was women's hormones would mess up our understanding of what we were really trying to study about the effectiveness of drugs. And so they didn't want the mess, menstrual cycles or menopause or whatever. So they studied men, but women's Health Initiative showed us women behave differently than men, and there's different needs for different treatments.

Connie: And so it's been very valuable.

Brent: But the conclusion today I was just looking it up. It does look like it's kind of both that, randomized. The 2002 Women's Health Initiative findings showed that combined estrogen and progestin in HRT found there's increased risk of breast cancer, heart disease, as you're saying, and that these led to the sharp decline in HRT. And then there has been some reevaluation.

Brent: And for women in different groups, it's probably somewhere in the middle. We thought it was really bad. And then we've since come to find that, hey, we need to weigh more carefully. There's so many benefits from HRT.

Connie: But it really hasn't changed society. Recommendations or practice. You know, they think for bone, for example, that you have, treatment that can be used instead. So this fascinates that can help hold on to the bone or these small molecule drugs that can help with bone. So they go why take any risks if we have some alternatives?

Connie: The most common predictor of a fracture is if you had a fracture already, it means your bones have lost quality to the point of having the first fracture. You're at risk for having another fracture because you can't really rebuild all that structure. That's why I'm in prevention. Build it up in the first place.

Brent: Is your view of HRT related to bone health that the pros outweigh the cons or the cons outweigh the pros? Like what's your view on it for menopause? Postmenopausal women?

Connie: Oh well, it's probably an individual decision between a patient and their doctor. And I'm not a MD, so I don't deal at all with drugs. I deal with prevention, building the bone and preventing the loss through lifestyle choices I don't have to make. And I'm not really qualified to make any recommendations on the drugs.

Brent: So we've talked about women. And so okay, we have bone health degrading starting very early on in life. Let's just say 19 or 20 based on the study that you reference, the rate of that degradation can change based on how active we are and based on our diets. There's an acceleration of that in women likely starting perimenopause, but not a lot of studies there.

Brent: So what we can say definitively is there's a big acceleration that happens at menopause. What is the version of that track for men?

Connie: Men, we've always said have fewer fractures, like about 20% of the rate or fractures compared to women. And this the decline in sex steroid hormones is slow and gradual. So they don't have that drop off that women have with menopause. But eventually they have fractures too. I'm a coauthor on a paper that just got accepted looking at national representative data, where men had more fractures than women aged 50 to 70.

Connie: And that blew me away. When we have not paid attention to men during that period of time. And so the paper partly calls for a need for policymakers and researchers. I want to wake up. We have a different scenario going on about the risk of men and fracture. So one thing we haven't discussed yet and who knows, maybe related to some of these things is the relationship of muscle to bone.

Connie: You really have to think of bone as a unit with muscle musculoskeletal, not independent, because the muscles, as you contract and move, put the biggest force and then your skeleton, I mean, you do some physical activity, but in your daily life the muscles are putting a lot of essentially physical activity onto your bone. You need to worry both about losing muscle in bone.

Connie: They work together to either cause problems or not. So we're seeing a huge increase in sarcopenia, which is the loss of muscle as people age, you know, use it, or losing philosophy. As people become more sedentary, they're losing not only bone but also muscle. And that hurts the bone in return because you're not putting that force on the bone.

Connie: So we need to worry about muscle and bone and that's where a lot of, interest currently in protein is coming in. Protein makes up half of your bone mass. All of those fibers that the minerals are deposited in or its protein. So we need to have enough adequate, good quality protein in our diet, which often during growth people choose diets that are enough in protein but elderly not necessarily you know, they're it's harder to chew and fix for themselves.

Connie: And expensive can be there's a lot of people looking at get do we have enough protein for protecting bone and muscle?

Brent: And then just to understand the role of muscle. And so you're saying that the more muscle that I have, the more stress I'm putting on the bone and the more stress I'm putting on the bone, the better for the bone.

Connie: Exactly.

Brent: Is also muscle protective of the bone, meaning that the muscle is. I don't want to go back to the basketball example, or I'm lifting something heavy that the muscle is in some way bearing more of the load and protecting that. Is there a prophylactic nature to muscle in that way, or it's just the is getting harder through force kind of thing where the the muscle is putting pressure on the bone.

Brent: And that's helping keep the bone stronger. If that question makes it, I don't.

Connie: Think a muscle is a really structural unit, the way bone is to help you with lifting and whatnot. I think it's more about putting the stress on the bone, like you're saying, because stresses during growth really determines your bone geometry as you grow. And then protecting that later in life is important. Bone geometry. As you increase the diameter of your bones, it exponential really increases your strength and your bones and resistance to fracture.

Connie: So your bone size, your circumference, and your bones are really important. So that's where exercise does the most good.

Brent: So what's actually happening there like like for example I am I'm doing more weight lifting than I've ever done. So I'm glad to hear this. And so let's say I'm doing something like a bench press. And today I can bench press 150 pounds. But I really work at it over the course of the next year. And let's just say in a year I can bench press 300 pounds or something, you know, like there's a really big increase.

Brent: I would assume that if I'm able to achieve that increase, you know, obviously my muscles are going to increase. I'm going to see that I have bigger muscles, and I'm thinking about my muscles when I think about bench bench pressing. But it seems also that something is going to be happening with my bones over the course of of that increase and my bones are going to be becoming stronger.

Brent: So in this hypothetical, what's happening to the bone? I mean, it's obviously again, the muscles increasing, but what's happening to the bone? If I'm able to achieve this.

Connie: It depends on your life stage. In, older life, you're helping to prevent bone loss. During growth, you're increasing the geometry, perhaps, and building it. So all good. And lately, I've been becoming more aware and vocal about the difference between why. Why men and women go to the gym. You're saying you go to the gym to build muscles, be more buff, be able to lift 300 pounds, press or whatever.

Connie: Women don't go to the gym for that. I don't want to say I want to lift 300 pounds and I want to be buff and whatnot. They want to look good. Sure. But I think they're much more likely to be going to the gym to protect their bones, and men are thinking about it when they go together.

Connie: You want both parts of the musculoskeletal system to be healthy.

Brent: But in my case, at 43, a 43 year old male, I'm not going to be increasing. Let's just say I have a really big increase in what I can lift. And I agree with you. It's very like male male centric. I'm going to be slowing the rate of loss. I'm not necessarily going to be gaining for.

Connie: Bone.

Brent: At 43. Yeah. Right. Right. Okay. I'd be gaining if I were doing that at 15. But at 43 I'm just slowing down the rate of loss. But I'm not necessarily gaining. Even if I am seeing a big increase in how much I can bench.

Connie: But I'd say that's likely true.

Brent: And then is there a difference between cardio and strength? Like if I'm if I'm a woman or man, you know, and I run a lot, am I going to be helping my bones in the same way that if I go to the gym and like I do, I do a lot of strength training?

Connie: You're hitting a tender spot with me. I have written a couple of grants trying to propose that we don't know enough about comparing different kinds of exercise on bone, and I proposed a study that, but I've not been funded yet to do that.

Brent: Side note how how much, are all the funding changes happening at the federal level? How much are you seeing that hit somewhere like San Diego State?

Connie: Yeah, I just want to cry.

Brent: It's so it's been that it's been that bad.

Connie: Oh, it's really unspeakable. I, I think America is on its way to losing its dominance in science.

Brent: And it's just because RFK doesn't really know what he's doing and they're just indiscriminately cutting or it's.

Connie: Well, I think the cutting started before he got appointed as secretary cutting. So it's yeah, it's all, the upper decisions, just starving the universities in research institutions to death or worried really big institutions that do research at the level of getting Nobel Prizes in discovery is very important. Medical careers are going to close.

Brent: Yeah. It seems important to understand this. I mean, just while we're on it. And I think you're going to know this better than I do. So I'll say it and then you can you can correct me as, as you as you have been doing this conversation. You know, I think there's this if we take the Harvard example of, like, Harvard's got a huge endowment, why are they spending taxpayers money?

Brent: And it's the answer really is like, not not all universities have the same endowment that Harvard does, but that really leading and edge research does not have commercial applicability right out of the gate. And so it's really expensive to do. You've got to invest really heavily to push science forward. And at some point down the road, there are commercial applications where there's a return on that investment.

Brent: But the research that's being done, there's often not an immediate return on the investment. And so we have to decide as a group of people as as all the people living in the US like, hey, are we going to subsidize this? Are we going to invest in it for the good of ourselves and for the good of the future?

Brent: Because you need to invest in it. When there is no ROI, there is no immediate commercial benefit or not. Because if there's if there's not a commercial benefit and we don't use some public good, we don't use the taxpayers to fund it, then it's just not going to happen. And so that's why the taxpayer money is required. That's why taxpayer money is important.

Brent: Do you agree with that?

Connie: I totally agree with that. You're missing one important element and that's training. The training pipeline is completely threatened now because for several reasons. One is if you don't have research coming in to have projects for people to come trained to do, they're not going to come to the US because there's nothing for them to work on and train.

Connie: And the second, the fear of international trainees to come here right now, if they could be arrested by Ice and, you know, not welcome. And whole countries are so mad at the US, they don't even want to come here for scientific meetings and whatnot. So if you cut off that training pipeline, you were, skirting on the notion that some people might think the investment ought to be in commercial for discovery instead of the universities.

Connie: Who are they going to hire? Who are they going to hire? That's train training before they hire requires an undergraduate degree, a graduate degree, a postdoc degree. Then those companies hire them to come and do the discovery in the drug industry. Who are they going to hire if the university pipeline for training is cut off?

Brent: Okay. Thank you for the for the divergence. I just can't help but asking about, the, on the research side, as we start to wrap, you had made a comment about a study that you were doing that, that maybe we're not taking men's bone health as serious seriously as you are. We talk a lot about women's bone health and osteoporosis.

Brent: So I think the two things we need to touch on are one, what is osteoporosis and and why can't we stop it or reverse it? It seems to be chronic. And then two is what are we not talking about related to men's both bone health. Maybe that we should be. So let's start with osteoporosis.

Connie: So osteoporosis is where your bones have deteriorated to the point that you're vulnerable to fracture. You've had a fracture. And when that happens it means you're set up to have more and more fractures. Once you have fractures in the hip, often you become institutionalized because you're not mobile. You can't get out with family and friends, so you're falling in, love goes down, you're in pain, and that can lead to death.

Brent: Okay, so that's osteo osteoporosis. And the leading to death, meaning that social impacts or falls or all the above, there are physical, mental impacts that can be especially pernicious as we age.

Connie: Correct.

Brent: And then on the men's both bone health side because, you know, coming into this conversation, I'd really thought, you know, I'm thinking about older women, osteoporosis, fall risk. But it sounds like, we've been under studying or underestimating what's happening for men, you know, what's your view of of how we correct that narrative?

Connie: We work so hard to get women to be studied. But in the field, the bone health men have been ignored. And with this new evidence that fracture even surpass women at that age range of 50 to 70 before they even have a conversation with their doctor about thinking of any kind of intervention or even a scan to know.

Connie: I'm hoping we wake up the field a bit, to say we need to pay more attention.

Brent: And do you think that's because we've made so much progress on women's bone health that women in a in some unstudied natural state, they actually, you know, their bone health deteriorates more quickly than men. But we've actually done such a good job offsetting that, that now that bone health of older men is actually worse than women, or it's that we just didn't pay attention to it at the beginning and it might be worse.

Brent: Just naturally.

Connie: I think it could be that it's just naturally worse because we haven't collected data on fractures in bone density in men until they're quite a bit older. So this, in Haines is an nationally representative large sample of Americans. So it stands for Nutrition and Health Examination Survey. So these, participants, these volunteers are brought in and given a bone scan at these different ages.

Connie: And like, now, oh, wow. We see men 50 to 70 before they would normally have any bone scan out in the medical community. Oh, they are really having fractures in low bone mineral density. So I think all of a sudden we're hopefully going to become aware. Whereas the data was in older men and it only showed 20% of the fractures in older men compared to women.

Brent: Okay. So take it seriously. You know, men, women, young, old the best way, the best way to prevent let's help our kids with great bone health up and through puberty. And then, if we're trying to prevent post puberty, let's make sure we're getting the sleep, diet, exercise that we need. We're getting Dexa scans to keep an eye on our bone health.

Brent: And let's not pay more attention to it for women than for men. We both need to pay a lot of attention to it.

Connie: Very well summarized.

Brent: Doctor Connie Weaver, thank you so much for joining us.

Connie: You're welcome.

Brent: Death clock is recorded in Boulder, Colorado, sometime, San Francisco, California, produced by Patrick Gudino, music by Patrick Lee, and hosted by yours truly. Brent Franson, founder and CEO of.