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

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 7 July 2025

⏱️ 92 minutes

🔗️ Recording | iTunes | RSS

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Summary

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In this episode from July 2022, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it’s measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods.

While this original episode is an AMA, it is available in full to all listeners as a special rebroadcast.

We discuss:

Overview of bone health topics to be discussed [2:30];
Bones 101: bone function, structure, and more [6:15];
Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [9:30];
The consequences of poor bone health [14:30];
The devastating nature of hip fractures: morbidity and mortality data [18:00];
Where fractures tend to occur in the body [23:45];
Defining osteopenia and osteoporosis [25:30];
Measuring BMD with DEXA and how to interpret scores [28:00];
Variability in BMD between sexes [35:15];
When should people have their first bone mineral density scan? [37:45];
How BMD changes throughout the life and how it differs between men and women [40:15];
How changes in estrogen levels (e.g., menopause) impact bone health [45:15];
Why HRT is not considered a standard of care for postmenopausal bone loss [49:00];
Factors determining who may be at higher risk of poor bone health [52:00];
Common drugs that can negatively impact BMD [55:45];
How children can optimize bone health and lay the foundation for the future [59:30];
Types of physical activity that can positively impact bone health [1:03:30];
How weight loss can negatively impact bone health and how exercise can counteract those effects [1:12:15];
Nutrition and supplements for bone health [1:16:00];
Pharmaceutical drugs prescribed for those with low BMD [1:18:45];
Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:23:30]; and
More.

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Transcript

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0:00.0	Hey everyone. Welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity
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1:01.6	subscribe. Welcome to a special episode of the drive. This week we are rebroadcasting our in-depth
1:09.4	AMA, which was AMA 37 on bone health.
1:13.1	It was released two 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.
1:23.1	In this episode, we discuss why fracture-related death rises steeply after the age of 65,
1:29.4	especially following hip and pelvic breaks, and why prevention must start decades earlier,
1:34.8	what bone mineral density is and how dexoscans measure it and how to read a T-score and
1:40.1	Z-score, how bone changes with age in men and women, the outsize effects of menopause
1:46.2	and estrogen loss, and the role of vitamin D, calcium, parathyroid hormone, and magnesium
1:51.6	in bone turnover, the difference between healthy bone, osteopenia, and osteoporosis, and
1:57.7	when each diagnosis is made, major risk factors for low BMD, when to start
2:03.5	screening, sooner than most guidelines suggest, and how often to repeat Dexa, which type of exercises
2:10.4	best improve or preserve BMD, nutritional priorities for bone, how weight loss without resistance training accelerates bone loss
2:19.6	and why combining diet with heavy load exercise can offset it, pharmacologic options when lifestyle
	...

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