Bone Health with Dr. Lani Simpson: Rational Wellness Podcast 164
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Dr. Lani Simpson speaks about Bone Health with Dr. Ben Weitz.
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3:30 The standard American diet and our sedentary lifestyle significantly contribute to risk of osteoporosis. Dr. Simpson explained that she has osteoporosis and was diagnosed in her mid 40s, while she is now age 71. We build up 80% of our lifetime bone bass by the time we’re 18 and Dr. Simpson was not leading a healthy lifestyle at that time. She started smoking at age 12 and she was drinking and doing drugs but at least by age 21 she stopped doing those things and started living a clean life and eating well, which is probably why she has never sustained a fracture. Not only are these early years very important for building up bone, but women can also lose 20% of their bone during the first 5-7 years after menopause, so it is crucial for these women to have good levels of vitamin D and not have a lot of digestive issues as well.
6:53 The bone density test (DEXA scan) is a type of x-ray that measures the density of the bone, specifically in the hip and the spine and possibly also the forearm. Dr. Simpson pointed out that she often includes the forearm in the bone density tests that she usually orders for her patients. During a bone density test, the patient lies on a table and should be properly positioned with their hips internally rotated 15 degrees. If the hips are not properly positioned there can be a 7% difference in bone density and this can makes the difference in the recommendation for taking a medication or not. If the person has a lot of arthritis in the spine, it might appear to be more bone density due to the calcium in the bone spurs.
13:49 A patient with osteoporosis is defined as having a T-score of -2.5 or less, which means that they have 30% less bone than the average 30 year old. When you get your bone density measured it is important to go to the same lab and make sure the lab uses the same machine, since the results can vary. It’s also best to place the hips in a 90 degree angle when measuring the spine, since this will flatten the lumbar spine and prevent viewing L4 overlapping L5.
20:02 When analyzing a DEXA scan report, the T-score is comparing that person to a 30 year old bone density, whereas the Z-score compares their bone density to an age matched group. In general, a T-score of negative 1 to negative 2.4 is considered to have osteopenia or low bone density, while a T-score of negative 2.5 or less indicates osteoporosis. For women post menopause it is recommended to focus on the T-score, while for women prior to menopause, you should focus on the Z-score. For men after age 50, focus on the T-score, whereas prior to age 50, focus on the Z-score. To measure bone quality, when they get their DEXA scan we can also order a Trabecular Bone Score that measures bone quality, typically for an additional $150 or so.
26:04 If you see a loss of bone on a conventional x-ray, that’s osteoporosis, not osteopenia. It must be a significant loss of bone to be seen on x-ray.
27:05 Lab testing for bone health should include a metabolic panel, CBC, urinalysis, Vitamin D, 25 hydroxyvitamin D, and 1,25 hydroxyvitamin D. Full thyroid panel including TSH, Total T4, Free T4, Total T3, Free T3, Reverse T3 and the thyroid antibodies. Bone markers, including C-telopeptide (CTX) is the best one to look at osteoclastic activity, while P1Np and Osteocalcin both give you a sense of bone buildup, of osteoblastic activity. Urinary NTX is the least valuable bone marker to measure.
34:17 If you have a patient with severe osteoporosis, say a negative 3, 3.5, or 4 or they have cascading fractures in the spine one after another, they may need medication and Dr. Simpson prefers the use of Forteo over the bisphosphonates like Fosamax. Forteo upregulates both osteoblasts and osteoclasts, so you are going to lose and gain bone, but you will definitely end up with more bone. And Forteo has a very short half life, either seconds, minutes or a few hours at most.
36:43 Bone is like muscle in that we are constantly in a process of losing and gaining bone. Osteoclasts break down old, broken down bone, osteoblasts build new bone and the key that the proper balance be maintained. Bone gets broken down from the course of normal life, strain, etc., and the osteoclasts clear this out, so we can build new, stronger bone. That’s how our bone quality stays good. The most popular drugs for osteoporosis are the bisphosphonates like Fosamax and Actonel, which act by inhibiting osteoclasts. You get more density and for some patients in the right dosage and for the right period of time, these drugs can be helpful, but they tend to get a buildup of junky bone, so the bone quality tends to go down and that’s why some patients suffer unusual fractures, such as of having your femur snap in half. Dr. Simpson prefers drugs like Forteo or Tymlos, but some patients can’t take them, such as if they have had breast cancer, So if patients do take Fosamax or one of the bisphosphonates, they should be followed with the bone turnover markers and they should only take them for as long as they are effective and no longer, preferably for as short a period of time as possible. The common recommendation is just to take these bisphosphonates for 5 years and bone turnover markers are usually not followed.
Dr. Lani Simpson is a Doctor of Chiropractic and a Certified Clinical Densitometrist and Bone Health Expert. She is the author of Dr. Lani’s No Nonsense Bone Health Guide: The Truth About Density Testing, Osteoporosis Drugs, and Building Bone Quality at Any Age and of Dr. Lani’s No Nonsense SUN Health Guide: The Truth about Vitamin D, Sunscreen, Sensible Sun Exposure and Skin Cancer. Most importantly for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis and her website is LaniSimpson.com. The following is a special discount code to get Dr. Simpson’s book for only $15: 15 book A discount code will get you a discounted fee on Dr. Simpson’s masterclasses for only $25: 25 special
Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.
Dr. Weitz: Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talked to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcast and give us a ratings and review. If you’d like to see detailed show notes and a complete transcript, please go to my website, drweitz.com and if you’d like to see a video version of this podcast, go to my YouTube page Weitz Chiro.
Our topic for today is osteoporosis and bone health. Our special guest is Dr. Lani Simpson. Osteoporosis according to the International Osteoporosis Foundation literally means porous bone. It’s a disease in which the density and quality of bone are reduced. As bones become more porous and fragile the risk of fracture greatly increases. The loss of bone occurs silently and progressively and often there are no symptoms until the first fracture occurs. Worldwide, 1 in 3 women over the age of 50 and 1 in 5 men will experience osteoporotic fracture sometime in their life. Osteoporosis and low bone mass are currently estimated to be a major public health threat for almost 44 million US women and men age 50 and older. Overall, 80%, 75%, 70% and 58% of forearm, humerus, hip and spine fractures occur in women, especially women over the age of 65. A 10% loss of bone mass in the spine could double the risk of spinal fractures and a 10% loss of bone mass in the hip can result in 2-1/2 times the risk of hip fractures. Breaking a hip can be particularly disastrous as 24% of those who break a hip will die within the next 12 months.
Dr. Lani Simpson is a doctor of chiropractic and a certified clinical densitometrist. She’s the author of Dr. Lani’s No-Nonsense Bone Health Guide, The Truth About Density Testing, Osteoporosis Drugs and Building Bone Quality at Any Age, which is going to be the focus of most of our talk today. If Dr. Lani’s No-Nonsense SUN Health Guide, The Truth About Vitamin D, Sunscreen, Sensible Sun Exposure and Skin Cancer. By the way, after this podcast gets posted, any of the listeners if you go to the show notes there’ll be a discount to purchase both of these books. Dr. Lani is also the co-founder of the East Bay Menopause and PMS Center and of the East Bay Osteoporosis Diagnostic Center. Most importantly, for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis. Thank you for joining us today.
Dr. Simpson: It’s great to be here. It’s great to see you too.
Dr. Weitz: Good. Good. Good. How much does the standard American diet and our sedentary lifestyle contribute to our risk of osteoporosis?
Dr. Simpson: A lot. Just to give you a little brief in terms of my own situation and why I ended up with a diagnosis of osteoporosis. I was diagnosed in my mid-40s. I’m 71 now. I’ve never taken a bone drug. Why is that? We have to look at a lot of things. But one of the reasons I ended up with osteoporosis was not what I was doing in my 40s but what I did and didn’t do in my teens. Because we build up 80% of our lifetime bone mass by the time we’re 18 and there’s still some building that goes on until we’re around 30 years old. I didn’t do that time well. I started smoking at the age of 12. I was drinking, doing drugs. I mean I did a lot of things. In fact, it’s amazing my bones are as good as they are. But I stopped all that nasty stuff by the time I was about 21 and I got a clue. Now, I’ve never sustained a fracture. Why is that? I have osteoporosis. I’ve had it for years, still do. The reason I haven’t fractured, some of its genetics, some of it is just the fact that I’ve also been eating really well since the age of 21. My bone health I think has been pretty darn good because I eat well. I have nuts. Don’t eat inflammatory foods. Don’t drink alcohol. I mean I live a really clean life now. That helps boost bone quality. There’s two things in terms of this… Well, there’s a lot of stuff is involved with the strength of bone. Again, genetics plays a role. Having good density and also bone quality. So, quality means there’s still some flexibility. I’m very athletic at my age. I took a very bad fall a couple of years ago where I wrenched my ankle worse than I ever have. I thought for sure I’d fractured it. It didn’t fracture. It just says that there’s a lot to this bone stuff. I work with people every week. By the way, I have a group over on Facebook that’s a free group. It’s called Dr. Lani’s Osteoporosis Myths and Facts. I have about 1000 people over there. But I deal with fractures every day. It’s so preventable. If I may just say one more thing. One of the things I’m trying to really educate people about is the loss of bone. That women are going to incur at menopause. Their doctors don’t tell them, and then I end up, they end up coming to me in their late 50s and all of a sudden they’ve lost an additional, sometimes 20%. Women can lose 20% of their bone density in that 5-year, 5 to 7 years post menopause. Then, let’s say you add to this Dr. Weitz a vitamin D deficiency and going through menopause or digestive issues and going through menopause. Those are going to be the high losers. Diagnosis of osteoporosis doesn’t mean you’re losing. We can talk about that in a minute actively. But I can tell you during that time, for women, they are actively losing bone.
Dr. Weitz: Now, one of the things you mentioned which is that bone density which is one of the main tests to assess bone health is a measure of the amount of bone. But it doesn’t actually tell us that much about the bone flexibility or the bone quality. It’s too bad that I don’t believe there’s really a good test for that…
Dr. Simpson: No. There is. Let me tell you about that.
Dr. Weitz: Okay.
Dr. Simpson: Okay. There’s bone density and if we’re talking T-scores here because that’s how it’s measured. If you got a T-score negative 1, negative 2-
Dr. Weitz: So, maybe you can explain what a bone density test is.
Dr. Simpson: Yeah. Okay. Go ahead.
Dr. Weitz: Okay. No. A bone density test is you go in and they take some… Well, why don’t you explain exactly what a bone density test is?
Dr. Simpson: Okay. It’s very simple as you’re about to point out. You go in, there’s no… Because a lot of times people think it’s something invasive, it’s not. They’re on a table and it takes about 20 minutes to do a bone density. Typically, doctors order the spine, and when they do order the spine they only are getting L1 to L4. The reason for that is is because the lower spine doesn’t have ribs over it and the pelvis over it so you can get a clear shot. That’s why we do L1 to L4. Then, they do the femur or what’s known as the hip and in two areas. They’ll look at the neck of the femur and what we call the total hip area which is more of an area. Any one of those areas, you’re diagnosed with osteoporosis. You have osteoporosis. Okay. It’s not like you have osteoporosis in one area and not another typically. Sometimes you can have it in say an arm from a disused thing or something like that. But typically, it’s systemic. You can also do the forearm. I always order the forearm, by the way, doc, in addition to the hip and the spine. Now, the other test for the bone quality-
Dr. Weitz: What’s the advantage of ordering the forearm?
Dr. Simpson: Well, there’s a lot of information I can get. When I’m looking at bone densities, I’m looking at nuances. I’m looking at the images. It’s kind of like a small x-ray and all that. What the forearm gives me is the wrist measurement and the diagnosis though for osteoporosis in the, or bone density in the forearms and mid-forearm. That’s compact bone. Now, compact bone up until you’re 65 should be good. Everyone uses their arms, right? I had a case this week she had a negative 3.5 which is, if we’re just looking at numbers… I’ll talk percentages. About 45% less bone density didn’t have as 30-year-old. She shouldn’t have that. This woman is athletic. Why did she have it? Because she has a condition called primary hyperparathyroidism. What does that do? It goes after compact bone. But also this is another area for me to look at a combination bone. Mostly cancellous bone. Let’s say, for instance, you’ve got arthritis in the spine. You’re going to have a false negative reading. Meaning, it’s going to look like you have more bone density in the spine because you have osteoarthritis.
Dr. Weitz: Because you have the bone spurs and-
Dr. Simpson: Yeah. That’s right. For me, when I’m analyzing a case, when I’m looking at bone, I’m looking at very carefully at bone density. I can tell you that frankly they’re wrong most of the time. There’s errors I find almost on every case. It’s stunning but people do not have to be trained and be in these facilities, even the doctors. It’s just-
Dr. Weitz: So, you say in their report that comes with the bone density test is not giving you the most accurate information all the time?
Dr. Simpson: Well, in fact there’s two videos that are on YouTube about this. I’m saying to you and especially the hip. The hip measurement is commonly incorrect. Here’s where we get into troubles when you do comparisons because just the rotation of the hip can cause a 7% difference. Then, the doctor says, “Oh my god. You’ve lost 7% in the last year. You need to do a bone drug when they haven’t actually lost. There’s a lot about this bone business, but I want to go back from them just to tell you about the bone quality test. It’s called trabecular bone score. Now, that means cancellous bone. What they’re going to be doing is looking… They can do this, it’s done on a bone density machine. But not very many places have it. Kaiser doesn’t have it. We’re in California and they don’t have it. The reason they don’t is because it costs $10,000 to buy the software to give them this information. There’s also a video on YouTube that I did where I interviewed the Swedish doctor who developed the software. What I can tell you, Dr. Weitz, is that when I look at bone density, I take history. I question thoroughly about fractures if they’ve had them. I look at that bone quality. Then, I feel prepared to make decisions. You got a lot of people in the gray area. Does someone need a medication or not? The answer to that is medications are needed by some people for sure, and then which ones? I mean, again, there’s a lot to think about and a full lab workup is very extensive.
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Now, back to our discussion.
Dr. Weitz: You want to talk about what a full lab workup is for a patient [crosstalk 00:13:54]
Dr. Simpson: Okay. Well, of course if somebody comes in… Well, everyone pretty much who finds me has osteoporosis. They’ve had a bone density they come to me, right? Beyond bone-
Dr. Weitz: On a bone densitometry test that’s a T-score of minus 2.5 or greater?
Dr. Simpson: Yeah or lower you would say, actually.
Dr. Weitz: Or lower. Okay.
Dr. Simpson: Negative 2.5 that each standard deviation is about 12%. You’re looking at about 30% less bone density than an average 30-year-old. Somebody could live their entire life with that. It depends on bone quality. It depends on a lot of things. But now let’s say you have a negative 4. That is a whole different story. You are not going to reverse that despite what you see on the internet about OsteoStrong or a lot of these companies that are putting out false information. You are not going to be able to reverse that. You’ve got a 60-year-old person. You don’t have the advantage of bone building hormones that are happening all the time. You got a 60-year-old person, you’re not going to reverse osteoporosis at that level. You can maybe halt it. Here’s who I can halt it in. People who are having what we call normal age-related loss, which I don’t really like that term but that’s 0.5 to 1% a year. But you think about this. Dr. Weitz, just add that up over 10 years. So, this somebody is not exercising because they just don’t or they can only do some what because they’ve got a foot problem or a knee problem. I mean you get my point here.
Dr. Weitz: Oh, I’ve heard that plenty of times. Yeah. Yeah. Yeah.
Dr. Simpson: Yeah.
Dr. Weitz: Just talking to patients everyday.
Dr. Simpson: They will lose and especially the small women. They are going to lose.
Dr. Weitz: By the way, I think maybe before we get to the lab testing, since we’ve been talking about bone density test, why don’t we go over some of the issues with bone density test first?
Dr. Simpson: Sure you want to go there?
Dr. Weitz: Well, because you were mentioning like the positioning area. What are some of the important things about the way the person gets positioned about the bone density test?
Dr. Simpson: I advise people get my book and in the book it tells you what to say when you go in to try to get the best bone density. I mean one of the things I tell people to say is my doctor suggests that you really make sure you’ve got that hip rotation right. You put them on and then, “Oh, somebody’s paying attention.”
Dr. Weitz: They’re positioned on a table and their legs are supposed to be against something, and then their feet are supposed to be rotated a certain degree, right?
Dr. Simpson: If you can. Sometimes you can’t rotate people. But, yeah. Again, this all pictured in my book and I’ll highly recommend it. You’re not going to get that whole picture from this discussion but that’s it. Yes.
Dr. Weitz: Do all the labs have that positioning?
Dr. Simpson: They have it. Do they use it?
Dr. Weitz: Oh. Okay.
Dr. Simpson: If you’re doing things quickly, a lot of times they don’t use it. Here’s the thing, again, to really get the technicians must often have not been trained. It’s not required. The doctors are not required to be trained and even the radiologists who do this lack training. They don’t even know how to interpret.
Dr. Weitz: I believe you said that the hips are supposed to be like internally rotated 15 degrees. Yeah.
Dr. Simpson: 15 degrees. They have a little thing that you put your feet in. When you’re on your back, although a lot of places don’t do this. I prefer it this way. But depends on the type of machine. There’s GE Lunar, there’s Hologic, there’s Norland. Most common is Hologic and GE Lunar but I like it best and Hologic typically does this when they put your knees, your lower leg up so that your legs are like that.
Dr. Weitz: Right. 90 degree angle with the hips-
Dr. Simpson: That’s what flattens the spine to the table. That’s going to get a more… Because a lot of times when they don’t do that, what you see is the lumbar vertebrae.
Dr. Weitz: [crosstalk 00:18:13]
Dr. Simpson: The lumbar vertebra half the size because it’s overlapping L5.
Dr. Weitz: Right.
Dr. Simpson: Then, let’s say the next time they have a bone density test the person didn’t do that. The density is going to, the comparison’s wrong. See my point? Yeah.
Dr. Weitz: There’s a lot of very subtle positioning differences that can change the results. The results will change if you’re in a different machine. Therefore, going to the same lab but even if you go to the same lab they might put you in a different machine.
Dr. Simpson: Well, you want to ask, good question. Yes. Kaiser does this a lot. When you go in say, “I’d like to be put on the same machine.” They may have it right in the room and still not put you on the same machine. Because when you are not on the same machine, you can have 2% to 3% to 5% difference just based on the machine itself. How often it was-
Dr. Weitz: Calibrated?
Dr. Simpson: Calibrated. Yes. Finish my sentences at any time.
Dr. Weitz: Thank you.
Dr. Simpson: I do actually… I used to hate people like that. Now, they’re my best friends. Yeah. You’ve just got to kind of do the best you can with getting through this. Again, our bones, we all have to get through this lifetime with pretty good bones. I mean that’s the name of the game. I mean you want physical independence that’s what we want. As you point out, those hip fractures change a person’s life. It might not kill them but you know that a lot of times the hip, the leg lengths may be different, a lot of different things can happen.
Dr. Weitz: When you’re looking at the report, the analysis of the dexa bone scan, the T-score is comparing them to a 30-year-old, correct?
Dr. Simpson: Yes. That’s correct.
Dr. Weitz: Then, what is the Z-score and how important is a T-score versus the Z-score? I’ve kind of been trained to just look at the T-score but-
Dr. Simpson: No. That’s correct. Except, okay, so women post-menopause regardless of age, you look at T-score. Women prior to menopause, Z-score. Men after the age of 50, T-score. Before that, Z-score. I don’t always pay attention to those hard lines because I know how to look at all this stuff. But the reason they have it like that is because that’s what’s been studied.
Dr. Weitz: We just described what the T-score is, what’s the Z-score?
Dr. Simpson: It’s age matched. It’s still the same difference, but you’re now looking at age matched. Then, a lot of people say, “Oh, well, it makes much more sense to do an age matched. I’m 60 years old. I’m not 30.” Well, I don’t want to be measured up against a average 60-year-old. I want to see how far I’ve come from an average 30-year-old. Now, let me give you another interesting tidbit. I’m 5’6 but my wrist size is 5 inches. I have tiny bones. My wrist size is not an average 30-year-old. That’s about six inches, okay? Some of my bone density as what we call false positive. I didn’t lose it. This is why I’m saying earlier, having a diagnosis of osteoporosis does not mean you’re actively losing. But anyway, I didn’t gain this because my bones are smaller. That’s about maybe 8% to 10% of my case. That said, smaller bones are at higher risk for fracture because there’s just smaller. I can jump just for a moment to the lab tests if you want me to do now because we’re talking about active bone loss.
Dr. Weitz: Yeah.
Dr. Simpson: You want to finish up or you have any other questions there?
Dr. Weitz: On the bone densitometry. Well, let’s see. What else do we want to talk about? What does the Z-score, and so Z-score, you’re comparing someone of the same age.
Dr. Simpson: Correct.
Dr. Weitz: What if there’s a discrepancy between the T-score and the Z-score?
Dr. Simpson: It depends on the age but you’re not going to see much. A lot of times like say if the woman is 30. You look at the teen and see it’s going to be pretty similar. But, again, as we get older that shift is going to happen between that T-score is going to be lower than the Z-score. If you have a 60-year-old woman, the Z-score could look normal. But if you look at that T-score, it’s going to show her well into osteoporosis.
Dr. Weitz: So, anything greater than minus or less than minus 1.5, we consider low bone density or osteopenia and then-
Dr. Simpson: Osteopenia is a misnomer. It’s kind of. It was never meant to be a diagnosis. So, negative 1 to negative 2.4 is osteopenia. If you want to use that term.
Dr. Weitz: Okay.
Dr. Simpson: Yeah. Or low bone density. Now, I did a whole webinar just on this topic of gray area. Because I also have a lot of patients, Dr. Weitz that have normal bone density and fracture and what does that say? That says several things that it could just be their bone quality is that poor. Some people can have good density but the quality of it, it’s like a piece of chalk. It can break. It’s dense. But it can break. But that said, the most typical thing I see when people start breaking and is low bone density and low, and often they’re going to have poor bone quality in the TBS score if I can get it. Because look, in California, we can typically find a place. But it can be hard to find.
Dr. Weitz: So, essentially, when we send them for the bone density scan, we ask for… What do we ask for to get a quality test?
Dr. Simpson: Well, first of all, the doctor has to be on board and a lot of them aren’t. A lot of them do not value the TBS score. I can tell you that tide is beginning to shift. I’m in a group of a hundred, probably more than that, top bone doctors in the country, and boy, did they use it as they have it. Because it just adds to the picture.
Dr. Weitz: If the patients have to pay extra for it, how much would… Is it an expensive addition?
Dr. Simpson: Well, you’re still going to have to order it. It’s not covered by insurance. It’s up to maybe $150.
Dr. Weitz: Okay. Yeah. I ordered a bone density test over here.
Dr. Simpson: Now, here’s another thing for people to know. If you don’t have insurance, don’t get a bone density test at a hospital. They can cost you as much as 1200 bucks. In other places it’s 300.
Dr. Weitz: Oh, so go to an outside lab rather than the hospital.
Dr. Simpson: An outside imaging facility. You might want to ask, “Are you ISCD certified?” Probably not but that’s my governing body, the International Society of Clinical Densitometry and if they’ve been trained that way, you’re likely to get a better technique. It doesn’t mean you’re not going to get someone that’s pretty good because if they’re really good they’ve actually studied what they’re doing and read the book. You can see it. It’s right there in the books, but training helps as you know. I mean it’s sort of like learning chiropractic from books. It’s different.
Dr. Weitz: Now, if you get a patient who has a conventional x-ray that shows a loss of bone, what does that mean?
Dr. Simpson: Oh, that’s osteoporosis. It’s not osteopenia. For you to see that on x-ray and that’s a very good point. Anytime on x-ray the word osteopenia is on the diagnosis. That is not osteopenia. It’s osteoporosis. Because you can’t see… In order to see anything in terms of bone on an x-ray you have to have about 40% if not more, less bone density, notice I’m not saying loss, but less bone density to be able to see it on x-ray. It’s missed on x-ray a lot. But that term is as you know has been used since we were in school but it doesn’t reflect really what the truth is.
Dr. Weitz: So bottom line if you see an x-ray of the spine or whatever it is and you see a loss of bone. That’s really significant. There’s no way it’s just a small minor-
Dr. Simpson: Oh no. It’s a big deal.
Dr. Weitz: Okay. Let’s go into the lab testing for a full workup for somebody with osteoporosis or bone loss.
Dr. Simpson: Okay. Well, we could be here for a long time.
Dr. Weitz: okay. So maybe some of the highlights.
Dr. Simpson: Okay. Again, there’s a whole chapter about this in my book but basic would be I’m going to get a comprehensive metabolic panel. CBC, the basics. Now, let’s say I’ve got somebody who has… It really depends on how severe the case is and what’s going on. Let’s say the person has digestive problems. I’m really concerned that this probably potential loss and also they’re just not absorbing right. But if I’ve got a case, I’ve got one bone density, it’s negative 2.5, I don’t know when that happened. Maybe it happened like me in my teens. I didn’t gain. Therefore, I’ve got to order more lab tests to determine whether or not active loss is occurring. A lot of people think, and I remember when I was diagnosed. I thought I was peeing out my bone every day. I just freaked out. I wasn’t actually losing at that time. I do the comprehensive metabolic panel 14. That’s the one I ordered. CBC, I do basic urinalysis, and then everyone’s going to get this, a vitamin D test, the 25 hydroxy vitamin D. Typically, by the way, I also… Because my new book is a lot about vitamin D. But I also order the 125 vitamin D and you have to know how to look at that. But the point is, I do order that on my osteoporosis patients. I’m going to order parathyroid test with calcium. It’s called intact parathyroid intact with calcium.
Dr. Weitz: So, analyzing calcium levels that’s something at [crosstalk 00:29:09]-
Dr. Simpson: I’m going to get back to that in a moment. Let me [crosstalk 00:29:10]
Dr. Weitz: … different point. Okay.
Dr. Simpson: Then, depending on what they say to me in terms… Because I take like a seven-page history along, have them write down everything they eat for a week and all that depth and forms. What I may do next? I might be thinking that person has thyroid disease. Because what people have to understand is that everything affects the bone. I’ve got to do a comprehensive evaluation. You’re smiling because you know what I’m talking about.
Dr. Weitz: Yeah. It’s what we call functional medicine.
Dr. Simpson: There you go. Okay. I have to look at all systems. As you know, in thyroid testing, they’re only going to do the TSH and the total of T4. I’m going to do free T3, free T4, TSH, total T4, total T3, and then I’m going to do reverse T3. Although I rarely find that by the way. I’m going to test the-
Dr. Weitz: Antibodies.
Dr. Simpson: … the thyroid antibody test. Because it’s that important. The third time in a woman’s life where she’s most likely to present with thyroid because puberty, pregnancy, perimenopause, menopause that’s when women express and so much more common in women. But I catch it with men too because I look for it, right? Because it’s not often looked for men anyway. Thyroid is one, parathyroid, I’m going to look at the kidneys. I’m going to do a 24-hour urine. That’s a basic test.
Then, I’m going to do bone markers. There could be a whole bunch of other tests. These are the basics I’m giving you. But bone markers are critical. You’re going to read or hear some doctors say, “Oh, I don’t order those. They don’t mean anything.” BS. I am so tired of hearing that. I can tell you that no top doctor who’s really evaluating bone doesn’t use them that I’m aware of, okay? That would be the C-telopeptide or CTX is the best one to look at osteo classic activity in terms of bone breakdown. But we’re really looking at bone turnover. The P1NP, so those two are always going to, and osteocalcin, I’m always going to order those. Osteocalcin is also, gives us a sense of buildup, P1NP does also. But you know what? If Osteocalcin is high… Well, let me just go to, I have to explain too much. The P1NP if that’s elevated or high end of normal, a lot of docs just used that. I don’t agree with that. But that typically is used to also follow anabolic medication such as Forteo and Tymlos because it’s showing osteoblastic activity. What I want to look at is bone turnover. The minimum I would order with bone markers would be the CTX, P1NP, and the only reason I might not order osteocalcin on the other ones because they can’t afford it. But osteocalcin would be in there and also an NTX, which is the least valuable but that’s what everybody orders. Often, they’re the one.
Dr. Weitz: The NTX is usually by urine, is that the one?
Dr. Simpson: There’s three. There’s a 24-hour NTX, don’t do that one. There’s a blood NTX, don’t do that one. The one to do is the random second catch. Now, a lot of doctors think it’s the better one but they say, “Well, some…” A lot of women this is true, you have to think about your patient may have trouble actually getting the second catch. If you’ve got somebody who has Parkinson’s, you’ve got somebody who has problems with, they might not be able to get the second catch, then do one of the other ones. But what I like to do is look at all of those together. That gives me an inside look that day of the workings of the bone. They’re not 100% accurate. But let’s say that CTX comes in at 700D and the NTX comes in on that high end also. Then, I know, I’m looking at active loss.
Dr. Weitz: Basically these markers of bone turnover are telling you, first you found out that you have some bone loss and now they’re telling you, right now are you in the process of losing, gaining or staying the same as far-
Dr. Simpson: Well, they don’t typically look at that. If you go to Kaiser, what you’re going to get is a diagnosis of osteoporosis, none of this kind of testing other than maybe the metabolic panel. You’re going to be put on Fosamax for five years and told to come back for a bone density test in five years. That’s absurd because in three months if somebody does require medication or let’s say they’re borderline. You say to yourself, “Well, this person’s borderline. They’ve never had a fracture. Their bone markers are a little high. I think I can handle this with this patient because they’re willing to work on nutrition and supplements and exercise. Let’s see if we can bring it down.” I do it all the time with people.
Dr. Weitz: Of course.
Dr. Simpson: Yeah. But let’s say we have somebody who’s a negative 3, negative 3.5, negative 4 becomes different. But there’s never a time where the foundation of what I do with patients is always nutrition, gastrointestinal health, exercise, and anything else that’s going on. Then, when medications are needed, the right medication and they’re … I can just tell you and I used to be anti-medication but medications when… I’ve seen people who are in what we call cascading fractures in the spine one after the other. It’s a scary situation and Forteo will stop it. You have pregnancy osteoporosis or women are fracturing giving birth. I get these patients. I see them.
Dr. Weitz: Forteo, you just mentioned is a medication that increases osteoblastic activity?
Dr. Simpson: It’s an amazing medication. But, again, and I want to say this. This is after a full evaluation has been done with somebody because if secondary causes are not fixed, those are the people who say, “Oh, I took Forteo. It didn’t do anything for me.” Well, they didn’t maybe fix the thyroid problem you have anyway. But, yeah. Dr. Claude Arnaud, who wrote the foreword to my book was my mentor for 20 years. He developed Forteo. Principal developer of Forteo. So, I was back there actually in the ’90s when this was being tested. Everyone was just blown away by what it was doing because it has short half-life. Fosamax has a half-life of 12 years. Forteo, we used to think had a half-life of seconds. But it can be minutes or hours. But the point is it has a relatively short half-life. It goes through the body and up regulates osteoclasts and osteoblasts, both of them. You’re going to lose bone and gain bone. But the osteoblasts are going to win out. But what the end result is going to be is that it’s gone after the old bone, got more, with more damaged bone and laid down new bones. It does a remarkable job with that. Yes. You’ve got to follow up with other things. I mean, again, all these areas are huge conversations.
Dr. Weitz: For patients who might be listening or practitioners who are not aware of these as we go through our life, it’s not just a question of you gaining bone up to a certain age, and then after that you just lose bone. Bone is like your muscles, we’re constantly in a process of losing and gaining bone. It’s more of a question of the balance. At any one point in time, we have osteoclasts breaking down bone that’s been damaged from the course of life and strain and et cetera. Then, we have osteoblasts that are building new bone. It’s really a question of that.
Dr. Simpson: Wait. That’s how our bone quality stays good.
Dr. Weitz: Right.
Dr. Simpson: By getting rid of old bone laying down new bone. That was a mistake when they were giving the bisphosphonates like Fosamax and the other drugs that we [crosstalk 00:37:39]-
Dr. Weitz: Yes. So, bisphosphonates is the most common category of prescription pharmaceutical drugs for improving bone density. As you mentioned, Fosamax and Actonel and there’s a whole series of these drugs and maybe you can explain what they do and what the problem is with these drugs.
Dr. Simpson: What we discovered was back in the ’90s, they were giving it out like candy. They were giving it as a prevention. I have a really good video with Dr. Jennifer Schneider who’s an internist and here’s her story. She was on a subway in New York, she’d been taking Fosamax for a long time. She’s having some thigh pain. She was on it for maybe five years and how when you stop on either a BART train or like in a subway, you kind of [inaudible 00:38:39] but her femur snapped in half.
Dr. Weitz: Wow.
Dr. Simpson: Now, after many of those started showing up they started getting a clue. But I’ll tell you something, doc. I predicted this back in the ’90s and I don’t think it’s because I’m that smart. It’s because I know that what they do is go after the osteoclasts and the osteoclasts are there for a purpose, to get rid of old bone. So, if you are too successful at suppressing those, you do it for too long and you’re not following bone markers… I’m going back to bone markers again. You overly suppress that bone. You’re not following bone markers because you don’t know what the hell you’re doing and what’s going to happen for a small percentage of people, but it still happens, they’re going to have more fragile bones. Why is it though and I’ll say this too, I’ve seen people who’ve been on it for 15 years, never had a fracture who come to me and I might freaked out. I’ll get them off. Help them get off of it. But-
Dr. Weitz: Because the current protocol is you should only be on a bisphosphonate for five years, is that correct?
Dr. Simpson: No. Well, that’s not my protocol. The current protocol should be with any medication what the bone markers tell you. You follow people with bone markers. The same thing even when you’re doing Forteo or Prolia, which I’m not a fan of. I’m just saying. Prolia injections, it does the same in a different way. But it goes after osteoclasts primarily. The recommendation by the companies do it every six months. Well, that’s lazy. No. Do the bone markers. Give the injection when the bone markers and maybe it’s nine months it starts, the turnover starts. But I’m not a huge fan of that. But also I might say too that and bisphosphonates and even Prolia. The first year, you’re going to have a kick in osteoblasts, and then you’re not going to have that. But there is a kick that does happen kind of through the backdoor in a way. I did want to mention that because a lot of people are unaware of that. Fosamax, I’ve learned that there are appropriate times for it. If you’re watching bone markers and you’re careful if that patient, it just depends. Maybe they can’t take Forteo or Tymlos because they’ve had breast cancer. Again, you’ve got a lot of things to think about.
Dr. Weitz: Your favorite drugs for patients with osteoporosis after you’ve done your nutritional protocol is Forteo and-
Dr. Simpson: Well, if it’s clinically appropriate. That my favorite drug is the one that is needed for that patient. It could be a bisphosphonate, even Reclast which is the yearly infusion. But there’s a way to get to that point. I would never like to see anyone just start on Reclast. I just had a patient the other day, negative 2.5. They’ve recommended the heavy-hitter without doing any bone markers or anything. I’m like, “This is ridiculous.” There’s a place for it. Again, it’s a longer conversation. But there’s a whole chapter of that in my book too, about medications that you can get a pretty good, a few of.
Dr. Weitz: But, in general, it sounds like you would prefer not to use a bisphosphonate unless that was absolutely necessary.
Dr. Simpson: In my perfect world if somebody, it’s not contraindicated to do an anabolic. I would prefer doing anabolic first because, let’s say you do it the other way around. Someone’s on Fosamax. Then, they got put on Forteo, it’s not going to have as big of an effect. Yeah. In my perfect world I’d want to build up the bone, help that bone stay there. You’re going to have to give them Fosamax or something or even hormones, by the way, bioidentical hormones for about a year.
Watch the bone markers. Make sure they stay stable. Then, you have to just watch bone markers over time. You may have somebody because you have these patients where you can’t correct a digestive problem. They have malabsorption really or they have horrible anxiety that just that you do your best, right? We have those patients.
Dr. Weitz: Right.
Dr. Simpson: Those folks may need more medication because they’re just unable whatever reason, physically or otherwise to handle what’s causing the bone loss. The stress and anxiety is a huge, huge impact on bone.
Dr. Weitz: We’re on lab testing and one of the things a lot of people would like to know is do I have enough calcium? Then, sometimes the patients will say, “Well, I had my serum calcium done and it says that’s normal. So, I don’t need calcium.”
Dr. Simpson: Oh, boy. Can we do another hour on this? No. Okay. In my new book I tackled this a lot more because I don’t think anyone should be taking vitamin D over 2000 and they even would question that honestly without taking the calcium level too. That’s because primary hyperparathyroidism, maybe I could argue well before early and 30 is fine. Because it comes on more as people are aging, parathyroid issue. But some people are, and the other big reason and I can tell you, I’ve had a lot of these people. When they take vitamin D and they’re over 50 ng/ml. Okay. The blood measurement nanograms per milliliter or in animals, it’s too tight. I’m not going to give the how to do the equation.
Dr. Weitz: Yeah. We’ll stick with the nanograms per milliliter.
Dr. Simpson: Nanograms per milliliter. Their blood calcium level will go up. You don’t want that blood calcium to be on the high end of normal. I don’t like high circulating calcium. I like to see it around 9.5 or 9.3, 9.5 is my sweet spot. I don’t want to see these people running around with 10. I interviewed one of the top bone, excuse me, repair thyroid surgeons in the country. We compared notes. If you’ve got someone let’s say a high end to normal calcium. That is never good. Never good. You cannot give people more vitamin D if they have that. You have to see, is it vitamin D causing it or is it primary hyperparathyroidism? Because she says anyone over 60 with high-end and normal calcium 10 is highly suspect of having an adenoma. They’re not cancerous but they are small tumors or enlargements of this very tiny parathyroid gland, which there’s four of them in the neck. So can be either that or can be high serum calcium in addition to that. By the way, I also order ionized calcium. That’s a basic order for me. So, ionized calcium because it’s that free and available calcium. It’s just a little different.
Dr. Weitz: Yeah. I’m familiar with that ionized calcium. But I noted in your book, you also talked about possibly a 24-hour calcium-
Dr. Simpson: Yeah. The 24-hour urine.
Dr. Weitz: 24-hour urine calcium.
Dr. Simpson: Yeah. That’s an interesting one too. Sometimes I will order three of them. I also interviewed one of the top nephrologists in the country about this and sometimes I have to order three of those to get what’s really going on. I might order the first 24-hour urine not change anything. Don’t tell them to go off calcium supplement is nothing. See what it is. Comes back 500 or 600. Whoa. Yeah. There’s a problem or they’re taking way too much calcium. Then, you want to do the next one where you have them not calcium for, calcium supplements or high calcium foods to make sure it’s not a kidney problem.
Dr. Weitz: Now, what you were just saying about vitamin D I didn’t quite get. You’re saying you think it’s dangerous to take too high a level of vitamin D for what reason?
Dr. Simpson: I’ve completely changed my viewpoint about vitamin D and how to correct a deficiency, number one. But it’s a hormone as you know. It’s in the androgen family. It’s a [inaudible 00:47:24] hormone. It’s a powerful hormone. Let’s say somebody’s been deficient for 30 years, which is likely in North America. Now, all of a sudden you’re giving him 10,000 a day. A lot of alternative doctors do. What’s the freaking hurry? What’s going to happen when that six week hits to two months and it becomes active? Oh my goodness. It’s just like, “Let’s have that flood of calcium come in.” Well, if you haven’t corrected the inflammatory issues in the diet and everything else that patient can end up in trouble as far as I’m concerned. I go more slowly with people. If they’re deficient I give him 2000. So 1000 should increase the blood level 10 nanograms per milliliter. Again, this is just me and a lot of people still feel very differently about it.
Dr. Weitz: I have to say I get a lot of patients and they’ve gone to their MD and had their vitamin D levels measured and they were 20 or 25 and they took 1000 and they went up to 26, really did nothing, maybe they took 2000. I find until we get them up to 5000 or 10,000, we don’t really see those vitamin D levels go up to the [crosstalk 00:48:42]-
Dr. Simpson: No. That’s not true.
Dr. Weitz: … range.
Dr. Simpson: That’s not true. Here’s the problem. They have to take it with fat.
Dr. Weitz: Right. I understand.
Dr. Simpson: Then, they have to have no problems with digestion. I’ve done this for so long that I’m utterly convinced that either they’re not getting a fat meal with it or the vitamin itself is incorrect. By the way, this vitamin D, the measurement in that, what’s in the bottle is commonly incorrect.
Dr. Weitz: Really?
Dr. Simpson: Yeah. I can’t remember the doctor’s name right now. I’ll remember it after we get done. But one of the most notable cases, you’d know him if I could remember his name. Instead of 2000 I used, there was 2 million.
Dr. Weitz: Right.
Dr. Simpson: You know I’m talking about?
Dr. Weitz: Yeah.
Dr. Simpson: But-
Dr. Weitz: Gary-
Dr. Simpson: N. Starts with an N.
Dr. Weitz: Yeah.
Dr. Simpson: Okay. You know what? But the point is that’s how it can be wrong. So, there are many things I think about with vitamin D. But if you give somebody 5000, that would get them to 50 because if they’re 20, it should get them to 70. So, unless there’s something wrong with the supplement or their digestion or fat, it should raise it.
Dr. Weitz: Okay. 2000 vitamin D, what about taking calcium? Does calcium cause cardiovascular disease? How much calcium do they need?
Dr. Simpson: Okay. I wrote an article on that. It’s in Huffington Post and that came out years ago when my position’s still the same. Here’s what the doctors are saying to patients [inaudible 00:50:17]. “Get all your calcium from your food. Get all your calcium from your food.” “Well, I don’t eat dairy. Am I getting all my calcium from my food? Do I really want to drink green smoothies that are full of oxalates?” We can go way into a lot of different content here. But I take calcium citrate. I do it in powder form and when I do, when you do take calcium, you only do it in small amounts. When they look back at those meta-analysis, Dr. Weitz, they’re looking at high dosing of calcium carbonate, which is the wrong one, we both know it.
Dr. Weitz: Yeah.
Dr. Simpson: They were giving it to them all at once. They never tell… So, could that be the reason that it showed that some people and they didn’t remove inflammatory diets. It’s not a functional medicine approach shall we say to be nice about it.
Dr. Weitz: Right. What’s a moderate dosage of calcium? 200, 500-
Dr. Simpson: No. It’s individual. In my case, I do… Because I do non-dairy. I eat a small amount of food. I don’t really don’t take in a lot. I’m a small person. A lot of the people come to me that way so it depends on the person. But what you want to think of and how I get my patients to think because I teach them is that you want to get about 12,000 a day of calcium. Now, if they have Crohn’s disease, if they’ve got something else, we might have to up it. Again, you got to look at all the different factors for each person. But around 1200 from all sources is good. If you are taking it, I try to keep it at around 200.
Dr. Weitz: [crosstalk 00:51:57]
Dr. Simpson: At a time. I take 600 so I’m taking it… I get a calcium citrate, put it in water and I drink it.
Dr. Weitz: Do you add magnesium at the same time?
Dr. Simpson: Well, that [inaudible 00:52:08].
Dr. Weitz: Two to one or what?
Dr. Simpson: I’m going to turn the tables on you. I’m going to turn the tables on you. Okay. There’s always that question, should you take… Do the two cancel each other out if you take it together? In other words, calcium and magnesium or do you take it separately?
Dr. Weitz: They help each other, don’t they?
Dr. Simpson: Well, depending on who you’re talking to and I’m in kind of in agreement with you. But I see it written a lot both ways and I’ve talked to a lot of chemists about this. They said, “No. Really. I mean to some extent it does.” But if you also look in nature other than dairy, you look at nettles, you look at oat straw, you look at a lot of different herbs that have a lot of calcium. They always have magnesium also. One of the biggest problems and I know you know this because we become gods to some patients. Patients who have suffered so much constipation because they have no magnesium and they are just blown away than in a week, we can cure that, and more water. I mean a lot of people it’s that simple, right?
Dr. Weitz: Yeah. Vitamin K.
Dr. Simpson: Okay. So, and K2.
Dr. Weitz: Can we measure vitamin K? By the way, should that be part of your lab panel?
Dr. Simpson: That test doesn’t really work. I interviewed also the woman who wrote the book. I know Kate something. I can’t remember. The vitamin K book she wrote that. Yeah. So that test doesn’t turn out to be that great. But osteocalcin is a bit of a marker because vitamin K increases osteocalcin activity. Honestly, I don’t worry about any of that. I just want people to take it. Why do I want them to take it? Because vitamin K has been shown in multiple studies at this point, not enormous studies but there’s enough I’m convinced that, and vitamin K2, MK7, MK4, I’ll talk about the two. Basically, and this is just people in the audience but basically helps bone take up calcium. This could be the missing link when you’re talking about people gobbling, taking high doses of vitamin D, they’re increasing calcium absorption by 50%, and on top of it they’re taking calcium. But they’re also not taking vitamin K.
Dr. Weitz: Right.
Dr. Simpson: Eating, again, inflammatory foods. Is that a set up for heart and artery problems?
Dr. Weitz: Right. Because one of the things that vitamin K does is reduces the potential for arterial calcification.
Dr. Simpson: Right. By the method I just said-
Dr. Weitz: Right. About regulating osteocalcin. Yes.
Dr. Simpson: The interesting thing about osteocalcin is the discovery that osteocalcin, that that was occurring in bone makes bone actually part of the endocrine system. It’s a gland. It’s a rigid gland. When you think of it that way, I mean I have such a respect for bone. It does so much and most people just think it’s just kind of sitting there. But it’s so active. I mean it’s really amazing. But then we have MK7 and MK4.
Dr. Weitz: Most of the supplements have MK7, but apparently most of the studies were done with MK4, right?
Dr. Simpson: That’s right. MK4, you’d be doing, by the study, about 670 milligrams of MK4 three times a day because it doesn’t stay in the system long enough. So, MK7 came about and got promoted a lot through the Canadian writer. She wrote the book, I just wish I could remember her name because I want to promote her book. Vitamin K, MK7 came along, it has a longer tail on it and it lasts longer in the system. Now, that’s in micrograms. So, when you ever see MK4 in micrograms, it’s not doing much. I mean it’s like not much. But MK7, minimum 100 milligrams a day or up to 180 for some people. But here’s the interesting thing. For some people it can cause insomnia. I have heard it enough and I just had a case last week where the patient was like, “I just can’t sleep. My skin is crawling. I cannot sleep at night.” We went back and forth with the MK7. It was definitely MK7. I’ve heard it enough. I’ve not seen studies show this and Kate said this too. The woman who wrote the book. She says, “I’ve seen it enough too that I think in some people that’s happening. So, if you’re taking MK7, do it early in the morning.” I’ll tell you something, in the near future I’m doing a whole webinar on the MK case myself. I’m leaning more towards MK4, again, as a treatment.
Dr. Weitz: On the other hand, MK7 has a lot of cardiovascular benefits.
Dr. Simpson: Well, they both do.
Dr. Weitz: But I think MK7 has more data on the cardiovascular.
Dr. Simpson: Well, MK4… No. They’re doing the same thing by the osteocalcin.
Dr. Weitz: Okay.
Dr. Simpson: It’s the same route. But MK4, and MK4 by the way, we actually produce it and interestingly enough in our large intestine too.
Dr. Weitz: Right. Gut bacteria.
Dr. Simpson: Yeah. It’s kind of interesting. Not much. I mean it doesn’t do that much but MK4 as you point out has been the most studied and my view might change on it in the near future. I have to kind of go back every now and then, as you know new stuff comes out. I got to go back and look at everything. Yeah.
Dr. Weitz: So, let’s say you have somebody and you have them on a nutritional protocol and just to finish up the supplement and I know once, again, everyone these topics we could talk another hour-
Dr. Simpson: Yeah, and I got to stop in about five minutes so…
Dr. Weitz: Oh, okay.
Dr. Simpson: Yeah.
Dr. Weitz: If there were one or two other supplements besides taking vitamin D, vitamin K2, calcium and magnesium, what would those be?
Dr. Simpson: Sometimes a protein supplement depending on the person. I’ll tell you something. I see quite commonly in my demographic of small women. Now, I get those are the prime. The osteoporotic patients I get are typically not diabetic. I get the small women who read, who are really in… Not that the diabetic people don’t read. I’m just saying I get a certain demographic. Small people don’t eat as much. They just don’t. So, sometimes they need a protein something. Okay? Boron, 3 to 6 milligrams a day. I want to have a full range of the B vitamins. I mean I think you should do. You and I are both going to go over diet, try to get as much as we can, people to look at diet and to get as much as they can from diet, and then we supplement from there. I mean there’s so many things you have to discover about bone. But, for instance, B12 is another one. B12 is important for them. B12, we now also know that if it’s too high is not good for bone. I keep learning that one too. So, I’d like I like to see B12 kind of in the upper three-fourths of the range, not high anymore.
Dr. Weitz: I have to say when we do serum B12 and B6, I’m seeing a lot of people high.
Dr. Simpson: Me too. B6, by the way, I’m glad you mention that. Because we now know that B6, you’ve got to go off of all B6 for about three or four days before you get tested for thyroid as well as that CTX.
Dr. Weitz: Got to go off of B6 before you take thyroid testing?
Dr. Simpson: Yeah, and also CTX. Now, the thyroid we thought about, that was true for a long time but Quest just came out with this in terms of the CTX test it’s influencing that. I tend to take people off of supplements unless it’s really important for them to be off of it for a couple days at least anyway because I just don’t want anything to influence the test if possible.
Dr. Weitz: Oh interesting. Before lab testing.
Dr. Simpson: Make sure that they drink water the day of the test because people think fasting, they’re not drinking. You have to drink water or the tests can be off.
Dr. Weitz: Right.
Dr. Simpson: Yeah.
Dr. Weitz: I don’t know what to touch on next because I know we got a minute or two. Strontium, fluoride, those are two substances that-
Dr. Simpson: I’m not a fan of strontium.
Dr. Weitz: Not a fan of strontium. Okay.
Dr. Simpson: I’m not and for a couple… Well, for a lot of reasons. But one is this that it gives false readings with bone density, much higher false readings than we thought. You can’t really trust bone densities once somebody starting strontium. The question is how good is the fracture reduction? Because that’s really what you were always looking at. There’s other issues in terms of heart potential and some other things with strontium. I just don’t see the need when I feel I’ve got much more data on the other medications when needed. I mean somebody’s borderline, I don’t see the need for anything. I see the need for nutrition and a lot of other things. Yeah. I just wouldn’t use it.
Dr. Weitz: [crosstalk 01:01:56]
Dr. Simpson: [inaudible 01:01:56] that’s what’s typically-
Dr. Weitz: Okay. What do you think about fluoride?
Dr. Simpson: Yeah. Don’t take fluoride.
Dr. Weitz: Okay. I’m not a great fan either.
Dr. Simpson: Well, fluoride, natural-occurring fluoride. Fluoride helps bone. I mean to some extent, a tiny amount would get in foods and all of that helps bone.
Dr. Weitz: It just replaces the calcium, right?
Dr. Simpson: Well, so does strontium by the way. That’s what it does.
Dr. Weitz: Right.
Dr. Simpson: Replaces calcium. So, you better think that’s a good idea and that’s how what I always say. You better think that fluoride or strontium is better than calcium in the bone. I just can’t go there with it.
Dr. Weitz: Right.
Dr. Simpson: No. I’m not a fan.
Dr. Weitz: Okay. I guess that’ll be a wrap. Any final words and best where get in contact with you to [crosstalk 01:02:49] about you and your programs?
Dr. Simpson: I do have a master class. People can join that. I do webinars that are strong teaching thing. I have slides and the whole thing. I’ll be doing a mentoring program in the fall. I hope that people go. They’re going to get a discount because you’re going to send them that in terms of my books. I also have videos over there like on fractures, individual things that are I think very high quality teaching tools.
Dr. Weitz: What’s the website?
Dr. Simpson: Lani, L-A-N-I, Simpson, S-I-M-P-S-O-N.com.
Dr. Weitz: There you go. Thank you, Lani.
Hi. Seven years I had osteopenia
Highest score was -1.7
Now nigjest score is -3.3
Have over and was done on different machine in different state. Is this POSSIBLE? I jave never fractured
Doc wants me to go ones but afraid to.
It is best to have test done on same machine and using same procedures for positioning. Have you optimized your diet, added moderate to heavy weight lifting at least 3 times per week, making sure sleep is good, and are you taking appropriate nutritional supplements in optimal dosages for you, incl. vit D, K2, Ca++, Mg+, vit C, collagen? Also look at female hormones and thyroid and gut health.