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Quick & Dirty: What is Osteoporosis

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Osteoporosis affects one in three women and one in five men over 50 and most people don’t know they have until a bone breaks. 

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In this episode, we’re breaking down how bone loss actually happens, why prevention starts as early as your 20s, and what diagnosis and treatment really look like in practice. We’re covering medications, lifestyle strategies, and why I think we need to be screening for this condition a lot earlier than current guidelines suggest.

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Because a diagnosis doesn’t have to define you but having the right information early absolutely can change your outcome.

 

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References

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Walker MD, Shane E. Postmenopausal osteoporosis. N Engl J Med. 2023;389(21):1979-1991. https://doi.org/10.1056/NEJMcp2307353

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US Preventive Services Task Force; Nicholson WK, Silverstein M, et al. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025. Published online January 14, 2025.

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Curry SJ, Krist AH, Owens DK, et al; US Preventive Services Task Force. Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(24):2521-2531. https://doi.org/10.1001/jama.2018.7498 

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White L. Osteoporosis prevention, screening, and diagnosis: ACOG recommendations. Am Fam Physician. 2022.

Harris K, Zagar CA, Lawrence KV. Osteoporosis: common questions and answers. Am Fam Physician. 2023;107(3):238-246.

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Dakkak M, Banerjee M, White L. Osteoporosis treatment: updated guidelines from ACOG. Am Fam Physician. 2023;108(1):100-104.

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Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025;334(10):894-??? https://doi.org/10.1001/jama.2025.6003 

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Morin SN, Leslie WD, Schousboe JT. A review on osteoporosis—reply. JAMA. 2025;334(20):1855-1856. https://doi.org/10.1001/jama.2025.15555 

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Ye C, Ebeling PR, Kline G. Osteoporosis. Lancet. 2025;406(10514):2003-2016.

https://doi.org/10.1016/S0140-6736(25)01385-6 

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Qaseem A, Forciea MA, McLean RM, et al. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017.

https://doi.org/10.7326/M15-1361

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Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al; Clinical Guidelines Committee of the American College of Physicians. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline. Ann Intern Med. 2023;176:224-238.

https://doi.org/10.7326/M22-1034

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Camacho PM, Petak SM, Binkley N, et al. AACE/ACE clinical practice guidelines… Endocr Pract. 2020. https://doi.org/10.4158/GL-2020-0524SUPPL

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Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women… J Clin Endocrinol Metab. 2019.

https://doi.org/10.1210/jc.2019-00221

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LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician’s guide… Osteoporos Int. 2022. https://doi.org/10.1007/s00198-021-05900-y

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Cosman F, Lewiecki EM, Eastell R, et al. Goal-directed osteoporosis treatment… J Bone Miner Res. 2024;39(10):1393-1405. https://doi.org/10.1093/jbmr/zjae119

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Reid IR, Billington EO. Drug therapy for osteoporosis in older adults. Lancet. 2022;399(10329):1080-1092. https://doi.org/10.1016/S0140-6736(21)02646-5 

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Händel MN, Cardoso I, von Bülow C, et al. Fracture risk reduction… BMJ. 2023;381:e068033. https://doi.org/10.1136/bmj-2021-068033

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Ayers C, Kansagara D, Lazur B, et al. Effectiveness and safety… Ann Intern Med. 2023. https://doi.org/10.7326/M22-1968 

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Sowers MR, Zheng H, Greendale GA, et al. Changes in bone resorption… J Clin Endocrinol Metab. 2013. https://doi.org/10.1210/jc.2012-3002 

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Greendale GA, Sowers M, Han W, et al. Bone mineral density loss… J Bone Miner Res. 2011. https://doi.org/10.1002/jbmr.308 

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Sowers MR, Zheng H, Jannausch ML, et al. Amount of bone loss… J Clin Endocrinol Metab. 2010. https://doi.org/10.1210/jc.2009-2720 

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Seifert-Klauss V, Fillenberg S, Schneider H, et al. Bone loss… Climacteric. 2012. https://doi.org/10.3109/13697137.2012.669584 

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Biondi B, Cappola AR. Subclinical hypothyroidism in older individuals. Lancet Diabetes Endocrinol. 2022. https://doi.org/10.1016/S2213-8587(21)00334-8 

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Acar B, Ozay AC, Ozay OE, et al. Evaluation of thyroid function… Int J Gynaecol Obstet. 2016. https://doi.org/10.1016/j.ijgo.2016.02.009 

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Frank-Raue K, Raue F. Thyroid dysfunction… Dtsch Arztebl Int. 2023.

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van Rijn LE, Pop VJ, Williams GR. Low bone mineral density… Eur J Endocrinol. 2014.

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Uygur MM, Yoldemir T, Yavuz DG. Thyroid disease… Climacteric. 2018. https://doi.org/10.1080/13697137.2018.1446933 

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Lobo RA, Gompel A. Management of menopause… Lancet Diabetes Endocrinol. 2022. https://doi.org/10.1016/S2213-8587(22)00007-9 

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Yong EL, Logan S. Menopausal osteoporosis… Singapore Med J. 2021.

https://doi.org/10.11622/smedj.2020157 

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Vilaca T, Eastell R, Schini M. Osteoporosis in men. Lancet Diabetes Endocrinol. 2022;10(4):273-283. https://doi.org/10.1016/S2213-8587(22)00012-2 

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Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men… J Clin Endocrinol Metab. 2012;97(6):1802-1822. https://doi.org/10.1210/jc.2011-3045

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Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of testosterone… JAMA Intern Med. 2017. https://doi.org/10.1001/jamainternmed.2016.9539 

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Ng Tang Fui M, Hoermann R, Bracken K, et al. Effect of testosterone… J Clin Endocrinol Metab. 2021. https://doi.org/10.1210/clinem/dgaa991 

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Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy… J Clin Endocrinol Metab. 2018. https://doi.org/10.1210/jc.2018-00229

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Reeves PT, Herndon DN, Tanksley JD, et al. Five-year outcomes… Shock. 2016. https://doi.org/10.1097/SHK.0000000000000586 

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Hoppé E, Bouvard B, Royer M, et al. Is androgen therapy indicated… Joint Bone Spine. 2013. https://doi.org/10.1016/j.jbspin.2012.09.011 

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Laurent M, Gielen E, Claessens F, et al. Osteoporosis in older men… Best Pract Res Clin Endocrinol Metab. 2013. https://doi.org/10.1016/j.beem.2013.05.002 

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Schroeder ET, Zheng L, Yarasheski KE, et al. Treatment with oxandrolone… J Appl Physiol. 2004;96(3):1055-1062. https://doi.org/10.1152/japplphysiol.00808.2003 

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Mavros Y, O’Neill E, Connerty M, et al. Oxandrolone augmentation… Med Sci Sports Exerc. 2015. https://doi.org/10.1249/MSS.0000000000000690 

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Miller JT, Btaiche IF. Oxandrolone treatment… Pharmacotherapy. 2009;29(2):213-226. https://doi.org/10.1592/phco.29.2.213 

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Orr R, Fiatarone Singh M. Oxandrolone… Drugs. 2004;64(7):725-750.

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Riggs BL, Melton LJ. The prevention and treatment of osteoporosis. N Engl J Med. 1992. https://doi.org/10.1056/NEJM199201303260406 

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Yao P, Bennett D, Mafham M, et al. Vitamin D and calcium… JAMA Netw Open. 2019;2(12):e1917789. https://doi.org/10.1001/jamanetworkopen.2019.17789

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US Preventive Services Task Force; Grossman DC, Curry SJ, et al. Vitamin D, calcium… JAMA. 2018. https://doi.org/10.1001/jama.2018.3185 

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Avenell A, Mak JCS, O’Connell D. Vitamin D… Cochrane Database Syst Rev. 2014;(4):CD000227. https://doi.org/10.1002/14651858.CD000227.pub4

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Shapiro CL, Van Poznak C, Lacchetti C, et al. Management of osteoporosis in survivors… J Clin Oncol. 2019. https://doi.org/10.1200/JCO.18.02142

 

Chapters

 

00:00 Intro

00:10 Importance of Bone Health at Any Age

00:52 Understanding Osteoporosis

01:54 Diagnosis and T-Scores

03:09 Treatment and Medication for Osteoporosis

08:52 Lifestyle and Prevention

09:41 Backed Study on Osteoporosis

11:05 Supplements and Its Side Effects

11:42 Can Osteoporosis Be Reversed?

12:16 Screening Guidelines

14:06 Who Else Could Experience Osteoporosis?

15:03 Exercise: Building Stronger Bones

19:22 Non-Approved Treatments

21:27 Conclusion and Key Takeaways

22:22 Outro

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