Bone Chatter: sTrong bones are more than density. Let’s talk Quality.

Bone health is close to my heart, professionally and personally. As a former radiographer who has reversed my own osteoporosis through lifestyle changes, I know firsthand how many gaps there are in what women are told about their bone health and what can be done to optimise it. This episode is my attempt to close a gap that is one of the biggest we’re not filling.Here’s the idea the whole episode is built on:Bone Strength = Bone Density + Bone QualityMost of us only ever hear about the first half. Today I’m giving equal airtime to the second.In This Episode…The density dominant health system: I walk through how the standard, conventional Australian medical pathway works, how our health system ‘supports’ bone health. It’s similar to the US, UK, Canada and perhaps where you are too.The conventional framework:1. Hit age 70 and you’re eligible for a Medicare subsidised DEXA bone scan (unless you have other health issues that warrant a scan or you’ve had a fracture from low force).2. Your GP (primary provider) writes a referral for a standard DEXA scan which measures ‘density’.3. If your T-score comes back below −2.5 (the threshold for osteoporosis) usually a conversation about medication then happens.I explain why Bone Mineral Density (BMD) or ‘density’ alone is not capturing the whole fragility picture.I use a wall analogy throughout the episode to talk about the types of bone we have and a construction analogy for how they come together. {yes, I was a project manager in a previous life - can you tell?}Meet the third bone cell we’re not talking enough about: You’ve probably heard of osteoblasts (builders) and osteoclasts (demolition crew) and the bone Remodelling process.I introduce the one that’s missing from that story, the osteocyte and explain why I think of it as the foreman on the site, sending the signals that coordinate the other two.I also share where osteocytes come from, and why the demolition crew is, cellularly speaking, a complete stranger to the builders; why the osteocyte foreman plays such an important role.Measuring bone quality: I share the tools, the ways to measure bone quality, that go beyond a standard DEXA. Scans such as DEXA with TBS, REMS and CT as well as bone turnover markers that can be assessed with a blood test.I do DEXA, REMS and bone turnover markers myself, for exactly this reason. They’re all bone health clues that offer up different information.The drugs - how they work: With bone cell knowledge shared, I then explain the three very different forms of osteoporosis medications in Australia. They may have different brand names where you are. · Antiresorptives (”the brakes”) like denosumab (Prolia) and alendronate (Fosamax)· Bone-Forming (”the builders”) like teriparatide (Forsteo)· Signal Modulator/Dual-Action (“The Renovators”) like romosozumab (Evenity)My goal is NOT to tell you which one is best or right, it’s to help you to know the basics so you can ask better questions of your own doctor, with greater confidence, because you understand broadly how they work.What strengthens the signal — and what quietly breaks it: Why mechanical loading is the trigger osteocytes respond to (to listen in and generate their signal) and why the oestrogen drop in perimenopause and post-menopause is a double hit - fewer signal-senders, and the ones left, leaning toward degrading.The movement that matters most: Appreciating that mechanical loading is the trigger for osteocytes I talk about the forms of mechanical load that they prefer - impact, multidirectional loading, and ‘surprise’ – yes, even osteocytes can become ‘bored’ and tune out.I also walk through some of the best human research on this including a one-legged hopping trial and an Army training study – both using HR-pQCT imaging to measure specifically, bone Quality.And I share why I’ve recently gone back to squash after 30 years away – because this sport has it all.[The research studies and links to them are in the Resources section below so you can dive in more yourself].Protein - the raw material behind it all: Not to weigh or rather ‘whey’ into this because it’s very topical right now. No. Rather because protein (collagen) determines our wall’s build quality. It’s what osteoblasts lay down first when they build bone.I get into anabolic resistance which gives clues to why we need more protein as we age, the most beneficial forms and how best to have it across the day. And I talk about the ‘conversion’ – how much of actual meat weight it takes to hit an ideal protein target.I say in the podcast that I’d add the protein information in the show notes so here it is:Bodies like ESPEN (the European clinical nutrition society) recommend older adults aim for roughly 1.0–1.2 g/kg/day – meaningfully above the general RDA of about .8. What’ that in pounds? about 0.45-0.54g/pound/day. However, requirements vary with body size, illness, kidney function, activity level and whether the person is under-fuelling.The right form of protein matters too. It’s thought that Leucine acts like a physical “on switch” for protein synthesis. Ideal sources: whey protein isolate (WPI), dairy, lean meats, poultry, fish, and eggs.Distribution matters, not just total intake. Research on older adults suggests protein needs to be spread across the day – around 30 g per meal, three times a day rather than loaded into one meal, to actually support the anabolic (building) response. That’s not 30g by weight. 30g of what the body uses is about a deck of cards size of meat protein. To get 30g of actual, usable protein, you need to eat roughly 100 to 120 grams of total meat weight (depending on whether it is lean chicken, fish, or beef).The Diabetic Bone Paradox: I mention this as a real-life example of how a particular (and rather common) condition can present as having a good quality bone Density on a DEXA scan but underneath, the bone Quality is frail. Something a standard DEXA scan does not show. Why some women can have a great-looking DEXA scan and still be at real risk, because density and quality are not the same thing.The Bottom Line…Strong bones = good density and good quality.Built by a signal you can strengthen, and a matrix you can nourish.My one ask this week: know your bones to help your bones.Consider asking for DEXA with TBS or a REMS alongside your next DEXA when next you scan to measure you bone health status. And if you haven’t yet, don’t wait. Take the initiative and do it! Ask.For your bone health, find a movement practice that includes impact. Move in ways that are safe for you that will strengthen that bone signal. Maybe that means introducing a new ‘surprise’ move.With a strong caveat here…Movement under the supervision or advice of a professional in the field who knows safe, effective moves and moves that will work best for you and your health status.This episode is information. Not an invitation for you to self-assess and dive in and do.While you’re at it, maybe take a good look at your protein intake.Next: in this episode we’ve talked about the conversation happening inside your skeleton. Next, I’m exploring how bone talks to the rest of your body as an incredible endocrine organ, sending signals to your kidneys, blood sugar, muscles, and possibly your brain.Our bones do so much for us. It’s time we stood back and appreciate just how amazing they are. Giving them what they need to be at their best. To avoid fracture.Because in midlife, you’re just getting started and Future You is cheering you on.Resources & Further Reading* Du, Y. et al., “Bone microstructure adaptation after 6-month unilateral hopping in postmenopausal women,” Osteoporosis International — PubMed · Open access full text* U.S. Army/University of British Columbia study on distal tibial microarchitecture during 8-week basic combat training — Wiley Online Library (JBMR Plus)* Deakin University systematic review & meta-analysis on exercise and trabecular microarchitecture — Calcified Tissue International · Full text on PMC* On the “diabetic bone paradox” — normal/high BMD with elevated fracture risk in type 2 diabetes — PubMedThis episode is educational, not medical advice. Please bring your own results and questions to your GP or specialist.Thank you so much for being here. I do hope you found a few gems in this conversation. If you know of someone else in you your life who might, then please share this on with them! That would be awesome. Thank you.And thank you to everyone who tuned into my live video like Lea! Join me for my next live video in the app.Anita xx This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit midlifeunfiltered.substack.com