Podcast Summary

Episode: "Bone Loss Confusion Explained (& How to Repair Weak Bones)"

Podcast: BETTER! Muscle, Mobility, Metabolism & (Peri) Menopause with Dr. Stephanie
Host: Dr. Stephanie Estima
Guest: Dr. Doug Lucas
Release Date: February 2, 2026

Overview

This episode delivers a comprehensive, science-backed look into women’s bone health across the lifespan, focusing on factors that accelerate or slow bone loss, the best and worst forms of exercise for bone, nutrition strategies, and the nuanced roles of hormones and medications. Dr. Doug Lucas, a double board-certified orthopedic surgeon and osteoporosis specialist, joins Dr. Stephanie for a detailed discussion, translating cutting-edge research and clinical wisdom into practical actions for women from adolescence through post-menopause.

Key Discussion Points & Insights

1. Why Bone Health Matters for All Ages

• Bone loss is common and preventable but often detected late (e.g., after an osteoporosis diagnosis at 65).
• "You can be 15, you can be 85. Everybody and their mother can help improve bone density and bone quality." (Dr. Stephanie, 04:41)
• Peak bone mass is mostly achieved by early adulthood; the window to optimize is brief (especially critical for young athletes and teenage girls).

2. Silent Saboteurs: Undereating and Excessive Dieting

• Chronic caloric restriction is rampant and detrimental across ages, stunting bone building especially in adolescence.
• "Only almost 100% of the patients that come in to see me with osteoporosis...are under eating. I mean, 100%." – Dr. Doug Lucas (17:10)
• The culturally ubiquitous drive for "thin = healthy" is actively working against strong, resilient bones.

3. Pregnancy, Breastfeeding, and Hormonal Shifts

• Pregnancy and breastfeeding temporarily lower bone density, but most women rebound after; concern arises mainly if entering pregnancy with pre-existing bone loss.
• "That baby will take from you what it needs to survive. So while you're pregnant, it is very likely that you will lose bone density." – Dr. Doug (08:57)
• Not all bone density loss is harmful—context and recovery matter.

4. Osteopenia vs. Osteoporosis: Definitions and Why Trends Matter

• Osteoporosis: T-score below -2.5; clear diagnosis.
• Osteopenia: T-score between -1 and -2.5—technically, just "low bone density," not a disease.
• "We really need to be more interested in the trend of bone density rather than just a single point in time." – Dr. Doug (13:01)

5. Impact of Sports and Menstrual Regularity on Young Women

• Weight-sensitive sports (dance, gymnastics, running) often promote under-eating, leading to lost opportunity for peak bone mass.
• "If you don't have at least five cycles of an ovulation and a regular luteal phase, then you'll be losing bone as a young woman." – Dr. Doug (22:53)
• Social and coaching norms pressuring for amenorrhea (loss of periods) are biologically harmful, not performance-enhancing.

6. The "Big Three" Hormones & Bone Health

Estrogen/Estradiol

• Inhibits bone breakdown (anti-resorptive) by shutting down osteoclasts.
• "We know estrogen's been well studied... It acts on both sides of the metabolism equation." – Dr. Doug (27:43)

Progesterone

• Stimulates osteoblasts (bone-building) but is rarely studied alone; micronized "bioidentical" form advised when used.

Testosterone/DHEA

• Anabolic: builds bone (and, indirectly, muscle); evidence in women is promising but limited by lack of high-dose, well-designed studies.
• DHEA at higher doses (≥50mg) raises bone mineral density.

7. Nutrition Essentials for Bone Building

Protein

• Most important macro: "Every study on protein intake and bone health shows that those that consume the most protein have the highest bone density always." – Dr. Doug (39:09)
• Target: 1g protein / lb ideal bodyweight (omnivores; plant-based need higher).

Micronutrients

• Calcium: Important but often overemphasized; whole-food sources (dairy, hydroxyapatite bone meal, algae) are preferred. Excessive supplementation (esp. with calcium carbonate) can be problematic.
• Vitamin D & K: Both critical; needed alongside calcium to direct mineralization and avoid arterial calcification.
• Magnesium, Boron, Phosphorus: Frequently deficient; boron particularly potent, often overlooked.
• Prunes: "Prunes, man, like that's my big takeaway: as a standalone intervention for osteoporosis." – Dr. Stephanie (00:42 & 48:57)
  • 5 prunes (~50g) a day provided positive effects in RCTs, attributed to boron content.

8. Exercise: From Worst to Best for Bone

• Worst: Swimming (low gravity/no impact), long-distance running, cycling (no impact).
• Neutral: Cardio activities like walking if not combined with resistance.
• Best:
  • High-impact/resistance training: Sprinting, jumping, and lifting heavy-ish (subjective to one's max).
  • Progressive overload is key; "Form before load" crucial, especially for those new or older.
  • "As long as you can move your body, you can learn how to lift weights." – Dr. Doug (60:00)
• Weighted Vests: Overhyped, may add minimal bone benefit and pose joint/pelvic floor risks, especially in overweight or menopausal women.

9. Medications: When You Need Them and How to Use Wisely

• Steroids & Certain Cancers: Accelerate bone loss dramatically; critical to "pull every lever" on lifestyle and monitor closely.
• Antiresorptive Drugs (e.g., bisphosphonates): Effective for halting bone loss, best for short-term (3–5 yrs max) use; risk of brittle bones/fractures with long-term use.
• "These drugs are really good... But for someone who is in...a couple years—it's a totally reasonable time to take a drug." – Dr. Doug (79:27)
• GLP1s (weight loss drugs): May reduce inflammation but often cause major muscle and bone loss; defensible only with concurrent high protein/resistance training, and cautious dosing.

10. Notable Quotes & Memorable Moments

• On Caloric Restriction and Dieting:

  "If you are under eating, you cannot build. Our body...is always sort of balancing back and forth between kind of anabolism and catabolism...If you lean on...the breakdown side, you're gonna lose bone...you'll develop osteoporosis." – Dr. Doug (17:10–18:01)

• On the Power of Exercise Selection:

  "Starting from a low point? I absolutely want you to have that mambi pamby pink dumbbell...That is progressively overloading on your way up." – Dr. Doug (61:40)

• On Hormones:

  "Estradiol works on both sides of the equation like most natural things do...but it has the strongest impact on the breakdown side." – Dr. Doug (28:22) "Progesterone...I love progesterone. I think it's a fantastic thing to add to estradiol always, not just if you have a uterus." – Dr. Doug (31:06)

• On Prunes & Boron:

  "There's a ridiculous number of studies looking at prunes and osteoporosis...It does improve bone mineral density as a standalone intervention, likely because of the boron." – Dr. Doug (48:58)

Timestamps: Important Segments

• Undereating & Bone Loss: (16:06–20:05)
• Hormone Impact on Bone: (27:40–36:28)
• Protein & Diet Principles: (37:51–41:25)
• Micronutrients for Bone: (42:40–49:32)
• Prunes/Boron as Interventions: (48:57–50:12)
• Exercise Ranking for Bone: (52:06–66:15)
• Weighted Vests: (68:06–73:53)
• Medications & Anti-Resorptives: (75:53–82:39)
• GLP1s & Weight Loss Drugs: (82:39–87:19)

Practical Action Items

• Track and periodically monitor bone density (DEXA) earlier than current medical guidelines, especially if dietary/hormonal risk factors present.
• Prioritize adequate protein (1g/lb ideal body weight), with attention to macros and critical micronutrients (esp. vitamin D, magnesium, boron).
• Incorporate impact/resistance exercises regularly; progress from bodyweight to heavier loads as tolerated and safe.
• Educate and support girls and women across the lifespan to shift mindset from "thin" to "strong."
• Consider short-term bone medications if dealing with unavoidable risk factors (steroids, specific cancer therapies), but escape dependence; actively "stack the deck" with lifestyle strategies.
• Don’t fall for fads: weighted vests are not a cure-all.
• If experiencing weight loss (incl. via medications), plan aggressively to retain/build muscle and bone via nutrition & resistance training.
• Eat your prunes—5 a day delivers boron likely to help bones!

Summary Tone

Both Dr. Stephanie and Dr. Doug deliver straight talk, science-backed recommendations, and a touch of humor (prunes and alien boron!) while tackling complex topics with compassion and lived experience. This episode is essential listening for women (and their families) serious about preventing frailty and optimizing lifelong bone health.

Additional Resources:

• Find Dr. Doug at Dr. Doug Show (YouTube/Podcast) and osteocollective.com
• For science-backed strength programming for women: drstephaniestima.com/lyft

"It's not about being perfect—it's about being better." – Dr. Stephanie