Bone health—everything you need to know [AMA 37 sneak peek] | Peter Attia, M.D.

Summary

In this episode of the Drive podcast, host Peter Attia discusses the significance of bone health, exploring topics like bone mineral density, osteopenia, and osteoporosis. He delves into the anatomy and physiology of bones, the roles of osteoblasts and osteoclasts, and the importance of calcium, vitamin D, and parathyroid hormone in maintaining bone health. The conversation also touches on the consequences of poor bone health and the impact of aging on bone health.

Takeaways

• 🗓️ The podcast was recorded on April 29th, which is a significant date in Formula 1 history due to tragic accidents involving Rubens Barrichello and Roland Ratzenberger, and also marks the anniversary of Ayrton Senna's death.
• 🏁 Peter Etia, the host, has a unique ability to remember dates and their significance, which was a fun fact shared during the podcast.
• 🦴 The podcast focuses on bone health, including topics such as bone mineral density, osteopenia, and osteoporosis, aiming to educate listeners on the importance of these issues.
• 👶 The importance of bone health is emphasized for all age groups, including younger audiences who may not have considered it relevant to them.
• 💪 Discussions on how bone health changes with age and the differences in bone health between sexes are planned to be covered in the podcast.
• 🏋️‍♂️ Physical activity as a means to improve bone health is mentioned, along with nutrition, supplements, and pharmaceutical interventions.
• 🤕 The podcast also intends to address how to manage bone health in the context of acute injuries, a topic of personal interest to the host following his shoulder surgery.
• 🦴 Bones are living tissues that play a crucial role in the body, including being a major reservoir for calcium and a site for blood cell production.
• 🧬 Osteoblasts are cells responsible for bone formation, while osteoclasts are involved in bone resorption, maintaining a balance in bone remodeling.
• 🦴 Vitamin D, particularly D3, is essential for calcium absorption and thus plays a critical role in bone health.
• 🔬 Parathyroid hormone is key in regulating calcium levels in the body, interacting with vitamin D to maintain bone health.

Q & A

What significant event in Formula One history is mentioned in the podcast related to April 29th, 1994?

The significant event mentioned is Rubens Barichello's severe accident during a practice day at Imola, where he hit a chicane and launched into a barrier, escaping with a concussion and a broken nose.

What was the first fatality in Formula One after 12 years prior to 1994?

The first fatality in Formula One after a 12-year gap was Roland Ratzenberger, who was killed on April 30th, 1994.

Who was the last person to die in a Formula One accident before Roland Ratzenberger?

The last person to die in a Formula One accident before Roland Ratzenberger was Elio de Angelis in 1982.

What is the difference between cortical bone and trabecular bone?

Cortical bone, also known as compact bone, forms the shaft and exterior of long bones, providing strength and rigidity. Trabecular bone, also called spongy bone, is found at the ends of bones and has a lattice-like structure that is less dense but provides support and houses bone marrow.

Why is bone marrow important in the context of the immune system?

Bone marrow is crucial for the production of white blood cells and red blood cells. It is also where memory B cells and T cells reside, which are essential for long-lasting immunity against viruses, including a rapid response to reintroduction of the same antigen.

What are the two main types of cells involved in bone formation and resorption?

Osteoblasts are responsible for building bone by producing collagen and mineralizing the bone matrix, while osteoclasts remove bone by reabsorbing the calcified bone and matrix, maintaining a balance in bone remodeling.

What is the primary mineral found in bones, and what percentage of bone is made up of this mineral?

The primary mineral found in bones is calcium, which makes up about 50 to 70 percent of the bone's composition.

How does vitamin D3 contribute to bone health?

Vitamin D3 is crucial for bone health as it increases the gut's absorption of calcium, which is essential for bone mineralization and preventing deficiencies that can lead to diseases like rickets.

What is the role of parathyroid hormone in calcium homeostasis?

Parathyroid hormone is the master regulator of calcium levels. When blood calcium levels are low, it stimulates the release of calcium from the bone into the blood and induces enzymes in the kidney to convert vitamin D into its active form, aiding in the reabsorption of calcium from the diet.

What are the potential consequences of poor bone health or low bone density?

Poor bone health or low bone density can lead to an increased risk of fractures, reduced physical function, and in severe cases, diseases such as osteoporosis, which is characterized by fragile and porous bones.

What is the significance of the date April 29th, 2022, in relation to the podcast host's memory abilities?

The significance of April 29th, 2022, is that it shares the same day and date as in 1994, which the host noticed and used as an example of his ability to remember specific dates and their historical significance, although he admits this skill is not as profound as it used to be.

Outlines

00:00

🏎️ Introduction to the Drive Podcast and Bone Health

The podcast begins with host Peter Etia welcoming listeners to the Drive Podcast, mentioning an AMA (Ask Me Anything) session. He discusses the significance of the date, April 29th, drawing parallels between 1994 and 2022, highlighting tragic Formula One accidents. The conversation shifts to bone health, emphasizing its importance across different age groups. Peter sets the stage for a deep dive into topics like bone mineral density, osteopenia, and osteoporosis, aiming to educate listeners on why they should care about bone health and how it changes with age.

05:00

🦴 Understanding Bone Structure and Types

This paragraph delves into the anatomy and physiology of bones, distinguishing between cortical (compact) bone and trabecular (spongy) bone. Cortical bone forms the shaft of long bones, while trabecular bone is found at the ends. The importance of bone marrow in producing blood cells is highlighted, especially in the context of immunity against viruses like COVID-19. Peter humorously touches on his interest in extending the longevity of bananas, suggesting a shift from human longevity to fruit longevity.

10:01

🚀 The Role of Cells in Bone Formation and Maintenance

Peter explains the roles of osteoblasts and osteoclasts in bone health. Osteoblasts are responsible for building bone by producing collagen and mineralizing it, while osteoclasts remove bone by reabsorbing calcified bone and the matrix. This process maintains an equilibrium in bone remodeling, crucial for bone mineral density. The discussion also touches on the composition of bone, emphasizing the presence of calcium and the organic matrix.

15:04

💪 Importance of Vitamin D, Calcium, and Parathyroid Hormone in Bone Health

The role of vitamin D, particularly D3, in bone health is discussed, highlighting its importance in calcium absorption from the gut. Vitamin D deficiency can lead to conditions like rickets, characterized by soft and spongy bones. Parathyroid hormone is introduced as a key regulator of calcium levels, stimulating the release of calcium from bones into the blood when levels are low. The interplay between calcium, vitamin D, and parathyroid hormone is crucial for maintaining bone health and calcium homeostasis.

🏆 Consequences of Poor Bone Health and Membership Program Details

The final paragraph addresses the consequences of poor bone health and low bone density, prompting listeners to consider the importance of bone health. It also introduces the Drive Podcast's membership program, offering exclusive content, comprehensive show notes, access to a private podcast feed, and discounts on recommended products. Listeners are encouraged to subscribe for full access to the AMA episodes and other member benefits.

Keywords

💡AMA

AMA stands for 'Ask Me Anything,' which is a popular format where the host answers questions from the audience. In the context of this video script, it refers to a session where the host, Peter Attia, discusses various topics related to bone health and longevity. The AMA format allows for an interactive and informative discussion, as seen in the script where Peter and his guest delve into subjects like bone mineral density and osteoporosis.

💡Bone Health

Bone health is a central theme in the video, focusing on the importance of maintaining strong and resilient bones. It encompasses aspects like bone mineral density, osteoporosis, and osteopenia. The script mentions bone health in relation to aging, gender differences, and lifestyle factors such as physical activity and nutrition. Understanding bone health is crucial as it impacts overall well-being and the prevention of conditions like fractures and bone diseases.

💡Osteoporosis

Osteoporosis is a medical condition characterized by weak and brittle bones, which increases the risk of fractures. In the script, osteoporosis is discussed as a significant concern related to bone health, especially as people age. The condition is often linked to low bone mineral density and is a common topic in discussions about bone health, emphasizing the need for preventive measures and treatment.

💡Osteopenia

Osteopenia is a term used to describe a condition where bone mineral density is lower than normal but not as low as in osteoporosis. It is mentioned in the script as a precursor to osteoporosis, indicating a need for attention and potentially preventive measures to avoid further bone loss. Understanding osteopenia is important for early detection and intervention in maintaining bone health.

💡Cortical Bone

Cortical bone, also known as compact bone, forms the shaft and exterior of long bones like the femur and humerus. It is dense and strong, providing structural support. In the script, cortical bone is contrasted with trabecular bone, highlighting the different roles they play in bone health. Understanding the structure and function of cortical bone is essential for grasping the overall concept of bone health and its maintenance.

💡Trabecular Bone

Trabecular bone, sometimes referred to as spongy bone, is found at the ends of bones and has a lattice-like structure. It is less dense than cortical bone but plays a crucial role in bone health, particularly in terms of bone strength and resistance to compression. The script discusses trabecular bone in the context of bone structure and its importance in overall bone health.

💡Bone Marrow

Bone marrow is the soft tissue found within bones, responsible for producing blood cells, including white cells and red blood cells. In the script, bone marrow is highlighted for its role in immunity, particularly in the context of post-COVID recovery. Memory B cells and T cells, which provide lasting immunity against viruses, reside in the bone marrow, making it a critical component of the immune system.

💡Osteoblasts

Osteoblasts are cells responsible for the formation of new bone tissue. They produce collagen and mineralize the bone matrix, contributing to bone mineral density. In the script, osteoblasts are contrasted with osteoclasts, which are cells that break down bone tissue. Understanding the balance between osteoblasts and osteoclasts is key to understanding bone health and the process of bone remodeling.

💡Osteoclasts

Osteoclasts are cells that break down bone tissue by reabsorbing calcified bone and the matrix. They play a crucial role in bone remodeling, balancing the activity of osteoblasts. In the script, osteoclasts are mentioned in the context of bone health, emphasizing the dynamic process of bone formation and resorption that maintains bone strength and integrity.

💡Vitamin D

Vitamin D, particularly its active form D3, is essential for bone health as it aids in the absorption of calcium from the gut. A deficiency in vitamin D can lead to conditions like rickets, characterized by soft and weak bones. In the script, vitamin D is discussed in relation to its role in calcium absorption and its importance in maintaining bone health and preventing diseases associated with poor bone density.

💡Parathyroid Hormone

Parathyroid hormone is a hormone produced by the parathyroid glands, which regulate calcium levels in the blood. When calcium levels are low, parathyroid hormone is secreted, stimulating the release of calcium from the bones and aiding in the conversion of vitamin D to its active form. In the script, parathyroid hormone is mentioned as a key player in calcium homeostasis and bone health, illustrating its importance in maintaining proper calcium levels and bone integrity.

Highlights

The podcast discusses the significance of bone health and its impact on overall health.

The host, Peter Attia, mentions the coincidence of the dates in 2022 matching those in 1994, including tragic Formula One accidents.

The conversation delves into bone health, focusing on bone mineral density, osteopenia, and osteoporosis.

Peter emphasizes the importance of understanding bone health early in life and its relevance to younger audiences.

The podcast explains the difference between cortical (compact) bone and trabecular (spongy) bone.

The role of bone marrow in producing white and red blood cells is highlighted, including its importance in immunity.

Peter humorously considers a career shift to 'banana longevity' to address the short lifespan of bananas.

The discussion introduces the balance between osteoblasts, which build bone, and osteoclasts, which remove bone.

The significance of calcium in bone health and its role in calcium homeostasis is discussed.

Vitamin D's role in increasing gut absorption of calcium and its impact on bone health is explained.

The role of parathyroid hormone in regulating calcium levels and its interaction with vitamin D is covered.

The consequences of poor bone health and low bone density are explored, including the risks associated with them.

Peter mentions the potential for future discussions on the 'banana conspiracy' in relation to fruit longevity.

The podcast outlines the importance of calcium, vitamin D, and parathyroid hormone in maintaining bone health.

The host encourages listeners to become members for access to complete episodes and additional exclusive content.

Peter provides information on how to access the member-only podcast feed and his social media handles.

A disclaimer is provided, stating that the podcast is for informational purposes only and not a substitute for professional medical advice.

Transcripts

hey everyone welcome to the drive

podcast i'm your host peter etia

all right

peter welcome to another ama how you

doing

doing well man the final final seven

episodes of ozark drop tonight we're

recording this on uh

april 29th

so

interesting date for two reasons by the

way the other thing that occurred to me

this morning

is that the days and dates in this year

2022 were the same as they were in 1994.

so

i was like oh my god today is friday

april 29th which is the same as it was

in 94. so on friday april 29th in 1994

was the practice day at imola and that's

when rubens barachela had that horrible

horrible accident

it we can link to the accident where he

basically hit the chicane and and

launched

um

into a barrier and amazingly only

escaped with a concussion and a broken

nose

the following day which is the same day

as tomorrow will be which was saturday

april 30th

was when

roland ratzenberger was killed which

made it the first fatality in formula

one in 12 years the last one being jill

vilnev in 1982

and then of course sunday may 1st which

will be the same this year was when

senna died

uh

so all in 1994.

yeah i was at the same race i mean you

had these three horrible accidents

resulting in two fatalities in one

weekend

um

but again just to think that it's the

exact same days this year as it was

um

28 years ago uh just i don't know why i

just sort of i didn't i never i didn't i

didn't notice that until today

oh that's kind of important information

right like your brain can only count so

much and

but i mean this is really off topic but

do you still have the skill that you had

back in the day where you can

like remember what day like day of the

week a date was

uh

only if i can peg it to something but

not not as profound as it used to be

i mean it used to be i remember in

meetings we used to just throw out

random random dates and then we would

fact check it i feel like we wasted a

lot of time doing that right someone

would tell me their birthday and i would

tell them what day of the week they were

born on

yeah love it

love it well

on the complete opposite end of that um

what we're going to talk about today

is is really a question that i mean it's

a topic that we get asked about a lot

and we've gotten a lot of questions that

have come in but we've never really

dove really deep into it which is what

we're going to do today and it's kind of

all things bone health bone mineral

density osteopenia osteoporosis kind of

all things of that nature and i know

this is something that you

work a lot with in your patients and i

know it's something that's of really big

interest for people and so

our hope is

that we can kind of go through this

episode and focus on you know why is

this important so why should people

care about this you know people

listening right now there'll be a

subsection of them that are going to be

super interested and there will be

probably another subsection who are

maybe younger they've never really

thought about their bone health and they

might not think it really applies to

them but our hope is in the beginning at

least we'll kind of walk through why

they should care about this and why they

should focus on it early on in life and

then

from there we'll talk about you know how

bone health changes as people age the

differences between sexism and men and

women and then we'll also focus on

things on how people can improve

or

kind of help their bone health become

better from physical activity to

nutrition

supplements drugs and more and then

if all that goes well and we still have

time which is always 50 50 on how these

amas go we'll also focus a little bit on

you know people dealing with acute

injuries and how they need to think

about this which i know is something

that

you're interested in given your recent

shoulder surgery and now you're kind of

not as active in one side of your upper

body as you used to be so

all that said i think before we start

going through those questions it's going

to be helpful to set the stage a little

bit just so everyone is on the same page

and the definitions and what we're

talking about so maybe why don't we

start with you know what are some of the

types of bones we'll be referring to

because at least for myself coming into

this

i just kind of think a bone is a bone

and i don't really think much more

beyond that so why don't you dive into

that a little bit

yeah i mean bone is

uh it's a it's a living tissue and i

mean okay that's obvious but i think

it's also easy for a person to kind of

forget that and think of bone as

somewhat inert but in fact bone is

heavily vascularized uh bone is an organ

that plays a very important role in a

lot of things i'm actually not going to

go super deep into the anatomy and

physiology of bones

i'll point out just a couple things

right so first of all we kind of think

of a couple types of sections of bones

so we think about the cortical or

compact bone and that's what forms like

the shaft and the exterior of long bones

so if you think of your femur your

humerus things like that you know they

have kind of like the the long shaft and

then the nubbins at the end so the shaft

of that is the cortical or compact bone

and then at the end you have the

trabecular uh bone sometimes called the

spongy bone so those are those are kind

of at the end of the bone and there are

some differences amongst those in terms

of their vascularization and things like

that

but again i think for the purpose of

this discussion just you know whenever i

talk about compact or cortical bone i'm

talking about the shaft and whenever i

speak about the spongy or trabecular

part i'm talking about the end

um

again i think marrow people probably

intuitively understand that marrow is

important but again it's very important

right marrow is what's producing our

white cells and our red blood cells so

in this era where we're thinking about

you know a postcovid world you know it's

important to understand that the memory

b cells and memory t cells that are

going to provide lasting immunity

against this virus and other viruses

reside in the bone marrow

and so the whole purpose of being

infected and then having a subsequent

infection that's less devastating

purpose of being vaccinated for the same

reason

is to have memory b cells and t cells

that are sitting there in the bone

marrow that can respond immediately and

quickly upon uh reintroduction of the

same antigen

you know when you mention nubbins it

kind of made me think about your banana

nubbins and you recently posted on

twitter you might be looking for a new

profession do you want to let people

know kind of

what your new interest is in the term in

the world of longevity

well yeah i mean as you point out i mean

i've i've

been very interested in human longevity

for

uh i guess probably about you know a

little over 10 years um and i'm sure i

will remain so but but i i i've at least

considered moving into banana longevity

because i think the opportunity uh for

impact is huge right i mean it's one

thing if you can figure out how to take

the average person

from being 80 to 90

um and that you know that'll have a huge

impact on the world but if you could

take the average banana

and go from like two days before it

turns mushy and brown to 10 days

i mean i i think it's revolutionary and

i just noticed i was on the usda's most

wanted list because of how many bananas

i waste so i got to do something about

this

yeah i mean if you solve the banana

crisis and you move to avocados they'll

probably give you a nobel peace prize as

well so i mean the upside is very high

in this new world

the thing is i mean avocados last so

much longer i mean you just have you

just have a window of opportunity to

like i can actually buy avoca i could

buy like seven avocados and eat them in

a week

i can't buy seven bananas and eat them

in a week like at one a day it just

doesn't work so

i think i think that entire fruit space

is just a racket i think the whole

banana infrastructure i think i think

bananas are a pyramid scheme like i

think it's just the whole thing is just

total scam

yeah maybe one of our upcoming amas

we'll just do a conspiracies with peter

attia and we'll just go into the world

of bananas so peter you mentioned um

earlier ago b cells and t cells can you

kind of walk people through what cells

make bones

yeah and again this can be made as

complicated or simple as you want i'm

going to kind of just try to thread the

needle a little bit and say just think

about osteoblasts and osteoclasts and i

kind of remember from medical school the

way i used to remember this so

osteoblasts

b

are responsible for building bone by

producing collagen bone matrix and

mineralizing it osteoclasts

remove bone by reabsorbing calcified

bone and the matrix so osteoblasts

contribute to increasing bone mineral

density osteoclasts the opposite

it's also important to understand this

exists in an equilibrium right so we're

constantly remodeling bone

um

so we're sort of adding to and

subtracting

from this and and basically turning over

calcium so

bone is like 50 to 70 percent mineral

and obviously what's the predominant

mineral it's calcium we'll talk about

that in a second it's about 20 to 40

organic matrix right so again what does

organic mean organic is carbon hydrogen

oxygen sulfur that and then the rest of

it is is a bit of water and lipid and

again you'll see that primarily in in

the marrow

so in an adult like the entire human

skeletal system can be remodeled

in a really long cycle right it might

take 10 years to turn over

all of the mineral and organic content

within the bone over and over again but

at the micro level calcium balance is

you know

happening quite frequently

um i don't remember the exact number i

want to say it's like 99

but virtually all of the body's calcium

is contained within bone

and therefore bone plays a very

important role in calcium homeostasis

and if anybody's taking a physiology

class they probably remember how

important calcium signaling is

to everything within a cell so

again we think of these bones as

structural entities which of course

first and foremost they are

but remember they're also a very

important reservoir for calcium which is

another very important ion in um

in the activity of every cell

and you talked a lot about calcium what

about vitamin d

what role does vitamin d play in the

bones

so they're both very important

and again there's there's sort of

two forms of vitamin d vitamin d2 and d3

but really when i talk about vitamin d

i'm going to mostly talk about d3 which

is the active form so

d so what's the problem with

being deficient in vitamin d well again

people might recall a disease called

rickets and you see this often in

developing parts of the world where

people are really malnourished and they

have

really really soft sort of spongy bones

and it's it's actually just yesterday i

had a friend over who

uh does a bunch of mission work in um

rwanda and she was showing me

a child at their uh camp whose legs

you know the child was like probably

five years old he was sitting down and

they were

doing something with his legs that you

would think would be impossible to do

with a human being basically while he

was sitting on the ground they were

able to move his foot back and forth

back and forth and he was in no pain but

it's because he didn't have bones that

were anything other than basically

rubber bands

so he couldn't stand

and

within

i want to say six months of correcting

his nutrition totally normal so

you know amazing opportunity when you

think about what's what happens in that

part of the world uh and how you can fix

that but

what is it about vitamin d well vitamin

d increases the gut's absorption of

calcium so if you're

woefully deficient in vitamin d you're

going to have trouble absorbing calcium

through the gut and we're going to talk

in this podcast later about the

importance of dietary calcium and or

supplementary calcium

and so you can see why that becomes

part of the issue

yeah

so the other thing to kind of keep in

mind here is the role of another hormone

and again i'm trying to only introduce

concepts now that are going to become

relevant later either through treatments

or nutrition or supplementation so i'm

you know being a little bit simplistic

but the other thing that you can't avoid

here is understanding the role of

calcium and parathyroid hormone so

i think most people are probably

familiar with their thyroid gland sits

here in the neck

um it's kind of got this shape to it

that where it's got like kind of two

main lobes and then each lobe has two

poles

well at each of those poles is a little

tiny gland called the parathyroid gland

so you have four of those

and the parathyroid gland

is really the master gland for

regulating calcium levels so low levels

of calcium in the blood stimulate

parathyroid hormone secretion as

parathyroid hormone level goes up it

simulates the release of calcium

from the bone into the blood now it also

induces

enzymes in the kidney which then convert

vitamin d into its active form to then

aid and speed up in the process of

reabsorbing more calcium from the diet

so

all of this stuff parathyroid hormone

calcium vitamin d

very important to maintaining bone

health and anytime you have things that

disrupt that system

you're going to see disruptions

potentially in the bones

yeah i think that was a good and kind of

quick overview of what will be important

for what we

cover next and i think the natural

follow-up to it is you know what is the

consequence of poor bone health what is

the consequence of

low bone density i think you know some

people are who will be listening this

will have already known issues of bone

density and some people have never

thought about this before in their life

and so

you know what would you say to those

people on why they should care about

this and why they should think about it

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[Music]