Bone health—everything you need to know [AMA 37 sneak peek] | Peter Attia, M.D.
Summary
TLDRIn 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
🏎️ 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.
🦴 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.
🚀 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.
💪 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.
Mindmap
Keywords
💡AMA
💡Bone Health
💡Osteoporosis
💡Osteopenia
💡Cortical Bone
💡Trabecular Bone
💡Bone Marrow
💡Osteoblasts
💡Osteoclasts
💡Vitamin D
💡Parathyroid Hormone
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
thank you for listening to today's sneak
peek ama episode of the drive if you're
interested in hearing the complete
version of this ama you'll want to
become a member we created a membership
program to bring you more in-depth
exclusive content without relying on
paid ads
membership benefits are many and beyond
the complete episodes of the ama each
month they include the following
ridiculously comprehensive podcast show
notes that detail every topic paper
person and thing we discuss on each
episode of the drive
access to our private podcast feed the
qualis which are a super short podcast
typically less than five minutes
released every tuesday through friday
which highlight the best questions
topics and tactics discussed on previous
episodes of the drive is particularly
important for those of you who haven't
heard all of the back episodes becomes a
great way to go back and filter and
decide which ones you want to listen to
in detail
really steep discount codes for products
i use and believe in but for which i
don't get paid to endorse and benefits
that we continue to add over time if you
want to learn more and access these
member-only benefits head over to
dot com peteratiammd.com slash subscribe
lastly if you're already a member but
you're hearing this it means you haven't
downloaded our member only podcast feed
where you can get the full access to the
ama and you don't have to listen to this
you can download that at
peteratiamd.com forward slash members
you can find me on twitter instagram and
facebook all with the id peteratiammd
you can also leave us a review on apple
podcast or whatever podcast player you
listen on this podcast is for general
informational purposes only and does not
constitute the practice of medicine
nursing or other professional health
care services including the giving of
medical advice
no doctor-patient relationship is formed
the use of this information and the
materials linked to this podcast is at
the user's own risk the content on this
podcast is not intended to be a
substitute for professional medical
advice diagnosis or treatment
users should not disregard or delay in
obtaining medical advice from any
medical condition they have and they
should seek the assistance of their
health care professionals for any such
conditions
finally i take conflicts of interest
very seriously for all of my disclosures
and the companies i invest in or advise
please visit peteratiammd.com
forward slash about where i keep an
up-to-date and active list of such
companies
[Music]
5.0 / 5 (0 votes)