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Dr Andrea Robertson is an Osteopath, Naturopath, and Nutritionist. Georgie Beames is a Psychologist and Coach. The information shared in this podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your health regimen.

Show Notes

Episode Transcript

Episode 16 - Osteoporosis: Building Strong Bones, How to get Calcium Without Dairy, and the #1 Exercise Lever

[00:00:00] Osteoporosis is quiet. It doesn't frighten anyone until it's already done its work, and the vast majority of women who have low bone density right now don't know it. Think of a bathtub with the tap running and the plug partially out. You can stand there turning the tap up as hard as you like, but if the drain is open, the water level doesn't rise.

And most of the conversation about bone health is about the tap. And for those who can eat dairy, where dairy doesn't cause inflammation, well, that's excellent. Yet if dairy causes you inflammation, it will be opening the drain, essentially leaking calcium from your bones and doing the reverse of what you're actually hoping for

Our sponsor today is Mineralite, an Australian electrolytes brand. And I have to tell you how I found them because this is a genuine story. Now, I'm really into paddle tennis, some may say obsessed , and a friend of mine introduced me to Mineralite to use for my hydration support during games. I was a little curious [00:01:00] because I'd been recommending clients avoid those terrible sugary sports drinks for years, but I wasn't really sure what other options were available.

I now know that Mineralite is the option I'll recommend. It's unflavored and contains no sugar, no sweeteners, no artificial colors, no nasty additives. Just clean electrolyte support in drops you can add to your water or any hot or cold drink. And my paddle? It was noticeably different. My energy held, my focus held, and I even won some games.

Mineralite is now in my water every single day. Go and check them out at mineralite.com.au or find them in most pharmacies and health food stores throughout Australia and New Zealand

Andrea: osteoporosis does not hurt. It does not announce itself. There is no symptom, initially anyway, no warning signs, no bad day that tips you off. Most women learn about their bones from an X-ray in an emergency department after a fall in their 70s, and by then, the [00:02:00] decisions that produced the results were made 20 and 30 years earlier.

Andrea: Today, I want to take you inside your own skeleton so you can make those decisions on purpose. Grab a cup of tea or listen in the car, and let's get into it

Andrea: I'm Dr. Andrea Robertson, osteopath, naturopath, and nutritionist. Here we nourish because food is medicine, and what you eat changes everything. We heal because the body has an extraordinary capacity to self-repair when we remove what's blocking it, and we rise because feeling well isn't the destination, it's the foundation for living the life you truly desire.

Andrea: This is Nourish, Heal, and Rise. 

Before we begin, a quick and important note. Everything I share on this podcast is for educational [00:03:00] purposes only. It's not personal medical advice, and it can't be, because in the context of this podcast, I don't know your health history, your medications, and what else is happening in your body. What I want this podcast to do is give you the knowledge to ask better questions, understand your body more deeply, and make more informed decisions in partnerships with the practitioners who do know you.

If something resonates and you wanna take action, please work with a qualified healthcare provider who knows your full picture

Andrea: Welcome back. In 26 years of clinical practice, bone health is the thing that women come to me about last. It sits behind the fatigue, behind the weight, behind the sleep, behind the hormones Nobody arrives in my clinic saying, "I'm worried about my skeleton." And I understand why. Bones feel like scaffolding.

Andrea: They feel like the part of you that just holds everything else up and doesn't need any attention. But your skeleton is living tissue. It is [00:04:00] being rebuilt right now while you listen to this. And through your 40s and 50s, the terms of that rebuilding change. So today, we are doing bone health properly.

Andrea: We're gonna start with what osteoporosis actually is and why it deserves more of your attention than it gets. Then we're gonna go inside the bone itself and look at how it rebuilds, and at the difference between bone density and bone quality, which are two very different things that get treated as one.

Andrea: Then we're gonna look at the estrogen window through perimenopause and when your losses actually begin. Then we're gonna talk about calcium balance, which is where most of the advice in this space can go wrong, and I'm going to correct two pieces of bone advice you have almost certainly heard that the evidence no longer supports.

Andrea: Then we're gonna go through how to get your calcium in if you don't eat dairy, which is one of the most common questions I get in my inbox. And I'm [00:05:00] creating this podcast on a client question. So I found in my podcast stats, because it's a very new podcast, I've only been going a couple of months, that the one listener Q&A question episode I did wasn't the most popular.

Andrea: So I've decided instead to use those questions to create specific topics for podcasts. So here it is. I had a beautiful listener question that asked, "How do we get calcium if we don't eat dairy?" So we're going to address that, and we're also gonna look at the co-factors, the nutrients calcium cannot work without.

Andrea: And we're gonna finish with load, which is the single most powerful lever you have, and with what to ask your GP at your next appointment. That's a lot of ground, so let's go, ladies. Let's get some really strong, healthy bones.

Andrea: Now for the science, the physiology, whatever you wanna call it, there are two words worth separating. Osteopenia means low bone mass. The word comes from the [00:06:00] Greek for bone poverty, which I've always thought is a very good description. You're not in crisis, but you're running on low reserves.

Andrea: Osteoporosis means porous bone, and it's a specific diagnosis made on a scan called a DEXA. An osteopenia diagnosis is also made by the same scan. So a DEXA is a very low-dose X-ray that measures the mineral density of your bones, usually at your hip and your lumbar spine, and sometimes at your wrist as well.

Andrea: It gives you a T-score, which compares your bones to a healthy young adult reference population. Below minus one is osteopenia, and at or below minus 2.5 is osteoporosis. Now, why does this matter?

The danger of thin bone isn't the thinness, it's the infrastructure, and typically it's the...

Andrea: The danger of thin bones isn't

Andrea: thinness, it's the fracture that can come afterwards, and specifically the hip fracture. When an older woman breaks a hip, [00:07:00] she generally goes to hospital, she has surgery, she stops moving, and the cascade that follows, potentially clots, pneumonia, muscle loss, loss of independence, is what causes the harm.

Andrea: In fact, that's what happened to my grandfather. So osteoporosis doesn't just happen to women. My grandad was 93, living on his own, still milking the cows on his farm, and unfortunately he got knocked over one day by one of the cows. He fractured his hip, and he didn't make it out of hospital after surgery as he developed pneumonia.

Andrea: We all said that he would have made it to 100 if it wasn't for that hip fracture. So just like my grandad, across the published literature, it shows that somewhere between

Andrea: One in five and one in three older adults die within 12 months of a hip fracture, depending on the population studied and the age of the group. Many of those who survive never return to independent living I want to sit with that for a [00:08:00] second because we talk endlessly about heart disease and cancer and dementia, and I kind of think we barely talk about osteoporosis.

Andrea: Osteoporosis is quiet. It doesn't frighten anyone until it's already done its work, and the vast majority of women who have low bone density right now don't know it. Nobody has scanned them. There is no symptom to prompt the question of a scan

Andrea: So the whole game here is played in advance. Now, let me take you inside the bone. Think of your skeleton as a construction site that never actually completes. There's a demolition crew and there's a building crew, and they are both on site every single day of your life. Old bone gets broken down and carried away.

Andrea: New bone gets laid in its place. That process is called bone remodeling, and it [00:09:00] turns over your entire skeleton roughly every 10 years. The demolition crew are called osteoclasts. Clasts, think of them as the crew that clears the site. The building crew are cells called osteoblasts. So

Andrea: blasts build. Clasts clear, blasts build. In your 20s and 30s, the builders are winning. You reach your peak bone mass somewhere around age 30. That is the most bone you will ever have. From there, it becomes a question of how fast the demolition crew works and how well you keep the builders supplied.

Andrea: Now, an important distinction to make, bone density and bone quality are not the same thing. A DEXA scan measures density. It tells you how much mineral is packed into a given area of bone. What it does not tell you is how that bone behaves when it's loaded, whether it [00:10:00] flexes or whether it shatters I'm back on the building site again.

Andrea: So think of reinforced concrete. The concrete is the mineral, your calcium, your phosphate, and then the steel reinforcing running through is collagen, the protein matrix that the mineral is laid down onto. Concrete on its own is hard and it is brittle. Hit it wrong and it cracks straight through. The steel underneath is what lets the structure bend a little under load instead of failing.

Andrea: And your bones are the same. You want them dense, and you want them slightly springy. Now, there's a really interesting instructive piece of medical history here. Decades ago, fluoride was used as a treatment for osteoporosis Because it reliably increased bone mineral density on a scan.

Andrea: The density went up, and the fractures went up, too, because the bone that fluoride produced was denser but also [00:11:00] more brittle. It was a better number on the scan, but it was a worse bone in the body. And I tell you that because it explains why I don't want you chasing a single number and why the whole picture, protein, collagen, movement, inflammation matters alongside the minerals

Andrea: And that's also where inflammation comes in. Chronic low-grade inflammation, the kind that simmers for years without ever declaring itself. It pushes the demolition crew to work harder. Inflammatory messenger molecules, cytokines they're called, like TNF alpha and interleukin 6, well, they directly stimulate osteoclast activity, the clasts being the clearers This is part of why conditions like rheumatoid arthritis, inflammatory bowel disease, and untreated celiac disease carry higher rates of bone loss.

Andrea: The gut inflammation and the bone loss looks unrelated from the [00:12:00] outside, but inside they're running on the same signaling. Which means an anti-inflammatory way of eating is not a separate project from your bone health. It is the same project. My three-week inflammation detox and my 12-week whole health solution programs exist precisely because so much of what damages us long term runs through that one mechanism around inflammation.

Andrea:   Now, let's talk about when our losses actually begin, because the answer is earlier than most women expect, and it's all related to our estrogen. Estrogen is not only a reproductive hormone, it has a direct protective role in bone.

Andrea: Think of it as a hand on the shoulder of the demolition crew, keeping them slow and steady. But as estrogen falls, that hand comes off. The best data we have on timing [00:13:00] comes from a study called SWAN, the Study of Women's Health Across the Nation, which has followed a large group of women right through the menopause transition for nearly two decades.

Andrea: In one analysis, published in the Journal of Clinical Endocrinology and Metabolism in 2020, the researchers looked at a measure of bone microarchitecture called the trabecular bone score. What they found was that it held steady. No decline at all until about 18 months before a woman's final period.

Andrea: Then it began falling by more than 1% per year. Across the 10 years spanning that transition, the total decline was over 6%. 18 months before your final period, which for most women is a moment you can only identify looking backwards. And through perimenopause, estrogen doesn't glide gently downwards, it swings.

Andrea: Like, it spikes up and it [00:14:00] crashes down for years before your cycles stop. Every one of those troughs is a period where the demolition crew starts working unsupervised. Now, the practical takeaway from all of this, the years between 40 and 55 are your window.

Andrea: What you do in this decade and a half either banks you a buffer or it leaves you walking into your 60s with nothing in reserve

Andrea: Now let's talk about calcium balance, and two things you may have been told that aren't true. So here's where most bone advice goes wrong. Almost everything you'll read focuses on how much calcium you take in. But calcium balance is what determines your bones. What comes in measured against what goes out.

Andrea: Think of a bathtub with the tap running and the plug partially out. You can stand there turning the tap up as hard as you like, [00:15:00] but if the drain is open, the water level doesn't rise. And most of the conversation about bone health is about the tap, turning it on.

Andrea: Very little of it is about the drain, losing it. And this is where I need to be kind of careful with what I'm saying, because the drain has been blamed on some things that don't actually hold up.

Andrea: The first thing I want to correct is protein. You will still hear from some well-known sources in health that eating too much protein leaches calcium from your bones and makes osteoporosis worse. The reasoning was that protein makes your body more acidic.

Andrea: Your body then pulls calcium out of the bone to buffer that acid, and you lose it in your urine. The current evidence does not support this. The National Osteoporosis Foundation commissioned a systematic review and meta-analysis on exactly this question, published in the American Journal of Clinical Nutrition in 2017.

Andrea: It pulled together 16 randomized controlled trials and [00:16:00] 20 prospective cohort studies. Their conclusion was that there was no adverse effects of higher protein intakes on bone, and that there was a moderate evidence for a protective effect at the lumbar spine. That's your low back. A separate meta-analysis published the same year found that higher protein intake was associated with a 16% reduction in hip fractures compared with a lower intake, and plant protein and animal protein performed very similarly, so it's good to know that.

Andrea: So protein is not draining your bones. If anything, it's helping to build them, and it's building the muscle that supports you and protects you when you stumble. For midlife women, that matters enormously, and I do not want a single woman listening to this cutting out her protein and cutting it down in the belief that she's doing her skeleton a favor, because she's not.

Andrea: Now, the second thing I want to correct is the [00:17:00] alkaline diet. This comes from the same acid-base reasoning, and it's the basis of an entire industry of alkaline waters, alkaline powders, and pH strips. The theory says a modern diet makes you acidic and your bones pay for it.

Andrea: Now, a systematic review and meta-analysis published in Nutrition Journal examined this question formally, applying causality criteria to fifty-five studies. The finding was that, yes, higher acid load does

Andrea: Increase the calcium showing up in your urine. But whole body calcium balance studies did not show an actual loss of calcium from the body. No intervention study demonstrated osteoporosis progressing,

Andrea: And no study identified a mechanism that functions around the pH level of your blood so your body's always gonna defend that pH within a very narrow range

Andrea: regardless of what you eat. Their conclusion was that a casual link [00:18:00] between dietary acid load and bone disease is not supported, and there is no evidence that an alkaline diet protects bone

Andrea: Eat your vegetables. Please eat a lot of vegetables. They bring potassium, magnesium, vitamin K, and a hundred other things to your bones, and the rest of what you need. Just don't buy the alkaline water. Save your money there. So what generally does open the drain? Smoking is one. Heavy alcohol intake is another.

Andrea: Long-term oral corticosteroid use, which is a significant one. Very low body weight, and a history of prolonged undereating. Untreated celiac disease and other malabsorption conditions. And worth knowing, weak dental enamel can be a clue here as well. Chronic inflammatory conditions also open the drain, and a sedentary life, which we'll come to in a moment.

Andrea: There's also long-term [00:19:00] acid-suppressing medication, the protein pump inhibitors, so that's your Nexium, your Somac, your Pariet. Stomach acid is part of how you liberate minerals from food, And long-term use of PPI medications has been associated with increased fracture risk in observational data through causation, though it's still debated.

Andrea: I wanna be very direct about this. Do not stop a medication because of this podcast. If you have been on one of these for years without review, the conversation is to have with your GP about whether you still need it and at what dose. Now, that is a legitimate question to ask them, so don't stop those medications on your own. In fact, I often support my clients to come off it with a conversation with their GP, but it takes nine months for my system to get my clients off PPI medications if they've been on them a long time.

Andrea: Because the minute you try to come off them too quickly, all the symptoms come back, so it has to be done in a very slow and supported way.

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Andrea: Now, we've talked about the drain, so I wanna talk about the tap, because this is the question that comes into my inbox almost more than any other, especially around bones and calcium and dairy.

Andrea: Women who don't eat dairy wanting to know how they hit their calcium target

Andrea: Let's start with the number. In Australia, the [00:21:00] NHMRC recommends one thousand milligrams of calcium a day for women aged up to forty, rising to thirteen hundred milligrams a day after fifty. Now, the part almost nobody knows, the amount of calcium in a food and the amount you absorb from it are very different numbers.

Andrea: Think of it as money in two different bank accounts. One you can withdraw from freely, the other charges a fee on every withdrawal. Same figure in the statement, but very different amounts that come into your hands. Dairy sits at around thirty percent absorption. And for those who can eat dairy, where dairy doesn't cause inflammation, well, that's excellent.

Andrea: Yet if dairy causes you inflammation, it will be opening the drain, essentially leaking calcium from your bones and doing the reverse of what you are actually hoping for. Now, it's tricky to work this out though, because does dairy [00:22:00] help or hinder you? Because we're all different, and that's exactly what I help my clients in my twelve-week program work out.

Andrea: Can they tolerate dairy? And if yes, which parts? The A1 casein, lactose, both, or none. And if we find they can't tolerate dairy, we need to look at other food sources of calcium. So you know how I said dairy allows thirty percent calcium absorption? Well, on the flip side, and it's not even dairy, so this surprises people, but kale is an absolute standout high calcium food with roughly fifty percent of the calcium in kale absorbed.

Andrea: And some studies put it higher than even fifty percent. Broccoli and bok choy are up there with it too. Uh, then we come to spinach. We would think that that might be in the same family, but it's actually at a very lowly five percent. Only five percent absorption, despite spinach having a reputation as a good bone food.

Andrea: And the [00:23:00] culprit is oxalates, naturally occurring compounds that bind calcium in the gut and carry it straight back out again. To match the absorbed calcium in one modest serve of kale, you'd need a quantity of spinach that no woman is realistically eating in one day. Spinach is a wonderful food for other reasons.

Andrea: Just don't count on it when it comes to bone health. And the same goes for rhubarb, beet greens, and some nuts which carry oxalates too. Eat them, but just don't lean on them for your calcium.

Andrea: So then we look elsewhere for dairy. Tinned salmon or sardines with the soft bones left in. And these are my favorite because you get the calcium, higher quality protein, and omega-3 fats in the same tin. Then we have tahini, which is ground sesame, and sesame is one of the densest calcium sources in the food supply.

Andrea: We also have chia seeds, kale as I mentioned, bok choy, broccoli, collards, and firm tofu set with [00:24:00] calcium, almonds, dried figs, edamame, fortified plant milk. So if you shake the carton, because the calcium often settles at the bottom. Let me also give you an example of a full day, because eat more calcium only becomes useful once it's put on a plate at mealtime.

Andrea: So it could look like this. Breakfast, coconut yogurt with tahini stirred in, a tablespoon of chia seeds as well, some berries, and a handful of almonds. Lunch could be a big bok choy and tofu stir-fry. And afternoon tea, maybe two dried figs, though I can't handle them. My mom tried to force-feed them to me when I was young and I can't stand them now.

Andrea: But if you're into figs, go for it. And then dinner, it could be tinned salmon with the bones blended into a beautiful salmon and veggie patty Alongside some stir-fried vegetables including kale. Stack that across a day and you are within reach of your target with no dairy on the plate at all.

Andrea: This is exactly the kind of mapping [00:25:00] we do with women inside my 12-week Whole Health Solution program, because the theory is the easy part, but the plate is where it either happens or it doesn't

Andrea: Now, where does milk sit in all this? There was a study that found milk activity increased fracture risk. That claim traces back to a large Swedish cohort study published in the British Medical Journal in 2014, following more than 60,000 women for around 26 years. It found that for every daily glass of milk, hip fracture risk was about 9% higher in women and mortality was higher too.

Andrea: But I wanna give you the honest version of that study, including the part that I have never seen quoted, actually. The authors themselves wrote that the observational design and the real possibility of residual co-founding and reverse causation Because of that, a cautious [00:26:00] interpretation is recommended.

Andrea: So reverse causation matters a great deal here. Women who have already been told they have thin bones are precisely the women who get told to drink more milk. The milk follows the diagnosis rather than causing it in that study. What I'd say plainly, and this is consistent with the Willett and Ludwig review in the New England Journal of Medicine in twenty twenty, the evidence that high dairy intake protects against fracture risk is much weaker than the marketing has ever suggested.

Andrea: Milk is not a bone insurance policy, and equally, one glass of milk is not dissolving your skeleton. If you drink milk and enjoy it, and it doesn't cause you inflammation, drink it. And if you don't enjoy it, and you don't feel good with it, you have everything you need without it. That's a much less exciting answer than either side of this argument wants.

Andrea: Now, if you [00:27:00] and your practitioner decide you need a supplement, here are three practical things I want you to know. Calcium is absorbed best in doses of five hundred milligrams or less at a time. So split the dose rather than taking one large dose at once. If you're taking calcium carbonate, just be careful of that one.

Andrea: Take it with food because it needs stomach acid to break down. And especially be careful if you're on one of those acid-blocking medications. That matters, and you may not be able to break it down as well because of that. Instead, my recommendation is calcium citrate. It's gentler and doesn't depend on stomach acid in the same way, and it's a form, as I said, that I generally prefer to recommend.

Andrea: And not more is better. Think food first, supplement only to close a real gap. Some research has raised questions around high-dose calcium supplementation, particularly without adequate vitamin [00:28:00] D and vitamin K2 causing arterial calcification. That's calcified plaques in your arteries. The evidence there is mixed, and I won't overstate it, but it's a good reason to build from food first and to keep any supplements modest and to only supplement for deficiencies.

Andrea: Now, calcium on its own is raw material sitting on the footpath outside the building site. There are three co-factors that help get it into the body and put it where it belongs

Andrea: Vitamin D is what allows you to absorb calcium across the gut wall. Think of vitamin D as the key that opens the door. Without it, the calcium can be left standing right outside, and it doesn't come in. This is one of my daily non-negotiables, and it is worth actually testing your vitamin D levels rather than guessing what supplemental dose you may need.

Andrea: I find most people are usually lower in vitamin D than what they expect, [00:29:00] and then usually supplementing at a lower dose than they need. Then vitamin K2 directs the calcium once it's inside into the bone and teeth rather than into the soft tissue and the arteries where you don't want it. So if vitamin D opens the door, K2 is the traffic controller.

Andrea: Leafy greens give you K1, which is related but does a different job. K2 comes from fermented foods and certain animal products. If you supplement vitamin D long term, K2 is worth discussing with your practitioner at the same time. And magnesium helps activate vitamin D into its usable form, so the whole chain depends on it.

Andrea: And beyond those three, bone is built from a spread of trace minerals, zinc, copper, manganese, boron, silicon. This is one of the arguments for eating a truly varied diet rather than fixating on a [00:30:00] single mineral or a single mineral supplementation. Your skeleton is not made of just calcium. It's made of calcium plus about a dozen other things, plus the collagen protein scaffold.

Andrea: Now, finally, the part that has nothing to do with what you put into your mouth. Bone responds to mechanical stress. This is a formal principle called Wolff's law. Bone adapts to the load placed on it. Load it, and bone builds. Stop loading it, and your body concludes that this bone is expensive to maintain and not need it and starts stripping it back

Andrea: The clearest demonstration of this is astronauts in microgravity with no load going through the skeleton at all. Astronauts lose bone from their weight-bearing sites at a rate of roughly 1 to 2% per month. They can be young, fit, extremely healthy people, but losing bone at a speed no disease could match purely [00:31:00] because the signal stopped arriving.

Andrea: Your body is not sentimental about your skeleton. It keeps what you use, and it gets rid of what you don't.

Andrea: Now the good news, and this is the study I most want you to hear about, and even better because it's an Australian study. It's called Lift More, run out of Griffith University and published in the Journal of Bone and Mineral Research in 2018. They took post-menopausal women with low bone mass, the exact group who have been told for decades to be careful and avoid heavy lifting, and they put them through eight months of supervised heavy resistance and impact training twice a week, 30 minutes a session, five sets of five repetitions at over 85% of their one repetition maximum.

Andrea: The training group increased lumbar spine density by nearly 3%, while the comparison group lost more than 1%. Femoral neck density, that's the top of your femur, the top of your leg bone, [00:32:00] held while the comparison group lost ground. And every measure of physical function improved: balance, sit to stand, and back and leg strength.

Andrea: That is 30 minutes twice a week.

Andrea: Now I'll share something personal here because it's kind of interesting, and I do think about this a lot. I spent years as a professional dancer at the Moulin Rouge in Paris, at Son Amar in Spain, on cruise ships through the Caribbean, dancing in Sydney on all sorts of different shows, and on the Sydney Showboat.

Andrea: Six nights a week, or sometimes seven, of jumping and landing and putting load through my skeleton. For years, I did that without a single thought about my bones. I was not building a bone density buffer on purpose. I was doing a job that I loved, but I built one, and I'm still drawing on that now. Now very few of you have done the French can-can twice a night every night for years,

Andrea: And you don't need to do that to have strong bones. Your skeleton doesn't care whether the load [00:33:00] arrived from being on stage or from a squat rack. It only cares that the load arrives. Now, I have a caveat about lifting heavy for you. The Lift More study was supervised, and it was done properly heavy. I'm not telling you to start from scratch and lift a really heavy barbell alone tomorrow.

Andrea: Find someone to teach you to lift well. Start lighter, add progressive overload, and build up. And finding someone to help you do that is one of the better investments you'll make for yourself in these decades.

Andrea: And the second thing, train your balance and your muscle, not only your bone because the fracture in the hip requires you to fall first. Now, I had a giggle recently because my friend told me that as she turned 50, that before 50, if you fell, you fell over. But after 50, you had a fall. Little bit of a difference, So ladies, it just makes us feel older after 50 because we have a fall versus falling over. But ladies, let's not [00:34:00] fall over, and let's not have a fall.

Andrea: Muscle mass, reaction time, and balance are what lets you catch yourself. Bone in midlife is a whole body conversation. Nutrition, movement, and of course, mindset too.

Andrea: And on mindset, you often have to find your why in order to look after yourself and find your best health for the long term. I help the ladies in my 12-week program with this through a couple of different exercises we do. Now, for me, my why is my mum. I've talked about her on the podcast before, but she developed breast cancer in her late 30s and went on to have some very strong chemotherapy.

Andrea: Again, had another diagnosis on the other side of breast cancer in her mid-40s. But it was really the chemotherapy that affected her bones in a very bad way, and she went on to develop osteoporosis. She also developed multiple chemical sensitivities, she couldn't take a lot of those osteoporosis [00:35:00] drugs.

Andrea: She tried Fosamax, and it nearly killed her, like literally nearly killed her. It was terrible. Anyway, I see my mum now. She's had 12 spinal compression fractures. She's in pain every day, and even though she, most of the time, maintains a really positive mindset, it's really hard for me to watch her going through that, and that's my why.

Andrea: I don't want to experience that pain and that disability and loss of function that my mum has experienced through developing osteoporosis. So girls, find your why. Find something that is bigger than you that helps you go towards your long-term best health because I don't know about you, but I want to live a really long life filled with best health, not just a long life with pain and injury and problems and no ability to do what I love.

Andrea: Now, let's go onto something practical, which is what to ask for at your next GP appointment. Ask [00:36:00] about a DEXA scan and ask early. In Australia, unfortunately, DEXA is not covered on Medicare until you're over 70, I think. Don't quote me on that, but I think it's about 70.

Andrea: Now, because of my mom's history, I asked to have a DEXA scan earlier, and I'm like, "Oh, don't worry about paying up front. That's fine." Anyway, it was only about $130, so it wasn't a huge amount of money, and I think that's a really good investment into your future health. So probably from the time of filming this podcast, maybe about two and a half years ago, I had my first DEXA scan, and it was good.

Andrea: It was fine. There was no osteopenia, no osteoporosis, and I was like, "Great." Then about 18 months later, I had another one after I had really been going into the gym and doing progressive overload and working in the gym twice a week, and my bone density had not gone down as I've got older and into the throes of perimenopause, but it had actually gone up.

Andrea: So I was really pleased about that, and it gives me full motivation to do a DEXA scan about every two years to keep [00:37:00] monitoring and also to keep lifting my heavy weights. Now, one scan is a data point, but two scans, like I had, are a trend, and a trend is the thing that actually tells you what your bones are doing.

Andrea: If you're perimenopausal and you've never had a DEXA scan, that's a reasonable conversation to open with your GP. It's a very small amount of money to invest in your future health. Then next, ask for your vitamin D level to be tested and for the actual number rather than just to be told it's fine. I like my patients to be around 90 to 100 or 110 for their vitamin D.

Andrea: And if you have unexplained bone loss, ask for celiac screening, thyroid, and parathyroid function, and take a look with your GP at any long-term medications that you're taking. All of these are really reasonable things to discuss. And if you have been prescribed medication for osteoporosis, the bisphosphonates or any of [00:38:00] the newer agents, please have that conversation properly with your prescribing doctor rather than with the internet.

Andrea: These medications have real benefits for women at genuine fracture risk, but they also have side effects worth understanding. Now, both things are true. That balance is specific to you, your scan, and your history,

Andrea: And everything in today's episode sits along that decision rather than replacing it. Let me bring it together for today's episode. Number one, bone is living tissue on a constant demolition and rebuild cycle, and it is quiet. No symptoms come until something breaks. Two, density and quality are different things.

Andrea: You want dense bone and springy Three, your losses begin earlier than you think, around 18 months before your final period, which means the 40 to 55-year-old window is where all of this bone health is decided. And then four, [00:39:00] calcium balance beats calcium intake. Watch the drain, not only the tap. Five, protein is not draining your bones, and the alkaline water is not saving them.

Andrea: Six, without dairy, you have kale, bok choy, broccoli, tinned fish with bones, tahini, chia, tofu, almonds, and figs, and the absorption amount matters. Seven, vitamin D opens the door, K2 directs the traffic, and magnesium runs the machinery. Eight, load your bones twice a week properly, and train your balance too, because we all need to not fall over or have a fall.

Andrea: Next episode, we're moving into a topic so many of you have asked me about directly. What blood tests to ask your doctor for at an annual screen, And how to know if it is okay if you're told the results are all [00:40:00] normal. I cannot wait to get into that one with you. So please hit subscribe or follow the show on whatever platform you're listening on right now, because you do not wanna miss a single episode.

Andrea: And if someone in your life needs to hear this, please share it with them too, because the more women who have access to this kind of information, the better. Just a little note, all of my free resources, my three-week inflammation detox, and my 12-week whole health solution can be found at andrearobertson.health.

Andrea: Everything you need is right there waiting for you. If you've loved today's episode, please take 30 seconds to leave a review on Apple Podcasts, Spotify, or wherever you listen to your podcasts. It genuinely helps more women find the show so they can nourish, heal, and rise too. Until next week, nourish your body, keep healing, and never stop rising.

Andrea: I'm Dr. Andrea Robertson, and this has been Nourish, Heal, and Rise.