March 27 Q&A Bone Drugs, Heel Drops, Vibration Plates, Oxytocin, IGF-1

March 27, 2024


Session Notes

The following points summarize the key topics and information shared during todays meeting:

1. **Pharmaceuticals for Osteoporosis**

Dr. Lucas acknowledged that traditional medical practitioners often prescribe drugs as the primary treatment for osteoporosis because that is the main tool available to them. Their goal is to prevent fractures, and they may not be fully aware of the downsides of these medications. Dr. Lucas emphasized the importance of individualized treatment while also discussing general trends and considerations.

2. **Hormones and Bone Markers**

Questions about bone markers and DHEA sulfate were discussed and the need to wait for stabilized hormone levels before taking action. The conversation also covered the use of commercial testosterone products for women, noting the challenges of dosing and the preference for compounding creams to achieve the correct dosage.

3. **Oxytocin**

Dr. Lucas described oxytocin as a drug, hormone, and peptide with applications in sexual health and potential benefits for bone density, although there are no studies directly linking oxytocin to increased bone mineral density.

4. **Breast Cancer and Hormone Replacement**

Dr. Lucas discussed the complexities of hormone replacement therapy for breast cancer survivors, especially those with estrogen-positive cancer. The conversation highlighted the need for a collaborative approach with oncologists and the exploration of alternative options if estrogen is not advisable.

5. **Peptides**

Dr. Lucas mentioned the regulatory challenges with peptides, such as abutamoren (MK-677), which have been removed from the market due to FDA actions influenced by pharmaceutical companies.

6. **Bisphosphonates**

Dr. Lucas expressed concerns about the over-prescription of bisphosphonates like Fosamax, Reclast, and Boniva. He discussed their mechanism of action, potential side effects like atypical femur fractures and osteonecrosis of the jaw, and the long-term implications of suppressing bone metabolism.

7. **Denosumab (Prolia)**

Prolia, an anti-resorptive drug that is popular due to its convenience and effectiveness in reducing vertebral fractures, was discussed. However, there is an increased risk of vertebral fractures after stopping the drug, which requires careful management.

8. **Romosozumab (Evenity)**

Dr. Lucas briefly touched on Evenity, which is used for a maximum of 12 months and has both anabolic and anti-resorptive phases. It is not considered a long-term solution.

9. **Anabolic Drugs (Forteo and Tymlos)**

Dr. Lucas spoke about anabolic drugs for patients with severe osteoporosis or high fracture risk, as they promote bone building without suppressing bone metabolism. He discussed the removed black box warning for osteosarcoma and the challenges with insurance coverage.



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Dr Doug: really was to just kind of hit some of the major.


00:00:04.211 --> 00:00:17.485

Dr Doug: The major drug points give people kind of my perspective on them, because I think we've had just again a lot of questions on different drugs when to use them when not to use them. And obviously there's every case is different.


00:00:17.515 --> 00:00:34.334

Dr Doug: But there's some generalities that I think we can talk about for those that have their video on or for those that are willing to turn their video on when you were diagnosed with osteoporosis, assuming you have osteoporosis when you were diagnosed with it, whose doctor told them to take a drug, a pharmaceutical for it.


00:00:37.215 --> 00:00:40.779

Dr Doug: everybody, except for Tom. Oh, Nope, Tom, too.


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Dr Doug: And I got some thumbs up awesome as well. Kim. Okay, Jim. So yeah. And so let me just start off by saying that that's totally normal and totally fine, because the the medical doctors, the Dos, the Mds. That are in the traditional medical system. It's the only tool they have.


00:00:59.075 --> 00:01:19.354

Dr Doug: so their goal is to help prevent fracture, so their goal, their their hearts are generally in the right place, and they have a tool that they feel like they can use, and their education probably hasn't really told them all of the downsides. And so they use the tools that they have access to. And that's generally gonna be pharmaceuticals, and they don't have the training to really talk about anything else.


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Dr Doug: So


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Dr Doug: Before I really dive in, I'm going to wait until it actually turns


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Dr Doug: 12 here on the east coast.


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Dr Doug: as everybody else is filtering in I'll just kinda reiterate that we're hey, Alan? That, we're gonna talk about drugs today. But if anybody has any questions about hormones, go ahead and drop those in the chat. So I wanna make sure we follow up on that from last week.


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Dr Doug: So, David, great question about Tim Loz.


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Dr Doug: yeah. Great question from Liz. That's a great question. I'll cover that.


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Dr Doug: Oof.


00:02:08.605 --> 00:02:17.674

Dr Doug: that's a complex and anatomy question, Susan. I'll see if I'll see if I can answer that. All right, let's start with Liz's question. We'll talk about that from a


00:02:17.795 --> 00:02:34.665

Dr Doug: a hormone perspective, and then I'll talk about oxytocin as well. Since that sort of bleeds in between drugs and hormones. So so? Liz asked. She said she had her bone markers and dhas sulphate done a few weeks ago. I assume I need to wait on hormone levels before acting on this


00:02:36.315 --> 00:02:54.595

Dr Doug: and then she has a question about commercial testosterone. So, Liz, I'm not sure I totally understand that question about Dha, meaning that, are you concerned that it was low and your bone turnover markers weren't weren't where you wanted them to be. If you give me more on that, and then, as far as the commercial testosterone. So


00:02:54.615 --> 00:03:04.205

Dr Doug: there are commercial testosterone products that are made from men, and Androgello is a product that's made from men. So you can use variations of dosing to work for women.


00:03:04.205 --> 00:03:28.525

Dr Doug: The challenge with a product like Android gel is, although it's actually not really strong enough for men either. But usually the the men's products are gonna be too strong. Right? So men have 10 x the the testosterone levels of women. And so if you were to use a a very small dose of a male strength product, it gets kinda difficult to use. So the amount of androg you'd wanna use would be very, very small. Same thing with like testosterone injections.


00:03:28.815 --> 00:03:35.885

Dr Doug: we can use an injection of testosterone, but the lowest strength you can get is 100 milligram per ml. So you're doing.


00:03:35.885 --> 00:04:00.775

Dr Doug: you know, point one, or you know, point O 5 Ccs of a of an oil which is just. It's there's almost more waste in the syringe than there is actually injected into the the muscle or sub queue. So it's just kinda challenging to do. And that's why we compound it and cream instead. Cause cream you can compound in whatever strength you want. So for men, we use 200 milligrams per milliliter for women. We would use 2, 4, 6, 8, 10,


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Dr Doug: and you know, somewhere around that range. So again, like.


00:04:03.365 --> 00:04:08.745

Dr Doug: like, you know, a tenth or a twentieth of the dose, if that makes sense.


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Dr Doug: And then Susan, ask a question about kind of some some tough anatomical stuff around the thyroid. I don't know that I can actually answer that in a logical way, Susan. So I'm gonna defer that to.


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Susan Jaye: I just wanted to know. I just wanted to know. I didn't make it clear. I just wanted to know if you have a thyroid ultrasound, and they tell you that you have a certain measurement of that. It's miss, or whatever, if that's the same as having a heart and heart test? Are they 2 different.


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Dr Doug: Those those are, yeah, those are gonna be different measurements altogether. Yeah.


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Susan Jaye: That's what I want to know. Thank you.


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Dr Doug: And problem.


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Dr Doug: Alright. So let's talk about oxytocin real quick. So oxytocin is a kind of a fun drug slash hormone, slash peptide that we use. So it kind of fits into the category of all 3,


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Dr Doug: because it is made technically kind of by a pharmaceutical company. But it's compounded generally is how we get it. So it is a drug. It is a hormone cause. It's made endogenously in both women and men, but more in women, and then it is short enough. I believe it's under 20 amino acids in length. So it then is also technically a peptide. So oxytocin is kinda cool because it's been used in the sexual health space for a long time. So


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Dr Doug: if you were to look at, you know, go back for decades where


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Dr Doug: researchers have been looking for different tools that both women and men can use to increase. We'll just call it desire intimacy. It's not like an erectile dysfunction drug, or the the same, but for women. But it does help to improve relationships between people. So it's kind of been leveraged in that space and sexual health for a long time, which is why I'm comfortable using it because it's been used in, you know, millions, and probably tens of millions of doses without reported side effects.


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Dr Doug: Oxytocin, naturally, is a hormone that's secreted in premenopausal women and higher levels


00:06:05.685 --> 00:06:20.974

Dr Doug: during the the period of time. Kind of right before ovulation, so sort of just naturally secreted in in an attempt for the brain to help the the body to become more attracted both to and from a partner, so to increase the likelihood of making babies


00:06:21.705 --> 00:06:30.044

Dr Doug: postpartum. So after a woman delivers a baby, she has a large increase in oxytocin, which potentially also helps with the delivery.


00:06:30.045 --> 00:06:52.894

Dr Doug: but helps with the letdown of milk, and then also helps with bonding of the baby. So for those of you that have had children, you might remember that screaming, pooping, biting monster that entered into your life. And it's amazing that we choose to love these things. I have 3 of them, so I can kinda say that, at least from the father perspective. But women are disappointed, secreted, so that they then are kind of


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Dr Doug: pushed into having a better relationship with this little thing right out of the gate.


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Dr Doug: So it's kinda cool that in that same postpartum period oxytocin bonds to osteoblasts and has a receptor there, so women will reliably lose bone mineral density during pregnancy, because the baby is sort of sucking it all out of you like a parasite, and then your body helps to put it back by using a a hormone like oxytocin, so we can leverage that and the postmenopausal timeframe to again encourage Osteoblast to make more bone.


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Dr Doug: There are no studies, and I say this every time I I recommend it to a patient. There are no studies looking at Bulmer density and oxytocin. But it is a fun drug slash hormone with pleasurable side effects that also should be increasing Bulmer density. So it's sort of a fun little hack, if that makes sense


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Dr Doug: hoop


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Dr Doug: any questions on that


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Dr Doug: great, it comes in a nasal spray.


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Dr Doug: So it's also not a


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Dr Doug: not another capsule


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Dr Doug: which we're always trying to avoid. Alright. So this is actually a great in between Sally. So thank you for putting this in here and being open to saying that out loud. So Sally put in the chat. She says, I'm a breast cancer survivor. Estrogen positive took Electrazole for 5 years. Cancer was stage one surgery, irradiation, how to decide if some form of hormone replacement is worth the risk.


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Dr Doug: boy, that's a really really tough question. And I have that exact same clinical scenario 2 h from now.


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Dr Doug: So I have this.


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Dr Doug: I have this conversation more often than I'd like to. It's really really tough.


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Dr Doug: it's tough, because we have to get buy in from oncology and oncology in general doesn't like hormones. So I never wanna just steer somebody, especially a breast cancer survivor to say, look, estrogen is safe. We don't need to worry about it. Let's just go do it. That would be irrational, and probably malpractice, technically.


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Dr Doug: because the truth is is that if you are at high risk, and I said this last week with with hormones.


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Dr Doug: if you're at high risk of developing breast cancer and a woman who has had breast cancer is at higher risk than a woman who has not. So if you're at high risk of developing breast cancer, and you're on estrogen, especially if it was estrogen positive. The recurrence of the same cancer is more likely than a different cancer.


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Dr Doug: If you're on estrogen, then you are more likely to have a new cancer grow faster. So it's sort of like throwing fuel on the fire, thinking that the fire is out and the fire wasn't out.


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Dr Doug: You know what I mean. So that's that's the risk. Now there are plenty of women, and if anybody remembers you know Suzanne Summers, who died, I think, last year. She was such a huge advocate for biochemical hormone replacement, wrote books about it. She had breast cancer. She survived. She was in remission. She went back on hormones, and then she died of breast cancer, recurrence.


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Dr Doug: super unfortunate


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Dr Doug: for her cause, because that was kind of her whole thing. She was such a big advocate for hormones. And then, unfortunately, that ended up killing her.


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Dr Doug: But it's an example of you know. It is risky, and there is risk. And so the question is, is, what do you have more risk of? We know that it's gonna improve your bone marrow density. We can say that confidently. If you have severe osteoporosis, and you're likely to fracture. You know your spine or your hip. What are you more afraid of what's what's a better option. And that's a very individual question.


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Dr Doug: So, Sally, that that question for us we would have to get. We'd have to get buy-in from your oncologist. Talk about estrogen! And if the answer was a hard No.


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Dr Doug: then we talk about other options. What about Progesterone? Was it progesterone positive? If not, can we consider Progesterone? What about testosterone? We know testosterone aromatizes to estrogen. But we can use testosterone and an aromatase inhibitor, and then you get the benefits of testosterone. And you don't have any estrogen. Would they be okay with that? And so we try to take a team approach. Sometimes oncologists are not open to anything at all. And then we just have to use other options. Right?


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Dr Doug: Hormones are a powerful tool, but they are not the only tool.


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Dr Doug: So then you can other also leverage other things like oxytocin and other peptides, and then really lean on the lifestyle stuff.


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Dr Doug: So hope that all makes sense.


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Dr Doug: And then, Beth, I will let me just mention this one Peptide, and then we'll get into the drugs.


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Dr Doug: So Beth asked about the peptide of Butamorin.


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Dr Doug: So a beauty more. And also it goes by the name MK. 6, 7, 7


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Dr Doug: is a Peptide that we were using for a while. And, Beth, if you if you haven't heard this yet. So the FDA went through and kind of wiped out a bunch of the different Peptides that we use.


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Dr Doug: not because they're dangerous. Not because there's any patient related issues with the Peptides purely because the FDA has a strong affiliation with pharmaceutical companies. Pharmaceutical companies don't like peptides because they can't patent those things, and they can't make money off of those things. So they strongly encouraged the FDA to eliminate them whenever possible. So they went through and eliminated some really really good Peptides


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Dr Doug: that had lots of human evidence, and again, millions of doses with no side effects or no bad outcomes associated with them.


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Dr Doug: So abutamorum was one of those, and the reason why we used it is that it increases. Igf one igf, one stands for insulin like growth factor. If you've never measured it, it's essentially how I describe it to my patients. Igf, one is like the anabolic catabolic switch. So if you are trying to gain muscle mass, you're trying to build bone. You want Igf one to go up. If you wanted to potentially lose weight, you want Igf one to go down


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Dr Doug: right? So it's this, like catabolic antibiotic switch in the Igf, one Peptides like abutamor, and Mk. 6, 7, 7. Storlin, Cjpamoral and testimoral all these different Peptides all function through the Igf one receptor.


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Dr Doug: if that wasn't too techy.


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Dr Doug: Okay.


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Dr Doug: alright. So let's talk about drugs, because this is a really, really it's a really important topic that I don't like to talk about, because I don't prescribe the drugs for the most part, but who in here has been told to take. You don't have to answer this if you don't want to. But who has been told to take abyssphosphenate? So Phosmax reclast Boniva, all those so like


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Dr Doug: about a quarter third of people on the call, right


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Dr Doug: when they recommended those drugs. So put your hands down when they recommended those drugs?


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Dr Doug: Did they do any testing to show that you were rapidly losing bone? Was your Ctx elevated? Did they have any any indication whatsoever that that was the right drug to use


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Dr Doug: no one. Right? So here, raise your hand. If they did do that


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Dr Doug: one.


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Susan Jaye: Phone density.


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Dr Doug: Right. It's all about bone density. But we don't know what that means. Right?


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Dr Doug: So here's the thing with the bisphosphonates. They're popular because they're cheap. They're oral. They, in theory, are low risk. And it's so easy to write right. If I'm a doctor and I have 5 min and your T scores less than negative. 2.5, or your frax is above, you know, whatever


00:13:45.765 --> 00:13:53.274

Dr Doug: it's so easy to just say bit. Let's just put you on a bisphosphony. What's the harm? It'll improve your bone mineral density, and it will


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Dr Doug: but


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Dr Doug: the bisphosphonate drugs in general, I think, are woefully overprescribed, and there are some potential risks.


00:14:03.605 --> 00:14:06.215

Dr Doug: So most of you have probably heard me talk about this. But


00:14:06.955 --> 00:14:10.704

Dr Doug: there's basically 2 categories drugs. So there is the


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Dr Doug: the antresruptive drugs. So the drugs that act mostly on osteoclasts. And then there's the anabolic drugs, the drugs that act mostly on the osteoblasts and build up bone. I'll talk about those last. So the anti-resive drugs include the bisphosphonates


00:14:26.446 --> 00:14:41.015

Dr Doug: prolaa, and to some extent of entity we'll talk about that one in the middle. The bisphosphony is the most popular. They've been around the longest, and there's so many different forms, you know, oral ib, you know, monthly and yearly infusions with reclast.


00:14:41.175 --> 00:14:47.894

Dr Doug: And so the Bisphosphonates literally poison the osteoclasts. So they stop working.


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Dr Doug: and then the Osteoblasts continue to work, some in as a result of that imbalance, that sort of uncoupling, of bone metabolism, you will see an increase in bone mineral density. Usually not always. I have a patient. Later today she was on fossil Max, I think, for 2 years, and her bone density continued to go down so clearly that wasn't the right drug for her.


00:15:06.855 --> 00:15:14.154

Dr Doug: But what I see in the labs. And when we look at the bone turnover markers is that when you squash ctx, so you push Ctx into the ground.


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Dr Doug: That's the breakdown marker. We expect that P. One and P. The Bone building marker, gets squashed, too. Now there must be some residual p. One. And P. That's why people continue to increase bone mineral density.


00:15:25.675 --> 00:15:40.305

Dr Doug: but we see them both very, very low, and that's why you run into problems with bone metabolism. So you run into the atypical femur fractures and osteone of the jaw, that if you've if you've ever looked up images of either of those things, you don't want either one.


00:15:40.395 --> 00:15:45.404

Dr Doug: And so that's why there are now restrictions on how long you can take the Bisphosphonates. So


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Dr Doug: if you are on depending on which one it could be 3 years 5 years. I think there's one that's in theory out to 7 years.


00:15:52.005 --> 00:16:08.354

Dr Doug: But you can't take them forever. Because if you squash bone metabolism indefinitely, you will eventually run into issues because you need to turn over your bone. Otherwise you end up with dense, fragile bone. So it looks good on Dexa. But you still have fractures, and that's the atypical femur fractures. And I can tell you that the


00:16:08.435 --> 00:16:12.965

Dr Doug: the they say that that's that's low risk. I just think they're under reported


00:16:13.115 --> 00:16:27.315

Dr Doug: cause we saw as an orthopedic surgeon is some all the time, you know. Obviously, we're in a biased space, and you know we're seeing femur fractures. But I saw a lot of atypical femur fractures. It was really common for women that have been on bisphosphonates, and were those ever reported? No.


00:16:27.645 --> 00:16:56.155

Dr Doug: so I think we don't. We don't really know what that risk is, but that's why I I really don't like these drugs osteosis of the jaws terrible. If you've ever seen videos of that, or experience somebody talking about their experience with it is terrible. And I think the likelihood of you know somebody as they age, you know, and you get into your sixties, seventies, and eighties and needing dental work is pretty darn high. So putting yourself in a situation where, you know doctors, the the dentists. They don't even wanna work on you. If you're on a bisphosphony. Has anybody experience that


00:16:56.325 --> 00:17:01.054

Dr Doug: right? They they'll literally be like, I'm not. I'm not touching you. I'm not gonna do anything for you.


00:17:01.205 --> 00:17:05.384

Dr Doug: And that's that's a problem, because we need our teeth to eat food.


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Dr Doug: So so in general, I don't like the Bisphosphonates. Those 2 side effects really scare me. There's other side effects like the oral ones. There's, you know. There's nausea. There's esophageal issues, you know. You upset stomach, or whatever. I'm not as worried about that. Usually you can do something about that or switch to Iv there's some reports about esophageal cancer. So I don't really know what to think about those reports. But for the most part it's the bone metabolism issues. If you squash bone metabolism forever, I think you're gonna run into issues.


00:17:32.615 --> 00:17:37.675

Dr Doug: So if you were 90 years old and you didn't have a choice, and you were mostly refined to a wheelchair, anyway.


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Dr Doug: Maybe that's the right scenario, right? You don't know what your life expectancy is. It might be 5 to 10 years. Then maybe it's okay. But if you're 50, if you're 60, even if you're 70,


00:17:48.265 --> 00:17:51.725

Dr Doug: I mean, you have too long. There's too much time left


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Dr Doug: to use a drug like that, because on the back end of that, what are you gonna do?


00:17:56.835 --> 00:17:58.564

Dr Doug: So I'll talk about that in a second.


00:17:58.745 --> 00:18:07.344

Dr Doug: So all right. So then that's bisphosphony. That's why I don't like it, and I don't think we should use it pretty much for the most part for anyone.


00:18:07.715 --> 00:18:14.485

Dr Doug: There are scenarios, though, where it makes more sense. So those scenarios would be like this breast cancer question. Right? So


00:18:15.455 --> 00:18:17.760

Dr Doug: let's say, a woman is on


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Dr Doug: whatever what, Sally, what'd you say you were on


00:18:22.105 --> 00:18:37.254

Dr Doug: electrosol? So that's a aromatase inhibitor. Right? So you're on a drug that will reduce estrogen and essentially take it to 0 for a kind of Perry, or even especially premin of causal woman. If you haven't gone through menopause yet, and you're put on a drug that blocks your estrogen


00:18:37.475 --> 00:18:46.034

Dr Doug: man. It is, I hear, terrible because your body is eliminated. Your body has been ripped off of estrogen instantaneously.


00:18:46.105 --> 00:19:01.425

Dr Doug: Menopause kinda does this right? Like you have it. You don't have it. You have it. You don't have it. Your body sort of get used to it, but you can adjust over time to some extent you still have symptoms, or most women will have symptoms, but you can adjust to it over time when you remove it completely


00:19:01.505 --> 00:19:16.645

Dr Doug: immediately. Women are really symptomatic, and as a result, the bone loss, not to mention the other stuff. But the bone loss is rapid. So in that scenario where you say, well, I know from the neurontologist says you're gonna be on this drug for the next 2 years or 3 years or 5 years.


00:19:16.795 --> 00:19:18.825

Dr Doug: You're gonna be on this drug for the next 5 years.


00:19:19.005 --> 00:19:35.084

Dr Doug: Why don't we use something temporarily that can help to shunt that blow, that, or slow down that bone loss right like that makes sense to me, and that's why there, one of the drugs reclass? There's a my cancer version of it. I can't remember the name of it. But use that same drug.


00:19:35.085 --> 00:19:52.734

Dr Doug: It's a an annual infusion. Slow down bone loss, poison your osteoclasts temporarily. That kind of makes sense. Right? So then you can maintain your bone mineral density while you treat the breast cancer, assuming you survive the breast cancer, then you're on the other side of it, and you add a much better starting point to maintain your bone density potentially without drugs.


00:19:53.035 --> 00:20:00.744

Dr Doug: So that's where I think that really makes sense. Other scenarios. If you have a rapid bone loss. Your ctx is really high and you can't slow it down.


00:20:00.815 --> 00:20:11.564

Dr Doug: We go through a program. You're doing all the things you're like. Shoot. My ctx is still 800. What do I do? Maybe it's time to actually put one of those things in place. I still probably wouldn't use it. Bisphosphony.


00:20:11.595 --> 00:20:17.625

Dr Doug: But before I move to the next drug, I would say Prolaa would be next any questions on bisphosphonates.


00:20:19.825 --> 00:20:23.225

Dr Doug: No, great. I'm not a fan case. You couldn't tell.


00:20:23.385 --> 00:20:29.675

Dr Doug: So the next probably most popular drug would be prolia who here has been recommended. Prolaa


00:20:31.585 --> 00:20:36.747

Dr Doug: some, not as many. I'm surprised, actually, because it seems really popular. So


00:20:37.986 --> 00:20:41.405

Dr Doug: yeah, Liz, do you have a question about bisphosphonates? Nope.


00:20:41.735 --> 00:20:43.245

Dr Doug: do you have a question about Perlia?


00:20:44.335 --> 00:20:45.974

Dr Doug: Do you have a question about something else.


00:20:48.085 --> 00:20:49.684

Dr Doug: You can ask your question if you want.


00:20:49.685 --> 00:20:51.574

Liz’s iPhone: I was recommended folia.


00:20:51.575 --> 00:20:52.864

Dr Doug: Okay, gotcha. Gotcha.


00:20:53.475 --> 00:21:11.694

Dr Doug: Yeah. So Prolaa has become more popular, I think, for 2 reasons. One is, it's just more convenient. So doctors have this problem with pills because patients don't wanna take them. So if you wanted to increase the likelihood of your patient being compliant, you can give them an injection once a month and then as long as they show up for their appointment, then you're good.


00:21:11.785 --> 00:21:41.105

Dr Doug: So that's a real thing. And doctors deal with compliance issues, especially in the bisphosphonates, because people don't wanna take them so it's popular with doctors because it gives them more control. Also, they can bill for the injection. So there's a financial incentive to using an injectable drug. It's an office visit, and you get a procedure code. So take that for what it is. Prolia is different than the bisphosphonates. It is also an anti resorive drug. It just works a little bit in a different pathway. I just recorded a new video on this.


00:21:41.155 --> 00:21:46.184

Dr Doug: So it's kind of a cool drug. It it works at the the rank Ligand receptor.


00:21:46.405 --> 00:21:56.034

Dr Doug: Or actually, I rank, laying it individually. So it sort of activates your immune system, tells your immune system to go after this thing that acts on the Osteo sites


00:21:56.075 --> 00:22:01.175

Dr Doug: downstream, impact osteoclasts it also downstream impacts part of your immune system.


00:22:01.425 --> 00:22:17.184

Dr Doug: which is why one of the side effects is increases risk of infection. But it works differently than this phosphinates, so it doesn't necessarily poison the Osteoclax, but it slows down their function, and we still see that same drop in. Ctx. We see that same drop in p. One. And P.


00:22:17.425 --> 00:22:40.924

Dr Doug: And they loved it, though, because it was so effective. And if you look at the numbers, it's really effective, especially for vertebral fracture. Right? So the the, I think, the original trial, the freedom trial. I wanna say, it was like a 40% higher than that 60% reduction in vertigo fractures which sounds really high. But that's a relative risk. And if you've heard me talk about these statistical things, there's relative risk, there's absolute risk.


00:22:40.925 --> 00:22:48.464

Dr Doug: It was still not insignificant. It was like a 4% reduction, absolute risk reduction for vertebral fractures. So that's not nothing.


00:22:48.475 --> 00:22:58.734

Dr Doug: It doesn't really do as much for hip. I think that just has to do with the mechanism. So the reduction in hip fracture was about 0 point 5% absolute risk reduction, which is not super impressive.


00:22:58.765 --> 00:23:07.465

Dr Doug: but what they liked about it is they didn't see in the initial three-year trial. They didn't see atypical femur fractures or osteonicrosis of the job like not a one. So that's cool.


00:23:07.625 --> 00:23:27.054

Dr Doug: So then they did a 7 year extension to that that initial 3 year trial that they got FDA approval from, and that 7 year extension took them out to 10 years. So they took everybody in the 3 year trial, and then they took all the people on placebo, and they added them. So then they had people that had been on it for potentially up to 10 years, or up to 7 years, and then some people that had gotten off of it.


00:23:27.355 --> 00:23:33.554

Dr Doug: and they show that again that it was actually pretty darn safe. I think they had one atypical femur fracture in in that trial.


00:23:33.965 --> 00:23:51.054

Dr Doug: and I don't think they reported any cases of osteonicrosis of the jaw. Now remember, these are all funded by Amgen. So take that for what it is. But they didn't report any of those complications. So they're sort of, you know, they're celebrating. They're like, Hey, now we have this long term solution that looks to be safe


00:23:51.175 --> 00:23:56.624

Dr Doug: for 10 years, and who knows how long? Right we can use this drug forever, but


00:23:57.215 --> 00:24:09.745

Dr Doug: is interesting. I don't know really where this came about, but Amgen also funded a look at another study, and this seems like a bad business move, responsible. But poor business choice. So they looked at another study


00:24:09.825 --> 00:24:23.395

Dr Doug: and funded it, and where they got X-rays, or they looked at who had X-rays of people that were on the drug, and people who had come off the drug. So people who had stopped prolee after, either before or after 3 years.


00:24:23.415 --> 00:24:33.795

Dr Doug: And what they found is that it wasn't that many. It was like 350 patients that had X-rays. There was an increased risk of vertebral fracture after stopping the drug


00:24:34.605 --> 00:24:40.934

Dr Doug: and the risk of multiple retrieval fractures in the group of people that had been on the drug for over 3 years that were stopping the drug.


00:24:41.365 --> 00:24:44.495

Dr Doug: So now you sort of find yourself in the situation where, like shoot.


00:24:44.715 --> 00:25:05.205

Dr Doug: I'm on a drug, and I can't get off of it, because if I get off of it. Then I'm gonna have a vertebal fracture. So that was kind of the takeaway from that study. And so now you know, a lot of people will hop on the they get recommended to be on the drug. They take their first injection, then they go on Facebook, and they're in a like an Osteoprosis group. And the people are talking about these, this risk of increased fracture. And you know, and then I get these messages on


00:25:05.235 --> 00:25:08.564

Dr Doug: on Youtube. And people are freaking out. And so


00:25:09.065 --> 00:25:15.925

Dr Doug: I think that we have to take into context of what the risk was. It was not high, it was in the single digits.


00:25:16.235 --> 00:25:30.645

Dr Doug: What we're just what we're simply seeing is that if you suppress osteoclast function for long enough, when you come off the drug, you're gonna see it an increase in function, right? The body's gonna rebound. You've been holding it down forever, and as soon as you let go of it it's gonna go nuts.


00:25:30.685 --> 00:25:38.315

Dr Doug: and that's what happens. And so osteoclasts go crazy. They reserve a whole bunch of bone and put you at increased risk of fracture, and it kind of just makes sense.


00:25:38.425 --> 00:25:45.174

Dr Doug: So there's a lot of people that are on this drug that want to come off of it, that are scared to come off of it.


00:25:45.445 --> 00:26:09.025

Dr Doug: What I said in the video is, you have to remember that a the percentage of people that have fractures is very low. The percentage of people that have multiple vertebal fractures, which is what is, you know, really scary, right? Just keep fracturing, keep fracturing. They also had multiple vertebal fractures before they started the drug. So if you're you know, the 55 year old woman who's been on it for 3 years, who's never had a fracture? Who has reasonable bone quality. That's probably not gonna happen.


00:26:09.495 --> 00:26:13.844

Dr Doug: And also the people that were in that study were probably not doing anything else.


00:26:14.395 --> 00:26:26.755

Dr Doug: Right? So like, you guys are motivated. You're doing stuff. You're here. You're learning. You're doing resistance training. You're eating the diet. That's gonna help your bones. You're pushing. Igf one up like that's not gonna be the same group


00:26:26.965 --> 00:26:49.425

Dr Doug: that was seeing the vertebra fractures. Can I guarantee that somebody's not gonna fracture? Of course not. But we have several patients that were on Proleah that are coming off of Prolaa. And we're really pushing as hard as we can without drugs to see what we can do, and so far their their Ctx. And P. One and P. Look good. If you read this book. Mccormick's book, you guys haven't read this like Bible on Bone Hill.


00:26:49.745 --> 00:26:55.534

Dr Doug: I'm slowly making my way through it. He talks about monitoring people, monitoring Ctx.


00:26:56.025 --> 00:27:12.805

Dr Doug: And give some case examples of prolaa and and watching. You know how quickly it rises right, and considering he, he even talks about like he's kind of a I wouldn't say he's a drug advocate, but he certainly talks about using them potentially using Abyssin 8. If you see it get too high. I haven't seen that happen yet.


00:27:13.125 --> 00:27:27.324

Dr Doug: and that's why I think that you know what we do is so effective because we're pulling all the levers we can, you know, from the lifestyle, from the supplements, from the hormones, from the Peptides, if applicable, doing all the things. If you do that, we don't see this massive increase in ctx.


00:27:28.115 --> 00:27:29.195

Dr Doug: Does that make sense?


00:27:30.835 --> 00:27:39.184

Dr Doug: So it is possible. So if you hear anybody really freaking out about that, please tell them it is possible we just have to have a solid approach and test frequently.


00:27:39.255 --> 00:27:46.595

Dr Doug: like I would get Ctx and P. One and P like every month, you know, know what's happening. Don't stick your head in the sand on that one, because you will lose bone quickly.


00:27:48.365 --> 00:27:49.295

Dr Doug: make sense.


00:27:50.635 --> 00:27:52.535

Dr Doug: cool any questions about Prolaa.


00:27:56.115 --> 00:27:56.805

karendunham: No.


00:27:58.985 --> 00:28:01.225

Susan Jaye: I just sent one. I just sent one.


00:28:01.225 --> 00:28:04.374

Dr Doug: Oh, sorry I'm not watching my chat.


00:28:06.195 --> 00:28:10.475

Dr Doug: Well, there, I missed a lot of things in chat. Sorry, guys.


00:28:11.105 --> 00:28:18.074

Dr Doug: all right, Susan, Susan says recently a woman told me that she had a broken shoulder, and her rheumatologist recommended prolee.


00:28:18.295 --> 00:28:22.334

Dr Doug: I looked it up and saw on the Internet that Prolaa does not target the thoracic spine.


00:28:22.365 --> 00:28:28.334

Dr Doug: I know certain bone drugs, target different spine hips. Some of these drugs work on different parts of the spine.


00:28:29.172 --> 00:28:31.145

Dr Doug: Yeah. So if


00:28:31.365 --> 00:28:32.075

Dr Doug: hmm!


00:28:32.495 --> 00:28:35.685

Dr Doug: They weren't, they weren't looking at. Is that true?


00:28:35.795 --> 00:28:45.314

Dr Doug: I think they were looking at spine fractures. They were talking about spine fractures overall. So Perlilla does work better on the spine than it does on the hip.


00:28:45.695 --> 00:28:47.855

Dr Doug: So it might be.


00:28:48.005 --> 00:29:00.154

Dr Doug: It might be the drug of choice for that particular person. It just depends on her situation, proximal, humorous fractures, that shoulder fracture. It is a fragility fracture depending on the mechanism


00:29:00.445 --> 00:29:03.594

Dr Doug: so that that could make sense again depending on the situation.


00:29:04.605 --> 00:29:18.404

Dr Doug: but not good for hips as much. Let me just go back and look at these. Is Fossa Maxabis, Phosphorine? Mary asked. The answer. Is that. Yes, Fossa, Max is like the quintessential bisphosphony. I'll come back to Ppis Kim


00:29:19.305 --> 00:29:25.404

Dr Doug: Melody asks, How does a person decrease their ctx while increasing their P. One. And P. Oh, that's such a good question.


00:29:25.505 --> 00:29:26.804

Dr Doug: Let's talk about that.


00:29:27.297 --> 00:29:45.465

Dr Doug: So when I started this game a couple of years ago, and I learned about the bone. Health, the bone bio markers. I was super excited to prove that we could raise P. One and P. Which is the building marker and drop. Ctx turns out that doesn't work that way. So these are the things we learned. So


00:29:45.605 --> 00:30:06.294

Dr Doug: bone metabolism when manipulated naturally, and what I mean by naturally is with natural occurring things, not with drugs necessarily, although with drugs. Kinda 2, the Ctx and p. One and P are linked, meaning that they tend to go up and down together. So it is not common that we see Ctx drop in p. One, and P. Go up.


00:30:06.635 --> 00:30:20.855

Dr Doug: That would be cool, and I have seen that happen a few times, but usually we see them move together. That's why we switched from looking at the independent markers. So Ctx and P. One and P. What their absolute measures are. We switch to looking at the ratio of the 2?


00:30:21.035 --> 00:30:26.674

Dr Doug: So you've heard me talk about that P. One and P. Over Ctx. Divided by 1,000. We do that because.


00:30:26.815 --> 00:30:29.104

Dr Doug: let's say, just give a couple of examples. So


00:30:29.175 --> 00:30:40.265

Dr Doug: actually, Michelle is a great example. So Michelle gave us her numbers. Right? So Michelle said. Her Ctx. Is 1, 58, and her p. One, and P. Is 30, and she's been taking Allendron it for 5 years. All right. So let's do some math.


00:30:40.555 --> 00:30:49.434

Dr Doug: So if we do the math on that, and we say, p. One, and P. Is 30, so we're doing 30, divided by point 1 5 8.


00:30:50.315 --> 00:30:51.855

Dr Doug: Your ratio.


00:30:51.875 --> 00:30:54.114

Dr Doug: Michelle, is 1 89


00:30:54.435 --> 00:31:00.734

Dr Doug: now for somebody who's not on a drug, 199 is not bad. I would actually take 189.


00:31:01.045 --> 00:31:20.474

Dr Doug: The, I think, where this falls apart is when you're on drugs that falsely suppress both of them. The ratio doesn't mean as much, so there probably is a threshold, and I don't know what it is yet of P. One and P. That we need to maintain cause I've seen. I saw a woman recently who was on pro Leah, and these were squashed like Ctx, double digits, and P. One and P like at 10,


00:31:20.625 --> 00:31:25.075

Dr Doug: right? But her ratio was 300. It looked amazing, but we know that she's not building bone.


00:31:25.255 --> 00:31:41.475

Dr Doug: so there's gotta be a threshold. We just haven't. We don't have data to know what that is yet, but we switched to the the ratio instead of the absolutes because we know that they're gonna go up and down together. It's how much they go up and down together. So, for example, let's say, Michelle goes off of Allendron. So she goes off the drug.


00:31:41.743 --> 00:31:42.815

michellethompson: Off of it! Now.


00:31:42.815 --> 00:31:46.374

Dr Doug: There we go alright. So you're you're off of it now. How long have you been off of it?


00:31:46.605 --> 00:31:51.224

michellethompson: Since last October. Ish.


00:31:51.225 --> 00:31:52.215

Dr Doug: Okay. Same way.


00:31:52.215 --> 00:31:58.834

michellethompson: Now I'm doing diet all the stuff the heel drops, weight training and stuff, and I have another bone scan in August.


00:31:58.955 --> 00:32:01.955

Dr Doug: Beautiful. When were these laps drawn before that I would assume.


00:32:02.847 --> 00:32:06.285

michellethompson: These labs were drawn in December.


00:32:06.625 --> 00:32:10.394

Dr Doug: Oh, so actually, so these were. You were probably more suppressed


00:32:11.095 --> 00:32:12.274

Dr Doug: when you were on it.


00:32:12.595 --> 00:32:20.525

Dr Doug: because for Alan drawn a it would have worn off by then. So you were seeing some bone metabolism more than you were when you were on it, I bet.


00:32:20.856 --> 00:32:23.295

Dr Doug: So that's cool, and you're getting a scan when.


00:32:24.130 --> 00:32:24.625

michellethompson: August.


00:32:25.145 --> 00:32:50.514

Dr Doug: Okay, cool. So I would recommend repeating Ctx and P. One, and P around the same time, or sometime before then. I like, you know, if I could do it again, you know. Really, there's no downside to doing it frequently other than it's expensive to do on your own. The other thing I would say is, make sure we just had this conversation yesterday, and it was really frustrating. Make sure that you're getting them done at the same time, and that they're fasted cause they do change throughout the day.


00:32:50.675 --> 00:33:00.834

Dr Doug: So that can be a really annoying thing for people. But try to do it the exact same time of day. Try to mimic as many of the variables as you can, and then you're going to get the best sense of what's going on.


00:33:00.845 --> 00:33:04.955

Dr Doug: But yeah, we'll see what happens. Right? So we'll see what happens in the spring and the summer.


00:33:05.395 --> 00:33:06.195

michellethompson: Yup!


00:33:06.335 --> 00:33:08.355

Dr Doug: Do all do all the things that's great.


00:33:11.965 --> 00:33:25.594

Dr Doug: Diane asked. Do you use bisphosphonates to prevent rebound after Prolaa? Is it possible to get off without those, and that's kind of what I was talking about. I don't know when you wrote this, Diane, but most doctors, if people come off of Prolaa. They will use bisphosphonates. But here's the thing.


00:33:25.725 --> 00:33:34.555

Dr Doug: If we are worried about the fact that we were suppressing bow metabolism for a decade, why would suppressing bow metabolism for another 5 to 7 years make sense.


00:33:35.145 --> 00:33:38.154

Dr Doug: It does prevent the rebound loss.


00:33:38.195 --> 00:33:44.124

Dr Doug: But we're further poisoning osteoclast and preventing bone from doing what it does. So we need to let the bone


00:33:44.415 --> 00:33:50.845

Dr Doug: go through metabolism if we're going to get it better. So I think they're just kicking the can down the road potentially making it worse.


00:33:51.735 --> 00:33:56.344

Dr Doug: Kim real quick on PPI's. So proton pump inhibitors


00:33:56.555 --> 00:34:01.784

Dr Doug: used for acid reflux and other things. Proton pump inhibitors do increase fracture. Risk.


00:34:02.045 --> 00:34:22.625

Dr Doug: They don't. They don't decrease Bominaro density. And this is where a lot of doctors get confused. There's some big studies that looked at PPI use, and it did not show that there was a decrease in bone mineral density. But there is an increase in fracture risk. So this is one of those areas where fract, where bow mineral density is sort of detached from fracture risk to some extent


00:34:23.225 --> 00:34:49.805

Dr Doug: that makes sense, and doctors fight back on that. Now there are reasons to be on ppis, even if you have osteoporosis. So let's say, for example, if you have evidence of esophageal cancer, precancerous cells, hyetal hernia that can't be fixed surgically. Some other reason why you need to be on a acid suppressing drug. Then I would trade that increased fracture risk for not having a soft cancer is absolutely terrible.


00:34:50.895 --> 00:34:51.675

Dr Doug: So


00:34:51.685 --> 00:34:56.444

Dr Doug: I always tell people don't feel bad. If you need to be on a drug for the right reason, just make sure it's the right reason.


00:34:58.191 --> 00:35:04.444

Dr Doug: Angie said, that she needs a bisphosphonate because she had her last perlia injection yesterday.


00:35:04.515 --> 00:35:06.555

Dr Doug: Yep, that's pretty common


00:35:06.835 --> 00:35:08.305

Dr Doug: or romos ozzy map.


00:35:09.665 --> 00:35:11.275

Dr Doug: which


00:35:11.345 --> 00:35:13.721

Dr Doug: is a vanity. So


00:35:14.445 --> 00:35:19.855

Dr Doug: that's a good but great transition. So, Angie, just, we're going to transition to to identity


00:35:19.985 --> 00:35:21.625

Dr Doug: any other questions on prelima


00:35:23.195 --> 00:35:31.304

Dr Doug: cool. So aroma, sozumab, Orlia, I'm sorry, or identity these names Perlia is denossumab


00:35:32.075 --> 00:35:54.145

Dr Doug: chromosome identity. So identity hit the market. I don't remember how long ago. It hasn't been that long, and it was sort of hailed as like the miracle drug, because the trials were really positive in slowing down fracture. So if you were a patient with multiple vertebra fractures. This was sort of the godsend, right? Because it would stop people from fracturing. So that's cool.


00:35:54.345 --> 00:36:09.365

Dr Doug: But you can only take it for 12 months. So talk about a short lifespan. What's the next plan? You've got to have something that you can do after that. And so identity is kind of cool. It's another sort of immune-based drug.


00:36:09.889 --> 00:36:23.404

Dr Doug: and it works. It's been told to be both anabolic and anti-resorptive. But what it really does is, it starts out anabolic, but then it ends up being anti-resortive. And so when you look at the bone turnover markers that kind of start to go up, but then they come down.


00:36:23.405 --> 00:36:47.684

Dr Doug: and I think that's why you can't use it past 12 months, too, is because at some point they just kinda stop. It stops being effective. So it's a really short term solution. If I had a patient that was actively fracturing, I think it's reasonable to use the side effect profiles pretty good from what we know now, I don't think there are any long term studies on it, though, but again, people aren't using it after 12 months, anyway. So you're only gonna use it short term. And you have to have a plan after that.


00:36:48.125 --> 00:36:57.884

Dr Doug: realistically. If I were treating a patient with it, which I would never do. But realistically, you'd actually want to stop it sort of at the peak of the anabolic phase, which would be around 6 months.


00:36:58.095 --> 00:37:08.095

Dr Doug: so take it for 6 months, stop and then do something from there. To continue to push that up would be my preference of how to use that drug. That's really all I have to say about that, because again, it's just not a long-term solution.


00:37:08.315 --> 00:37:10.945

Dr Doug: Those aren't those aren't the people that I hear


00:37:11.165 --> 00:37:12.554

Dr Doug: any questions about that


00:37:14.635 --> 00:37:27.034

Dr Doug: cool? Alright. So let's talk about anabolic drugs. So anabolic drugs are my favorite. I've prescribed them. I can think 3 times, so I don't. I still don't use them a lot. But antibiotic drugs would be Forteo and Timlos.


00:37:27.185 --> 00:37:49.274

Dr Doug: The reason why I like them when we need a drug is because they don't squash bone metabolism. They elevate it. So p. One, and P. On Forteo and Tevlos will go from whatever the starting point is in the double digits. It'll hit, you know, 1, 5,200. 300. I've seen it over 300, right? So that's rapid bone building. That's why they work the way they do. But Ctx goes up too.


00:37:49.285 --> 00:37:58.474

Dr Doug: and so you still have to look at the ratio. But the ratio for the patients that I've seen on it is always positive. I mean, it's like the ratio is 300. 400. It looks amazing.


00:37:59.505 --> 00:38:17.854

Dr Doug: The so the benefit is, you rapidly build bone. I use it for patients where their T- score is terrible, and they're at very high risk. If they've already had a fracture, they're in a deep, dark hole, and I'm confident that the things that we're gonna do are going to help them. But I wanna help them faster, right? This is where we would use an anabolic really drive this?


00:38:19.955 --> 00:38:28.955

Dr Doug: it works, I mean, every time, and the only downside I see is it can mess with your calcium metabolism. So you see potential of the side effects of having hyper calculation


00:38:29.215 --> 00:38:51.685

Dr Doug: because you're again, you're building bone. Actually, it's hypo calciumia. You're pulling bone out of the bloodstream. But either way you have to check your electrolytes potentially, change your dose, change your frequency, whatever most people can get through that without an issue. The black box. Warning that's that's subsequently been removed is all about osteosarcoma bone. So that's a scary sounding cancer. And it is a terrible cancer.


00:38:52.055 --> 00:38:57.124

Dr Doug: But it's never been reported in an adult taking this drug ever. Not once.


00:38:57.265 --> 00:39:04.265

Dr Doug: So the reason why they got that black box warning was because in the original drug trials on mice or rats. I think it was rats.


00:39:04.727 --> 00:39:22.254

Dr Doug: The rats developed osteosarcoma, but if you go back and look at the rat model that they used, and it was like like all of them, it's like, but if you go back and look at the rat model that they used, it's a model that is prone to developing cancer. So you give a


00:39:22.255 --> 00:39:41.385

Dr Doug: a a rat model that's prone to developing cancer, a drug that rapidly turns over a single cell line. What's the likelihood that it's gonna develop cancer? It's pretty high. And so when you then took that to the human studies, they stopped them after 2 years because they tried to do the math on the rat lifespan. And when they developed cancer and what that relates to with humans, that's impossible. Math, by the way.


00:39:41.435 --> 00:39:49.945

Dr Doug: so they stopped it at 2 years. We don't have any data past 2 years. There was not a single case of osteosarcoma, and I think the reason why is that in adults


00:39:50.235 --> 00:39:58.545

Dr Doug: sorry in humans, in humans, osteoarcoma is a kid disease, and it is terrible. And I've treated it and it sucks.


00:39:58.595 --> 00:40:02.645

Dr Doug: but it's it's a disease of adolescence in young adulthood.


00:40:03.055 --> 00:40:14.325

Dr Doug: We don't see it in older adults. We don't see it in mature adults, so I just don't think that we're in a position with our bone growth and the the condosites, and how they're developing. We're not going to see osteosarcoma


00:40:14.435 --> 00:40:17.645

Dr Doug: in in older adults with this drug. I don't think ever


00:40:17.835 --> 00:40:32.704

Dr Doug: so. I think that they did a huge disservice to the drug and the potential benefit of the drug by putting that black box label on it. I think there is potential use of this drug again. We've used it a handful of times when we've really needed it. The challenge is, it's hard to get insurance to pay for it.


00:40:32.765 --> 00:40:35.935

Dr Doug: and they always refuse it. They kick it back every time.


00:40:37.085 --> 00:40:41.895

Dr Doug: So that's the insurance game which is really annoying any questions about the antibiotics


00:40:44.565 --> 00:40:47.974

Dr Doug: cool? I do have a list of questions. Actually, I should be looking at.


00:40:48.895 --> 00:40:53.863

David Callen: One quick question at your own time. Loss. Do


00:40:54.365 --> 00:40:59.055

David Callen: Can you work out and continue? You know, resistance, training that type of thing to


00:40:59.205 --> 00:41:00.575

David Callen: strengthen the bond.


00:41:01.795 --> 00:41:02.681

Dr Doug: You better?


00:41:03.475 --> 00:41:13.485

Dr Doug: Yeah. And so let me. Just that's a great comment. So the way that we use it is we don't change anything other than the fact that you're on this drug.


00:41:13.735 --> 00:41:33.385

Dr Doug: And when people come into the program and they say, Hey, I was told to take Forteo and my doctor's really pushing me to do this. This is my starting point a lot of times, we'll say, look, let's get your bone turnover markers now, before you start it, go ahead and start it if you have access to it, and then we'll just layer the program on top of it by the time you end up coming off of it in one to 2 years.


00:41:33.385 --> 00:41:51.135

Dr Doug: Then you're gonna have such a good program. You're gonna have a better chance of maintaining the bone that you've built than if you you know, did nothing, which, again, is what most of the population would do right. So absolutely do all the things put everything in place, and that way when you come off of it. It's just like you were shot up an escalator at the airport, and now you're on the next floor.


00:41:51.445 --> 00:41:54.295

Dr Doug: you know. It's just a much faster way to get there.


00:41:55.255 --> 00:41:56.904

Dr Doug: I have a question, too.


00:41:56.905 --> 00:41:57.275

Diane K Miller: I'm.


00:41:57.275 --> 00:41:58.645

Dr Doug: Yes, Diane! Hi.


00:41:59.333 --> 00:42:03.904

Diane K Miller: Are they still saying? You can only take it for 1, 2 year span, and not again.


00:42:04.175 --> 00:42:19.165

Dr Doug: I have heard that they lifted the 2 year restriction. I've not seen that in writing from any any one, any organization. So I've heard that the FDA. Will allow it, but I don't know that insurance companies would pay for it, and it is stupid, expensive.


00:42:19.515 --> 00:42:21.165

Diane K Miller: Okay. Thank you.


00:42:21.165 --> 00:42:34.722

Dr Doug: Yeah, cause I I had somebody I don't remember. I I don't think this was a patient or remember somebody on Youtube who like there was the same guy, one person who just kept saying, Just take foretail forever. I was like, I don't know. I don't know if that's a good idea.


00:42:34.965 --> 00:42:42.114

Diane K Miller: Well, I already took it once. It was a long time ago, but my insurance is through Eli Lily who makes it


00:42:42.285 --> 00:42:43.325

Diane K Miller: so? I.


00:42:43.325 --> 00:42:45.185

Dr Doug: You'd think, yeah, I bet.


00:42:45.185 --> 00:42:47.175

Diane K Miller: And make trouble getting it approved.


00:42:48.765 --> 00:42:51.825

Dr Doug: Yeah, can that be shared with other people? Can you get it for others?


00:42:52.702 --> 00:42:53.817

Diane K Miller: I wish.


00:42:54.535 --> 00:42:55.128

Dr Doug: Me too.


00:42:55.425 --> 00:42:57.405

Jennifer Doak: I have a question about Tim Wells.


00:42:57.405 --> 00:42:58.530

Dr Doug: Yeah. Hi, Jennifer.


00:42:58.905 --> 00:42:59.945

Jennifer Doak: About


00:43:01.625 --> 00:43:06.344

Jennifer Doak: I don't know electrolytes. And I mean, I'm assuming you're gonna end up with


00:43:06.935 --> 00:43:10.115

Jennifer Doak: probably higher calcium. Or is that only some people.


00:43:10.405 --> 00:43:12.285

Dr Doug: Yeah, it's it's only some people.


00:43:12.815 --> 00:43:14.235

Jennifer Doak: So would you.


00:43:14.765 --> 00:43:18.955

Jennifer Doak: Is that in your urine or in your blood to California, or both.


00:43:18.955 --> 00:43:29.814

Dr Doug: So what they're worried about is in blood, so it can mess with electrolyte balances in serum, which calcium is very tightly controlled. That's why we really like.


00:43:30.275 --> 00:43:51.195

Dr Doug: I don't often worry about what your blood calcium looks like, because your body's gonna control your blood calcium very tightly. You're gonna see it in urine, too. If you have hyper calcemia, it's gonna come out in urine, right? Cause your body's gonna get rid of it. But I don't really worry about that, either, because it's there's no downside to having calcium and urine as long as your bones continuing to get better right? It's just excreting calcium that you're using otherwise.


00:43:51.605 --> 00:43:55.065

Jennifer Doak: Does that tie into anything at all with like.


00:43:55.725 --> 00:43:58.145

Jennifer Doak: possibly too high of vitamin d.


00:43:58.675 --> 00:44:15.435

Dr Doug: Yeah, it's an interesting question. And I've not seen that studied because anytime the the women's health initiative basically demonstrated that calcium and vitamin d is the gold standard treatment for osteoporosis. So all of the drug trials are going to have calcium and vitamin d. 2.


00:44:15.435 --> 00:44:45.304

Dr Doug: Just depends on what dose. And what form? Right? But that's usually crappy calcium. So it's calcium carbonate or calcium citrate and not a lot of vitamin d. So in the studies. You're not gonna see that in our patient population and people that are coming, you know, they're coming to see us with 5,000 10,000 Iu or 50,000 iu of vitamin DA day. Could that impact calcium? Absolutely right? So now you have 2 really big tools that are manipulating calcium metabolism. And I think that's dangerous on both fronts.


00:44:47.605 --> 00:44:55.115

Dr Doug: Yeah. Vitamin d is, it's real. It'll impact your calcium absorption. We don't need that much vitamin d


00:44:55.425 --> 00:44:59.475

Dr Doug: a couple of questions I want to hit here that were submitted ahead of time.


00:44:59.715 --> 00:45:05.414

Dr Doug: Sandy Lane was, she said, that she's about to receive her fifth prola dose


00:45:05.954 --> 00:45:16.965

Dr Doug: she doesn't like the side effects. She's looking to get off of Prelima, but have been told to do so would need to take a drug like phosphor, Max Boniva reclass, etc. Those are all the Bisphosphonates.


00:45:17.105 --> 00:45:22.985

Dr Doug: So we already kind of covered that sandy. And then is this true? No.


00:45:23.425 --> 00:45:49.544

Dr Doug: hopefully, if so are there. Meds you recommend from research that have the least side effects. So my my preference would be actually. And I've not seen a study on this. But what I would love to see is somebody who is really at risk, or let's say they come off prelate, and they're starting to see a Ctx climb, and they're everything else is optimized rather than using. Anti-resorptive Lycabis phosphinate. See what happens with an anabolic


00:45:49.595 --> 00:46:02.594

Dr Doug: right? So instead of saying, Whoa, Whoa! Whoa, let's put the brakes on the osteoclass. Let's help out the other side of the equation. This is a simple math problem. So let's use an anabolic, and let's drive up P. One and P. And then if the ratio makes sense, then we're okay.


00:46:02.845 --> 00:46:09.065

Dr Doug: So I would love to see that I don't think it's been studied, but I think that would be a cool study to do, and you could do that clinically.


00:46:09.465 --> 00:46:16.405

Dr Doug: So that's the answer to that. But, Sandy, I haven't even seen the need for that. So I think if you have a solid plan you shouldn't see it go crazy.


00:46:21.125 --> 00:46:23.584

Dr Doug: And then I just answered that


00:46:23.945 --> 00:46:27.415

Dr Doug: same thing with Annette. She wants to stop Prola.


00:46:29.515 --> 00:46:33.205

Dr Doug: What is the worst I can expect?


00:46:33.575 --> 00:46:34.515

Dr Doug: We don't know


00:46:34.695 --> 00:46:37.885

Dr Doug: right? We just we just don't know. There's not enough data on that.


00:46:38.245 --> 00:46:43.245

Dr Doug: Lynn was asking, does reclast damage boom remodeling? Yes.


00:46:43.285 --> 00:46:51.255

Dr Doug: if so, for how long? Yeah. Good question. So this goes back to bisphosphonates a reclass being an Iv bisphosphonate. So once a year injection


00:46:51.645 --> 00:46:55.285

Dr Doug: and the half-life is years


00:46:55.895 --> 00:47:19.734

Dr Doug: years. So you'll see this drug stay in your system for you know, 5, 10 years. It depends on how you metabolize it, but it's gonna be there impacting your bone for a long time. I've had patients who've been on it, and their bone turnover markers are still suppressed 2, 3 years later. Right? Ctx is still super low. So it is. It's in there long time. And then how long does the rerun effect to last after


00:47:19.835 --> 00:47:49.255

Dr Doug: Forteo? That's a kind of a different question. So Lynn was asking, How long does the rebound effect last after Forteo. It's kind of like that's sort of using a prolia term and applying it to Forteo. So it doesn't. Really, it's not the same thing. What happens after you stop, Forteo, is that you're on this sort of like, rise right? And then when you stop, it's gonna plateau. And if you haven't changed anything, it's gonna drop. It's not really a rebound. There are not. There is not an increased risk of fracture. After stopping Forteo and timeline like there is afterlia. So? Not really the same thing.


00:47:50.015 --> 00:47:51.154

Dr Doug: Yes, Diane.


00:47:51.275 --> 00:47:53.334

Dr Doug: sorry to catch a mid swallow. There.


00:47:55.595 --> 00:48:03.004

Diane’s iPad: Hello! Put a little bit of it in the chat, but it was back to the eventity. But


00:48:03.618 --> 00:48:12.045

Diane’s iPad: so I, in September had an X-ray have a 6 bird with 6 end plate fractures in the thoracic and lumbar spine.


00:48:12.518 --> 00:48:27.805

Diane’s iPad: Verte Bay heights are maintained, with the exception of I believe it's Cl. 4, 5 so over 2 year period previous to that I was like, go on the Bisbos. No, go on the prolea.


00:48:28.315 --> 00:48:38.105

Diane’s iPad: I'm scared and then on that one get on end of eventity asap but I had pretty much already decided that I was gonna try


00:48:38.545 --> 00:48:44.385

Diane’s iPad: your route this route. So mostly. So I'm I'm I'm comfortable with not being on the drugs. But


00:48:44.783 --> 00:48:57.414

Diane’s iPad: my question, and the only thing that cause I'm in Canada. The only thing I can get is a dexa and a Ctx. So in 6 months my Ctx. Went from 1.1 4 0 to point 7 5 8.


00:48:57.695 --> 00:49:03.618

Diane’s iPad: So it's going down. I know that 1.1 was not good. I knew I knew that, but


00:49:03.915 --> 00:49:07.685

Dr Doug: What's the reference? So those are going to be different units. What's the reference range.


00:49:07.835 --> 00:49:17.875

Diane’s iPad: I I'd actually have to give that to you at some. But I I listen to you very. Oh, because you've repeated this many times, and I think I have it


00:49:18.575 --> 00:49:21.235

Diane’s iPad: once you do the the change from


00:49:21.685 --> 00:49:26.174

Diane’s iPad: once you move the decimal right, so that 1.1


00:49:26.245 --> 00:49:32.235

Diane’s iPad: 4 0 or point 7 5 8 is what you would be using when you would be calculating it against the.


00:49:32.235 --> 00:49:33.385

Dr Doug: I got it, yeah. And then.


00:49:33.385 --> 00:49:33.775

Diane’s iPad: Yeah.


00:49:33.775 --> 00:49:35.775

Dr Doug: If that's true, that is really high. Yeah.


00:49:36.215 --> 00:50:00.485

Diane’s iPad: And then I'm down to point 7 5 8, and next week I go for another one. I've been getting these tests every 6 months which I have to pay for. But anyways, I can't get a P. One. Np, I'm trying to find a place in Washington where I can get a. P. One np, and then our and around. But I'm coming up blank. So right now, my question is with regard to those end plate fractures, and I've had them describe to me are those Osteo productors.


00:50:01.295 --> 00:50:05.735

Dr Doug: Yeah, it's it's gonna depend on what they look like. The fact that you didn't lose


00:50:05.985 --> 00:50:07.725

Dr Doug: height is good.


00:50:08.031 --> 00:50:17.274

Dr Doug: But I was just. I just had this issue. It's so hard to actually get images and look at images. People try to send me desks all the time. The desk never work so aggravating.


00:50:17.275 --> 00:50:17.975

Diane’s iPad: Yeah, I'm.


00:50:17.975 --> 00:50:30.765

Dr Doug: A lot of times. Radiologists don't really get specific, especially on X-ray on Ct. It's usually a little bit more clear. If there's if there's an inplate fracture, especially if there's multiple. I would almost say we have to assume. Because why else would they be there?


00:50:31.185 --> 00:50:32.315

Dr Doug: I think we're


00:50:32.705 --> 00:50:33.565

Dr Doug: go ahead.


00:50:33.715 --> 00:50:40.874

Diane’s iPad: I had the X-rays in September, and then I then I and I've had 2 MRI's one I paid for, and then just a recent one that was through the hospital.


00:50:40.875 --> 00:50:47.034

Dr Doug: Yeah, well, that's what I was gonna say. So MRI MRI can over estimate.


00:50:47.498 --> 00:50:56.204

Dr Doug: Excuse me, MRI can overestimate. And depending on how much edema there was how much swelling in the bone there was. You can kinda get a sense of where these real or not.


00:50:56.205 --> 00:50:57.118

Diane’s iPad: None, none.


00:50:58.145 --> 00:51:02.434

Dr Doug: Yeah. So then, how old were they, you know, and if you could compare them to the previous MRI.


00:51:03.192 --> 00:51:03.815

Diane’s iPad: Send a little.


00:51:04.715 --> 00:51:05.075

Dr Doug: Yeah.


00:51:05.205 --> 00:51:06.284

Dr Doug: like, because it.


00:51:06.515 --> 00:51:13.685

Diane’s iPad: They explained that they're not acute, not then. It only goes from acute to old but there's been no change from September to like last week


00:51:14.211 --> 00:51:18.105

Diane’s iPad: at all. And one of the radiologists


00:51:18.375 --> 00:51:24.864

Diane’s iPad: I got to speak to, and he said, he's not so sure that this just isn't the way my spine is. Does that make it sense.


00:51:25.435 --> 00:51:43.980

Dr Doug: Yeah. And that's that's the challenge, right? So we we don't know and there's no way to know again. MRI can overestimate you could get a Ct. And you could look at them more clearly that way. But I don't know. It's it's really tough. So I think this is one of the reasons why in the studies on the drugs


00:51:45.125 --> 00:51:52.204

Dr Doug: they don't like to use even X-ray because it's going to over estimate.


00:51:52.745 --> 00:51:59.805

Dr Doug: Oh, there you are. Yaki just disappeared on me, Diane. There you are, so I'll get back up here. Oh, I know.


00:52:00.835 --> 00:52:08.135

Dr Doug: Let me move you, anyway, I can still see you. So yeah, so it's tough. I would just, I would pretend, like they're real.


00:52:08.335 --> 00:52:16.864

Dr Doug: because it's probably more important. It it probably makes more sense to pretend like they're at least real, and that you have some some concerning spine weakness.


00:52:17.125 --> 00:52:18.884

Dr Doug: because you're gonna treat it, anyway.


00:52:19.025 --> 00:52:21.354

Dr Doug: So let's just assume that this is what I would do


00:52:21.515 --> 00:52:28.874

Dr Doug: if you were my patient. So let's just assume that they're real. Let's do all the things we can do. But that doesn't mean we necessarily jump, jump on a drug?


00:52:29.325 --> 00:52:30.435

Dr Doug: Does that make sense.


00:52:31.135 --> 00:52:31.485

Diane’s iPad: Will share.


00:52:31.820 --> 00:52:35.505

Dr Doug: Factors is scary. But the fact that you haven't lost height


00:52:35.855 --> 00:52:37.625

Dr Doug: and they don't look like they're new.


00:52:38.375 --> 00:52:43.334

Dr Doug: Let's just move. Let's just move forward to be cautious. But you're doing all the right things getting the getting the labs.


00:52:43.425 --> 00:52:46.064

Dr Doug: One thing I wanted to say is, if you can get to Washington.


00:52:46.814 --> 00:52:51.145

Dr Doug: Look at life extension as a company that you can order the labs through.


00:52:52.635 --> 00:52:53.645

Diane’s iPad: Alright! Let's do that.


00:52:53.645 --> 00:53:04.044

Dr Doug: Life extension has a panel. Ctx. P. One. And P. You can do it without a doctor's order, and they should be able to draw it. In Washington State. There are some states where they have restrictions.


00:53:04.393 --> 00:53:09.174

Dr Doug: The more left coast States describe that, however you will, are more restrictive than the others.


00:53:09.525 --> 00:53:11.665

Dr Doug: If that made sense. Okay.


00:53:11.665 --> 00:53:22.195

Diane’s iPad: I mean my, my my spine is like negative 3.9, and it's an addictive. 6 months later was negative 3.7. Yes, I'm on strontium because I'm throwing everything up.


00:53:22.477 --> 00:53:23.605

Dr Doug: Do it? Yeah, go.


00:53:23.725 --> 00:53:24.934

Diane’s iPad: Right? So, okay, so.


00:53:24.935 --> 00:53:25.450

Dr Doug: Sink.


00:53:25.965 --> 00:53:40.004

Diane’s iPad: Yeah. And I mean, and I'm I'm I'm I'm a gym rap by nature, but I I am in there doing you know currently cause I've lost some weight. But I'm 115 pounds. I'm doing 100 pound dead list. So I'm I'm not hurting myself


00:53:40.165 --> 00:53:40.945

Diane’s iPad: right.


00:53:40.945 --> 00:53:46.944

Dr Doug: Good. Yeah. I mean, I I well, I don't. I mean, I can't say that you're not gonna have a fracture, but I think you're doing all the right things.


00:53:47.155 --> 00:53:53.104

Dr Doug: Yeah. So I would say, Diane, connect with David, because, David, you are. You live in Canada right?


00:53:54.125 --> 00:53:54.945

Dr Doug: Where'd you go?


00:53:56.495 --> 00:53:57.595

David Callen: No, I'm not.


00:53:57.855 --> 00:53:59.294

Dr Doug: Oh, you're not! Oh, there you are!


00:54:00.015 --> 00:54:02.824

David Callen: But let's see, is Lab Corp, in Canada.


00:54:03.235 --> 00:54:03.965

David Callen: Nab.


00:54:03.965 --> 00:54:04.775

Diane’s iPad: Poor!


00:54:04.775 --> 00:54:05.974

Dr Doug: Lab, core.


00:54:06.575 --> 00:54:08.975

David Callen: It's the Major, Us. Player.


00:54:08.975 --> 00:54:14.205

Dr Doug: I wouldn't be surprised if they weren't. Canadian. Canadian healthcare is tough to be a.


00:54:15.005 --> 00:54:15.395

Diane’s iPad: And you know.


00:54:15.895 --> 00:54:35.524

Diane’s iPad: When you say the left province I live in that left province of BC. And it is the worst. If I'm I, if I go to Alberta, or I go to Manitoba or Ontario I can get. I can get these things. So you know I am planning on winters, winter subsiding, and I'm planning to go wherever I've gotta go as far as I got. But yeah, so.


00:54:35.805 --> 00:54:42.985

Dr Doug: He is helpful. The Rems, though I don't think you're going to find a rems until you get from where you are. I mean the closest one, I think, would be in Chicago.


00:54:43.845 --> 00:54:46.115

Diane’s iPad: Actually, there's one in Alberta I call.


00:54:46.115 --> 00:54:47.744

Dr Doug: Oh! There is! Oh, cool and.


00:54:47.925 --> 00:54:51.874

Diane’s iPad: Yeah, so I will. I will like, I say, I wait until the roads are better. But.


00:54:51.875 --> 00:54:53.291

Dr Doug: It would be helpful. Yeah.


00:54:53.575 --> 00:55:06.554

Diane’s iPad: That identity is the reason why that identity was so. What I felt pushed was because it was going to do that increase the strength, so to speak, is that that's the given. My situation.


00:55:06.555 --> 00:55:10.935

Dr Doug: If I again, if I had a patient that was actively fracturing. So let's say you had 5


00:55:11.315 --> 00:55:14.025

Dr Doug: acute or subacute fractures on MRI.


00:55:14.245 --> 00:55:15.385

Dr Doug: Different story.


00:55:15.625 --> 00:55:16.315

Diane’s iPad: Okay.


00:55:16.315 --> 00:55:17.525

Dr Doug: Right? Different story.


00:55:18.275 --> 00:55:18.565

Diane’s iPad: Said.


00:55:18.565 --> 00:55:27.504

Dr Doug: It's tough, it's really tough. Let's answer a couple of questions. I do have to leave on time because I'm doing a talk on hormones for my wife's company.


00:55:28.115 --> 00:55:33.355

Dr Doug: hormones and weight loss. That's a fun conversation. Let's go, Lori.


00:55:34.885 --> 00:55:51.765

Lori Riggio: Hello, Dr. Doug, I have a question for you for the P. One Np. Minus 55.8, and my ctx. Is 3 47. You had explained how to do a ratio of that to kind of make meaning of those numbers. Can you share that with me again?


00:55:51.765 --> 00:55:54.064

Dr Doug: Yeah, same again, 55.8.


00:55:54.345 --> 00:55:58.874

Lori Riggio: 55.8 for the P. One Mp. And the Ctx. Is 347.


00:55:59.185 --> 00:56:09.795

Dr Doug: So the way that you do that is 55.8, divided by point 3 4 7, and that gets you 160. And so those are natural numbers. Right? You're not on a drug.


00:56:10.415 --> 00:56:11.475

Lori Riggio: Yeah. No drugs.


00:56:11.475 --> 00:56:28.124

Dr Doug: Yeah, so so that ratio where we find it. You're probably in sort of like, the yeah kind of middle to lower third somewhere around that rain. You know the the fortieth percentile. Maybe if we were to extrapolate statistics. So it's okay. But it could be better.


00:56:29.115 --> 00:56:36.635

Lori Riggio: Okay? Because my lumbar Dexa was negative 3.9, which is quite scary.


00:56:37.271 --> 00:56:59.068

Lori Riggio: So I'm trying to do all I can, you know from you know the exercise thing. But I saw that a weighted vest might be a good way to build bone, but I don't know which one, and I don't know how much weight to start with, and if you think that's not even worth it. I was looking into the vibration platforms, but they're so expensive. So can you give me a direct.


00:56:59.355 --> 00:57:01.074

Dr Doug: The low hanging fruit. I know. Yeah.


00:57:01.075 --> 00:57:02.315

Lori Riggio: That is great. This is the.


00:57:02.315 --> 00:57:05.257

Dr Doug: Challenge right? Cause there are. There are a lot of things


00:57:06.345 --> 00:57:31.165

Dr Doug: so weighted best. I've got a video on that. It's a little bit older, but there is evidence to support using a weighted vest. The studies would aim at getting to 10% of body weight, but start low. Go slow. Obviously they're loading your spine. That's why you're using them. But they can also put your spine at risk. So that's something that you could consider if you wanna drop if you go. And are you in the the slack community chat.


00:57:31.485 --> 00:57:32.505

Lori Riggio: No.


00:57:32.505 --> 00:57:58.074

Dr Doug: Get, get in slack and ask for some links to some Amazon products. Cause there's a number of people have put stuff like that in there we need to add one to our Amazon list. So maybe go to the the chat there, or slack rather, and put that in there, and we'll get some of the most popular items. We'll put them in the Amazon affiliate list. So you guys will all have access to that. So I think that's that's a re very reasonable. It's it's a you know, not particularly expensive thing to do.


00:57:58.425 --> 00:57:59.165

Lori Riggio: And up.


00:57:59.575 --> 00:58:05.245

Dr Doug: Plates, I think, are cool, because it's a way to do impact. There we go or anchor. Just put one in there for you. So if you look in chat.


00:58:05.245 --> 00:58:05.575

Lori Riggio: Thank you.


00:58:05.979 --> 00:58:07.195

Dr Doug: Assuming aranta. That's.


00:58:08.222 --> 00:58:08.740

Dr Doug: So


00:58:09.975 --> 00:58:20.555

Dr Doug: the vibration plates, I think, are cool, a way to stimulate or simulate, rather impact without doing impact. But you're right. They're expensive. If you're gonna get a good product, you're gonna spend some money.


00:58:20.870 --> 00:58:25.835

Dr Doug: And then what I would say, too, is, look at the video that I did on heel drops.


00:58:26.318 --> 00:58:32.065

Dr Doug: You know, as a as a free way to do impact. That's a no brainer.


00:58:33.185 --> 00:58:33.525

Dr Doug: Friday.


00:58:33.525 --> 00:58:36.865

Lori Riggio: Them, and then I was hurting my neck was killing me, so.


00:58:36.865 --> 00:58:38.374

Dr Doug: It's an incredible amount of.


00:58:38.521 --> 00:58:38.814

Lori Riggio: Later on.


00:58:38.815 --> 00:58:42.974

Dr Doug: Yeah, I I agree so easier way into it. Easier way.


00:58:42.975 --> 00:58:43.414

Lori Riggio: All right.


00:58:43.795 --> 00:58:58.925

Dr Doug: I will say, too, if you have issues. So people that can't do impact the vibration plate. I know they're expensive. But I mean, I I've really I. So I have a power plate. And I really enjoy using it as a way to warm up my joints. I have pretty significant arthritis in my knee.


00:58:59.185 --> 00:59:07.314

Dr Doug: and so like warming up my joints before I do squats. But do any of those things, I use it for my upper body. Now, too, I use it every time. I pretty much use it every day. Yeah, Lorna.


00:59:07.315 --> 00:59:08.794

Lori Riggio: Okay, just.


00:59:08.795 --> 00:59:10.375

Dr Doug: Sorry, Tom, I'll come back to you.


00:59:11.155 --> 00:59:13.545

Lorna Nichols: I just bought a power plate.


00:59:13.685 --> 00:59:14.665

Lorna Nichols: and


00:59:15.105 --> 00:59:18.255

Lorna Nichols: I was amazed when I first got on it.


00:59:18.315 --> 00:59:28.964

Lorna Nichols: I liked the way it felt, and it was actually relaxing, I thought, and I really craved doing it because of the way it feels. So I


00:59:29.005 --> 00:59:34.754

Lorna Nichols: I it was a huge investment for me, but I'm very, very happy with it, did it?


00:59:34.755 --> 00:59:39.705

Dr Doug: Yeah, I I like that company far away above the others, for sure.


00:59:39.735 --> 00:59:42.304

Dr Doug: All right. So, Tom, what do you have for us?


00:59:45.565 --> 00:59:48.034

Dr Doug: I can't hear you. I think you're still muted.


00:59:50.205 --> 00:59:51.685

Dr Doug: See if you can get there.


00:59:52.015 --> 00:59:53.195

Thomas Schellberg: Mute! Unmute! Hi!


00:59:53.477 --> 00:59:55.175

Dr Doug: Hear me! I hear you, Buddy.


00:59:55.535 --> 01:00:01.014

Thomas Schellberg: What's your opinion of neuroma surgery? I hear your foot, doctor, or a foot doctor.


01:00:01.015 --> 01:00:04.785

Dr Doug: Well, I'm still a foot doctor, still, an orthopedic surgeon.


01:00:05.493 --> 01:00:14.984

Dr Doug: And aroma surgery is a plus minus. You gotta have the right diagnosis. If you truly have a neuroma, then it helps. If you don't have an aroma, it doesn't help. So


01:00:15.005 --> 01:00:23.224

Dr Doug: it's I'd say it's about a 50 50, usually not in my hands, because I didn't do very many, because most times that pain wasn't coming from an aroma.


01:00:23.345 --> 01:00:30.345

Dr Doug: But on average, if you look at pediatric and orthopedic surgery combined. It's about a 50% success rate.


01:00:31.045 --> 01:00:48.924

Thomas Schellberg: I'm gonna I'm gonna see another doctor to look at this going on for 4 or 5 years, and I'd like to do some backpacking, running, and even the the heel drops. Any of those would be a help, because right now I can't do much weights, because I've also got thumb pain.


01:00:49.195 --> 01:00:51.444

Dr Doug: Yeah, yeah, we talked about.


01:00:51.445 --> 01:00:53.305

Thomas Schellberg: I'm looking at a bunch of things here.


01:00:53.305 --> 01:00:56.115

Dr Doug: Yeah, we talked about using straps to help with the thumb pain.


01:00:56.615 --> 01:01:03.735

Thomas Schellberg: Yeah, it's not helping. But I'm gonna get 8 weeks off because I'm also having surgery for an inguyl hernia. So.


01:01:03.735 --> 01:01:04.814

Dr Doug: Oh, man. Yeah.


01:01:04.815 --> 01:01:06.335

Thomas Schellberg: Won't be doing any.


01:01:06.335 --> 01:01:09.444

Dr Doug: Don't live! Don't live forward from that! Oh, my gosh!


01:01:09.685 --> 01:01:10.255

Thomas Schellberg: Yeah.


01:01:10.255 --> 01:01:19.994

Dr Doug: Alright. Well, so, guys, I gotta run liz and Janet, drop your questions in the chat or in in slack, and we'll start with those next time, and then next week I am off grid my birthday is on Saturday, so I'm disappearing and I will be back at the end of the week. So Carrie is going to talk to you, I think, about