A Blog About Bones
Bone health is an intricate balance of biology, nutrition, activity, and medicine. For those using advanced medical tools such as GLP-1 medications for weight loss, or considering enhanced testing and medical advise options like those offered at Sarasota Wellness and Concierge Medicine, understanding the broader picture of bone strength is crucial. This post explores four facets of bone health: GLP-1 medications, resistance training, nutrition, and a heartwarming Thanksgiving tradition.
GLP-1 Medications and Bone Health
GLP-1 receptor agonists (e.g., Ozempic, Wegovy, Mounjaro, Zepbound) have dramatically changed weight-loss strategies. However, a recent study in JAMA Network Open indicates these medications may increase the risk of fractures, particularly in older adults, when compared to those not treated with GLP-1ra. The trial was an interesting secondary analysis comparing a standard group and moderate to vigorous exercise program (not clearly indicated in this study but I will go on to define this more) group with a GLP1 receipt or placebo. Comparing all groups, those with a GLP1 medication and exercise fared the best in terms of weight loss and preserved bone density. Those in the GLP1 medication and no exercise group lost weight (although less than with exercise), and lost significant bone density. Then finally, those in the exercise and placebo group had less weight loss but preserved bone density.
That does all of this mean?
Bones are far more than inert scaffolding. They are living tissues that undergo constant remodeling, regulated by the interaction of osteoblasts (bone builders) and osteoclasts (bone breakers). Factors affecting this delicate balance include:
Mechanical Stress: Weight-bearing and resistance exercises stimulate remodeling.
Nutrients: Adequate levels of calcium, magnesium, and vitamin D are critical.
Hormonal Balance: Hormones such as insulin, estrogen, and parathyroid hormone directly impact bone turnover.
Why GLP-1 Medications can confer an increased risk of fracture:
Rapid weight loss decreases mechanical load on bones, disrupting their adaptive processes.
Lean mass reduction (loss of muscles sometimes referred to as sarcopenia), often a side effect of rapid weight loss by caloric restriction alone, further reduces stress on bones.
Lack of appetite and caloric consumption decreases micronutrients including Vit D, Calcium and magnesium, increasing the risk of osteoporosis and fractures.
Our Approach at Sarasota Wellness:
Bone Density Screening: We offer DEXA scanning for a comprehensive view of bone health, body composition, and risk assessment.
Holistic Interventions: We always pair medication with tailored exercise plans and dietary counseling for optimal outcomes including the most weight loss, but also the safest weight loss.
Monitoring and Prevention: Regular follow-ups ensure that treatment balances weight loss with skeletal health.
Resistance Training: Build Strength, Protect Bones
Resistance training is one of the most effective ways to preserve and enhance bone health. A landmark study published in Medicine and Science in Sports and Exercise demonstrated the role of progressive resistance training in increasing bone mineral density and muscle mass simultaneously. I know we just discussed how the addition of exercise played the largest role in bone health, so why does it work? Exercises apply stress to bones, stimulating osteoblasts to lay down new bone. Bone health relies on engaging muscles and bones with consistent, increasing resistance. This begins with foundational bodyweight movements and extends to incorporating external loads for enhanced strength and resilience. Below, we explore a spectrum of training options and the science behind their role in supporting bone health and functionality.
Bodyweight-Specific Movements
Bodyweight exercises are a fantastic starting point, especially for beginners or those who may not have access to gym equipment. These movements lay the foundation for strength and mobility while applying enough resistance to promote bone health.
Walking:
A low-impact, weight-bearing activity that stimulates bone remodeling, especially in the hips and lower spine.
Ideal for all fitness levels and can be easily integrated into daily routines.
Functional Bodyweight Movements:
Air Squats: Strengthen the lower body, preparing the legs and hips for more advanced exercises. Start by using a chair as a target or handles to push up with your hands.
Push-Ups: Engage the upper body and core while targeting the arms, shoulders, and chest. Start against a wall and work to fully parallel to the floor on your knees and then a plank.
Pull-Ups: Strengthen the upper back and arms, essential for posture and spinal support. Start more upright with a low bar or rings and progressively move to parallel before adding a band or doing negatives.
Burpees: Combine cardiovascular and strength components, mimicking everyday actions like bending and reaching.
These movements form the baseline for functional strength, making everyday activities like standing up, reaching, or carrying groceries easier and safer.
Incorporating External Loads
To progress from bodyweight movements, external resistance can enhance bone-loading effects and overall strength gains.
Equipment Options:
Barbells and Dumbbells: Ideal for precise, adjustable resistance in compound lifts.
Kettlebells: Versatile for explosive movements and functional strength.
Sandbags and Weight Vests: Mimic real-life lifting and carrying scenarios.
Household Items: Water jugs, loaded backpacks, or bags of rice can substitute when traditional equipment isn’t available.
Functional Movement Translations:
Burpees: Comparable to picking up an item that fell under a table.
Farmers Walks: Simulate carrying groceries or other heavy items long distances.
Clean and Jerks: Similar to storing heavy items on high shelves.
Deadlifts: Mimic lifting a (grand)child or dog food bag from the ground safely.
Functional movements not only strengthen the body but also build real-world utility, improving quality of life and reducing injury risks.
Progressive Overload for Strength and Bone Health
The principle of progressive overload involves gradually increasing the resistance or intensity of your exercises to stimulate continued adaptation. This applies to both bodyweight and externally loaded movements:
Start with manageable resistance to learn proper form and avoid injury.
Increase load incrementally by 2–5% weekly to ensure consistent progress.
Focus on major compound lifts, such as squats, deadlifts, and bench presses, to target multiple muscle groups and maximize bone loading.
Training Frequency:
Aim for 2–4 days per week of resistance training, depending on your goals and needs.
Balance with cardiometabolic exercises (e.g., cycling, running) and mobility/balance exercises (e.g., yoga, tai chi) to maintain overall fitness.
Tracking Progress: DEXA and InBody Scans
At Sarasota Wellness and Concierge Medicine, we emphasize data-driven approaches to health. Advanced tools like DEXA scans and InBody Scans provide critical insights:
Bone Health: DEXA scans measure bone mineral density, identifying risks for osteoporosis or fractures.
Body Composition: Track changes in fat, muscle, and lean mass to ensure balanced development.
These technologies, combined with guidance from practitioners who actively train themselves, allow for precise and personalized fitness recommendations.
Why It Matters
A well-rounded training regimen—including bodyweight, external resistance, and functional movements—is essential not only for bone health but also for everyday strength and injury prevention. By integrating resistance training into your lifestyle and monitoring progress with advanced tools, you can support long-term skeletal and muscular health effectively. At Sarasota Wellness, we advocate a "whole-body approach" to fitness, integrating strength training with cardiometabolic and functional movement strategies.
Recipe Spotlight: Pickled Herring
Nutrition is a cornerstone of bone health, and small, oily fish like herring, sardines, anchovies, trout and salmon pack a potent punch of nutrients vital for skeletal strength:
Vitamin D: Aids calcium absorption.
Omega-3 Fatty Acids: Reduce inflammation and may protect against bone loss.
High-Quality Protein: Essential for muscle and bone repair.
Pickled Herring Recipe:
Ingredients:
Fresh herring fillets (1 lb)
White vinegar (1 cup)
Sugar (½ cup)
Thinly sliced onions
Spices: Bay leaves, mustard seeds, allspice
Instructions:
Rinse herring and soak in salted water for 1–2 hours.
Create a brine by simmering vinegar, sugar, and spices.
Layer herring and onions in a glass jar. Cover with cooled brine. Refrigerate for 24–48 hours.
Serve on rye bread with hard boiled eggs, cucumber or a dollop of sour cream for a quick, nutritious snack that supports bone health. Don't forget to top it off with some fresh dill!
Thanksgiving Gratitude and the Wishbone Tradition
Thanksgiving offers a time to reflect on the blessings in our lives. This year, I’m especially thankful for:
Joining Sarasota Wellness and Concierge Medicine.
Returning to Florida to work alongside my wife, Savannah, and close friends Amy and Zyad Asi.
The incredible patients I’ve served in North Carolina and the new relationships I’ll build here in Florida.
A special Thanksgiving tradition is breaking the wishbone. Known anatomically as the furcula, fracturing this fused clavicle structure symbolizes hope for the year ahead. My wish? That our members stay free of broken bones, maintaining strong, healthy skeletons for years to come.
Let’s carry this spirit of gratitude into the holiday season while prioritizing health and well-being.
Next Steps for Bone Health
Schedule a DEXA Scan: Sarasota Wellness offers advanced imaging for bone density and body composition.
Start a Strength Program: Our team can design a resistance training regimen tailored to your needs.
Optimize Nutrition: From personalized meal plans to supplements, we’ll ensure you get the building blocks for strong bones.
Contact Sarasota Wellness and Concierge Medicine today to learn how we can help you live a stronger, healthier life.
References:
GLP-1 Medications and Bone Fractures: JAMA Network Open
Resistance Training and Bone Health: PubMed Study
