Ep.156 Osteoporosis Isn’t Inevitable: Midlife Bone Health Strategies That Work

Think Bone Loss Is Just a Part of Aging? Think Again.

This episode of Asking for a Friend is sponsored by Better Help. https://betterhelp.com/askingforafriend

If your doctor’s only advice for bone health is “take calcium, vitamin D, and wait,” this episode is your wake-up call. I’m joined by Dr. Doug Lucas—former orthopedic surgeon turned bone health specialist—who’s on a mission to help women prevent and reverse osteoporosis with science-backed strategies that actually work.

In this powerful conversation, we dive into the root causes of bone loss in midlife, why waiting until 65 for a DEXA scan is far too late, and why hormone therapy outperforms traditional bone medications in head-to-head studies. Dr. Lucas breaks down the real risks of GLP-1 medications on bone density, what the research says about weighted vests, and how to exercise safely with low bone mass or an osteoporosis diagnosis.

We even cover what every mom should be telling her daughter now to lay the foundation for lifelong bone strength. If you want to stay strong, independent, and fracture-free well into your 70s, 80s, and beyond, this episode is a must-listen.

👉 Don’t wait until a fracture forces you to take action. Hit play now and learn how to protect your bones—and your future—starting today.

You can find Dr. Doug Lucas at:

https://www.osteocollective.com/

https://www.youtube.com/@Dr_DougLucas or on any podcast platform

https://www.instagram.com/dr_douglucas/

This episode of Asking for a Friend is sponsored by Better Help https://betterhelp.com/askingforafriend

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*Transcripts are done with AI and may not be perfectly accurate.

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Episode Transcript

Michele Folan (00:00):
This episode of Asking for a Friend is sponsored
by BetterHelp.
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(01:24):
fitness and everything inbetween.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
Welcome to the show everyone.
If you're a woman in midlife,chances are you've been told to

(01:44):
take calcium, vitamin D andmaybe get a DEXA scan.
But have you ever trulyunderstood what's going on with
your bone health?
This week, on Asking for aFriend, we're diving deep into a
topic that doesn't get nearlyenough attention osteoporosis.
It's often viewed as aninevitable part of aging, but it
doesn't have to be.
Bone loss can begin earlierthan most of us think, and by

(02:07):
the time we're in our 50s or 60s, the decisions we made decades
ago can catch up with us.
But here's the good news thereare real, practical steps we can
take to protect and evenrebuild bone at any age.
I've invited Dr Doug Lucas, anosteoporosis and hormone
optimization expert, to help usmake sense of it all From

(02:29):
understanding your DEXA scanresults to the latest insights
on hormone therapy, supplements,nutrition and the truth about
weight training.
Dr Lucas brings clarity to asubject that can feel
overwhelming.
We also talk about what to tellour daughters so they can build
strong bones early and avoidthe struggles so many of us are
facing now.

(02:50):
If you've been confused,frustrated or just curious about
what's happening to your bonesin midlife.
This episode is your guide tostaying strong, mobile and
empowered for the long haul.
Dr Doug Lucas, thank you forbeing here today.

Doug Lucas (03:06):
Yeah, thank you, Michele, and we have a lot of
work to do if we're going tocover all those topics.

Michele Folan (03:11):
No, I know and I have like you know how your eyes
are bigger than your stomach.
This is what happens when I geta guest on my show.
I have way too many questions,so we'll kind of dig in and
we'll get to everything that wecan, but first of all, tell us a
little bit about where you'refrom and then your career path

(03:33):
into medicine, and then what ledyou into the world of
osteoporosis.

Doug Lucas (03:37):
Yeah, so right now I live in beautiful Asheville,
North Carolina.
So at this phase we're stillrecovering from the big
hurricane in the fall.
But everything is on track andpeople are recovering well, so
still very happy to be here.
My professional trajectory is alittle bit abnormal, so I'll
give you kind of the quickversion of it, which is I
started off not in the medicalfield at all.

(03:58):
I started off actually in thefine arts.
So I was a professional balletdancer by trade.
I left that, went to medicalschool as I realized that it's
really hard to make a living inthe fine arts.
So I was a professional balletdancer by trade.
I left that, went to medicalschool as I realized that it's
really hard to make a living inthe fine arts.
In medical school I was thinkingthat I would do something more
along the lines of primary care.
I really liked the idea ofmusculoskeletal manipulation.
I went to a DO program insteadof an MD program for that reason

(04:21):
and I did learn those tools.
But then I happened to.
I had to do an orthopedicsurgery rotation as a medical
student and just fell in lovewith the operating room, the
power of surgery, the power ofbeing able to fix something that
is broken literally is broken Ican fix it, and it was so black
and white.
So that became my clear purposemoving forward and did the

(04:44):
traditional residency andfellowship and started practice
as an orthopedic surgeon and didthat for about a decade.
But in that process realizedthat one of the things that I
was really missing in mypractice is being able to spend
time reading, doing research,educating and then actually
educating my patients, and Ifound that I really enjoyed

(05:05):
talking about prevention morethan talking about how I could
fix their problem or at leastmake their problem different.
And so I was able to, for a lotof different reasons and
circumstances, get out of thetraditional medical model, start
a practice that's specific forhealth optimization, so we do
essentially a ton of prevention.
And then that practiceeventually actually pretty

(05:26):
quickly became very specializedin osteoporosis because of my
background in orthopedics.
So it was this combination ofkind of functional medicine,
integrative hormones and a bonehealth background that
culminated into this program tohelp people to prevent and
reverse osteoporosis.
For the most part, naturally,that led to the YouTube channel,
that led to me communicatingwith all the leaders in the bone

(05:47):
health space and really lovingthis kind of niche that we've
built out around osteoporosis,because there's so much need and
there's so much to talk about.

Michele Folan (05:55):
Oh my gosh.
Okay, so I got to back up.
So as an orthopedic surgeon,you had to see some pretty scary
bones, you know.
When you were doing surgery didthat like were the bells
ringing at that point for you?
You?

Doug Lucas (06:12):
know, what's amazing about you know, being in the
subspecialties in medicine isthat you are, you are told to,
and you really have to createwalls around you so that you can
do what you do efficiently foras many people as possible.
And that is we are all, asphysicians, surgeons, we're cogs
in the system.
And so, even though, yeah, Iabsolutely saw poor quality bone
and there were cases whereliterally I feel like you know,

(06:34):
I'm putting plates and screws onbone and it feels like you're
screwing something into amarshmallow, but yet when you,
you know you're doing thesurgery and you do the best you
can technically and then at theend of that you tell the patient
wow, you have some bone qualityproblems.
You should really see someoneabout this.
And that's kind of it right,because as an orthopedic surgeon
, it's not my specialty.
I mean, I knew about the drugsbut I didn't prescribe them.

(06:57):
I would send them to.
Actually, one of my PAsdeveloped a concierge bone
system around that, but wedidn't have a place to send them
and I thought that was isolatedto where I started practice.
But it turns out that it'sactually a national and truly a
worldwide problem where nobodywants to talk about osteoporosis
because nobody has a specialty,nobody really enjoys treating

(07:18):
it, because they don't havegreat tools, they're not trained
to and don't have time to talkabout the lifestyle pieces that
need to be talked about.

Michele Folan (07:24):
Well, and I shared with Dr Doug before we
started and some of youlisteners have already heard me
tell this story but two yearsago I had my first DEXA scan and
it came back with osteoporosis.
Maybe no surprise, based onfamily history and European
descent light highs, small frame, whatever.
Blah, blah, blah.

(07:45):
And so when the primary caredoctor who was filling in for my
regular healthcare providersaid okay, well, we're going to
up your calcium, up your vitaminD, we're going to put you on
Fosamax or a bisphosphonate andwe'll see you back in two years.
That's what I got abisphosphonate and we'll see you

(08:05):
back in two years.
That's what I got.
So, listening to you talk, yousaw that there was this huge
void and you've addressed it.

Doug Lucas (08:11):
We're trying to address it.
I think we are.
We're doing a great job withwhere we are.
There's more that we can do.
We'll talk about that.
But what you experienced,Michele, is absolutely the
standard of care, and I think itis substandard.
I don't think it's adequate,but I never disparage doctors
for making those recommendations, because that's what they're
trained to do and that's allthat they know to do.
They want to prevent fracture,just like I want to prevent

(08:34):
fracture, but we're usingdifferent tools.

Michele Folan (08:36):
So, on that note, what are some of the biggest
misconceptions you hear fromwomen when it comes to
osteoporosis?
What are they hearing and whatdo you have to kind of change in
terms of mindset when they comesee you?

Doug Lucas (08:51):
Yeah, I think, hands down, the biggest thing is that
women are told by their doctors, usually or by their friends,
that bone loss is inevitable.
You said that out of the gate,that you disagree and I want to
bring that up again, but thatbone loss is inevitable.
Especially if you have a familyhistory, you will develop
osteoporosis.
If all of us live long enough,we will develop osteoporosis.

(09:12):
That's the number one thingthat I hear that we need to flip
the script on, becauseosteoporosis is absolutely
preventable and all of us, if wehave the capacity to do the
things that we need to do, canabsolutely change the trajectory
of bone loss and build bone.
I see it in my practice everyday in our patients, women and
men ages 50s, 60s, 70s, 80s.

(09:34):
We can do that and we don'thave to accept that bone loss is
inevitable as a part of aging.

Michele Folan (09:39):
All right, so there is a genetic component,
though, correct?

Doug Lucas (09:44):
Absolutely yes.

Michele Folan (09:45):
All right, and you brought up men and at four
o'clock this morning, when I wasawake, unfortunately, I started
thinking about I wonder howoften you are treating men.
And then I started thinkingwell, is that hormonal?
Was it because they had celiacdisease early in life?
Like what are you seeing in menversus women?

Doug Lucas (10:06):
Yeah, so it could be both of those things.
The difference between men andwomen is that it just generally
happens later, unless they haveone of those underlying things,
and you just mentioned probablythe two biggest ones, right?
So some kind of gut dysfunctioncould be celiac, you know, or
low testosterone, which in menresults in low estrogen, which
will cause rapid bone loss, andso, yeah, those are the two most

(10:27):
common things.
If you look statistically, thevast majority of humans
diagnosed with osteoporosis arewomen.
We're talking 80%, probably ormore, but I think that we have
more bone health issues in menthan we know Now.
They have a higher startingpoint.
So this is good, but I think,especially with the low
testosterone epidemic that we'reseeing, with the lifestyle, the

(10:47):
challenges, the stress, thesleep, all the things, I think
we're probably going to see, ifwe can start screening young
adults, more men that areaffected than we know.
In my practice we're still Imean gosh, I haven't looked at
the statistics but probably 95%women, because those are the
individuals who are gettingscreened, who are concerned
about their future going to thedoctor, right?

(11:09):
Men just like to not go to thedoctor, so they're still mostly
women, but we do have some menin our program and I do hear a
lot of comments in our communityand on our YouTube channel from
men who are concerned aboutbone health.

Michele Folan (11:20):
And then one other question about men.
Is there any connection withmen?
I just see you start talkingand you get my brain going With
men with disordered eating, orperhaps extreme athletes that
aren't getting in enoughnutrients.

Doug Lucas (11:37):
Yeah, absolutely so.
Those things are true for bothmen and women, but the
population of men that we seethis in is going to be men A lot
of times.
They have an endurance athletebackground.
They could be cyclists.
Professional cyclists arenotorious for low bone density.
They could be cyclists,marathon runners, ultra marathon
runners.
All the same things that causethis in women can cause it in

(12:00):
men.
We just don't see it as oftenagain because they have a higher
starting point.

Michele Folan (12:03):
All right, I want to talk about the DEXA scan.
Yeah let's, because we get ourscores back and we have no
freaking idea what these numbersmean.
And is there really a concern?
Or where is that on thethreshold?
And I do want to ask you thisreal quick too Does it matter

(12:24):
that we get our DEXA scan fromthe same place each time to make
sure that we're using the samekind of machine and calibration?

Doug Lucas (12:33):
Yes, so I'll answer that backwards.
So DEXA is, it is the currentstandard I hate to say gold
standard, because it'sdefinitely not gold, but it's
the current standard.
It's what most people haveaccess to.
It's covered, you know,medicare, commercial insurance,
if you meet the age requirements, etc.
So dexa's not going anywhere.
But dexa has a lot of problems.

(12:54):
It is an x-ray, just a low youknow low radiation x-ray, but
it's still an x-ray and it canonly tell certain things because
of the technology limitations.
One of the the challenges, asyou mentioned, is if you go from
machine to machine you'll get adifferent T-score.
So if you're repeating a DEXAscan and you go from one machine
to a different company'smachine, they have different

(13:15):
algorithms which are going tospit out a different T-score.
Now they're going to be close,but they're not going to be the
same.
And if you are looking forimprovement, if what I'm doing
is beneficial, is my T-scoregoing to improve over time?
It should.
But if you're going from adifferent machine to a different
machine, you don't know,because the difference between
the machines could be two, four,some studies even say 6%, and

(13:38):
if you saw a 6% improvementyou'd be doing jumping jacks and
unfortunately that might not bereal if you're just using DEXA,
especially if you're going todifferent machines.
Now, even within that on thesame machine, position matters
the person who's doing the scanmatters.
Updates to the software canmake a difference.
There's all of these differentvariables that you, as the

(13:59):
consumer, have no control over.
So DEXA is needed because itgives us the T-score and then we
can use that T-score toextrapolate some kind of
fracture risk.
And that's what we'reultimately worried about is what
is your fracture risk?
The problem is it's not thataccurate, it's not that
sensitive or specific tofracture risk, but it's all that
we have for the vast majorityof people.

(14:19):
But there are some alternativesthat we can talk about.

Michele Folan (14:22):
Okay, down the street from where I live, a
place opened up.
It's called DexaFit.
Are you familiar with thiscompany?

Doug Lucas (14:30):
I am.

Michele Folan (14:31):
Okay, what's the difference between me going to
the local hospital and getting aDexa scan and then going to
this place and going to DexaFit?

Doug Lucas (14:38):
I haven't seen a report from DexaFit.
I've heard the name of thecompany.
My concern with Dexa, outsideof the conventional medical
model, is that oftentimesthey're mostly looking at body
comp.
So they're looking at bodycomposition.
They'll tell you about yourvisceral fat and your
subcutaneous fat and all thesethings, which is great.
There's value in that.
But I don't know that that'sgoing to give you the right

(15:01):
lumbar spine, vertebral T-score,hip T-score, total hip, femoral
, neck, et cetera.
I don't think they're going tobreak it down like that from a
bone perspective.
I could be wrong because, again, I haven't seen their report,
but generally they're mostlylooking at body comp.

Michele Folan (15:13):
All right, I might run down there one day and
just talk to the owner and say-yeah, get a sample report.

Doug Lucas (15:20):
Yeah and send it my way.
I'd love to learn more about itbecause it is becoming more
available.
They're opening that up a lot.

Michele Folan (15:25):
All right.
Other alternatives to the DEXAscan.

Doug Lucas (15:30):
There's basically right now, there's almost like
three things that you can do.
So you can do a DEXA scan Inthe conventional system.
Some places are doing CTs, soquantitative CT, which can tell
you about your bone quality andyour density and actually can
estimate strength of your bone,and that is an option.
It's very accurate, but it'smostly used in research, to be

(15:51):
honest.
And then there's the ultrasounddevices.
So the company Ecolite out ofItaly has a product called REMS,
which is an acronym, and REMSis an ultrasound device that
looks just like the abdominalultrasound wand that you would
see at your OBGYN or in youremergency department, and you
can look at bone with thatdevice because they have a
specific algorithm, proprietaryalgorithm, that can tell you

(16:13):
both density but also bonequality, which, again, is
ultimately probably moreimportant, because what we want
to know is fracture risk, and ifyou can get both of those
variables, you can much moreaccurately predict fracture risk
.

Michele Folan (16:24):
And are those starting to be more readily
available here in the US andcovered by insurance?

Doug Lucas (16:34):
Not covered right now, which is one of the
challenges.
It's difficult in the US to getpast what is the gold standard
or the current standard in oursystem, because everybody has a
DEXA right.
Like, dexas are globallyavailable, covered by insurance.
So insurance companies don'twant new technology and DEXA
companies don't want newtechnology, so it's going to be

(16:56):
really hard for them topenetrate the market.
I think that it will happen,but the way that it needs to
happen is that we need toessentially create the demand.
To create the demand, you haveto put the device all over the
country, and the United Statesis a big country.
So this is going to take a lotof investment from entrepreneurs
who want to bring thistechnology to their clients, and
this is happening.

Michele Folan (17:14):
Oh good, okay, I'm like, sign me up.
I like new technology, if youcould tell.
All right, we're going to takea quick break and when we get
back I want to talk about whenthe time is.
We should be concerned aboutwhen bone loss starts.
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(18:20):
Okay, we are back.
Before we went on the break, Ireally want to know about when
does bone loss typically beginand how early should women be
thinking about their bone health?

Doug Lucas (18:35):
That is such an important question and maybe you
know the answer.
So for me, when I startedlooking at this, one of the
reasons why we really nichedinto the space of osteoporosis
is that the recommendations theyjust don't make sense.
They just are illogical Becauseright now in the United States
and this is true across most ofthe recommendations they just
don't make sense.
They just are illogical Becauseright now in the United States
and this is true across most ofthe globe but in the United

(18:57):
States the recommendation is toscreen for osteoporosis for
women at the age of 65 and formen at the age of 70.
And the most recent USPSTF isthat it Preventive Services Task
Force.
So the USPSTF recommendationswas to screen all women and
maybe men at 70.
It was like eh, if you want to,what's crazy about that and so

(19:20):
illogical is that we know thatwomen on average will go through
menopause at the age of 50,maybe 51, right?
So if you wait until you screenfor 15 years and you know that,
what's happening predictably ifa woman is not using hormone
replacement therapy, is rapidbone loss for the first five
years, maybe 10 years, and thenit's going to kind of plateau

(19:42):
out at the 15-year mark, youhave already missed your
opportunity to prevent bone losswith HRT.
Estradiol is FDA-approved forprevention of osteoporosis in
women, but if we're notscreening, how do we know to use
it?
And so it's mind-blowing to methat this is the recommendation.
Now I understand, from a publichealth perspective, that you

(20:05):
want to screen for diseases whenyou're likely to see them.
So yeah, that makes sense,except that we don't want to
just identify it, we want toprevent it, because you can
build bone from an osteoporosisstarting point but hey, let's
prevent it instead or let'scatch it earlier and let's have
a better starting point.
This is the difference betweenthe conventional medical model,

(20:25):
which is let's identify diseaseand treat it with a drug or a
surgery, versus the healthoptimization model or the
integrative model, which sayslet's prevent disease in the
first place and then, if we findit, let's catch it early so we
can do something about it withmaybe something less aggressive,
with less side effects.
So that's the big issue withscreening From my perspective.

(20:46):
Then the follow-up question iswell, when should we screen?
For me, I would say 30 yearsold.
For all men and women.
We should know what's happeningwith bone health, because your
peak bone density occurs in your20s.
If you don't know where you arein your early 30s, then you
don't really know what youshould be doing about it as an
adult.
You already said you knowgradual bone loss is expected.

(21:08):
I kind of mentioned thatalready too.
It's true.
If you look at the statisticalaverage, we start to lose bones
slowly from about the age of 30onward for women, until about 50
when it accelerates and for menit just kind of slowly
accelerates for the duration oftheir lifespan.
But if you don't know yourstarting point, you don't know
if you should be doing somethingdifferent and that would
definitely impact the way youchoose.

(21:29):
Potentially for women, you knoworal contraception, which is
bad for bone If you're, if youhave a dysfunctional cycles and
you're not ovulating, you'regoing to pay closer attention to
that.
If you have low bone mass tostart with, what is your diet
looking like?
Like is it okay for you tocontinue to?
You know binge and purge and gothrough the diet wars and all
these things.
You know if you're watchingyour bone and considering bone

(21:50):
health as a biomarker of healthspan, if you're losing bone,
something's wrong.
But we don't know that that'strue unless we're screening.
So I think and this is thevalue of having an ultrasound
device on the market we shouldbe screening every adult at the
age of 30.
And if they have low bonedensity, screening them again on
a regular basis, because ifthey're losing bone, something's

(22:11):
wrong and we need to figure outwhat it is.

Michele Folan (22:13):
Yeah, because it could be anything.
I mean, it could be.
You're not absorbing nutrients,your diet is just poor.
And then should we be tellingour daughters right now lift
weights, get enough protein.
What else should we be tellingthem?

Doug Lucas (22:31):
I mean, the good news about bone health is that
the bones are telling us a story, they're giving us signals, but
you have to listen to them andunfortunately that means imaging
and blood work.
But the other side of that isthe way to resolve bone loss is
mostly lifestyle.
You just said two of the biggestpieces.
So diet and exercise are two ofthe biggest pieces.
When it comes to bone healthand when we build out our

(22:53):
program for patients, the mostimportant things that we tell
them is we have to initiallytrack what you're eating so we
know what you're eating, andthen make recommendations and
universally unless they've beenwatching my YouTube channel for
the last two years universally.
They're under eating proteinand we need to start there, get
them to an adequate amount ofprotein and then build the rest
of their diet around that.

(23:13):
And then, from an exerciseperspective, absolutely we all
need to be doing resistancetraining because we lead
sedentary lives.
Unless you're a manual laborerand you're out there working in
the fields or in construction orwhatever.
Most of us are behind a desk,sedentary, not stressing our
muscles and bones, and that willresult in bone loss in all of

(23:34):
us.
We have to do resistancetraining to stress that and it
has to happen on a regular basis.

Michele Folan (23:38):
All right, Any of my clients who are listening
and are tired of me talkingabout lifting weights and eating
enough protein.

Doug Lucas (23:46):
if you don't believe me, listen, you can't talk
about it enough I know, I know,I know.

Michele Folan (23:51):
But you know, it's kind of fascinating because
I will sometimes have clientswhen they really don't know how
much protein they've been eating.
I'll have them track theirprotein for a couple days, or
just in their macros in generalfor a couple days, before we
really dive into things, and youwould be shocked.
Like, well, maybe not shocked.
Well, I wouldn't be shocked.

(24:11):
No, you wouldn would be shocked.
Well, maybe not shocked.

Doug Lucas (24:12):
Well, I wouldn't be shocked, no, you wouldn't be
shocked.

Michele Folan (24:13):
But they're shocked because they think, well
, maybe I'm getting about 60,maybe 75 grams and they're
getting like 40.
40.
Yeah.

Doug Lucas (24:21):
And that's 40 is the magic number.
Actually, we see it all thetime yeah, 40.
Yeah, oh my.

Michele Folan (24:27):
God and you know what.
I'm not dogging anybody because, frankly, a lot of women
haven't had that awareness aboutwhat they're eating, and plus
we've diet culture andeverything else that we've had
to deal with all these years.
So, anyway, I got to get to HRT, because this is a biggie right
.
What role does HRT play in notjust preventing but reversing

(24:52):
bone loss?

Doug Lucas (24:53):
Yeah.
So I have to be careful what Isay, because the FTC doesn't
like it when I say that you canuse hormones to reverse bone
loss, because it's not FDAapproved for that.
But let's be clear it is FDAapproved for the prevention of
osteoporosis, meaning that weknow that it has a significant
impact on bone, and I travelaround the country on stages
talking about the impact ofestradiol and progesterone in

(25:16):
the research and it is so, socrystal clear.
It outperforms bone drugs everytime Actually, not every time,
but any time a study is done.
Well, it outperforms bone drugs, even in the own bone drug
studies, and I have some ofthese studies that I like to
talk about.
I'm actually recording on thistoday, where you know where
Fosamax, the manufacturer ofFosamax, tried to show that
Fosamax was better than HRT andit just failed so miserably.

(25:38):
And it just goes to show that,like, the standard of care is to
use these bone drugs.
But we should, in my opinion,have a different perspective,
which is hmm, let's talk about,like, the risk benefit of HRT
for all women post-menopause Notthat all women have to do it,
but let's have that conversationBecause over the last 24 years,
women have not been gettingthat conversation.

(26:00):
It's getting better, but it'sstill very, very rare and we
need to have that conversation,knowing what's going on with our
bones, because, again, if wedon't know, we can't have that
conversation.
So, if you look at theliterature, estradiol, when used
as a single intervention, withprogesterone when needed, but if
you're using HRT as anintervention, can have up to a

(26:22):
10% increase in bone mineraldensity on average over the
course of 12 months.
That is a massive increase withwhat is actually, in my opinion
, not well done HRT increasewith what is actually, in my
opinion, not well done HRT.
So I think we could use this asa tool to improve bone quality,
improve bone density.
We can use it to reverseosteoporosis I can tell you what
that definition means for mebut we can use it for those

(26:43):
purposes.
Obviously, these are off-labelaccording to the FDA, but so is
everything that I do, so thatdoesn't bother me, it doesn't
bother my patients.
We're looking at this throughthe lens of healthspan, not just
isolated at let's look at yourbone density.
But there's so many potentialbenefits of HRT that this is a
conversation that absolutely hasto be had with every woman,
with the perspective of bonehealth, healthspan,

(27:05):
cardiovascular health, brainhealth, et cetera.

Michele Folan (27:07):
All right.
Patch versus oral.

Doug Lucas (27:12):
Yeah, I'm not a fan of oral, just not because it
doesn't work, but because itgoes through extensive
metabolism.
So everything you consumeorally, if it gets absorbed into
your gut it'll go through theliver and when it goes to the
liver it gets metabolized intobyproducts.
The liver is really, reallygood at metabolizing things.
It's what it does.
So whenever you take somethinglike estradiol, for example, it

(27:33):
goes through the liver.
I forget what the actualpercentage is, but it's
somewhere between 80, 90%probably.
That is no longer estradiol.
So that estradiol didn'tactually do you any good.
So you're getting a smallerpercentage.
You're getting all thesebyproducts of estradiol which in
some women is fine.
In some women it's not.
Some studies it shows thatthere's an increased risk of
blood clot.
But if that was all we had,then we would say, okay, let's

(27:55):
consider the risk benefit.
But fortunately we do havetopical.
So now commercially preparedtopical is through patch.
So these are kind of timerelease patches.
You swap them out twice a weekand it's going to provide
estradiol at variable dosesdepending on the strength that
you're given.
And it gives you a pretty goodlevel of estradiol at the higher

(28:16):
dose strengths and the downsidefor me is that it's going to
vary quite a bit from woman towoman how it's absorbed and
you're kind of going to get arise and a fall over the course
of the couple of days that thepatch is on.
So patches aren't perfect, butthey are generally covered by
insurance and they'reinexpensive.
So that's an option thatcertainly could be considered.
My preference is actually touse a cream that's applied twice

(28:38):
a day but that gets into thekind of compounding pharmacy
bioidentical space.
I think that's more physiologicbut it's more work.
So you got to kind of find thebalance there of what works for
you.

Michele Folan (28:48):
Do you have a dosage that you think is optimal
, based on studies that they'vedone?

Doug Lucas (28:53):
Yeah.
So here's the funny thing aboutestradiol levels and this is
oddly controversial and this iswhere I should spend less time
on social media because peoplewill call me out for this.
I don't know.
I guess it's good because wecan bring it up, but it's such
an unnecessary argument.
But we like to measureestradiol levels and there's
plenty of providers that saydon't measure estradiol, it

(29:14):
doesn't do you any good, justtalk about symptoms.
From my perspective, I wannaknow what it's doing.
I don't necessarily change mytreatment based off of estradiol
alone, but we're measuringestradiol.
We're doing testosterone freetestosterone, dhea, fsh, ctx, p1
and P.
We're looking at the boneturnover markers and the other
hormone markers to get a senseof what's happening in the big

(29:35):
picture.
So what we've found that'sreally interesting is that the
strength of the cream or patchor whatever can be extremely
variable from woman to woman,what the impact will be on the
hormone levels in the blood.
And this is why some doctorssay, well, don't measure because
they're all over the map.
Well, kind of, they are allover the map.
But the big picture starts toget clearer when you get
adequate biomarkers.

(29:56):
So some women I just had apatient this week.
She's taking like a half amilligram of topical estradiol a
day, which is a very, very lowdose, and her levels are through
the roof.
So she's just a hyper absorber,so she absorbs it really well
through the skin.
Her estradiol levels are prettyhigh, but her FSH is actually
not at goal.

(30:16):
So she's a unique case whereshe actually has pretty high
levels of estradiol but itdoesn't seem like it's having
the impact we want it to, andthat's a receptor thing and
there's different ways you candeal with that.
But this is why working with aprovider who understands
hormones very intricately isreally important, because most
doctors and actually my team didthe same thing.
They looked at that and theywere like, oh my gosh, she has

(30:37):
to reduce her dose.
I said no, she doesn't, her FSHisn't at goal, her receptors
aren't saturated, she actuallyneeds more estradiol.
And so it's this challengingbalance.
But then we have the flip sideof that too, where some women
will be on high strength eitherthe highest patch strength
that's available, or a cream ata very high dose, and they just
don't have much in blood and soit just takes more and more for

(30:59):
them.
Or potentially, some womenactually use injections, or some
women will go on to pellets forthis reason, but you might need
a different delivery systemdepending on what's going on.

Michele Folan (31:08):
All right, speaking of pellets, then what
about testosterone in the mix ofall this?

Doug Lucas (31:13):
Testosterone is interesting.
So there are some.
I just interviewed a physicianyesterday, dr John Robinson, and
his wife, Christina Bosch.
They're out in Scottsdale.
They spoke at ourOsteocollective retreat this
last year and they're they're apellet practice, so they do
mostly pellets.
They do some injections, butfor the most part they're
offering pellets and it's reallyinteresting, you know we have.

(31:38):
The reason why I interviewedhim is we have the same goals
but we use different tools toachieve them, which I think is
so interesting.
Because if you again go onsocial media and you hear this
back and forth of pellets arebad, creams are bad, compounding
, blah, blah, blah, there's allthis infighting in the hormone
space.
But what's great about metalking to John and Christina is
that we can see, look, they'redoing it totally differently but

(32:02):
achieving the same results, andthey might even be doing it
better than me.
And this is where it's great toactually listen to your peers
who are doing somethingdifferent to say, oh well, I
hadn't thought of it that way.
So they're using a pellet likethis and using progesterone like
this.
But to get back to yourquestion, they're big advocates
of testosterone, but theirpatient population is younger,
and so this is where there's adifference between testosterone
from a pellet.

(32:22):
Yes, it can be done wrong.
Yes, high doses can beproblematic, but for some women
can provide great relief,whereas we like to use creams.
But creams are going to convertmore to DHT and there's the
potential for more issues withacne or hair loss as a result of
that conversion when it'scoming through the skin.
So for us, we find that ourolder patient population doesn't
do as well with testosteronecreams.

(32:42):
Maybe they would do better withpellets, right?
So it's just kind of aninteresting like art of medicine
here and trying to figure outwhat works for different
populations with the differenttools that we have.

Michele Folan (32:53):
Don't say hair loss, god, that is the scariest
thing, and I and I.
I just went back on topicaltestosterone because my libido
went in the tank and it was timeto get things going again and I
I hesitated because of the hairloss thing, so I'm fine, it's
been a couple months, I'm okay.

Doug Lucas (33:16):
And there are tools to help block that DHT
conversion.
So there's ways around it.
But we do find that, especiallyas our patients get older, they
tolerate less and lesstestosterone.
But I'm intrigued by John'sapproach of using lower-dose
testosterone pellets in olderwomen.
Now you have to be carefulbecause you can't get that
pellet out.
So you got to know what thedose is.
But I'm intrigued by thispotential to use this.

(33:38):
And then the other side of ittoo is we're all telehealth, and
through telehealth, becausetestosterone is a controlled
substance, it's getting harderand harder to use it as a tool.
It's getting shut down state bystate by the local state DEAs,
and so that's becoming a biggerissue as well from telehealth
practices.
So there's some conversion todifferent tools as a result of
that.

Michele Folan (33:57):
Got it.
And then one last questionabout the hormone therapy.
If I'm, say, I'm 68 and I getdiagnosed with osteoporosis, is
it too late for me at that pointto start using hormone therapy?

Doug Lucas (34:10):
Oh my gosh, that's the million dollar.

Michele Folan (34:15):
Sorry.

Doug Lucas (34:16):
No, no, it's good.
So I addressed this.
Actually, we have a masterclasswe do every couple of weeks and
this is one of the things Italk about, because I hear this
story probably more thananything else, that story that
you just described.
Right, 65, mid-60s, I finallyget screened for osteoporosis.
I have the disease.
I go to my doctor, I tell him Iread about hormones.

(34:37):
I listened to this Dr Doug guyon YouTube and he said I should
be on estradiol and their doctorsays no, that's crazy, you're
too old for that.
What a catch-22, right.
But here's the thing.
So we address this all the time, and what I love about this
conversation is I was kind oflearning about it sort of, as
the literature was reallychanging.
And then what was a slam dunkfor me is last year, in 2024,

(35:00):
the Women's Health Initiative20-year follow-up publication
came out, and they did a greatjob in there breaking down the
risk in this intervention groupof women who were on these two
synthetic products.
So not great HRT to start with,but this is the data that was
used to say you shouldn't startat 65.
So now you can look at thatsame data broken out by decade

(35:22):
compared to placebo, and what'sreally interesting here is that
I think doctors just kind of getthis wrong.
If you look at starting HRT inthe WHI within 10 years of
menopause, there was aprotection from cardiovascular
disease.
True, if you started between 10and 20 years out, you lost that
protection.
So, based off of thatcomparison, yes, it is riskier.

(35:45):
But if you look at the data ofwomen 10 to 20 years out who are
on HRT or starting HRT versusplacebo meaning the women who
were not on HRT or not startinga placebo there was no
difference in cardiovascularrisk.
So it's not riskier thanplacebo or non-users.
So, while, yes, I could say"'Michelle, it would be more

(36:08):
dangerous for you to do it now"'than 10 years ago, but I don't
have a time machine, I can'ttake you back 10 years ago.
So that's the wrong question.
The right question is how muchmore dangerous is it now for you
to do this than do nothing?
And for most women 10 to 20years out, the answer is there
is not increased cardiovascularrisk.
Now, that said, you have to lookat individual risk factors.

(36:31):
I had a great patient, I think,a couple weeks ago, who's a
good example of this, because westart a lot of women in their
60s on HRT.
But this is a woman who wantedto start on HRT.
She was mid-60s, 15 years outfrom menopause, but she had been
a type 2 diabetic for the last20 years.
Her A1C was not well controlled, her inflammatory markers were
elevated.
So you start stacking up theseother risk factors.

(36:53):
She had high blood pressure,right, so she's kind of a
metabolic mess.
Over the last 20 years she'sprobably developed significant
disease.
So what do we do with her?
Well, we said, look, I thinkthere might be risk here that we
probably don't want to take.
We can look under the hood,scan the coronary arteries and
see what they look like.
And we're doing that.
And unfortunately I don't thinkthat they're going to look good

(37:14):
.
But we're going to look andwe're going to see, and if they
look bad, then we won't moveforward with estradiol.
Now that doesn't mean we can'tpotentially do other things, but
HRT specifically optimized withestradiol, progesterone and
testosterone if needed.
That's not a picture that shewould.
That she'd be a good candidatefor even though she's in her 60s
.
That same thing is true forwomen in their 70s.
But the individual risk factorsreally start to stack up, so it

(37:38):
becomes less likely for womenwho are 20 plus years out from
menopause, although it happenswhen we've started women who are
in their 80s on hrt becausetheir coronary arteries looked
better than mine, you know.
So what risk am I preventingthem from having?
So it's a really interestingconversation.
I hope to continue to bringthis to the market and
demonstrate that the researchdoes not show that, especially

(38:00):
for women 10 to 20 years out,that it is more risky than
placebo.

Michele Folan (38:04):
So real quick, before I go on to GLP-1s,
because I want to make sure wetalk about that too.
I want to make sure we talkabout that too when you talk
about risk versus risk.
If I am 72 and I have afracture, what is my prognosis?
In general, it's terrible.

Doug Lucas (38:21):
Yeah, it's terrible and that's a great point.
Thank you for bringing that up.
So if you're in, I mean, itdoesn't actually matter, but if
you're in your 70s and you havea hip fracture, for example, the
likelihood of you passing away,dying in the next 12 months is
around 30%.
30%, that's high.
There's not a lot of diagnosesthat have that high of a
mortality rate.

(38:41):
The likelihood of losingindependence meaning you either
die or you lose independence isgoing to be around 60% or
potentially even higher.
The other 30% that regainindependence are usually not the
same.
So a hip fracture is a lifechanger, potentially a game
ender, but it's definitely alife changer and this is what we

(39:04):
absolutely have to avoid.
I have fixed I don't know howmany hundreds of hip fractures
and I've only had one patientwho seemed like she bounced back
, but she was very young.
So this is the risk benefitconversation that I'm having
with patients, which is and thisis a great way.
I'm glad you said it If youthink about the risk of hormones
.
So, for example, some peoplewould say that there's an

(39:24):
increased risk of developingcancer.
I don't think that's true.
Your cancer might grow faster,but you can argue.
You know, maybe there is alittle bit of increased risk.
Some people would argue it'syou know, it's a rare.
It's a rare risk thing, okay,fine, but you know what's not a
rare risk fracturing your hipwith osteoporosis, which has has

(39:44):
a higher mortality rate.
Hip fracture right, which has ahigher rate of losing
independence.
Hip fracture, which one iswell-treated with HRT
osteoporosis.
So for me it's a very clearpicture and I don't wish a case
of breast cancer or any kind ofcancer on anybody.
But we all get scared aroundthe big C word but we forget

(40:05):
about the fracture and whathappens with the fracture, and
that's really, really powerful.

Michele Folan (40:09):
Thank you for clarifying all that, because
that's one of those things that,just again, it just doesn't get
talked about enough is thelong-term risk factors with
fracture.
All right, I said I wanted totalk about GLP-1s because I am
wondering about are there anyrisk factors?
Good, easy for me to say riskfactors with GLP-1s and extreme

(40:35):
weight loss, and then, on theflip side of that, is there any
data out there suggesting thatGLP-1s may actually help with
bone density?

Doug Lucas (40:43):
Yeah, I'm going to answer those backwards.
So there is evidence to supportthe idea that GLP-1 drugs, or
GIPs, are beneficial for bonehealth.
The evidence is not strong andit's mostly just theoretical.
But if you think about the wayGLP-1s work, when they increase

(41:04):
the GLP-1 hormones, the GIPhormones, the result is improved
insulin sensitivity.
Obviously there's weight loss,but that's going to result in
reduction in inflammation,reduction in oxidative stress.
So we know that inflammation,oxidative stress and poor
insulin sensitivity areassociated with osteoporosis.
So it makes sense that man, ifthese drugs can do this, they

(41:26):
should improve bone health.
But that's not what we seeclinically.
So for me, in my practice, mostof my patients are underweight,
so I don't have a lot ofpatients on GLP-1s.
But sometimes we'll have apatient come in who's had a
weight loss journey, who is on aGLP-1, maybe a maintenance dose
or maybe a microdosing orwhatever is on a GLP-1, maybe a
maintenance dose or maybe amicrodosing or whatever, and
they want to stay on it.
Early on we said, okay, that'sfine, I think that we can be

(41:49):
successful because of all thisdata that says that we should be
able to be successful.
But I can tell you that not oneof those patients has been able
to improve bone density whileon a GLP-1.
Now, again, this is a smallsubset of our patient population
.
I'm not saying this is trueacross the board, but we are a

(42:11):
practice, that is, we're talkingabout doing the things that you
need to do to not lose bone,while on GLP-1s we're talking
about doing resistance training,eating adequate protein.
They're tracking their food andyet they're still not growing
bone.
This is really concerning for me, because there are millions of
people on GLP-1s, right, yes,and so you know.
We're not screening youngadults.
We don't know what their bonelooks like when they start, so

(42:32):
we don't know where they are.
Now.
I already think that there is akind of a tsunami of
osteoporosis that we don't evenknow about, and I think it's
just getting worse and worse andbigger and bigger because of
all the people on GLP-1s.
If you are not eating adequateprotein, you're not doing
resistance training, you arelosing bone.
In fact, the studies are veryclear on this.
They talk about the percentageof your weight loss that comes

(42:56):
from lean mass.
Some studies say 40%, some say60%, whatever, and people say
it's muscle.
No, they didn't say muscle,they said lean mass.
Lean mass includes muscle andbone.

Michele Folan (43:09):
Yikes.

Doug Lucas (43:10):
So I'm very concerned about it.
I would love to know what thedose is that is beneficial to
bone.
I think it's going to be a verylow dose.
I think it's a micro dose, ahalf of the starting dose or a
quarter of the starting dose orsomething like that.
I think it's probably out thereand we're going to figure this
out over time because I don'tthink these drugs are going away
.
But right now my concern is, ifyou're at a commercial dose the

(43:32):
regular dosing schedule thatyou are likely losing bone and
you should really get screened.

Michele Folan (43:38):
Okay, great advice.
Appreciate that very much,because I you know.
I have clients that are usingthem and I am telling them I
don't care if you're not hungry,you still have to eat the
protein.

Doug Lucas (43:50):
Eat more.

Michele Folan (43:50):
Yeah, I'm like eat more please.
All right, I want to just do aquick rundown of supplements,
because this is the question Iget all the time.
Michele, what are you taking?
And I'm like don't listen to me, I'm not a doctor, so you are
the doctor.
Calcium, I'm a doctor.

Doug Lucas (44:07):
Yeah.
So let me just lead into thesupplement conversation by
saying this Nobody's going tosupplement their way out of
osteoporosis, right, right, itis not a supplement deficiency
problem.
I like them, we use them, werecommend them, we have great
affiliates and we'll talk aboutthose companies, but nobody's
going to supplement their weightof osteoporosis.
This is a lifestyle problem andthen we can supplement on top

(44:27):
of that.
So we'll start there Now withcalcium.
Calcium, obviously, like youwere recommended calcium and the
recommendations from the BoneHealth and Osteoporosis
Foundation here in the US is1,200 milligrams of calcium if
you're over the age of 60 and800 IU of vitamin D.
The research isn't great thatthat's actually doing much,
because osteoporosis is, Ialready said, not a supplement

(44:48):
deficiency.
It's also not a calciumdeficiency for most people.
So my thoughts on calcium is weneed to look at what you're
eating and if you're gettingadequate calcium through diet,
don't supplement it.
You don't need to, and whatthat means for me is anywhere
over 800 milligrams a day and ifyou do need it, then consider
calcium more like a mineralcomplex that you need.

(45:09):
So if you look at our favoriteproducts like AlgaeCal makes a
good product.
There's some other companiesthat make some good products
with whole food forms of calcium, but they're essentially
multi-mineral products, not justcalcium by itself.
So the idea of taking calciumcitrate or calcium carbonate
alone or with vitamin D, I think, is really missing the big
picture, because our bonesaren't just made of calcium,

(45:30):
they're made of so many mineralsand we need all those minerals
if we're going to build backbone.

Michele Folan (45:34):
All right, k2.

Doug Lucas (45:36):
Love K2.
Challenge with K2 is that wedon't really know what the right
dose is, and so I just did aninterview with John Neustadt.

Michele Folan (45:45):
He's one of the oh, he's been on my show.

Doug Lucas (45:47):
He's been on your show, yeah.
So he's a big fan of K2 as MK4.
I generally talk about K2 asMK7 because of the longer
half-life, you don't have todose it as frequently, et cetera
.
His perspective is there's moreresearch on MK4, and he's right
.
But the dose you have to takeof MK4 is very super physiologic
these big doses of MK4, but itseems to be very safe.

(46:09):
If you look at how much K2 weget through food, it's not very
much.
You're talking like a coupledozen micrograms, right?
So my preference now is reallyto say look, if we're going to
take K2, we need to take K2 asMK7 and MK4.
Let's just bridge the gap.
Let's do them both.
What's the downside?
There's no risk of blood clot.
There's really no otherdownside of taking an adequate

(46:32):
amount of K2.
And that super physiologic doseof MK4 doesn't seem to have any
negatives because it isactually pretty well studied.

Michele Folan (46:39):
All right, well, that's what I'm taking.
Of course I'm taking hisproduct because that's what he
told me to take.
So I listen, I do listen.
All right, collagen, butspecifically Fortebone collagen.
Is there any data besides thestudy that they sponsored
themselves?

Doug Lucas (46:55):
Besides their study?
No, no, there's not.
Not that I found.
I still like collagen, though Ithink it's a health span play.
I use collagen every morningand Fortibone's part of that.
But there is only that onestudy and it was sponsored by
Gelita, who makes Fortibone.
So make of that what you will.
The other challenge I have withFortibone is Gelita doesn't
disclose where they get theirbones, so we don't really know

(47:16):
how they're sourcing their bones.
We don't know what those cowsate, we don't know what they
were exposed to.
So we're kind of caught herewhere, yeah, fortibone is the
studies behind it or the studybehind it, but other products
are clear about their sourcing.
I would love to put those twotogether, but right now you got
to pick one or the other.

Michele Folan (47:35):
All right, well, I'm taking that too.
Me too.
I'm like, oh well, okay,creatine.

Doug Lucas (47:43):
I love creatine.

Michele Folan (47:44):
All right For bones.

Doug Lucas (47:45):
Yeah, directly for bones.
I actually have this pending asa topic to review At this time.
I've not seen evidence to saydirectly that it helps with
bones.
I honestly can say that Ihaven't looked at it deeply but
it definitely hasn't come acrossmy desk.
But I like it both for musclemass strength, cognitive
function.
Creatine for me makes a lot ofsense.

Michele Folan (48:04):
All right, I want to talk about the weighted vest
.
It's not a supplement, buteverybody's got one.

Doug Lucas (48:14):
It is a supplement, Supplemental weight it is.
I talk about this a lot and itkind of is.
Again, this is a social mediathing where my Instagram thinks
I'm a 60-year-old woman, so Iget all these advertisements for
all kinds of stuff.
Most of the people that Ifollow are women in the
menopause space, because this ismy audience.

(48:34):
Weighted vests are everywhere.
They're everywhere.
Everybody's got a weighted vest.
You should spend your entirelife in a weighted vest.
The research that is usuallycited about weighted vests and
bone health, I think ismisrepresented.
It does show that it slows downbone loss, so I don't think
that there's nothing here, butit does not help build bone

(48:54):
independently.
So I think we have to be clearon what it is.
It might help you to slow downbone loss, that's true, but the
problem I have with weightedvests is that if you're looking
at an overweight population, wesay gosh, if you could lose 10%
of your body weight.
We know that it woulddramatically improve your joint
pain, how you feel, your energy,your activity level, and

(49:14):
there's a lot of reasons forthat, but yet then we're telling
every postmenopausal orpremenopausal woman to put on
10% of their body weight andthen wear it throughout the day.
So for me it's a little bit of aconflict where I'm concerned
about your joints, concernedabout what the potential
negatives are.
Are you going to put yourselfinto a dangerous situation for
those that are truly fragile andfrail with a weighted vest?

(49:36):
And I think it's certainlypossible.
And so for me, when a patientasks about it, I say look, if
your joints are doing great,then absolutely, because it's
probably going to help you.
But if you're concerned aboutyour joints, you have knee pain,
hip pain.
Adding a weighted vest isprobably going to make that
worse.
So it's not that powerful.
We have other tools.
I'm not a huge fan, but we dohave patients that use them.

Michele Folan (49:58):
Okay, yep, I've got one.
I've got one of those too, butI do want to say this, knowing a
lot of people and myself thathave been diagnosed with
osteoporosis there is thishesitancy to lift weights.
We're afraid we're going tohurt ourselves, we're afraid
we're going to fracture.
How do we approach that?

(50:18):
Do we go to physical therapyand have someone walk us through
that, based on what our scoresare?

Doug Lucas (50:24):
Yeah, this is one of the hardest things we've had to
deal with because, again, we'reall telehealth.
We're nationwide telehealth,we're working with our patients
through Zoom, and this is not aparticularly techie population
to begin with.
So we're asking a lot to say.
We're going to help you figureout how to lift weights.
For someone who's never liftedweights before, who has a
diagnosis of osteoporosis andhas been told not to lift more

(50:45):
than five pounds or they'regoing to break their spine, this
is a really challengingstarting point.
The good news is that the humanbody is amazing and we can start
with some very, very basicthings, especially for those
that have not been exercising,people that have no history of
activity.
You can start very, very basic,very, very low and
progressively overload and seetremendous improvement.

(51:07):
So that's sort of our approachis we start with body weight
exercises, we're looking at form.
We have now a trainer.
Her name's Daisha Enos andshe's been in this space for a
long time, so she has officehours and people will send
videos and talk about form andthis doesn't feel good.
What about this strap orwhatever?
So we can kind of guide themthrough this very simple kind of

(51:28):
thing and then theyprogressively overload and we
have multi-phases in our programthat we can expose them to.
So I think most people can doreally well with just that.
Now, if you need extra help, yes, having the right trainer who
can look at form, put theirhands on you and be like you
know your hip no, it must comeback like this, you know, those
things are really helpful.
Physical therapists can behelpful if it's the right

(51:48):
physical therapist.
And this is the hardest thingis who do I go to locally?
And that's really hard for meto say.

Michele Folan (51:54):
Yeah, and I did do that.
I did go to a physicaltherapist and I worked with her
personally.
But you know insurance doesn'tcover that.
I had to pay that out of pocketbut I wanted to make sure that
I wasn't putting myself at risk.
Now I just pretty much just goand do and I think hopefully I

(52:15):
don't fracture right.
But I know I need to do thisbecause I need to build my bone.

Doug Lucas (52:21):
And that's the hardest thing is, our goal is to
prevent fracture, but in orderto stress our bones, we have to
stress our bones.
And this is where some peoplesay, well, I won't do anything
that will put me at risk offracture.
And I say, well, then the bestthing you can do is to go on a
bone drug and cross your fingers.
But the truth is that theydon't really prevent fractures
that well either.

(52:42):
Yes, statistically better, butpeople still fracture on bone
drugs.
So you got to find that, findout what's right for you.
But it is hard because, yes,you're putting yourself at risk.

Michele Folan (52:52):
I will not do a box jump okay.
Because that scares me.
I'm afraid I'm going to falland chip a tooth, but I do jump
rope and I enjoy it.
I only do like five minutes butit gets my.
That's hard.
Yeah, it is hard, but I do that.
I do heel drops.
Anything else I can be doingfor impact?

Doug Lucas (53:13):
Yeah.
So impact is probably thehardest thing, and so we have a
whole impact progression programtoo, and we start with heel
drops and we work people up toassisted hanging drops like they
do in the Lift More trials.
So there's a whole spectrum ofthings you can do from an impact
perspective, but honestly, someof the best literature is just
on heel drops.
You can develop a tremendousamount of force by simply

(53:33):
dropping onto your heels and allthat force runs up through your
spine, so I don't think younecessarily need to do more than
that.
For those that want to do morethan that, we talk about the
modalities like the osteogenicloading and the whole body
vibration, power plate,bio-density, et cetera.
Those are cool tools if peoplehave access to them, but
similarly they're an investment.
They can be relativelyexpensive, not covered by

(53:55):
insurance, et cetera.

Michele Folan (53:56):
Let's talk a little bit about your practice,
because you did mentiontelehealth.
You see patients in person.
What other services do youoffer within your practice there
?

Doug Lucas (54:07):
Yeah, so I think I can announce this, and you're
going to be the first place thatI've announced this, so I'm
very excited.
So we have two practices, or wehad two practices.
We have Optimal Human Health,which is the health optimization
company that became anosteoporosis clinic, essentially
, and we have a company calledPema Bioidentical, which is our
women's hormone company eitherpeople that have graduated from
Optimal Human Health or havecome in who only need the HRT

(54:30):
side.
So what we were doing in thosetwo practices was relatively
novel and unique, and we gotpicked up by a large telehealth
platform called LifeMD, who'sbeen mostly in the weight loss
and men's health space, and sowe met with the leadership of
LifeMD, explained what we weredoing.
They absolutely loved it, knewthat that was a direction that
they wanted to go, and the onlyway to make that happen is for

(54:52):
them to acquire our companiesand our team, and then we are
now in the process of buildingout this platform or these
services on their platform.
So we will be able to do thisnot only at scale, but also with
commercial insurance and withMedicare.
The details of that I can'ttalk about yet, but that's our
big picture goal is to create awomen's health division, so my

(55:15):
title is literally the VP ofWomen's Health.
We're gonna create a women'shealth division that can address
hormone optimization and bonehealth not as an afterthought
but as a primary perspective andendpoint of care.

Michele Folan (55:27):
This is so exciting for you.

Doug Lucas (55:29):
It is.

Michele Folan (55:30):
I mean to be recognized that, hey, this is a
missing piece in ourorganization.
All this hard work that you'veput into this, the passion has
truly paid off, and for yourteam, because I know you
lovingly have put a teamtogether as well.
So congrats.

Doug Lucas (55:48):
Yeah, thank you and the team's very excited.
We have been really fighting.
We've been fighting the goodfight to grow this in a cash pay
model and it's great.
Our program is great as it is,but it's expensive and it's not
like the company makes a lot ofmoney.
We essentially run even.
It's hard to provide theseservices, which are high-level

(56:11):
services, in a cash-pay modelbecause the cost really adds up.
I'm excited to get this done atscale leverage the resources of
a large telehealth platform tobe able to negotiate with the
LabCorp and the companies thatwe need for the labs and the
data and all the platforms.
We can bring down the costsignificantly and then add in

(56:34):
insurance where it'll cover someof these services.
We can create hybrid models,very excited about what's to
come, because there's trulynothing on the market like it.

Michele Folan (56:42):
Oh, that's fabulous.
Well, congrats again.
Yeah, thank you.
I do have a personal questionfor you.
What is one of your ownself-care non-negotiables?
What's something you do foryourself?

Doug Lucas (56:52):
I train.
I train every day, and what Imean by train is either lift,
weights, mobility, sauna.
I have a power plate and redlight.
I have to do that every day.
It's absolutely non-negotiable.
If I don't do it, I'm a bear tobe around, and I don't want to
do that to my family.

Michele Folan (57:09):
Self-awareness, that's good.

Doug Lucas (57:13):
It was not sudden and I learned that over decades.
So there you go.

Michele Folan (57:18):
I love it.
See, it's not just women.
Men need to do the self-carething too.
All right, tell us a little bitabout the Dr Doug Show.
Where can we find that?

Doug Lucas (57:28):
Yeah, so Dr Doug Show, mostly designed for
YouTube, so it is a fewinterviews.
It's mostly me talking aboutresearch and the subtitle is
Bones, Hormones and Health Span,so you can kind of let that
speak for itself.
But mostly on YouTube, it isavailable on podcast as well.

Michele Folan (57:42):
Perfect.
I will put all of that in theshow notes, Dr Doug Lucas.
Thank you so much for beinghere today.

Doug Lucas (57:49):
Thank you,

Michele Folan (57:51):
Hey, thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
, and did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
Thank you.