Key topics and timestamps
00:00 – Why happiness and bone health belong together
03:10 – Bone quality vs. density: beyond a DEXA number (TBS explained)
07:25 – Labs that matter: CTX and P1NP, how and when to test
12:40 – Foundations: nutrition, gut health, and smart calcium (K2, magnesium, boron)
20:15 – The exercise breakthrough: LIFTMORE study and the ONERO method
28:50 – Balance, posture, and safe impact training (without spinal flexion)
33:30 – Vibration therapy: low-intensity options vs. high-intensity caution
41:00 – Devices and programs: OsteoBoost, OsteoStrong, and what I actually recommend
47:15 – Medications today: bone-building anabolics vs. antiresorptives
53:00 – Hormones that help build bone (estrogen, progesterone, testosterone, DHEA)
58:10 – Scans that guide decisions: DEXA, TBS, echoultrasound (REMS), BodySpec, wrists/hips
1:05:00 – Weighted vests, collagen peptides, protein, and jumping guidelines
1:09:20 – Your 30-day “Happy Bones” action plan and how to get support
Welcome, girlfriend—let’s talk bones and joy Well, hello and welcome back to the Girlfriend Doctor show—this time, in blog form. I just hosted a powerful community call with my dear friend, bone health expert and true happiness teacher, Margie Bissinger, PT, CHC. She’s helped thousands of women strengthen their bones, improve posture, and bring more joy into their lives. Our conversation was so rich that I’m expanding on it here for you—so you can take clear, confident action right now.
Here’s my promise: stronger bones aren’t just possible—they’re likely—when you combine the right movements, nutrients, labs, and mindset. And yes, happiness itself is part of the treatment plan.
Bone quality vs. bone density: you need both. Most of us only hear about DEXA scans and T-scores. Helpful? Yes. Complete picture? Not quite.
Density vs. quality: Bone strength is density + quality. DEXA measures density. Quality often gets missed.
Ask for a TBS add-on: Trabecular Bone Score (TBS) is software applied to your spine DEXA image that estimates bone microarchitecture (quality). It’s incredibly helpful for fracture risk.
Consider REMS ultrasound (Echolight): This radiation-free ultrasound assesses bone quality and density at the hip and spine. It’s promising and useful as an adjunct (not a replacement) to DEXA.
Scan smart: If you can, get both hips and the wrist, plus the spine. If you ever have a hip replacement, you’ll still have a baseline on the other hip and wrist. Always request both hips if possible.
The labs that tell you what’s happening right now This is a big one. A DEXA tells you where you are. Bone turnover markers tell you what your bones are doing.
CTX (C-terminal telopeptide of type I collagen): Indicates bone breakdown (osteoclast activity). Elevated CTX suggests active bone loss, often from inflammation, stress, poor sleep, or other root causes.
P1NP (Procollagen type I N-terminal propeptide): Indicates bone formation (osteoblast activity).
Why it matters: You can make changes and recheck in 3–6 months to see if your plan is reducing breakdown and/or increasing formation.
Testing tips: Do it first thing in the morning, fasting. Avoid collagen, biotin, and intense exercise for ~48 hours before. Your results are far more reliable this way.
Foundations first: nutrition, gut, and smart supplementation. Food and absorption make or break bone rebuilding. If your gut is inflamed or you’re not absorbing nutrients, the rest doesn’t “take.”
Protein: Your bones are ~50% protein by volume. Most midlife women under-eat protein. Center each meal around protein and amino acids. If appetite is low, essential amino acids or collagen peptides are an easy assist.
Collagen peptides: Helpful for bone and connective tissue. Look for formulas that include Fortibone peptides (some brands carry research-backed versions). Take away from your bone turnover lab draw.
Calcium (quality and dose): More is not better. Aim for a total of roughly 800–1000 mg/day from food + supplements combined. Use food first (leafy greens, small bones in canned salmon/sardines, sesame/tahini). If supplementing, avoid calcium carbonate (poor absorption, lowers stomach acid). Citrate, malate, or microcrystalline hydroxyapatite are better tolerated options.
Vitamin D3: Essential for calcium absorption and immune health. Know your level and personalize your dose with your provider.
Vitamin K2: The calcium “traffic cop” that helps move calcium into bones and out of arteries and soft tissue. Both MK-7 and MK-4 forms are useful. MK-4 has robust bone research; MK-7 has strong heart and bone support.
Magnesium: A must-have cofactor for vitamin D and bone formation. Many women are deficient.
Boron: Small amounts support bone metabolism and hormone balance.
Gut health: If you aren’t having 1–2 easy, well-formed bowel movements daily, address it. Healthy microbiome, robust stomach acid, and low gut inflammation are non-negotiable for nutrient absorption.
Exercise that builds bone: heavy, safe, and supervised The LIFTMORE study changed the game by showing that properly supervised, heavy resistance and impact training improved both spinal and hip bone density—even in older adults.
The ONERO method (created from LIFTMORE’s research) is now offered at select clinics. It focuses on:
Heavy overhead press
Weighted squats
Deadlifts
Progressive impact (small, controlled jumps)
Balance and posture work
Safety is everything:
Work with a trained physical therapist or ONERO-certified practitioner if possible. In Canada/US, BoneFit-trained PTs are another great option.
Start where you are. You may spend weeks mastering posture, breathing, and bracing before loading heavier.
Breathe and brace: Exhale as you engage pelvic floor and deep core (“belly button in and up”), then perform the effort. Maintain a neutral spine.
Avoid deep rounding (flexion) if you have osteoporosis. Most vertebral fractures occur in the front of the vertebra; flexion loads that weak area.
Impact: how much and how to progress. Gentle impact stimulates bone formation, particularly at the hip.
Start with heel drops: Rise onto toes and gently drop heels. Progress to small, soft-surface hops.
Jump rope or no-rope hops: Short sets (e.g., 10 reps), multiple rounds, with good form and posture. Quality over quantity.
Work up gradually. If you have pelvic floor concerns, posture issues, or pain, get evaluated by a PT first.
Vibration therapy: the nuanced truth
Low-intensity vibration (LIV): The Marodyne LIV platform delivers gentle, low-magnitude signals shown to influence stem cells in bone marrow toward bone (rather than fat) differentiation. It’s well-tolerated and can support bone and balance, especially for those who can’t yet lift heavy. Ideally 5–10 minutes, once or twice daily, five days per week.
High-intensity vibration platforms: Some people love them for balance and rehab, but there are caution flags. If you use them, keep settings low, maintain knee flexion to dampen head/neck vibration, and stop if you feel discomfort. I lean toward LIV for bone-specific safety and intent.
Devices and programs: what I do—and don’t—recommend
OsteoBoost (hip-worn device): The research does not convincingly show meaningful hip/spine improvements; some users reported discomfort. I do not recommend it as a primary strategy.
OsteoStrong centers: Despite marketing, real-world reports and research reviews raise safety and efficacy concerns (including injuries). I do not recommend this as a first-line option.
ONERO program: I love this. It’s supervised, evidence-based, and modifiable for injuries and limitations.
Modern medications: when they fit an integrative plan If your T-score is very low (e.g., ≤ -3.5), you’ve had fractures, or your CTX is high (active bone loss), you and your physician may consider starting with bone-building (anabolic) medications while you implement lifestyle changes.
Bone builders (anabolics): Teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity). These can build bone. Evenity is often limited to 12 months and has cardiac considerations.
Then “lock in” gains: Follow with an antiresorptive (e.g., zoledronic acid/Reclast or denosumab/Prolia) to maintain bone built by anabolics.
Important sequence: Starting with bisphosphonates can reduce the effectiveness of later anabolic therapy. Work with an experienced endocrinologist and an integrative plan to personalize.
Hormones that help bones rebuild. Hormones are a huge lever for bone health—especially during perimenopause and after menopause.
Estrogen: Slows bone resorption (anti-resorptive).
Progesterone, testosterone, DHEA, and pregnenolone: Support bone-building physiology and muscle mass. Many women feel better mood, sleep, and strength with appropriate, personalized hormone therapy.
Testing and timing matter. Always work with a knowledgeable provider and monitor labs and symptoms.
Scanning smarter (and more affordably)
DEXA: Still the gold standard for density. Ask for both hips and spine; consider adding a wrist. Add TBS for bone quality.
Echoultrasound (REMS/Echolight): A helpful adjunct in certain settings; not a replacement for DEXA.
Hip replacements: You won’t be able to track density in the prosthetic hip, so getting both hip baselines early is wise.
Budget ideas: Some centers offer cash prices far below insurance rates—call around. Mobile DEXA body comp services (like BodySpec) can provide frequent trackable snapshots; consider them supplemental to a high-quality DEXA with TBS when possible.
Weighted vests, collagen, and protein: my take
Weighted vests: Useful for adding load during exercises like squats or step-ups. I don’t recommend wearing them all day or for long walks—posture and joint strain can suffer.
Collagen peptides: Yes. Great for bone matrix and connective tissue. Consider formulas with Fortibone peptides. Don’t take it within 48 hours of CTX/P1NP testing.
Protein and essential aminos: Most women feel and perform better for bone and muscle when they prioritize protein at each meal. Essential amino acids are a great “light” option on lower appetite days.
Your 30‑day Happy Bones jumpstart
-
Week 1:
Labs: Order vitamin D, and talk to your provider about CTX and P1NP.
Sleep first: Lights out routine, cool dark room, consistent schedule.
Protein anchor: Build each meal around protein; add vegetables and healthy fats.
Walk daily: 20–30 minutes, posture tall, arms swinging.
-
Week 2:
Supplements: Discuss vitamin D3, K2 (MK-7 and/or MK-4), magnesium, and boron with your provider. Use food for most of your calcium; supplement only the gap.
Gut basics: Hydration, magnesium-rich greens, fiber, and gentle movement for regularity.
-
Week 3:
Strength training: Book a session with a PT or ONERO/BoneFit-trained pro. Learn bracing, neutral spine, and form for squats, deadlifts, and overhead press.
Balance practice: 5 minutes daily (single-leg stance near support, tandem walk, Tai Chi).
-
Week 4:
Add gentle impact: Start heel drops; progress to small hops if cleared.
Consider the LIV platform if appropriate and in budget.
Rejoice in small wins: Better posture, steadier mood, stronger grip—these matter.
Why happiness belongs in your bone plan. Chronic stress raises cortisol, which accelerates bone breakdown and blunts bone-building. Joy isn’t “extra”—it’s medicine. Movement you enjoy, supportive community, uplifting conversations, deep laughter, restful sleep—these are biological inputs your bones respond to.
Margie embodies this. Her work pairs precise bone strategies with practical happiness habits, and the results speak for themselves. I’ve seen it in my community too: when oxytocin rises and cortisol falls, women feel—and build—better.
Listen to the full episode for the juicy details. In the episode, you’ll hear:
Real member questions about DEXA, TBS, CTX/P1NP, vibration therapy, osteo devices, and more
A candid discussion about medications and how to use them wisely
Specific exercise cues you can try today for safer lifting and impact
How happiness practices amplify your bone results
Tap play on the podcast episode and join us. You’ll leave feeling empowered, informed, and ready to make your next right step.
Q&A
Q: What are the most useful bone labs?
A: CTX (bone breakdown) and P1NP (bone formation). Draw fasting, early morning; avoid biotin, collagen, and intense exercise for ~48 hours.
Q: How can I safely start building bone with exercise?
A: Learn bracing and neutral spine with a PT or ONERO/BoneFit pro. Begin with form, then add load to squats, deadlifts, and overhead press. Add gentle impact when cleared.
Q: Which supplements matter most?
A: Vitamin D3, vitamin K2 (MK-7 and/or MK-4), magnesium, adequate protein/collagen, and small-dose boron. Get most calcium from food; avoid carbonate forms.
Q: Are vibration plates safe and effective?
A: I favor low-intensity vibration (e.g., Marodyne LIV) for bone support and tolerability. Use high-intensity platforms cautiously and at low settings if at all.
Q: Should I consider medication?
A: If bone loss is severe or active (very low T-scores, high CTX, fractures), discuss starting with anabolic therapy (Forteo, Tymlos, Evenity) and then maintaining gains with an antiresorptive—within a comprehensive lifestyle plan.
Q: DEXA vs. TBS vs. ultrasound—what do I ask for?
A: Get a high-quality DEXA with TBS if available, both hips and spine, plus a wrist. REMS ultrasound (Echolight) can be an adjunct, not a replacement.
Ready to go deeper? Queue up the full podcast episode for real-world Q&A, expert tips from Margie, and the encouragement you need to take your next step. You’ve got this—and we’ve got you.
Links Mentioned:
MORE Natural Approaches to Osteoporosis & Bone Health Summit
Mastering Your Hormones Masterclass
Connect with Margie Bissinger:
Connect with Dr. Anna Cabeca:
Disclaimer: This article is educational and not medical advice. Always consult your healthcare provider for personalized testing, diagnosis, and treatment.
