Recently I interviewed Margie Bissinger, as we chatted about bone density and thyroid health, and below is the written transcript. If you would prefer to listen the interview you can access it by Clicking Here.
Dr. Eric Osansky: With us, we have Margie Bissinger. We are going to be talking about healthy bones, how to improve bone health. As usual, I am going to dive into Margie’s bio. Margie Bissinger is a physical therapist, integrative health coach, and happiness trainer. Margie has over 25 years’ experience helping people with osteoporosis and osteopenia improve their bone health. Margie is the author of Osteoporosis: An Exercise Guide. She oversees all of the osteoporosis initiatives in the state of New Jersey as a representative to the New Jersey Interagency Council on Osteoporosis. Margie also teaches an online six-week program, “Happy Bones, Happy Life” to give people the tools to naturally achieve optimal bone health. Margie is the host of the Happy Bones, Happy Life podcast and the“Natural Approaches to Osteoporosis and Bone Health Summit.” Thank you so much for joining us, Margie.
Margie Bissinger: Thank you so much for inviting me. I’m so happy to be here.
Dr. Eric: Same here. Glad that you could join us. Why don’t we start out by giving your background? How did you start helping people to improve their bone health, to have happy bones and a happy life?
Margie: It was really interesting because I’m a physical therapist. My area of expertise is orthopedics, working with people with back pain, neck pain, head and neck TMJ. Then I moved from Chicago to New Jersey. I was working in my own private practice as a physical therapist, and a group of doctors asked me if I would see their patients with osteoporosis. This was way back. There wasn’t even a lot at that point in time. I said, “Sure.” I was absolutely mortified by what I saw. I was so upset because well-intentioned individuals, the doctors said they had to exercise, but they didn’t have guidance. They didn’t know where to go, or they didn’t get specifics. They had no idea. They found exercises through books or magazines or their trainer, and they were doing exercises that increased their risk of fractures.
At that point, I got really involved at the state level, the national level. That’s when I wrote my book. I need to get involved here because people need guidance. That is what got me started.
Fast forward, I had a son who had diabetes. I saw how food played such an important role in his condition. That is when I went back to school to study nutrition and became a health coach. I have always taught my patients happiness. There is a real correlation between happiness and chronic pain. The same thing with osteoporosis. That is how I got to do what I do.
Dr. Eric: Why don’t we jump into some of the common causes of osteopenia and osteoporosis?
Margie: For women especially, it’s menopause and the reduction in estrogen. As people age, they lose bone density. People think this is an older person’s issue. It’s really every age because the more bone we have—it’s like a bank as a kid—the more we can draw on later. There are lots of root causes. You’re big into this. All sorts of things. If there are certain medications, malabsorption, any problems with the gut, people aren’t getting their nutrients. They can have micronutrient deficiency. That’s a big one that I see.
Also, in terms of environmental toxins, stress, inflammation. When people have inflammation chronically, it’s going to affect their bones. This is something missed. There are so many underlying root causes. People are treated with a Band-Aid and not looking at these underlying causes that need to be dealt with in terms of a person getting better, really improving their bones and overall health. Also, people who are inactive. That is so common today, where people are sitting a lot. Certain medications. Thyroid, too. That’s your area.
Dr. Eric: We’ll definitely talk about the thyroid. How about medications? What are some of the common medications? PPIs are one of them.
Margie: That’s a big one. So many people are on PPIs, proton pump inhibitors. That’s the Nexium, Tums, anything blocking the acid. There are studies that show that people who are on these medications that block the acid actually have a significant increased risk of fractures and osteoporosis. There is a big correlation. We need that stomach acid. So many people are on that. It was never meant to be long-term. People need to know about this. If they are on these, don’t just get off them; work with your healthcare provider. But there are alternatives.
Even if you had to be on an acid-blocking medication, which some people do for ulcers, there are different ones such as the Tagamet and the Pepsid that don’t affect the bones. PPIs are a big reason. So many people are on them. People know about this.
The one that is so interesting, and people don’t know about, are anti-depressants. It’s not something the doctor will typically say, “I’m putting you on this anti-depressant. Just so you know, one of the side effects is reduced bone density and increased fracture risk.” It’s not usually talked about. The SSRIs, anything dealing with the serotonin, is going to affect bone density. They have done studies on that. That is really important to know. A lot of people are put on them, and they feel better, so they stay on them. That can significantly reduce their bone density and increase their risk of fractures and osteoporosis. That’s a big one.
Another category is any of the steroids, like corticosteroids that people are on, for asthma, inflammation, different things. Even a shorter-term dose of that can affect your bones. For cancer treatments, the aromatase inhibitors as well. There are more categories.
We can talk about thyroid. What happens in the bone is there are two things going on. It’s like build and repair. The bone we have doesn’t just stay there. What our body does to keep our bone nice and healthy is it gets rid of old bone and adds new bone. It throws away the old bone and builds new bone. What happens when there is too much thyroid hormone, or hyperthyroidism as you all know, is that it overdoes it. It gets rid of the osteoclasts; those are the breakdown cells. There are too many breakdown cells, so it offsets the balance. We’re breaking down most bone than we’re building up. That is a big one where if it’s not managed correctly, this can really affect bone health. Even if people have hypothyroidism, and they are taking too much of the medication as well, that can affect your bone, too.
Dr. Eric: Good points. With hyperthyroidism, that can affect bone density. What you’re also saying is if someone has hypothyroidism/Hashimoto’s, and they are taking thyroid hormone replacement, whether it’s levothyroxine or dessicated thyroid, that can also have a negative impact on bone density.
Margie: If your thyroid hormones aren’t balanced, if you have Hashimoto’s, first of all, the inflammation itself, the autoimmunity can be affecting your bones just like it can affect so many different things. Also, you need the right amount of thyroid hormone for building bone as well. Both areas can be affecting bone.
Dr. Eric: I have written some articles in the past where thyroid hormone is important when it comes to bone quality. If you don’t have a sufficient amount of thyroid hormone, that can decrease bone quality, and over time, can increase the susceptibility of fracture.
Margie: That’s a good point you brought up. A lot of people get the bone density test. It just has a number. That number has nothing. It just says how much bone is there. It’s quantity. It has nothing to do with quality. That’s so important because you can have two people with the exact same bone density, but one could fall and not fracture, and one is like chalk with them. That matters so much. That’s such a good point you brought up.
There is a test called the Trabecular Bone Scoring (TBS). It’s software added to the bone density that some places have now that can give you more information on your bone quality as well as the bone density.
Dr. Eric: What type of test is that?
Margie: TBS, Trabecular Bone Score. Not that many places have it unfortunately. A lot of doctors don’t order it, and it may not be covered by insurance. It’s just software that when you get your regular bone density, and it’s incredibly helpful information. Not only does it give you the density, but the quality, which is so important. It’s something that is often not thought about, but it will make the difference if you fracture or not. That’s huge in terms of your bone health.
Dr. Eric: It’s not an actual scan then, from what I understand.
Margie: It’s software that goes on the regular bone density. They can even take if the place has it. They can look at a bone density. You can’t mix places unfortunately. That’s an issue. The test is not that accurate. You can’t take the findings of one center and bring it to another. You have to stay at the same place. Sometimes you have to balance out what’s more important. Usually it’s staying at the same place. For anyone getting it for the first time, just check with your center. I’m a big believer in this test. It gives you additional information.
Dr. Eric: Good to know. How about stress? What impact does stress have on bone density?
Margie: I’m so glad you asked this question. People come to see me, and they are so worried if they are doing the right exercises. Are they eating the right foods? They don’t realize that the stress itself is such a problem. Stress is your body’s own steroid. Cortisol is your body’s steroid. It does the same thing as being on steroids. There have been studies done on both animals and humans that show that increased cortisol reduces bone density. It really makes a difference.
Every single person I work with, I really teach them life is stressful, so you can’t just say to get rid of stress. Doesn’t happen. But you can learn techniques so that you’re more resilient, and the stress isn’t going to topple you over. That’s my favorite thing I do. I teach people to reduce stress as well as increase happiness, which they have shown that people who are content with life and are happier have increased bone density. It all goes together.
I look at osteoporosis as an opportunity. People find out. It’s not something that you feel oftentimes. You’re 50, you get a bone density, and you’re like, “Oh no. I have osteoporosis.” You conjure up these images of your life is ruined. You can’t enjoy all the activities you did: playing with your grandchildren, etc. It’s very scary. I look at it as an opportunity to examine your life. What is missing? For example, stress. Am I a stressed-out person? Where can I improve upon it? Am I a couch potato? When you do all these things that help the bones, your whole life gets better. You’re in your 80s, and you’re lifting things. You have never felt better in your life. That’s how I look at it. Look at it as an opportunity to see where you may have issues that you need to deal with.
The bones aren’t in isolation. I know that’s something you practice as well. One part of the body,it all goes together. When something is wrong with the bones, usually there are other areas as well.
Stress is so important. I just think it’s something that every person needs to stop and see where they are at. I’ve always been a happy person, but physical therapy, you can get really busy. I remember working like crazy, shoving my lunch down. One day, I decided to take a meditation program for eight weeks. I did this Jon Kabat-Zinn program. The first class, we didn’t do much. The second class, I got a speeding ticket on the way to meditation. That was the best thing that happened. It hit me in the head that I was not practicing what I preached. Since that day, around 11 years ago, I made these practices such an important part of my life. It’s completely changed everything. I can’t say enough about how it’s helped me personally as well as everybody I work with. Very big thing.
Dr. Eric: Another reason why people should incorporate some type of mind body medicine or something else to manage stress. There is only so much we can do about the actual stressors. When it comes to stress management, there is definitely a lot we can do.
Margie: Absolutely. The benefits, I’m sure you’ve seen this as well in terms of health. I just can’t get over it actually, how big a role this plays. It also helps your digestion. The body thinks you are running from a tiger, and it shuts down digestion. If digestion is shut down, we are not absorbing our nutrients. We may be eating properly. All sorts of things with reducing our stress and learning the mind/body techniques are so helpful.
Dr. Eric: How about the gut microbiome, and how it impacts bone density?
Margie: Yes, they have done research on that. The composition of the gut microbiome, new research is coming out about how it can affect your bone density. As everybody knows, the gut can be the root of everything, especially when it comes to your bones. It’s one of the first things I have people work on. Oftentimes, people will just say, “I see your bone density. Let’s go on a medication,” not realizing this person has major issues. It’s good to have it evaluated, see what you can do to improve. Eat as best you can. Your prebiotics, your postbiotics. Do things to help the gut microbiome. Get it evaluated too. There are people who have issues, and that will definitely affect your bones.
In terms of the other thing with the gut that I find, the biggest thing that I see in my practice is food sensitivities. One that I see time and time again is gluten. It plays such a role. I can’t even tell you how many people have gotten off gluten and really improved their bone density and bones. Most doctors who deal with osteoporosis, the endocrinologist will test for Celiac Disease. They don’t go any further. That’s a real problem. Celiac Disease affects a small portion. Anyone who has non-Celiac gluten sensitivity or problems with gluten can also have significant inflammation and significant problems with their bones because they are not getting the nutrients. It’s not something that is routinely done. I think everybody should be tested for that personally as well. It’s very common, and it’ssomething that needs to be evaluated in the whole scheme of looking at why you might be losing bone.
Dr. Eric: That’s interesting, too. How about the dairy controversy? Like gluten, some people will say to avoid dairy because it’s inflammatory. There are others who say when it comes to bone health, you need to have dairy to have healthy bones. Can you talk about dairy and other foods that you would recommend that might be able to help with bone density?
Margie: That’s such a good question. It’s true. You will watch television. Years ago, they had the milk moustache. That’s what people are told. “Drink your milk. You will have strong bones.” That’s not what’s been found. The countries that have the most dairy do not have lower incidents of osteoporosis. There is not a correlation with increasing your dairy and osteoporosis at all. For so many people, dairy is inflammatory. That’s not what you want to do. You certainly don’t want to increase your inflammation. That is not what I tell people. A lot of people who can’t tolerate dairy, myself included. I eat very little dairy, if any. Some people can tolerate healthy dairy, like organic and pasteurized. Other people who can’t, there are lots of other ways to get your calcium.
I am a big believer in the leafy greens. Some of the ones that people don’t know about are collard greens. You can use that as a wrap. They have 250 mg of calcium per cup. Kale. Bok choy are some good ones. A lot of people think spinach is a good green. Spinach has oxalic acid, so you are not going to be getting the calcium from it. Not that you can’t have it, but don’t use that. Sardines are a great way to get calcium. Chia seeds. There are ways to get calcium outside of dairy. Don’t increase your dairy at all. I don’t believe in that. A lot of people need to appreciate how inflammatory dairy is. It’s one of the things I also often have people either eliminate or test for because it can be an issue as well. We certainly want to get rid of anything that causes inflammation.
Dr. Eric: Is broccoli also high in calcium?
Margie: Broccoli is good. It’s not huge, but it certainly is a very good thing to take, yeah.
Dr. Eric: You mentioned inflammation, which is huge because it’s not just the foods. We mentioned stress, which can lead to inflammation, a pro-inflammatory response. There are so many things that can cause inflammation. As a healthcare practitioner, a health coach, physical therapist, that is not just diet, not just stress management, but there are other things you look into to try to reduce inflammation.
Margie: Absolutely. There is a major workup when it comes to osteoporosis. I believe it’s so important. As I said before, it’s like putting a Band-Aid on it. I like to see in the bloodwork the homocysteine level and the C-reactive protein. That is just in the regular lab work. It can be ordered by any doctor. It’s not anything special when you get your bloodwork. It gives tremendous information.
A lot of people don’t know. Even just today, this morning, I spoke to someone who got diagnosed with very low bone density. Her numbers were awful in terms of her homocysteine and C-reactive protein. She didn’t realize; she doesn’t know. They are trying to figure out what could be causing it. That’s very important to see. Is there underlying inflammation? It can be for many reasons. It can be infection, food sensitivities. That’s why I’m such a big believer in working with a functional medicine or integrative or someone like you, working with someone who deals with this so you can delve in and see.
Osteoporosis, unlike some other things, let’s say you come in with eczema, or your stomach is hurting. You will know if you are getting better. With bones, you don’t know right away. It’s not as though the bone density test is that sensitive. Oftentimes, people do have other issues where we can see if they’re improving. That’s why it’s so important to initially figure out what could be the root cause because you don’t want to miss anything. Yes, inflammation. People who have rheumatoid arthritis, anything inflammatory because of autoimmune issues will affect the bones as well. It’s a big reason, and it’s something that needs to be taken into consideration and often isn’t.
Dr. Eric: Supplements. There are some people who might ask about taking calcium supplements. What are your thoughts?
Margie: It’s an interesting situation. Calcium is one of those situations where more is not better. What I see is people are getting calcium in their diet. In the United States, what’s recommended for anyone over 50 is 1,200mg of calcium. In terms of other places, it’s like 700. If they are put on 1,200, and they are getting some in their food, that’s more. I see people getting too much calcium because they think that’s the panacea. Let me take calcium supplements. They take the calcium plus what they are getting in their food. It’s too much.
There has been research, nothing 100% conclusive that we can say, “Oh yes, for sure,” but there has been some research on when there is increased calcium over the 1,200, people have had increased kidney stones, increased cardiovascular issues. It used to be called the National Osteoporosis Foundation, and now it’s called National Bone Health. They changed the name because bone health is in all ages, not just osteoporosis.
The recommendation is get as much as you can from food. Only supplement if necessary. That’s what I believe. See what you can get from your food. More is not better.
But the key thing here is that, and this is what’s missing. I work with all sorts of doctors. Most doctors will recommend calcium and Vitamin D, which is so essential; and make sure you have the 25-hydroxy Vitamin D so you see what your level is. Don’t guess this. It’s so important. We see now how it really has been helping with so many things. Our Vitamin D level is so critical. Yes, Vitamin D, calcium, and exercise. They will tell you this.
The other thing is there are some more things that are beyond critical. To absorb that calcium, yes, you need the Vitamin D. I believe in eating the rainbow. You need a whole symphony. It’s not just a few vitamins that will do the trick. You need to eat everything. However, the key ones for osteoporosis are magnesium. So many people are deficient in magnesium. Years ago, we had a 1:1 ratio. The amount of calcium we had to magnesium. Now, people are so deficient in magnesium. It’s so important for so many different activities in your body. At last half the calcium to magnesium, minimum.
The other thing that is so important is Vitamin K2. Vitamin K2 takes that calcium and makes sure it gets into the bones and not into the soft tissue. It’s so important. There is a food called natto that is a Japanese food that is very high in one type of K2 called MK7. They found in those areas of Japan there is a huge reduction in osteoporosis.
Those are the key ones. There is a lot more in terms of manganese, boron, zinc. There are a lot of other things in terms of supplements. Eating from the rainbow. Anti-inflammatory diet is so important. Not the calcium by itself. Try to get it from your food. If not, then you can supplement. The one supplement I don’t like is calcium carbonate. That reduces the acid, like Tums.
Dr. Eric: I’m glad you brought up the K2. Whenever I have someone take D3 supplement, I make sure they take the K2 as well for the reason you mentioned. You said you do recommend for people to test that 25-hydroxy. You have all of your clients go through that?
Margie: Typically, they have had it. Maybe it’s just who I work with here. All of the doctors order that. When people are referred to me, they already have osteoporosis or osteopenia, for the most part. Typically, that is part of the routine workup, the 25-hydroxy test. That is already done typically. I don’t think there is anyone that hasn’t had that that has been referred. That is part of the medical workup.
Dr. Eric: I agree. It is important.
Margie: The other thing is the parathyroid hormone. I’m doing this summit. I had a doctor who is a parathyroid surgeon come onthe summit. So often, she said this is missed. If someone has a tumor on their parathyroid, that can significantly affect your Vitamin D and calcium. A huge reason for osteoporosis is doctors are taught in medical school that if your calcium on your bloodwork is a little bit high, don’t worry about it. No big deal. She talks about that a lot. My point is that that is something that is important in the bloodwork for people to know about. That calcium level doesn’t affect the calcium you are getting in your body, but it can be very important for the parathyroid hormone. Make sure you have a look at the parathyroid hormone. The doctor should. But I wanted to mention that.
Dr. Eric: Good point. They don’t get as concerned if a nutrient like that is high. They are worried about something being low. If calcium is too high once, you want to retest. You can also do a test for parathyroid hormone pretty easily in the blood.
How about exercise? What impact can exercise have on improving bone health?
Margie: This is where I think we can all make such a difference. First of all, the research has shown certain types of exercise can really increase bone density. There was a study called the Lithmore Study done in Australia. They took people who had osteoporosis, low bone density, and put them through some serious weight training, not just minor. They showed improvement in bone density.
But the key thing here is safety. This was a supervised study. I really don’t believe to just go out, find a video, and start doing it. That’s dangerous. As a physical therapist, if you’re not in good posture, if you don’t know what you’re doing, you could really hurt yourself. What I always say is, if you can, and usually this is covered by insurance, get a referral to physical therapy, at least once, so you can figure out what’s best for you. They can look at if you have shoulder problems, hip problems, and give you a custom exercise program. That is my first thing.
Regardless, exercise is so important. The types of exercise that increase bone density are resistance. When the muscles contract against resistance, it’s like tugging on the bone and saying, “We need more bone here.” Strength training is really important. That is what they have shown makes a difference. I would not start it on my own unless you have been doing it for a while. I would work with someone who is knowledgeable in osteoporosis.
High-impact. This depends. If you already have osteoporosis, check what level you’re at with the people you’re working with. But for younger people, jump. Jumping, high impact forces increased bone density. Exercise at any stage can make such a big difference. That’s what I have seen. It’s so incredible. Whatever you can do.
You can always do balance exercises. Everybody should do those all day anyway. Not all day, but often, if you don’t use it, you lose it, both with exercise and balance. By improving your balance, you’re not going to fall. That is what is causing the fractures for the most part. Everybody can do balance exercises. That would be tai chi, standing on one foot, doing stabilizing. I love tai chi. That’s one of my favorites. Even just shifting your weight. The good thing is that when you do it, it’s amazing the difference.
Everybody, even if you’re at high risk, even if you’re on medications, can do the right exercises. That’s what I see. People think, “I will just walk 10 miles.” Yes, it’s good to walk. They did show in the Nurses’ Health study that they reduced your risk of hip fractures. That’s not what is actually increasing bone density. It’s the strength training. It’s lower reps. It’s 8-10 reps, not 50 reps.
The summit I’m doing, I have physical therapists who are fantastic, who are the people who teach the physical therapists demonstrating safe exercises, posture. That is critical. I’m very passionate about that. I’ve seen people, even twice a week when they are doing the right exercises, not only improve their bone density, but improve their strength and activity levels. You feel empowered. You feel really great when you exercise and improve your strength.
Dr. Eric: Especially the balance. I think about that. I do talk to patients at times about increasing weight-bearing exercises, especially with hyperthyroid patients. You also want to be cautious with that. You might need to work with someone for that as well. The balance makes a lot of sense to do what you can to prevent from falling in the future.
Margie: I work with the State of New Jersey on several state programs on exercise. People in their 70s, they’re older. By just doing these several balance exercises, it’s been amazing, and people have said how they felt they were gonna fall. When they are doing weight shifting, when you are going forward and back, which is part of tai chi, they said they didn’t. I can’t even tell you how many people have commented that they really feel these exercises have prevented them from falling. It’s not hard. You can throw these in during your day. That’s what’s so exciting.
Dr. Eric: The last question I have for you, Margie, is I have had a number of broken bones in the past. Early last year, my wife broke her big toe, and it was slow to heal. My question is if you have anything to speed up the healing process, whether it’s supplements or a cold laser (she thought that was beneficial). I wanted to pick your brain on that a bit.
Margie: I always make sure that people are getting the nutrients. I would really up your multivitamin. You’re getting the calcium, magnesium, boron, zinc, everything that builds bone. Make sure you’re getting enough protein. We didn’t talk about that. A lot of people think, “Too much protein isn’t good.” There is a Goldilocks, but you need enough. A lot of people as they get older aren’t getting that much protein for bone healing. Yes, make sure you are getting enough nutrients. If you need to supplement, this is when I would make sure if there is any question to make sure you are getting the bone-building nutrients.
#2 is there is some electrical stimulation. If people are not healing, that can speed up the process. They have done research on different electrical stimulation units. They have done those with non-union fractures. The orthopedists do have different things to help with fracture healing.
Dr. Eric: Thank you so much. You shared a lot of valuable information. Greatly appreciate it, Margie. If you could let people know where they can find you and where they can learn more about you?
Margie: Go to my website, MargieBissinger.com. The podcast is there, too.
Dr. Eric: What’s the name of your summit?
Margie: I’m so excited about this; you have no idea. I have wanted to do this for several years. It just worked out. It’s called the Natural Approaches to Osteoporosis and Bone Health Summit. I have 46 experts in different areas. What I wanted people to do is get tools. The physical therapists are actually showing the exercises. One person is a personal trainer who deals with osteoporosis, who actually worked with Jackie Onassis and Caroline Kennedy. She is showing amazing balance exercises. One physical therapist, Sherry Betz, really shows you how to do the exercises. I have physical therapists demonstrating and explaining the exercises in detail.
I have all sorts of people who deal with this; that is their area of expertise. Functional medicine doctors who work with osteoporosis. What works? What hasn’t worked? People talking about the foods. How to make foods. What do we need to eat? Stress. Not only do these people talk about stress reduction, but they have you go through processes. Even Chinese medicine, going through what we can do from that realm to help our bones. There is so much information. It’s a smorgasbord that you can pick from.
Even signing up. I wrote this exercise book, so that is a free gift when people sign up, just to get people started. It’s basic, what can you do easily. I don’t believe in overwhelm, so I want people to get things gradually. There are a lot of free gifts and lots of tools. That is what I wanted to do. Unfortunately, this information is not out there. Every person does not deal with osteoporosis from a functional medicine viewpoint. I wanted to show people what else is possible.
It’s not on medication at all because that wasn’t the point of it. Even if someone is on medication, absolutely come because you need all of this to build your bones. It goes into every aspect of bone health with all sorts of tools and things that people can put into their life. I’m excited about it getting all this information in one place and out to people. And it’s free. People can listen for free. They don’t have to pay for this.
Dr. Eric: They might as well take advantage of it. This is information that not just people with hyperthyroidism can benefit from, but pretty much everyone. A lot of people are faced with bone density problems as we get older. Whatever age you are, if you are younger, you want to prevent.
Margie: It’s such a good point. The next generation, if we start early, think of the kids. They are sitting like couch potatoes, not eating a good diet. It’s setting them up for poor bone health throughout life. I have a pediatrician who does a thing about milk, why that’s not what to get for the kids. She does a whole talk on what to feed your kids. I also have a whole program called Million Dollar Bones wheresomeone talks for teens about what to do. This is where we are going to make the impact. We are going to change the trajectory of osteoporosis if we start young. 80-90% of bones women have by 18 and men have by 20. It’s all ages. It’s not as if you wait until you’re older. Every age, there are things that can be done. That is what is so great. Putting bone health on the map. Why not enjoy your years later? Why have to worry about later? It’s not necessary when there is so much that can be done.
Dr. Eric: I couldn’t agree more. Thank you so much, Margie. Appreciate you taking the time to share this wonderful information.
Margie: Thank you so much. It’s been a pleasure.