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In the last eighteen months, Charlotte has fractured her ribs, broken her wrist, and experienced a spontaneous vertebral collapse. She is otherwise healthy and eats well, and her parents lived nearly to a hundred. If she breaks her hip, the data indicate she has roughly a one-in-three to one-in-two chance of being dead within a year, and I am afraid that is what is coming.
Her doctors have given her the soft label “osteopenia,” a phony statistical category I will dismantle below. Charlotte does not have osteopenia. Charlotte has osteoporosis. Three fragility fractures in a year are the disease announcing itself in plain language. I wrote this for her so she has the information to reverse what she can and to refuse what she should.
Why bone disease deserves your attention more than breast cancer
About one in five Americans over age 65 fractures a hip. Depending on the cohort, between a quarter and more than half of those people are dead within a year. Many survivors never walk normally again and end their days in nursing homes. As a public health problem, this dwarfs breast cancer, yet cultural attention is reversed. Hip fractures happen mostly to women, but men are not exempt; men who break a hip die at higher rates than women.
The orthodox approach is to scan everyone, label about half of postmenopausal women with a manufactured precondition called “osteopenia,” and feed them oral or injected bone drugs that, in the populations they are mostly given to, do not prevent the fractures that matter and cause new fractures of their own. The story of how this came to be is representative of how modern healthcare works.
The osteopenia con: a hotel meeting in Rome
In June 1992, the World Health Organization convened a small group of bone experts at a hotel near the top of the Spanish Steps in Rome. Until that meeting, osteoporosis had no numerical definition; doctors mostly diagnosed it after a bone fracture. The funders wanted a number because it could be screened for, and a screening test could be sold alongside a drug. Merck, the maker of Fosamax (alendronate), had funded the development of inexpensive dual-energy X-ray absorptiometry (DEXA) scanners and was pushing hard to get them into doctors’ offices.
Anna Tosteson of Dartmouth, who was in the room, later told NPR what happened. After two or three days of arguing, the group settled on −2.5 standard deviations below the mean for a healthy young adult as the osteoporosis cutoff. Anyone with a T-score of −1.0 to −2.5 was given a new label coined on the spot: osteopenia. Tosteson said the term was created mostly because public health researchers prefer clean categories. None of them imagined it would be marketed back to patients as a disease that needed treatment. Steven Cummings of UCSF, one of the most cited osteoporosis researchers alive, said flatly that there was “no basis, no biological, social, economic or treatment basis, no basis whatsoever” for using −1.0 as a clinical line, and that, as a consequence, “more than half of the population is told arbitrarily that they have a condition they need to worry about.” Alix Spiegel told this story for NPR in a piece you can read here.
So roughly half of postmenopausal women now wear a label that was invented off the cuff in a hotel suite during a meeting paid for by a company that needed more women on its drug. The chairman of that meeting, John Kanis, has confirmed in print that osteopenia was never meant to be a disease. It became one because Merck and the DEXA-scanner industry needed it to be one. Once the label existed, the algorithm wrote itself: scan, label, prescribe, repeat.
Bisphosphonates: poison sold as medicine
Fosamax, Boniva (ibandronate), Actonel (risedronate), and the IV drug Reclast (zoledronate) are bisphosphonates, sold as bone-saving drugs. For the women they are mostly prescribed to, they are worse than nothing. TheNNT.com summarizes the Cochrane data with their usual clarity: in postmenopausal women without a prior fracture, no high-quality study has shown a meaningful reduction in fractures that matter. The drugs show a fracture benefit only in the smaller subset of women who already have osteoporosis on a scan and a previous broken bone. That is a population perhaps a tenth the size of the population being medicated.
These drugs do real damage. The Fosamax label and the post-marketing literature now document:
• Atypical femoral fractures. The thigh bone snaps with almost no force. The drugs were sold to prevent this and instead cause it. The risk rises with treatment duration beyond about three to five years.
• Osteonecrosis of the jaw. The jawbone deteriorates, sometimes after routine dental work. Merck has paid out hundreds of millions of dollars to settle these claims; in one Fosamax settlement, the company paid $28 million to dispose of about twelve hundred suits.
• Esophageal erosion and esophageal cancer. Oral bisphosphonates are sufficiently corrosive that patients are advised to remain upright for thirty minutes after dosing. Some users still develop esophageal injury, and the cancer signal has been debated for years.
• Atrial fibrillation. Multiple analyses link bisphosphonate use to higher rates of this dangerous arrhythmia.
• Bone and muscle pain, GI distress, eye inflammation, kidney injury, low calcium, hypersensitivity reactions. Lists of forty-plus reported side effects are not hard to find.
There are roughly eighty million bisphosphonate prescriptions written in this country. The financial reason is simple. Doctors who administer IV versions in their offices keep a margin on what they buy and inject; the same arrangement applies to Lupron for prostate cancer and several oncology drugs. If a physician set up that kind of revenue split with another physician, it would be illegal fee-splitting. Routed through a corporation, it is the business model. I covered the same dynamic in the oncology section of Butchered by “Healthcare”.
Comment: If your doctor wants to put you or your spouse on a bisphosphonate and there has been no prior fragility fracture, you should walk out. If there has been a prior fracture, the conversation is more complicated, but it should still begin with the question, “What are we going to do about her hormones, vitamin D, vitamin K, magnesium, and muscle mass first?”
The newer drugs are worse
When the bisphosphonate franchise started showing wear, pharma rolled out three replacements. Each is more dangerous than the drug it was meant to improve upon.
Prolia (denosumab) is a twice-yearly injection that powerfully suppresses bone resorption while it is on board. The catch is that it does not remain in the bone the way a bisphosphonate does. When a dose is missed or the patient stops, bone turnover rebounds above pretreatment levels, and a wave of multiple spontaneous vertebral fractures can occur. The FDA Prolia label reports that six percent of women who stopped Prolia in the pivotal trial developed new vertebral fractures, and three percent developed multiple new vertebral fractures. The Cleveland Clinic and others now describe roughly one in fourteen patients who discontinue without sequential antiresorptive coverage as suffering rebound fractures, and registry data link discontinuation to increased mortality. Once on Prolia, a patient is effectively trapped on it, because getting off it safely requires giving another antiresorptive (often a bisphosphonate) for an extended period to mop up the rebound. Patients are rarely told this when they are signed up.
Evenity (romosozumab) is a monthly injection given for one year. It carries a black box warning for heart attack, stroke, and cardiovascular death. It is contraindicated in anyone who has had a heart attack or stroke in the prior year. The FDA prescribing information exists because the pivotal ARCH trial showed an excess of major cardiovascular events with Evenity compared with the bisphosphonate alendronate. Some real-world studies argue that the cardiovascular signal is smaller than ARCH suggested. The black box warning remains on the label.
Forteo (teriparatide) and Tymlos (abaloparatide) Are daily injections of a parathyroid hormone fragment. They build bone, but the original Forteo label carried a black box warning for osteosarcoma based on rat studies showing dose-dependent bone cancer. The boxed warning was removed in 2020, though the rat data did not change; the FDA simply allowed the company to stop printing the warning. Treatment is capped at two years.
The pattern across all five drug classes is the same. Each works by sledgehammering one side of the bone-remodeling system. None of them addresses why a sixty-year-old woman is losing bone in the first place, which is tied to her sex hormones, vitamin D, vitamin K, minerals, muscle mass, and mechanical loading. Charlotte does not have a bisphosphonate deficiency.
From my book Hormone Secrets
I wrote Hormone Secrets several years ago to share what I had learned with the patients I saw. The osteoporosis chapter opens with a real woman I called Hattie. The version below is lightly cleaned up and corrected; the substance is what was in the book.
Hattie is sixty-four and works as a federal prosecutor. She is small, single, and Chinese, and lives under chronic stress. Ten years ago, her physician told her she had “osteopenia” and started her on bisphosphonate injections, then followed her with DEXA scans. The scores still worsened. When she finally needed her hip replaced, the orthopedic surgeon told her the bone was “crumbly.”
Two years ago, Hattie started a comprehensive program: estrogen, progesterone, DHEA, testosterone pellets, vitamin K, selenium, and 10,000 IU of vitamin D daily. She added ipriflavone. Since starting hormones, she has been able to handle jury trials and high-intensity legal work like an attorney half her age, and she cut her Prozac dose in half. Her repeat DEXA showed her bone density up seven percent over two years. She is starting human growth hormone and hopes to do even better.
The lesson from Hattie’s story is that treating bone disease is endocrine and nutritional, not pharmaceutical. The standard pathway treats osteoporosis as if the only issue is low bone density on a scan, then tries to push that number up with drugs that force the bone’s remodeling machinery into submission. Real treatment restores the signals the bone is waiting for.
Conventional doctors usually start with bisphosphonates. TheNNT.com summarizes the Cochrane data and concludes that the drugs do not prevent fractures in women without a prior fracture and help only a small subset of women who have both osteoporosis on a scan and a prior broken bone. The drugs cause atypical femur fractures, jawbone rotting, esophageal injury, atrial fibrillation, and dozens of other side effects. Plaintiffs filed thousands of lawsuits against Merck over Fosamax-related jaw and femur disasters. The company paid $28 million to settle twelve hundred of them.
In contrast, hormone treatment usually makes people feel better while preventing and reversing bone loss. Estrogen, testosterone, DHEA, and vitamin D all build bone. Human growth hormone alone can increase bone density by about eight percent per year in some patients.
Non-hormonal treatments worth considering include selenium 200 mcg a day; vitamin K2, which I once described as “might be valuable” and now consider essential at doses of about 180 to 360 mcg a day of MK-7; and ipriflavone 600 mg a day, an isoflavone approved for osteoporosis in Japan and sold over the counter in the US. The evidence on ipriflavone is mixed; some Italian and Japanese trials show benefit, while a 2001 JAMA trial of 474 white women found no fracture or bone density benefit and a signal of low lymphocyte counts. If a patient uses it, lymphocyte counts should be checked.
The natural history of bone loss
Bone is not a static structure. It is a constantly remodeled tissue, with osteoclasts dissolving old bone and osteoblasts laying down new bone. In a healthy young adult, these processes balance, and peak bone mass is reached around age thirty. After that, bone is slowly lost.
Estrogen levels fall sharply at menopause, and bone loss accelerates for roughly the next five to ten years. Trabecular bone in the spine and the hip is lost faster than cortical bone in the long bones. By the time a woman is in her sixties, she may have lost twenty to thirty percent of the bone she had at thirty-five. The first warning is rarely a scan; it is a fracture from a minor fall or a vertebra that compresses without trauma.
Men lose bone too, but more slowly because their testosterone declines more gradually than women’s estrogen. In men, testosterone aromatizes to estrogen, and that estrogen is what protects bone. Men who are chemically castrated with Lupron for prostate cancer lose bone quickly, which is one of many problems with it.
Risk factors for osteoporosis
• Female, postmenopausal, small-framed, of European or Asian background.
• Family history of osteoporosis or fragility fracture.
• Low body weight.
• Smoking and heavy alcohol use.
• Chronic steroid use, including inhaled steroids at high doses.
• Long-term proton pump inhibitors (Prilosec, Nexium and similar). They block the stomach acid needed to ionize calcium and other minerals.
• SSRIs and SNRIs (Prozac, Lexapro, Cymbalta and similar) have a documented association with reduced bone density and increased fracture risk.
• Chemical castration agents such as Lupron, aromatase inhibitors used after breast cancer, and methotrexate.
• Anticonvulsants and the diabetes drug class called thiazolidinediones (Actos).
• Hyperthyroidism, hyperparathyroidism, untreated celiac disease, inflammatory bowel disease.
• Sedentary life and lack of impact loading. Bone responds to mechanical stress; without it, bone goes away.
• Vitamin D deficiency, vitamin K deficiency, magnesium deficiency, and chronic low protein intake.
• Excess soda, especially cola, which is associated with lower bone density in women.
Should you get scanned?
The USPSTF currently recommends DEXA screening for all women sixty-five and older and for postmenopausal women under sixty-five with additional risk factors. The 2025 update emphasized DEXA over other modalities. For Charlotte, the question is moot; she has fractured three times in eighteen months. She is osteoporotic by clinical criteria regardless of what the scan shows, and the only utility of a scan now is to track response to therapy.
For women over sixty without prior fractures, get one DEXA scan, mostly because the result tells you whether you are looking at maintenance or whether you need an aggressive program. Repeating scans every two years or so is reasonable for tracking. Pay attention to the absolute T-score and the trend. Bisphosphonates are a failed medication class and should never be prescribed, but the other interventions here are reasonable. Ignore the term osteopenia, for this is a psych-op to sell more toxic medicines.
The scan is a brief, low-dose X-ray test. The radiation dose is about one-tenth of that of a chest X-ray. It is one of the few tests in conventional medicine that I think most women should undergo.
Vitamin D: the foundation
Vitamin D is a steroid hormone, not a vitamin, and it regulates thousands of genes involved in immune regulation and bone metabolism. The official US recommended daily allowance is 600 to 800 IU. That amount is criminally low. It will prevent rickets and almost nothing else.
Three people I trust on this topic have steadily advanced my thinking: Neal Rouzier, MD, who has kept his level around 200 ng/mL for years; Henry Lahore, the retired Boeing scientist who built VitaminDWiki.com and keeps his level at 200; and the Brazilian neurologist Ciccero Coimbra, whose ultra-high-dose protocol of about 1,000 IU per kilogram per day has produced thousands of multiple sclerosis remissions. Jeff Bowles, the polymath autodidact who wrote The Miraculous Results of Extremely High Doses of the Sunshine Hormone Vitamin D3, documents over a thousand self-experiments at doses ranging from 25,000 to 100,000 IU a day.
In my view, supported by these authorities and not by mainstream medicine, 25-hydroxyvitamin D blood levels well over 100 ng/mL are healthier than the levels most people have today. Standard guidance calls 30 to 100 ng/mL “sufficient” and tells most people to aim for 40 to 60. I think 80 to 150 is closer to right for most adults, and that some people, including those with neurological or autoimmune disease, or active infection, do better at levels even higher. I used this approach to address my own Parkinson’s after realizing my level of 120 was probably not high enough.
Comment: If you decide to push your D level high, you must take it with cofactors and monitor your blood levels. About one in ten thousand people has a genetic glitch that prevents normal regulation of vitamin D, and high doses in those individuals can cause hypercalcemia. Testing every two months while you are titrating up is cheap insurance. Most people need 8,000 to 10,000 IU a day to reach a level around 80 to 100. People with VDR receptor polymorphisms may need three to four times that amount.
On the rat poison question: D3 is used in some rodenticides at doses 40,000 to 100,000 times higher than in human supplements. Rats are tiny. The argument that 5,000 or 10,000 IU is dangerous because rat poison contains 100,000 IU per dose is the same logic as saying water is dangerous because you can drown in it.
Vitamin K2 is Essential.
In my book, I wrote that vitamin K “might be valuable” for bone. That sentence undersold it. Vitamin K2 is essential for both the bone effect of vitamin D and for keeping calcium out of the arteries while putting it into bone.
Vitamin D3 increases calcium absorption from the gut. Vitamin K2 directs calcium to where it should go. Without enough K2, the calcium mobilized by vitamin D is more likely to end up in arterial walls than in the trabeculae of bone. K2 activates osteocalcin in bone and matrix Gla protein in arteries; both proteins require K2 to function.
The 3-year randomized MK-7 trial in 142 postmenopausal osteopenic women, with vitamin D and calcium in both arms, showed that 375 mcg of MK-7 daily reduced undercarboxylated osteocalcin by sixty-five percent and improved bone microarchitecture. A 2022 meta-analysis of sixteen K2 trials in postmenopausal women showed improved lumbar spine bone mineral density. Knapen and colleagues showed that 180 mcg/day of MK-7 over three years preserved spine and femoral neck density.
The Japanese standard osteoporosis dose is 45 mg/day of MK-4, about a hundred times the typical Western K2 capsule. The US and most of Europe have settled on much lower MK-7 doses (180 to 375 mcg). [Note for emphasis: there are 1,000 micrograms in one milligram, so a milligram dose is huge compared to a microgram dose.] I take a high-dose K product such as Life Extension’s Super K, which contains MK-4, MK-7, and K1. Anyone who takes vitamin D in meaningful doses without K2 is missing the second half of the equation.
The mineral cofactors
Magnesium. Probably eighty percent of the population is deficient because industrial farming has stripped the soil. Most magnesium is stored in bone and soft tissue, so blood tests miss the deficiency. High-dose vitamin D depletes magnesium quickly. Heart palpitations, panic attacks, restless legs, leg cramps, and fatigue on high-dose D are usually due to magnesium deficiency, not D toxicity. Take 400 to 800 mg a day of magnesium glycinate, citrate, or threonate. The only common side effect of higher doses is loose stools.
Boron. In regions with boron-rich soil, arthritis and osteoporosis are uncommon. In boron-poor regions, both diseases are widespread. Rex Newnham’s work in Australia documented that 30 mg of boron twice a day cleared arthritis within months. The US and EU have made boron supplements hard to get, with doses limited to near-homeopathic 3 mg. Borax (sodium tetraborate) is freely available, food-grade (you eat the laundry detergent in small quantities), and supplies plenty of boron when used in tiny amounts. I take a quarter teaspoon daily, mixed into table salt.
Zinc. About a third of people worldwide are zinc deficient. Zinc is required for vitamin D receptor function and thymus health. Take 15 to 40 mg daily, ideally with copper if you take it long-term, since zinc depletes copper.
Selenium. Selenium status is inversely correlated with osteoporosis in observational studies; in a recent analysis, postmenopausal women in the highest dietary intake quartile had dramatically lower odds of osteoporosis. A randomized trial of 200 mcg/day for six months did not change bone turnover markers in postmenopausal women, so the data are mixed. A reasonable dose is 200 mcg a day; some clinicians start higher for a month and then drop back. I sometimes get mine from 3 Brazil nuts a day, which puts me in roughly that range without a pill.
Comment: Two minerals to avoid. I do not recommend supplemental calcium, ever. The body extracts more calcium from food than most people realize, and pushing more calcium in capsule form tends to deposit it in arteries and kidneys rather than bones, especially in the absence of adequate K2. I also avoid supplemental iron. Adult diets add about a milligram of iron a day to the body’s stores over a lifetime, which is inflammatory, and Parkinson’s patients have excess iron in the substantia nigra. I donate blood for that reason.
Hormones: the real first-line therapy
Estrogen rebuilds bone in postmenopausal women. The Women’s Health Initiative scared a generation of women off estrogen by misrepresenting an oral conjugated equine estrogen plus synthetic progestin combination as bioidentical hormone replacement. It is not. Properly dosed bioidentical estradiol, given orally or as a pellet, along with bioidentical progesterone, is the single most powerful pro-bone intervention available to a postmenopausal woman. Estradiol in patch form is inadequate for bone improvement, and if this is desired, it should be given along with oral estradiol. Estrogen benefits include better mood, sleep, cognition, skin, and libido, as well as lower all-cause mortality when started near menopause.
Testosterone builds bone in both sexes. In women, low-dose pellets or troches restore libido, energy, and lean mass, with a bone-building effect. In men, restoring testosterone to the upper end of the normal range protects the hip and spine and lowers the risk of frailty fractures.
DHEA is a precursor adrenal hormone that drops sharply with age. At 25 to 50 mg a day in women and somewhat higher in men, it tends to support bone and muscle along with mood and energy. It is harmless and can be given in multi-hundred mg doses to elders in order to relieve arthritic symptoms.
Progesterone, when given as oral micronized progesterone, has a modest pro-bone effect on osteoblasts and is useful for sleep and anxiety. While progesterone cream can relieve some symptoms, it is ineffective in treating osteoporosis because its half-life is only an hour.
Human growth hormone has been shown to increase bone density by several percent per year in some studies. It requires injection, is expensive, and is overregulated in the US. Peptide secretagogues such as ipamorelin or sermorelin can stimulate the patient’s pituitary and produce part of the same effect at a fraction of the cost and regulatory risk.
Hattie’s seven percent gain in two years on hormones shows what is possible. That is a faster rate of bone gain than almost any drug produces, and the patient feels better throughout. The contrast with the fatigue, bone pain, and dread that usually accompany Fosamax could not be sharper.
Whole-body vibration: the device that grows bone without drugs
Bone is a “piezoelectric” tissue. It responds to mechanical loading by laying down more matrix at sites of strain. NASA documented this in reverse in zero gravity: astronauts lose bone rapidly in orbit, and they need targeted mechanical stimulation to recover.
Clinton Rubin and colleagues at Stony Brook discovered that low-intensity, high-frequency vertical vibration (around 30 to 90 Hz at very small accelerations, well under one gravity) stimulates bone formation through the same mechanotransduction pathways. Simply standing on a properly engineered platform for ten or twenty minutes a day signals to bone that it is being asked to support a load. This signal is enough to slow or reverse postmenopausal bone loss in some women without any drug.
The Marodyne LiV platform is the device built on Rubin’s research. It vibrates at 0.4 g, low enough to be safe for people with osteoporosis and far below the gym-style “Power Plate” devices that run at 1 g or higher and carry contraindications. A 2016 meta-analysis of low-magnitude whole-body vibration in postmenopausal women showed improved lumbar spine bone density and fewer falls. The technology will not match what hormones and a serious resistance program can do, but it is genuinely additive, especially for someone like Charlotte who cannot yet load her spine aggressively.
Resistance training and impact: the LIFTMOR data
The LIFTMOR trial from Australia enrolled postmenopausal women with low bone mass and put them through twice-weekly heavy resistance and high-impact training: deadlifts, overhead presses, back squats at 80 to 85 percent of one-repetition maximum, plus jumping chin-ups with drop landings. (This is very aggressive and more than I can safely do now at 72.) After eight months, the lifting group had increased bone at the spine and femoral neck and improved functional performance, while the control group lost bone. There were no fractures. The lesson is that heavy resistance training, properly coached, is safer for fragile bone than the protective non-loading regimens most older women are sent home with.
Charlotte is sixty and otherwise healthy. She should lift heavy loads under supervision two or three times a week. Walking is not enough; even brisk walking does not provide the loading signal bones need. Hopping in place when she can tolerate it, climbing stairs, jumping rope on a soft surface for short intervals, and progressively heavier deadlifts and squats with a coach who understands the LIFTMOR protocol will do more for her bones than any drug.
Other supplements with mixed evidence
Ipriflavone is a synthetic isoflavone that inhibits bone resorption and stimulates osteoblasts. It is approved in Japan and Italy for osteoporosis at 600 mg per day in three divided doses and is available over-the-counter in the United States. Italian and Japanese trials at this dose show preservation of bone density and modest gains in postmenopausal women, with vertebral fracture reductions in some studies. A 2001 JAMA trial in 474 white American women showed no benefit and a real signal of low lymphocyte counts in about thirteen percent of users. If a patient takes ipriflavone, lymphocyte counts should be checked every few months. Hattie tolerated it well.
Strontium. The prescription form, strontium ranelate, increased cardiovascular risk and was eventually withdrawn from much of Europe. The over-the-counter form, strontium citrate at 680 mg a day, has been widely used in the integrative world. Strontium substitutes for calcium in the bone matrix, inflating DEXA bone density readings by atomic mass alone. Some of the apparent benefit on a scan is artifact. The actual fracture-prevention data for strontium citrate are weak. I do not recommend strontium.
Silicon. Horsetail extract or orthosilicic acid provides bioavailable silicon, which supports collagen cross-linking in bone. The evidence is modest. It is inexpensive and has no obvious downside. As a side benefit, silicon binds aluminum in the body and can help eliminate it. You can buy Living Silica liquid on Amazon or better yet, drink Fiji silica water, a liter a day.
Collagen peptides. Hydrolyzed collagen at 5 to 10 grams per day has shown benefits for bone density and bone matrix in postmenopausal women in randomized trials. It is also beneficial for skin, joints, and connective tissue.
Sun. Direct sunlight on bare skin, taken regularly and without sunscreen on as much skin as possible, produces vitamin D in the body in the form of D3 sulfate, which supplements cannot match, and triggers the release of nitric oxide and other beneficial molecules. Sun avoidance is one of the great public health blunders of our era. The skin cancers that scare people are mostly squamous and basal cell, which are easy to remove and rarely lethal; the lethal kind, melanoma, is more common in people who get little sun than in those who get a lot.
What this means for Charlotte
Three fragility fractures in eighteen months mean Charlotte’s skeleton is in trouble right now. Her doctors’ “osteopenia” label is meaningless nonsense. In a just world, giving her a bisphosphonate or related drug would be a criminal act. She needs:
• A full bioidentical hormone workup and replacement: estradiol, progesterone, testosterone, and DHEA, with a clinician who knows how to dose them. Oral estradiol; oral micronized progesterone; testosterone cream or pellets; DHEA 25 to several hundred mg. This is by far the most critical step, along with vitamin D, K2, and magnesium. The rest is window dressing.
• Vitamin D3 at a starting dose of 10,000 IU daily, with the goal of raising her 25-hydroxy level to 80 to 120 ng/mL, with blood checks every two months until stable.
• Vitamin K2. 180 to 360 mcg of MK-7 daily is conventional as part of a multi-K product such as Life Extension Super K, but if you look for it, you can find products with 45 mg per capsule.
• Magnesium glycinate 400 mg twice daily, boron from borax in daily doses, zinc 25 to 30 mg daily, selenium 200 mcg or five Brazil nuts daily.
• Use a whole-body vibration platform, such as the Marodyne LiV, for ten to twenty minutes a day. This is a useful piece of equipment, not a gimmick.
• Twice-weekly progressive heavy-resistance training with a coach who understands the LIFTMOR protocol, plus impact loading as her healing allows.
• No calcium supplements. No bisphosphonates. No Prolia. No SSRIs, if at all avoidable. No proton pump inhibitors unless absolutely required.
• A repeat DEXA in twelve months to track progress, with the understanding that the trend matters more than the absolute value.
If Charlotte does this and stays patient, the available evidence and my own experience with patients like Hattie indicate she should hold or measurably improve her bone density within a year, and she should feel substantially better throughout. The pharmaceutical alternative is to be slowly poisoned for a decade, with worse bones at the end and a jaw that may rot.
The hard part is finding a clinician who will help her. Consider nearly retired physicians, anti-aging clinics experienced with bioidentical hormones, and a small number of integrative practices. Most conventional internists and gynecologists will fight her every step of the way. That is not a comment on their character; it is a comment on what they are trained to do. Clinicians at WorldlinkMedical.com have been trained as I have, and many of them can be very helpful. A lot of them are nurse practitioners, and they’re fine too.
Charlotte, this one is for you.
This problem is ubiquitous, and your friends need to learn about it.
