The Bone Clinic

12/04/2026

Here is more evidence that lifetime physical activity can prevent hip fracture - this time from Norway. (In men again...sigh...many old cohort studies disproportionately studied men. Apparently women's health was not important.)
In a nut shell:
1. Inactive men were more likely to fracture than active men.
2. Thin men were more likely to fracture than men who were not thin.
The details:
Of the original 16,205 men aged 40–49 and recruited in 1972–1973, data from12,900 men was available for analysis in relation to hip fractures occurring between 1994 and 2018 (i.e. after age 62). In 195,384 person-years of follow-up, 1542 men (12%) had a hip fracture (most around age 82). Body mass index (BMI) is calculated from height and weight (weight divided by height squared) to determine a rough indication of soft tissue mass, and is primarily taken to reflect body fat. The greatest risk of hip fracture was found in inactive men with low BMI (< 22 kg/m2), compared to active men with a higher BMI (≥ 25). Active men were at lower risk across all categories of BMI.
Study limitations: no women; use of BMI to estimate thinness; physical activity self-reported through questionnaire.
Take home messages:
1. Thin, inactive men should take action in middle age to reverse those modifiable risk factors of hip fracture.
2. Increasing muscle (not fat) is obviously the best way to increase BMI.
3. Twice weekly heavy resistance training will achieve both goals - it will increase activity and increase BMI. ®

Summary Research on hip fracture prevention in men is limited. In men, physical activity and body mass index were independently and jointly associated with hip fracture risk, with the highest risk among inactive and thin men. Promoting exercise and healthy weight in midlife may reduce fracture burde...

28/03/2026

Big pharma certainly doesn't need our help marketing osteoporosis (OP) drugs, and we are VERY aware of the shortcomings of OP meds, so please don't interpret this message as wholesale promotion of medications. Nevertheless, my goal is to provide science-based information to help people make decisions about their OP therapy as a whole, and so the following might be helpful for some. There is plenty of evidence from clinical trials that certain OP drugs can increase BMD and reduce the risk of OP fracture. Zolendronic acid (marketed as Aclasta) is one such drug and was originally prescribed to be delivered in annual infusions. Over time it has become clear that the treatment epoch can be extended to at least 18 months without any notable loss in effect. This recent study suggests that treatment timing can be extended even further, reporting a single infusion prevents fractures in low-risk 50-60 yo women for 10 years, with greater benefit between 5-10 years than 0-5 years. So for the many people averse to the idea of taking any OP med at all to reduce long-term fracture risk, very infrequent doses of zolendronate might be an option for you. Something to think about. (I repeat, I am not actively pushing people to take OP medications - exercise is my jam - just trying to help with evidence-based information.)

AbstractContext. We recently reported that zoledronate (zol) given once at baseline or twice (every 5 years) reduced fracture risk over 10 years.Objective.

26/03/2026

The REMS saga continues. For those who don't know, radiofrequency echographic multi-spectrometry (REMS) is a relatively new ultrasound method that manufacturers and distributers claim provides a better estimate of fracture risk from bone mineral density (BMD) and fragility score (FS) than dual-energy x-ray absorptiometry (DXA; the usual way to measure BMD). This week researchers in Sydney published data from over 200 women and men that casts serious doubt on that claim. They showed that, in fact, REMS BMD and FS are largely determined by age and weight, rather than by any feature of the bone itself. They illustrated this clearly by repeatedly scanning 5 participants but inputting different ages and weights for each scan (see Figures below). They showed that artificially increasing a patient's age caused a REMS BMD decline of over 6% per decade for the hip, and artificially increasing a patient's weight by 5 kg caused a REMS-BMD increase of over 4%. To be clear, these were repeat scans of the exact same person scanned on the same day so there was no possible chance that the bone would have actually changed. The only real explanation is that the algorithm the REMS device is using to produce BMD is dominated by age and weight, rather than anything measured from the bone. DXA isn't perfect, but at least your score won't change if the technician accidentally puts the wrong age or weight into the machine when they scan you! Looking forward to hearing how supporters of REMS explain or debunk these findings.https://link.springer.com/content/pdf/10.1007/s00198-026-07960-4.pdf

23/03/2026

People often worry about having dental procedures while on osteoporosis medication such as denosumab (Prolia, Jubbonti, Stoboclo, etc) because of the risk of medication-related osteonecrosis of the jaw (MRONJ) - which is a fancy way of saying bone tissue death around the surgery site. Denosumab (Dmab) therapy involves 6 monthly injections. Unfortunately, stopping Dmab therapy is associated with rapid bone loss, so temporarily stopping treatment to have oral surgery is not advised because it greatly increases a patient's risk of osteoporotic fracture. A recent retrospective study of 258 osteoporotic patients receiving Dmab, of whom 91 underwent oral surgery, determined the optimal surgical timing was more than 3 months after the last Dmab injection. This is very helpful information for people on Dmab to know. But you know what you don't have to worry about causing MRONJ after oral surgery? You guessed it. Bone targeted exercise, aka, ONERO®

Abstract. Osteoporosis patients treated with denosumab (Dmab) remain at risk for medication-related osteonecrosis of the jaw (MRONJ), particularly after de

21/03/2026

Nice easy to understand overview. ONERO falls under strength.

🆕🗞️New overview of systematic reviews published by the American College of Sports Medicine, about resistance training for muscle size and function in healthy adults, with key conclusions in infographic. Bottom line: Train consistently with high effort. Progress the difficulty over time. If you want to get stronger, lean towards higher difficulty and lower reps. If you want to get bigger, volume of sets and a focus on eccentric loading (controlled, slower lowering of weight) may be more important. To build power, you need a balance between effort/difficulty and speed.
For the research article look here: https://pmc.ncbi.nlm.nih.gov/articles/PMC12965823/

19/03/2026

Every year at the Griffith University Thanksgiving Service we remember and express our gratitude for the donors to our Body Bequest Program that supports students of anatomy in the Faculty of Health. Back when I was Head of School of Anatomy in 2009, I helped design the original Service, and have had the honor of MCing every one since. This year I was especially delighted to introduce the recently retired Prof Emeritus Mark Forwood to give an address about his career in anatomy. Those who know him professionally would be familiar with his research focus on mechanical loading of bone,💪🦴 which is just one of the reasons we get along so well.

05/03/2026

I have been musing over this paper for a while now. I am interested in whether exercise provides long term protection from hip fracture, but it is an exceedingly hard topic to study, because it requires a lifetime of data and VERY large sample sizes to capture enough fractures. The Fins have a long history of research in exercise for bone health so it was no surprise to see them publish a paper describing a very longitudinal study of hip fracture incidence after age 50 in 1844 male former athletes vs 1216 population controls from1972 to 2015. While this seems like a very large sample, for a fracture study it's actually not. So it also didn't surprise me that despite Figure 1 showing a clear trend of fewer hip fractures across life in the athlete group than controls, the difference was not statistically significant. Subgroup analyses also showed no difference in hip fractures between athletes doing low intensity exercise and controls. Athletes engaging in HIGH intensity exercise though had considerably fewer hip fracture than controls, until around 75 years. High intensity exercise for the win - again! What DID surprise me was that after age 85, hip fractures in those high intensity athletes were actually HIGHER than controls for the remainder of their lives. (Check out Figure 2B below.) In my musings as to why this might be I am wondering if low body weight and low lean mass in those athletes with the longest survival (which may have been the thin endurance athletes with good heart health) could have put them at greater risk of falling (the main cause of hip fractures) later in life as they scaled back their exercise involvement. Alternatively, perhaps the mere fact that the former athletes retained an ability to move around in old age put them at greater risk of falling. Frail people tend to mainly sit or lie down which inherently reduces fall risk. Science is enigmatic. It's fun to speculate.
https://onlinelibrary.wiley.com/doi/full/10.1002/jbmr.4624

13/02/2026

More good news - this time about coffee as well as tea! My previous post created such a ...forgive me...storm in a tea cup, I thought some of you might be interested in another caffeine-related publication - this time wrt dementia. Happily, data from 2 large-scale prospective cohort studies (aka highest quality observational data, for the haters lol) including a total of over 130,000 women and men, and 43 years follow up, showed "greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels." Moderate intake = 2-3 cups/day of coffee or 1-2 cups/day of tea. Before you all ask, no the effect was not evident for decaffeinated versions and yes, potential confounding factors were controlled for. So once again we see the Goldilocks principle in action - not too little and not too much is best.
Please note, I am not able to provide universal access to the full paper. It is behind a paywall and I don't own the journal! But this link is to the abstract where you will find a good summary. Your local library will likely have access to the full paper because JAMA is a major journal. https://jamanetwork.com/journals/jama/article-abstract/2844764

06/02/2026

The personal burdens of osteoporotic fractures (pain, disability, loss of quality of life, financial cost) are well known - if you don't happen to know, trust me, they are VERY high. What is less well known is the cost of social care (formal and informal care after discharge from hospital) for patients who experience hip fractures. A large UK study across 77 NHS hospitals followed almost 17,000 patients aged over 60 for 120 days post-hip surgery, tracking residential care, home care, home adaptations, and care from family and friends. The average cost of this 'social care' was £15,525 per person with a national cost for all hip fractures from 2017-2021 of £1.25 billion! Remember, this is not counting the cost of the actual hip surgery and hospital stay! After discharge, 93% of people returning home needed increased formal and informal care, with 61% requiring home adaptations and 7% requiring increased residential care. The informal care costs significantly outweighed formal care costs. The hidden costs of osteoporosis are really hitting our back pockets.

AbstractBackground. The cost of medical care associated with hip fracture has been reported but the cost of social care is less well understood. Social car

06/02/2026

We are often told that caffeine and alcohol are bad for bone. But it's difficult to know how bad because ethically you can't do a trial that doses people up with things that might be harmful, and the effects of caffeine and alcohol can be difficult to separate from the effects of other behaviours that might also influence bone. So I was interested to read this recent publication by some researchers in Adelaide who ran some clever statistics to examine the relationship between tea and coffee consumpton and bone mass in almost 1000 postmenopausal women over a 10 year time period, controlling for confounding variables. Turns out there was a positive relationship between tea consumption and BMD, especially for people with obesity. The same couldn't be said for coffee where more than 5 cups a day was associated with lower BMD especially in women with higher alcohol intake. The image pasted below shows this declining BMD with cups of coffee and increasing BMD with cups of tea. Something to think about.
https://www.mdpi.com/2072-6643/17/23/3660

01/02/2026

A recent meta-analysis of 37 weight loss drug studies (semaglutide or tirzepatide), including over 9,000 participants, found that weight was regained at an average of 0.8 kg/month after stopping the drug, for a projected return to baseline weight in 1.5 years. Cardiometabolic improvements were also reversed in the same time period. This weight regain was 4 times faster than after stopping structured dietary behavioural programmes. Full paper: https://lnkd.in/eTvk8KwZ
Dramatic weight loss always includes loss of muscle and bone as well as fat, whereas weight regain is fat. This is obviously the worst possible outcome. Combining weight loss drug therapy and cessation with ONERO® is likely to prevent muscle and bone loss. I would love to do that study. Open to funding suggestions!

06/01/2026

Was wonderful to catch up with Margie Bissinger and talk about the exciting new data coming out of The Bone Clinic. Here is the interview on her Happy Bones, Happy Life Podcast.
Happy listening. :)
https://m.youtube.com/watch?v=CTtiaEHRAGs&pp=0gcJCR4Bo7VqN5tD&fbclid=IwVERDUAPJgEBleHRuA2FlbQIxMABzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR6nEXJuGE8YNQ68T3WxP60AtxAZ5MzvRkmdoGK56FKagrxaZu3m9xsqRSAgrA_aem_nlFbqlj-HhvHC1PlPArG-w

What if you could increase your bone density and reduce fractures with just a few weightlifting sessions a week? Tune in for the latest groundbreaking resear...