An Osteoporosis Diagnosis: Critical Steps to Take With Dr. Lani Simpson

Osteoporosis is a silent disease, meaning it often has no symptoms. People only get tested after they've had a fall and broken some bones.
Everyone’s bones become weaker as they age, but this process happens too quickly in some people. Women usually lose bone rapidly when they reach menopausal age.
So when should you see a doctor? How is Osteoporosis diagnosed and treated? What are the critical steps to take after an Osteoporosis diagnosis?
In this episode, my guest, Dr. Lani Simpson, and I discuss this and other information about bone health.
Dr. Lani is a chiropractic doctor and a Certified Clinical (bone) Densitometrist (CCD). A riveting, seasoned, professional speaker, Dr. Lani expounds and astounds audiences with the fascinating world of bones, bone health, and Osteoporosis. She is the author of the No-Nonsense Bone Health Guide.
Over the past 30 years, Dr. Lani has established herself as one of the leading experts in women’s health care. Her clinical experience and her multi-disciplinary approach have enabled her to educate thousands of clients and professionals about some of today’s most common health challenges for women, one of which is Osteoporosis.
If you're concerned about your bone health, listen to this informative episode of the Happy Bones, Happy Life podcast!
“For me, you have to think about bone density as one part of the information, and then you think about the TBS as at least as much, if not more, information. That bone quality is very, very important. So, keep in mind that I have people with normal bone density who are fracturing easily. That's because their bone quality is not good.” - Dr. Lani Simpson
In this episode:
[00:00] - Intro
[02:30] - What does a DEXA scan show?
[06:00] - How to choose your bone density scan facility
[12:11] - Is the Trabecular Bone Score (TBS) a major deciding factor in treating patients?
[16:37] - Bone turnover markers that are critical for Osteoporosis evaluation
[29:50] - The relationship between potassium and bone mineral density
[34:42] - Recommended calcium supplements for bone health
[36:21] - What is the best way to use Osteoporosis medication?
[42:31] - What is Dr. Lani's training program all about?
[48:05] - Do weight vests help people with Osteoporosis?
Resources mentioned
- A special discount for Dr. Lani's Bone Health Course: 40% off at $695 for podcast listeners - lanisimpson.com/pages/margie-...
- Dr. Lani's Website - lanisimpson.com/
- Dr. Lani's weekly Live Masterclass: $35/month - LaniSimpson.com/pages/masterc...
- Get Your Copy of Dr. Lani's No-Nonsense Bone Health Guide - lanisimpson.com/products/bone...
- Improve Your Posture in Two Weeks - www.happyboneshappylife.com/p...
More about Margie
Website - margiebissinger.com/
Facebook - / margie-bissinger-ms-pt...
Instagram - margiebissi...
DISCLAIMER - The information presented on this podcast should not be construed as medical advice. It is not intended to replace consultation with your physician or healthcare provider. The ideas shared on this podcast are the expressed opinions of the guests and do not always reflect those of Margie Bissinger and Happy Bones, Happy Life Podcast.
*In compliance with the FTC guidelines, please assume the following about links on this site: Some of the links going to products are affiliate links of which I receive a small commission from sales of certain items, but the price is the same for you (sometimes, I even get to share a unique discount with you). If I post an affiliate link to a product, it is something that I personally use, support, and would recommend. I personally vet each and every product. My first priority is providing valuable information and resources to help you create positive changes in your health and bring more happiness into your life. I will only ever link to products or resources (affiliate or otherwise) that fit within this purpose.

[@JemJean2012]

Dr Lani, you are answering all my questions and concerns. My task is to get my doctors on board to do all these tests you mentioned. I am 74 and do not want to take a drug until I know all the facts. Thank you so much for your work. Bless you.

[@200Nora]

I am 68. I was diagnosed with osteoporosis in 2021. I refused the medications because I know they are not curing anything just using the old weak bone to make it appear thicker. I seeing people have more fractures on the meds. Fast forward. I may still have it, but I have not had any fractures. I changed my diet and drink lots of bone broth that I make myself, learned to manage my stress and sleep better. I did Vit D because at the time of the dx it was very low. I do a couple of caplets of bone up because calcium especially the carbonate will cause me to constipate. I exercise two or three times a week with weigh/resistance. So far I feel fine and building muscles is very important when you have OP. This is my experience may be different for others. Thanks, very informative.

[@julimdjaffri6100]

I have been thin all my life and going through menopause worries me that my bones will be fragile. I had a great fall last year and my hip hit the ground, my arms protecting me from hitting the ceramic pot (I was gardening..). I was sore the next 2 days but wondered how I managed to survive, all bones intact. Listening to Dr. Lani really gives me great relief. Being small does not mean weak bones. I have always been active and even started lifting weights recently. Thank you for giving me hope!

[@Onestep2atime]

Thank you for the information about bone quality. I just got the bad news that I have osteoporosis yesterday. My doctor was surprised because I am only 54. Interestingly, I haven’t had a broken bone. I also fell down a flight of stairs last summer and hurt my fingers and head. However, I didn’t break any bones.

[@karenl5861]

This is a very informative session. The new course Dr Lani is offering can be so helpful for healthcare professionals and those of us that want to be better informed in our own treatment plan. I can have better discussions with my doctors.

[@dniki2152]

What an intelligent, informed and generous person. Would like to see and learn more. Thank you🎉

[@magpiegirl3783]

I like her approach. She’s dogmatic about some things but generally a pragmatic person who has sifted the chaff from many of the osteo arguments and theories. I wish medicos would approach osteoporosis as she does.

[@miriamsadof867]

How do you feel about whole body vibration machines for osteopenia/ osteoporosis?

[@ReinaACrowe]

I've been watching Dr. Doug Lucas who has recent studies he goes over. It's been helpful.

[@cindysharp4466]

He’s great!

[@magpiegirl3783]

I have found much of his material very helpful and I like the way he breaks down and explains various research studies. I’m no linger following him because of his promotion and alliance with Osteostrong. He is now promoting AlgaeCal (instead of the products he said he used in his master classes) which is a partner of Osteostrong. I valued his independence but that seems compromised now.

[@deetin3658]

I like him also .also in Cali fornia

[@deetin3658]

An astro strong clinic is by me, but I have a pinched nerve in my neck and I did start it, but my pinch nerve in my neck really woke up when I did that with my arms and all night long. My nerves and my body would not calm down. I couldn't do it anymore. I'm not gonna lay down and try to sleep. And I can't sleep because the nerves in my body. Just won't calm down so I stopped doing it.

[@magpiegirl3783]

@@deetin3658 The Osteostrong vibration machine is way too vigorous for some people … gave me severe vertigo and sore neck. One of the machines really hurt my shoulder. So I stopped. Had to go to Physio for the neck pain, told her what happened and she said she had treated several people over the years from Osteostrong, and recommended not doing it. I’ve been on different sites where commenters have said they actually had vertebral fractures as a result. I know there is a court case in the US suing Osteostrong for a fracture. The problem with it, is that there’s no way of knowing if it might injure you until you actually do. The other thing I do not trust is the lack of studies the CEO does not do about actual statistics of improved bone density. I’ve watched him a few times and don’t trust him. One of his backers is Tony Robbins.

[@gordonhalstead9846]

Best 👌 podcast happy bones happy life brilliant podcast presentation so informative 👍 ❤Lucy watching Best lecture 👌 subject happy bones 😀 happy life ❤😊

[@christinedonga7734]

Margie, thank you so much for this. It was excellent. I actually just last week joined her Master Class.

[@deetin3658]

You just showed her book.I do have her book.I read her book.

[@arleenm7367]

Thank you for this discussion! I recently had my first over 65 Medicare DEXA that said I have osteoporosis. I've been in shock because and I've been a runner for years, including numerous marathons and even ultramarathons. I've fallen many times on trails and never broken bones (except my nose once) . I do need to work on upper body and posture with some weight training. But I'm going to ask my doctor about these other tests and start doing weight training before any bone drugs (I'm almost sure my doctor is going to recommend).

[@cindysharp4466]

My Dr went straight to the drugs. I’m trying the supplement route and doing heal drops, weights and walking (never been a runner) Fingers crossed. Best of luck to you!

[@arleenm7367]

@@cindysharp4466 Good luck to you also! I haven't been to my doctor for the followup yet, but I'm going to refuse any drugs and go the exercise & supplements route for now.

[@jenniferroberts7581]

I did that - huge mistake.

[@calista1280]

Don't forget that the Dexa Scanner compares us to 35 year olds.... So, of course, it's natural for our bones to be less dense when we're twice their age!

[@jenniferroberts7581]

@@calista1280 Which doesn't change the reality of osteoporosis and fragility fractures.

[@magpiegirl3783]

Wonderful interview. I’ve read her book and I’ve also done a lot of study on Osteoporosis since my diagnosis. Her approach aligns with what I would like to see treating and managing this condition. I’m doing the Onero program - the Onero program is supervised by physiotherapists and people have to be interviewed to undertake the program. There’s actually a lot in Lani’s interview here and I like her pragmatic approach. I’m seeing an endocrinologist in a couple of weeks and I’ll ask about the lower dose of drug. Thanks for your work Lani and thanks for presenting this interview. I wish doctors would take Lani’s approach. I do agree with her views on Osteostrong, but question whether she has actually looked at the research on the low intensity vibration. Yes, knowledge is empowering and as Lani says, start critically thinking.

[@aheartforhealth]

Hello Magpiegirl. Thank you for your informative comments. I have severe osteoporosis and taking the meds do not make sense to me. I’m still doing research. I like getting info from others experience.

[@thuyle1075]

If doctor Lani can provide CE credits for the class, she’ll have a lot more people willing to sign up for it. I hope she can provide CE soon

[@ReinaACrowe]

What is your take on REMS scans?

[@lisasmith2016]

How do you feel about raloxifene for those with osteoporosis and a history of hormone positive breast cancer?

[@kikigirlkauai]

I wear wrist guards when I ride my bike or do some hikes, in case I fall hard. . I don’t run anymore and miss it but I always wore wrist guards.

[@catherineburbank3936]

How do I sign up for Dr. Lani's class.

[@MamaLu7753]

I was just diagnosed with part osteoporosis and part osteopenia. I had not broken a bone since I was 14 and fell off top of car. I am 70 now. But 2 days ago I fell back with a heavy package I was bringing in house and now I have a non displaced fracture of my wrist. I ate country food as a kid and teen. No junk food, no sodas, no restaurant food. 5 babies and I nursed 2 of them for over a year. I was always under 100 lbs. until I was 46 years old.

[@brenda012249]

Hello Dr. Lani, I appreciate your knowledge, I heard you say take your hormones, I have worked in the medical field for 45 years and just retired March 2024, I have tried for so many years to get get the hormones, I was on for a couple years and at age 53 I was no longer allowed to get a prescription for it and was told it could cause cancer, I have no cancer history, so now I have osteoporosis and I don’t understand why we can’t get hormones I all ready had for 45.

[@jeans3374]

Could you address Covid causing low bone density? There have been numerous articles on it affecting density. I was fine 5 prior but after covid, I had a bone density of osteo penia and porosis. ( Second test however showed different levels. so they vary greatly also)

[@amyangelaartucci9238]

I diagnostic osteoporosi 1 -3T

[@hollylorn131]

My doctor only did the CTX test, not the P1NP. The CTX was 397 post menopause. I don't know what this score means. Can you explain the range for CTX and this 397 score? It was done close to 6 p.m. in the day with no fasting. Is it still accurate if it wasn't done at 9 a.m. fasting? My doctor gets results but is not good at explaining the results of individual tests. Thanks.

[@beyondfitrd]

I just finished doing a literature review on bone turnover markers. Recommended "Treatment Target Ranges" for CTX fall in the lower half of the premenopausal Reference Interval, which means not higher than 250, or 300pg/mL, depending on the citation. As far as the protocal for getting a usable lab result there are four guidelines: 1) Draw laboratory tests fasting in the morning from 7:30 AM to 10:00 AM (required for CTX but not for PINP), 2) Advise alcohol avoidance the day before the blood draw and avoid excessive alcohol in the month before the blood draw, 3) Advise excessive exercise avoidance the day before the blood draw, 4) Hold biotin supplements for 72 hours before the blood draw. Bottom line is that both the time of day, and not having been fasting, render your recent CTX not useful. Note that both food and time-of-day affect CTX levels hence item #1.

[@skitchyjohnson]

​@@beyondfitrddo you have a link to your review article? Thanks

[@conniejohnsoncj8724]

I am on aromatase inhibitors for breast cancer and prior to taking them had CTX test 0.524 ng/mL now one year post taking them my CTX was 0.837 ng/mL. Tests were done 830 am after fasting and in Ontario Canada we have to pay ourselves. I paid $80. I’m 62 and have been in menopause for 12 years! I can’t take hormones because the type of breast cancer I had ER+ PR+ and Her2- I am very small boned and have not had broken bones at all! I’m now worried about the change in CTX and taking the aromatase inhibitors and having to more than likely take a medication! What is the best least invasive medication to take?

[@jeangriggs201]

I can’t find the TBS scoring anywhere. I live between Austin and San Antonio Texas. Go figure 🤦‍♀️

[@deegey1]

My son is a Doctor in Austin and will ask him about the TBS scan.

[@jeangriggs201]

That would be great

[@debranelson9921]

My first bone scan included wrist scan…now they say they don’t do wrist scans…why the change. I’m in Medicare now with secondary 😊

[@kikigirlkauai]

I just got my welcome Medicare bone density test. Can’t get anyone to show me the X-ray scan and explain what it shows specifically. They said I have osteoporosis. That may be true but my bones are still pretty strong.

[@karenzimmer7607]

I just got on Medicare and didn't know we got a bone density test.

[@calista1280]

Keep in mind that Dexa Scans compare us to a 35 year olds bone density... smh Seems like a perfect setup to push their profit making drugs! When our bones are probably just fine for our age!

[@karenpeters4457]

It would be helpful to know if hat kinds of tests these turnover markers are: CTX, PIN1, blood, urine, and what trend? Meaning taking the test several times in a given time to establishing the trend? Very unclear.

[@marilynkerr7137]

Dr. Doug Lucas has informative videos on all the tests listed. 53:30

[@deetin3658]

And how do I get In touch with you, I'm in New York. I take vitamins. my blood. Work is pretty good.

[@OMGaNEWBIE]

Hi Margie -- I looked up Dr. Lani's book No Nonsense Bone Health, & it was printed WAY BACK IN 2014. Surely since then new medical updates and medications have become available? Her interview info seems current, but I'm concerned if that recent info is in her 2014 book via an update? Would you please let me know. Thank you.

[@mollysurujbally887]

I have osteoarthritis on my right knee

[@mollysurujbally887]

I am 78years can I take calseum

[@deetin3658]

I think I bought you a book a while back. Where are you located and you're seventy five you look fabulous. My gynecologist keeps wanting me to get injections. 68 never broke a bone I just don't understand why he's so adamant about giving me injections. I'm not doing it. I do the natural way as best. I can got the Dexter scan minus 2 point maybe 5 in some areas and then I got the. Ecolite in New Jersey, New York. It's not covered like 300. If you want both hips done, give a different perspective on the bonesome are not as good. Some are good. Some are better than good so next I don't know what to do.

[@Maylene65]

If this is so important, why do we have to wieght to age 65 to even get a DEXA bone eray? Why can't this start at 50 or 55 when our hormones are changing and bone loss is immanent. Why is medicine the ONLY thing providers prescribe?

[@magpiegirl3783]

Absolutely bloody right! That’s what I say too. All the interviews I’ve watched with doctors saying osteoporosis is preventable and that you should prevent it rather than wait to try to cure it - and guess what? They don’t bloody test till you’re already highly likely to have lost bone significantly.By all means, wait till women have gone through menopause and see if they have reached osteoporotic stage in their bone. Makes sense, doesn’t it? I’m bloody furious that women are put in this position. I apologise for the rant. Here’s a flower for you for listening. 🌺

[@valmartinez-west9725]

Because that is all they learn in school. They learn very little about nutrition. They are also trained to support big pharma. Just dish out drugs to make us sicker and then more drugs to counteract the other drug…..I was diagnosed at 52 with osteoporosis and my doctor wanted me to take a drug. I said no and he got in my face and said if I don’t take it I won’t be your doctor. So needless to say he never saw me again. I am now 70 and have not taken any drugs yet. Still have osteoporosis of the spine but not the hips now🤷🏼‍♀️

[@marionlyon7157]

In Ireland, radaigophers read Dexa scans

[@cindysharp4466]

I am a -3 in my left hip. Rheumatologist recommended Evenity. He said you can do it for one year. Then you have to go on a fosamax for the rest of my life. I’m 58 and that was my only option. I decided against it for now. Do you always have to be on these drugs forever?

[@magpiegirl3783]

You have to stay on Prolia for life because as soon as you come off it, you lose not only the bone gained but even further loss (bone rebound effect). That happens because of the way the drug inhibits the osteoclasts and as soon as that inhibitor is no longer present, the osteoclasts have a party. Spontaneous vertebral fracture is a high risk when coming off Prolia, so that’s why doctors are supposed to either keep you on it (which has implications for your immune system) or put you on a bisphosphonate. I know some doctors just keep patients on bisphosphonates long term, but many put patients on a “drug holiday”. This management should be based on bone turnover markers, although many doctors don’t bother with them. (Pretty slack way of managing the condition IMO). I know that you take the Evenity and then go on a bisphosphonate, but had not heard it needs to be for life. I’d definitely be getting clarification and even a second opinion. Bisphosphonates were originally prescribed only for 5 years max because of the risks of atypical femur fracture, gastrointestinal problems and ostenecrosis of the jaw. Good luck ….don’t be afraid to do your own research on this topic.

[@TheNemsue]

Weighted vest = weight-bearing exercises! Use common sense, but I am all about weighted vests!!

[@aledaburkholder6402]

Tell me more about weighted vests

[@shar7508]

I’ve heard they are not effective. Has it helped you?

[@mollysurujbally887]

I have osteoarthritis in my right knee

[@mollysurujbally887]

Omg I have osteoarthritis in my right knee I am following up therapy on Facebook I can't afford injection looking on

[@farrahfrench7690]

Unfortunately, Anabolic medications are not indicated for people with a hx of radiation .

[@shazben9822]

I have been diagnosed with severe osteoporosis I’m 63 and went through menopause age 55 I asked my gp about hrt and was told no it causes brittle bones Last yr I was at the hospital with my severe emphysema Respiratory failure and pneumonia but my back was so painful It felt like I was being stabbed in the back every time I coughed I was told it’s muscular after he was poking his finger in my back and spine I nearly shot through the roof I said ur abit rough aren’t you He was seeing what reaction he got I said really oh you expect me to shout out in pain and he said yes I said I’m not that kind of person but that really hurt It’s muscle from coughing with your infection 5 months later I was in with my gallbladder and had to have a Ct scan because they couldn’t find the stone that was originally there Well they didn’t find the stone but it did reveal 2 severe wedge fractures at T6/7 which is my thoracic spine It also clearly stated was present on X-ray in March ! Muscles pain I was told and not only that the fractures were that severe I now have kyphosis which is due to the fractures and I have lost height I was sent for a dexa scan and my hip score was -3.7 I have severe osteoporosis and put on alendrate acid The appointment to see a rheumatologist took months and she wants me to go on zoldronate acid which is a yearly infusion for 3 yrs I don’t know who to believe anymore I have researched and watched loads of videos on KZbin I don’t feel I have much option but to go with the infusion I keep putting it of because of the meds affecothe jaw but according to what has been said here she has never come accross anyone with it from the drugs buts it’s still possible although they do say it’s rare I haven’t been sun free for just over a yr now and the rheumatologist did say it may help with the pain She didn’t say it would but it helps sone people This is the last thing I needed with having the severe emphysema at stage 4 I suffer enough and now this It will prevents me from having any surgery on my lungs because they they would possibly fracture my spine and ribs with being so close to my lungs Ive spoken to people claiming they can reverse osteoporosis with all the packets of protein and whatever eles they want to sell me but I don’t believe it

[@jenniferroberts7581]

I had very bad osteoporosis (and a spine fracture) - took Evenity (one of the newest drugs) for a year (it's only a year treatment). Regained 16% of BMD in just that year. Now on Prolia. The serious side effects are rare and having fractures is horrific. There is NO WAY to reverse severe osteoporosis with diet alone.

[@shar7508]

I hope she answers your question! I am so sorry that you are going through all of this. It does seem as though the drugs may be your best bet. God bless you!

[@shazben9822]

@@shar7508 thank you for your reply I have read others saying don’t go on prolia? How long are you on that for and how long can you stay on it and how often is it taken, is it helping and do you have good diet along side, do u excersize allot as it the one thing I can’t do because of my breathing .. I feel I’m not long for this world really I do and it’s depressing me so much .. I’m desperate for a teeth descale but have terrible problems even trying to brush my teeth because I get so breathless.. do you know what your hip score was on dexa scan and did you lose height.. sorry for the questions I now feel desperate

[@elvirabroekhuizen8718]

What about The Rebounder?

[@calista1280]

Don't believe that puts enough pressure to strengthen bones...

[@redhen689]

It’s low impact. You need higher impact.

[@patriciacarboni2634]

Overwhelming for a lay person.

[@deebrooks9488]

In the same blood draw at Labcorp, I had several of the same tests for different Doctors and they all came out different! For example my sodium came out low for one Doctor and high for a different Doctor! Now I don't trust Labcorp.