Bone density reports often lead to panic or quick prescriptions. Let’s step back.

Case #8 – The Surprised Osteoporosis Diagnosis

Patient: Rosa, 60-year-old retired teacher
Chief complaint: None, until DXA scan shows osteoporosis
Context:
She’s offered medication and told to take calcium and walk.

1. What we knew on Day One

• DXA shows osteoporosis at spine
• Mild height loss, some back discomfort
• Diet moderate in calcium but low in overall nutrient density
• Minimal resistance training, mostly walking when she remembers
• History of PPI use, low stomach acid symptoms
• Possible family history of fractures

Pause:
Do you treat “bone density,” or bone as part of the whole terrain?

2. The upstream view

We explored:

• Nutrient status beyond calcium (D, K, magnesium, protein)
• Gut absorption (stomach acid, medications, gut health)
• Hormonal status and history
• Movement (impact, resistance training)
• Fall risk and balance

We framed bone as:

“Living metabolic tissue responding to hormones, nutrients, load, and inflammation.”

3. Plan and outcome

Plan (coordinated with her other doctors):

• Ensure adequate protein and bone-supporting nutrients
• Address gut factors impacting absorption
• Implement resistance and balance training program
• Consider appropriate medications where indicated — we complement, not replace
• Fall risk mitigation in home and life

Outcome:

• Improved strength and confidence
• Better markers of bone health over time
• Reduced fear and more proactive engagement

4. Takeaways for your practice

Pearl #1: Bones respond to load and nutrients, not just medication.

Pearl #2: Stomach acid and gut health are often overlooked in osteoporosis.

Pearl #3: Fracture prevention is about density + strength + fall risk.

Action step:
For your next osteoporosis patient, create a “bone plan” that includes:

Nutrition, movement, gut, and safety — not just pills.

FM 2.0 Lens

FMU goes further into:

• Genetics affecting collagen, vitamin D handling, and bone turnover
• Lab interpretation for bone turnover and mineral metabolism
• Terrain maps for bone that overlap with cardio, brain, and cancer risk

Clinical Rounds helps you talk about bones as part of the whole system.

Take care,

Ron Grisanti, D.C., D.A.B.C.O., D.A.C.B.N., M.S., DIANM, CFMP

P.S. If these Clinical Rounds are resonating and you’d like a step-by-step path to practice this level of upstream, terrain-based thinking with support and structure, the next FMU Fellowship cohort is now forming. You can hold your seat with a $150 deposit so you don’t miss the enrollment window. To learn more or reserve your seat, click here.

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