New Era for Osteoporosis Treatment: CTX, P1NP & Beyond

In this episode of The Root Cause Medicine Podcast, Dr. Kate Kresge talks with Margie Bissinger, PT, CDCES, founder of the Bone Health Academy and host of the Happy Bones, Happy Life podcast, about modern, root‑cause approaches to osteoporosis and bone health in 2025. They cover advances in testing, nutrition beyond calcium and vitamin D, targeted exercise prescriptions (including LIFTMOR/ONERO‑style strength training), the role of hormones, and practical tools clinicians can use to help patients build stronger, safer bones.

You'll hear them discuss:

• New perspectives on exercise for bone: high‑intensity resistance, progressive loading, jumping protocols, balance work, and posture stabilization
• Blood markers of bone turnover: CTX and P1NP— how to interpret values and use them to guide treatment
• Micronutrients beyond calcium & D: magnesium, vitamin K2 (MK‑4 and MK‑7), boron, zinc, tocotrienols, B‑vitamins (homocysteine), and protein needs
• Gut health, malabsorption (including gluten sensitivity/celiac) and earlier screening for at‑risk patients
• Hormone replacement therapy (bioidentical estrogen) for fracture prevention and CTX improvement
• Practical use and limitations of interventions: strontium, weighted vests, vibration plates, and jumping programs
• Useful clinical labs and screenings: 25‑OH vitamin D, magnesium, homocysteine, hs‑CRP, parathyroid screening (total serum calcium & 24‑hour urine calcium), thyroid, micronutrient panels, and stool/microbiome testing
• Patient empowerment: reframing diagnosis as opportunity and combining lifestyle, supplements, testing, and when needed, medication

Guest Introduction

Margie Bissinger, PT, is a physical therapist with over 30 years’ experience specializing in bone health, nutrition, and rehabilitation. She co‑leads practitioner training (Restore & Rebuild / Bone Health Academy), hosts the Happy Bones, Happy Life podcast, and teaches integrative approaches to reduce fracture risk and improve bone quality.

Labs Mentioned

• 25‑hydroxy vitamin D
• CTX (C‑terminal telopeptide)
• P1NP (procollagen type 1 N‑propeptide)
• Total serum calcium
• 24‑hour urine calcium
• Magnesium
• Homocysteine
• hs‑CRP
• Thyroid labs
• Micronutrient/interstitial testing (specialty panels)
• Gluten/celiac testing
• Stool/microbiome analysis

Supplements Mentioned

• Calcium
• Vitamin D
• Magnesium (glycinate, dimalate, citrate, Mg‑threonate referenced)
• Vitamin K2 (MK‑4 and MK‑7)
• Tocotrienols (vitamin E subtype)
• Boron
• Zinc
• Omega‑3s
• B‑vitamins / folate (for homocysteine)
• Essential amino acids / protein formulations
• (Strontium discussed — concerns raised)

Guest and Sponsor Details

• Margie Bissinger — website: margiebissinger.com (free exercises, programs, Roadmap, Bone Health Academy) Podcast: Happy Bones, Happy Life (available on major podcast platforms & YouTube)
• Bone Health Academy — Certified Integrative Bone Health Practitioner Program (bonehealthacademy.com)
• Mentioned collaborators: Dr. Kim Millman; Dr. Keith McCormick; Dr. Belinda Beck (LIFTMOR research)
• Sponsor / platform referenced: Fullscript (clinician dispensary used by Margie)

Timestamps

00:00 Episode intro; topic overview (osteoporosis & bone health in 2025)

03:00 Exercise advances and empowerment through strength training

05:50 Nutrition overview: calcium, vitamin D, absorption & gut health

08:08 Vitamin K2: MK‑4 vs MK‑7 research and dosing discussion

11:50 Importance of magnesium and preferred forms

18:33 Protein needs updated: ≥1.1 g/kg and essential amino acids

24:22 Bone turnover blood markers: CTX and P1NP — interpretation & clinical use

31:05 Common drivers of elevated CTX: inflammation, hormones, parathyroid

36:43 Exercise prescription specifics, posture, stabilization, and BoneFit / BoneFit/PT resources

43:16  Weighted vests: when they help and when they hurt

45:35 Vibration plates: low‑intensity vs high‑intensity, safety considerations

49:01 Hormone replacement therapy: role in bone protection and CTX improvement

55:22 How Margie began focusing on bone health and integrative care

59:25 Strontium: effects on DEXA accuracy and recommendations

01:02:56 Jumping protocols and impact dosing for bone

01:07:05 Homocysteine and bone: thresholds and correction

01:13:33 Resources and recommended reading (Dr. Keith McCormick; Bone Health & Osteoporosis Foundation; BoneFit)

01:17:20 Closing: reframing diagnosis as opportunity; where to find Margie

Frequently Asked Questions

Q: Can strength training actually increase bone density in people with osteoporosis? 

A: High‑intensity, supervised resistance training (e.g., LIFTMOR/ONERO protocols) has been shown to increase bone density and improve bone quality.  

Q: Are CTX and P1NP blood tests better than DEXA for guiding osteoporosis treatment? 

A: CTX measures bone breakdown and P1NP measures bone formation, letting clinicians track turnover and treatment response long before DEXA changes.  

Q: Is vitamin K2 important for bone health — and which form should patients take? 

A: K2 (both MK‑4 and MK‑7) helps direct calcium into bone and research supports using both forms for fracture risk reduction and cardiovascular benefit.  

Q: Could an undiagnosed parathyroid tumor be causing unexplained bone loss? 

A: If total serum calcium is >10 mg/dL (especially over age 40), consider parathyroid evaluation because benign adenomas can drive significant bone loss.  

Q: Will jumping a few times a day improve bone density? 

A: Short daily impact protocols (e.g., 10 jumps twice daily) have produced measurable bone gains in studies when done with proper progression and posture.  

Q: Is homocysteine linked to fracture risk and is it reversible? 

A: Elevated homocysteine (>15 µmol/L) is associated with lower bone density and higher fracture risk, and levels often improve with targeted B‑vitamin repletion.

Disclaimer: The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.