New Era for Osteoporosis Treatment: CTX, P1NP & Beyond
October 16, 2025
Margie Bissinger guides clinicians through a modern, integrative approach to osteoporosis — emphasizing that effective care extends well beyond calcium and vitamin D. Use targeted labs (CTX, P1NP, calcium screening, homocysteine, hs‑CRP), address gut health and nutrient absorption, optimize protein and micronutrients (magnesium, K2, tocotrienols, B‑vitamins), prescribe posture‑focused, progressive resistance and impact exercise (e.g., LIFTMOR/ONERO protocols), and consider hormone therapy and appropriate medications when indicated — all while empowering patients to see diagnosis as an opportunity for durable, whole‑person improvement.
In this episode of The Root Cause Medicine Podcast, Dr. Kate Kresge sits down with Margie Bissinger, PT, MS, CHC—a leading voice in integrative bone health and founder of the Certified Integrative Bone Health Practitioner Program.
Together, they explore the new science of osteoporosis care in 2025, where bone strength is viewed as a reflection of whole-person metabolic and structural health—not just calcium and vitamin D intake.
Clinicians will learn about the synergy between next-gen nutrients like collagen peptides, magnesium, vitamin K2 (MK-4 and MK-7), and gain a nuanced understanding of updated protein recommendations, power training, posture work, and low-intensity vibration in the treatment of bone density issues. Margie shares evidence-informed protocols, bone turnover marker monitoring, and strategies for gut–bone axis optimization—empowering practitioners to guide patients through safe, measurable, and sustainable bone rebuilding.
Clinical Takeaways from This Episode
- Osteoporosis as a Systems Issue: Bone loss is often a downstream signal of broader imbalances—inflammation, gut health, nutrient absorption, and stress physiology—not just low calcium intake.
- Vitamin K2 Synergy (MK-4 and MK-7): Margie highlights evidence for both forms: MK-4’s fracture reduction benefits and MK-7’s cardiovascular and bone maintenance support. She recommends using both for comprehensive osteocalcin activation and calcium metabolism balance.
- Magnesium and the Mineral Matrix: Magnesium glycinate, citrate, and threonate are preferred for absorption and metabolic synergy. Boron and zinc round out the trace mineral support network.
- Protein and Collagen Peptides for Bone Formation: Research in 2025 updates protein goals to ≥1.1 g/kg/day in older adults. Collagen peptides paired with vitamin C and resistance training can enhance BMD and reduce fracture risk.
- Gut–Bone Axis and Microbiome Influence: Dysbiosis and gluten sensitivity may impair bone remodeling. Stool testing can guide probiotic selection and dietary strategies; Lactobacillus reuteri and strain-diverse probiotics show early promise.
- Hormone and Parathyroid Considerations: Margie stresses evaluating estrogen, DHEA, cortisol, and parathyroid status. Subtle hyperparathyroidism can drive hidden bone resorption—often missed in standard workups.
- Bone Turnover Markers CTX and P1NP: Functional use of P1NP (bone formation) and CTX (bone resorption) provides faster feedback than DXA alone. Optimal CTX and P1NP suggest balanced remodeling.
- Power Training, Posture & the Onero Program: Evidence from the LIFTMOR and Onero trials supports high-intensity, low-rep resistance training (5 × 5 sets, twice weekly) under supervision. Margie emphasizes core stabilization, and avoiding forward flexion to reduce fracture risk.
- Jumping, Impact & WBV Platforms: Even heel-drop jumps improved BMD in trials. For non-impact populations, low-intensity vibration plates may safely stimulate mesenchymal stem cells toward osteogenesis. Margie advises avoid high intensity vibration plates.
- Inflammation, Homocysteine, and CRP Monitoring: Elevated hs-CRP and homocysteine (>15 µmol/L) correlate with increased fracture risk. Functional ranges (<1.0 mg/L CRP; <8 µmol/L homocysteine) guide anti-inflammatory and methylation support with omega-3s and activated B vitamins.
Guest Introduction: Margie Bissinger, PT, MS, CHC is a physical therapist, integrative health coach, and founder of The Bone Health Academy and Happy Bones, Happy Life Podcast. With 30+ years of clinical and teaching experience, she integrates posture-focused PT, nutrient synergy, and mindset coaching to empower patients and practitioners alike. Margie co-founded the Certified Integrative Bone Health Practitioner Program with Dr. Kim Millman and serves on the New Jersey Interagency Council on Osteoporosis. 🔗 margiebissinger.com
Core Labs for Monitoring & Personalization
- Bone turnover: P1NP, β-CTX (baseline → 3–4 mo follow-up)
- Calcium
- Vitamin D (25-OH)
- Magnesium (RBC)
- Zinc (RBC)
- Homocysteine
- hs-CRP
- Parathyroid hormone (PTH)
- Thyroid panel
- 24-hour urine calcium
- Body composition metrics
- DEXA + trabecular bone score (TBS)
Nutrients & Supplements Discussed
- Collagen peptides
- Vitamin C
- Magnesium glycinate, citrate, threonate
- Vitamin K2 (MK-4 & MK-7)
- Boron
- Zinc
- Tocotrienols to support osteoblast activity
- Activated B-vitamins (B6, B12, folate) to support homocysteine regulation
- Omega-3 fatty acids (EPA/DHA) for inflammation modulation
Lifestyle & Exercise Strategies
- Onero/power training
- Postural strengthening to reduce vertebral compression
- Balance work (Tai Chi, Qigong, proprioceptive drills)
- Low-intensity WBV
- Jump training
- Stress & sleep regulation
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 for some populations 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 / 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
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 for some populations 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 / 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
Citations
- High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial - PubMed
- High-intensity exercise to prevent fractures — risk or gain? | Nature Reviews Endocrinology
- Heavy resistance training provides short-term benefits on bone formation in well-functioning older adults - ScienceDirect
- McCormick K. Great Bones: Taking Control of Your Osteoporosis. 2023.
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.