Episode Focus

This season-opening episode examines whether bone health is approaching a “Big Bang” moment similar to diabetes 15 years ago—and, critically, how to ensure that the scaling of bone health care does not repeat the moral and practical mistakes that accompanied diabetes’ transformation.

The episode is anchored by a conversation with Victor Montori, MD, Professor of Medicine and endocrinologist the Mayo Clinic, author of Why We Revolt, and founder of the Patient Revolution, followed by a panel discussion with bone health clinicians.

Why This Conversation Matters Now

Diabetes care transformed rapidly once previously fragmented forces—screening, therapeutics, reimbursement, and technology—converged. That transformation improved outcomes, but it also introduced new burdens: over-reliance on metrics, protocol-driven care, administrative overload, and erosion of patient and clinician agency.

Bone health today shows many of the same pre-transformation conditions:

• A large, mostly undiagnosed at-risk population
• Fragmented ownership of care
• Reliance on single metrics (e.g., T-scores) to make complex decisions
• Growing technological capability without fully formed care models
• Increasing economic pressure from preventable fractures

This episode explores whether bone health is on the verge of a similar inflection point—and what lessons from diabetes must guide its evolution.

Core Conceptual Comparisons

• HbA1c <> T-score: Both are population-level summary metrics that became over-empowered as individual care decision-makers.
• CGM <> bone health monitoring: Diabetes advanced not by finding a better number, but by capturing lived, dynamic risk. Bone health has not yet had an equivalent “continuous risk” moment.
• Fragmented care ownership: Just as diabetes once belonged to “everyone and no one,” bone health risk today lacks clear longitudinal accountability.
• Undiagnosed disease burden: In both conditions, risk is widespread, silent, and often only recognized after harm occurs.

The Patient Revolution Lens

Dr. Montori’s work frames healthcare reform as a moral project, not merely a technical one. Key principles guiding the episode include:

• Care must fit into patients’ lives, not the reverse
• Metrics should inform conversation, not replace it
• Scale without humility risks industrializing fragility
• Clinician and patient burden are ethical concerns, not side effects

These principles serve as a safeguard as bone health care begins to scale.

Panelists:

Bryan Huber, MD, Orthopedic Surgeon

Dudley Phipps, PA-C, CEO/Executive Director, American Society of Osteoporosis Providers

Peter T. Bianco, MBA, Moderator, The Bone Health Basement Tapes

Season 3 Trailer: Bone Health’s Big Bang?

Bone health has never lacked importance. Fragility fractures are predictable, costly, and life-altering—and clinicians have long known how much better outcomes could be with earlier intervention.

So why does prevention still feel so hard to sustain?

In Season 3 of Bone Health Basement Tapes, we explore a possibility—one we’re not yet sure we believe.

What if bone health is approaching its own Big Bang?

Not a sudden breakthrough. Not a guaranteed transformation. But a moment where long-standing forces—clinical capability, workforce expertise, practice leadership, technology, and system design—may finally be starting to align.

Across the season, we dig into the realities providers and practice leaders live with every day.

We explore why fragility risk is often visible long before a fracture—but acting on that risk can still be inconsistent and difficult. Why bone health programs can succeed locally yet struggle to survive or scale. Why effective therapies and digital tools exist, yet operational, staffing, and financial friction remain. And why prevention so often depends on individual effort rather than durable systems.

We also examine the evolving role of technology in bone health—advanced imaging, analytics, workflow tools, and digital platforms that increasingly make risk visible and care more measurable. Not as silver bullets, but as catalysts that raise an important question: If we can see more, measure more, and know more—why is it still so hard to act consistently?

Along the way, we look at how bone health fits into the broader healthcare ecosystem—how it intersects with surgery, post-acute care, employers, and families—and why the value of prevention is widely felt, but unevenly captured.

We draw careful comparisons to other disease areas, like diabetes, where meaningful change only happened once technology, accountability, workforce development, and investment caught up with clinical knowledge. Not as a promise—but as a lens for asking better questions.

Season 3 also turns its attention to the people doing the work: the growing importance of specialized training, clearer roles, and deeper expertise—and why workforce development may be one of the most underappreciated foundations of sustainable bone health care.

This is not a technology showcase. And it’s not an investor pitch.

It’s a grounded, practice-first conversation about how bone health actually works today—and what would need to change for prevention and optimization to become easier to deliver, not harder.

We’re not declaring a transformation. We’re exploring whether the conditions for one might finally be emerging.

Welcome to Season 3 of Bone Health Basement Tapes: Bone Health’s Big Bang?

This episode goes inside ASOP’s Provider Certification pilot—the first step toward a scalable, provider-focused training and credentialing path for bone health.

We unpack why the curriculum was built, how the pilot was structured, and what the early results suggest about standardizing care pathways to meet rising demand.

You’ll hear what worked, what needs refinement, and how certification can translate into practice-ready workflows that improve identification, treatment initiation, and follow-up—without adding friction to busy clinics.

Our guest, Alexandra Rocco, PA-C (Utah Orthopaedics), brings a frontline view from the pilot: how the coursework shaped team roles, documentation, imaging, and treatment protocols; what barriers remain; and where certification can accelerate access before a first fracture. If you’re a clinician, practice leader, or payer, this conversation outlines how certifying providers can turn overlooked fracture risk into proactive, reimbursable care at scale.

Physical therapy is one of the most powerful tools we have to reduce fracture risk, restore mobility, and preserve independence—yet it remains underutilized and overlooked in most osteoporosis care models.

In this episode of The Bone Health Basement Tapes, we’re joined by Dr. Payal Sahni, PT, DPT, Sr. Physical Therapist at Burke Comprehensive Spine and Orthopedic Rehabilitation Center, the former Program Director of the New York State Osteoporosis Prevention and Education Program (NYSOPEP) at Helen Hayes Hospital and a nationally recognized leader in bone health rehabilitation.

Together, we examine the systemic blind spots that have excluded physical therapists from the core of osteoporosis management: reimbursement structures that undervalue movement-based care, siloed specialty practices, and a cultural overreliance on medication over muscle.

Dr. Sahni shares insights from her two decades of work at the intersection of clinical care, research, and community outreach—including how evidence-based PT programs are preventing falls, treating complex fracture cases, and reshaping what post-diagnosis support can look like.

This conversation challenges conventional frameworks and asks a provocative question: What would bone health look like if physical therapy were treated as essential—not optional?

Bio:

Dr. Payal Sahni, PT, DPT, HSP, MCMT, is a distinguished physical therapist and educator with over two decades of experience in orthopedic rehabilitation, specializing in bone health and osteoporosis care. She is a Senior Physical Therapist at Burke Comprehensive Spine and Orthopedic Rehabilitation Center in West Nyack, NY. She has also served as the Program Director of the New York State Osteoporosis Prevention and Education Program (NYSOPEP) at Helen Hayes Hospital in West Haverstraw, New York.

Dr. Sahni's academic journey began in India, where she earned her Bachelor's in Physiotherapy from Rajiv Gandhi University of Health Sciences, Bangalore and her Master's in Physical Therapy from SBSI Dehradun. She later obtained her Doctor of Physical Therapy (DPT) degree from Dominican University in Orangeburg, New York.

Throughout her career, Dr. Sahni has been a fervent advocate for integrating physical therapy into bone health management. She has developed evidence-based exercise programs focusing on osteoporosis, balance, fall prevention, and ergonomic assessments. Her commitment to education extends to lecturing at outreach programs for clinicians and patients, emphasizing the importance of strength training and nutrition in maintaining bone health. She has also been at the forefront of developing and teaching osteoporosis-related continuing education programs for rehabilitation professionals.

Dr. Sahni's research contributions include publication of the first long term case report on the rehabilitation of pregnancy and lactation-associated osteoporosis and vertebral fractures, in The Musculoskeletal Journal of Hospital for Special Surgery. She has presented numerous papers on osteoporosis rehabilitation at the Combined Sections Meeting of the American Physical Therapy Association.

In addition to her clinical and research endeavors, Dr. Sahni served as a medical advisor for Wellen (acquired by OsteoBoost), a platform dedicated to bone health and is a member of the Bone Health & Osteoporosis Foundation’s Ambassador Council.

Dr. Sahni's holistic approach to patient care and her dedication to advancing the role of physical therapy in bone health make her a leading voice in the field.

This episode of the Bone Health Basement Tapes: Originals series features an in-depth conversation with Dr. Michael McClung, Founding Director and now Director Emeritus of the Oregon Osteoporosis Center.

Dr. McClung reflects on a distinguished career that has reshaped the field of fracture prevention and management through pioneering research, evidence-based innovation, and far-reaching educational impact.

From his early days establishing a dedicated bone and mineral clinic to his leadership in pivotal clinical trials that brought transformative therapies to patients worldwide, Dr. McClung has consistently championed rigorous science and practical solutions.

A recipient of the 2025 ASBMR Frederick Bartter Award, he shares his journey in advancing fracture risk assessment tools, his experience translating research into policy as a member of WHO and international task forces, and his vision for the next generation of bone health interventions. This episode offers a rare and inspiring perspective on how one physician-scientist’s dedication to evidence, innovation, and impact has reimagined fracture management for millions at risk of osteoporosis and related diseases.

“When you get a hip fracture, there is a 30% chance that you die within the next year. Let’s say you have renal disease or something like that—the risk jumps to 50%. These patients not being able to be on the right medication because it’s financially hard to make these clinics work - is going to kill people because they aren’t going to get the care they need.”

– Dr. Russell Goode

In today’s episode, we’re taking a close look at how the buy-and-bill reimbursement model is breaking bone health in the United States. Our guest, Dr. Russell Goode, is a board-certified orthopaedic surgeon specializing in hip and knee replacement, including the anterior approach and robotic-assisted, muscle-sparing techniques. He has performed more than 8,000 fracture-related procedures and co-directs the Gulf Orthopaedics Bone Health Clinic in Mobile, Alabama, alongside his wife, Sarah.

Dr. Goode also serves on the board and executive committee of the American Society of Osteoporosis Providers, where he helps shape national efforts to close the fracture prevention gap. Drawing from his surgical expertise, leadership in bone health, and firsthand experience navigating complex reimbursement systems, he explains how buy and bill creates barriers to osteoporosis therapy, discourages prevention, and traps care in a reactive cycle. Together, we explore the unintended consequences of this model, discuss practical alternatives, and consider why orthopaedic surgeons—already on the front lines of fragility fractures—are uniquely positioned to realign incentives, expand access, and improve outcomes.

Biography:

Russell D. Goode, MD, FAAOS, is a board-certified orthopedic surgeon specializing in orthopedic trauma and adult reconstruction, practicing in Mobile, Alabama. He earned his Bachelor of Science degree in Chemistry with a minor in Biology from the University of South Alabama, where he also completed his medical degree at the Frederick P. Whiddon College of Medicine in 2010. Dr. Goode continued his training at the University of South Alabama Health System, completing his orthopedic surgery residency in 2015. He further specialized through a fellowship in orthopedic trauma at the University of Missouri School of Medicine in 2016.

Dr. Goode is highly skilled in managing complex and simple fractures, from wrist to shoulder and pelvis to toes, having performed over 8,000 fracture-related procedures. His expertise extends to adult reconstruction, with a focus on anterior total hip replacement and robot-assisted total knee arthroplasty, including muscle-sparing approaches, under the mentorship of Dr. Michael Granberry. He is also deeply committed to osteoporosis prevention and treatment, co-directing the Gulf Orthopaedics Bone Health Clinic alongside his wife, Sarah Goode, DNP, where they provide comprehensive care, including DEXA scans and advanced medication management for primary and secondary osteoporosis.

Affiliated with Mobile Infirmary Medical Center, Providence Hospital, and Springhill Medical Center, Dr. Goode is an active member of the American Board of Orthopaedic Surgery, the American Association of Hip and Knee Surgeons (AAHKS), the Orthopaedic Trauma Association, and the American Association of Orthopaedic Surgeons (AAOS). He serves as adjunct faculty at the Alabama College of Osteopathic Medicine and the University of South Alabama Department of Orthopaedics, where he trains residents in advanced orthopedic principles. Additionally, Dr. Goode is involved in innovation and product development, holding consulting agreements with Johnson & Johnson and Arthrex Medical, and serves as the primary investigator for clinical research with Precision Clinical Research in Mobile. He also oversees the Frederick N. Meyer Orthopaedic Residents Fund, a 501(c)(3) nonprofit supporting educational scholarships for orthopedic residents.

In this international edition of The Bone Health Basement Tapes, we welcome Dr. Jo De Schepper, a leading voice in musculoskeletal health from St. Niklaas, Belgium. As an orthopedic surgeon with a sub-practice focus on treating osteoporosis, Dr. De Schepper brings a uniquely integrated European perspective to the evolving role of bone health in surgical care.

Together, we explore three major themes shaping the future of osteoporosis management in his practice:

1. The Orthopedic Surgeon as a Bone Health Leader – Why Europe places orthopedic surgeons at the center of prevention and treatment, and how U.S. systems might evolve similarly.

2. Osteoporosis as a Chronic Disease, Not a Life Stage – A reframing of bone fragility as a long-term, manageable condition—akin to diabetes—that affects more than just the elderly.

3. A Total Innovation Package: Surgery + Digital Tools – As Principal Investigator of an injectable bone-strengthening agent currently in use in Europe, to emerging digital health platforms for longitudinal care, Dr. De Schepper discusses how comprehensive solutions—not isolated technologies—are the key to progress.

This cross-continental conversation offers new insights for U.S. providers looking to expand the scope of osteoporosis care, integrate new technologies, and align surgical practice with proactive skeletal health.

Jo De Schepper, MD is a distinguished orthopedic surgeon based in Sint-Niklaas, Belgium, with a specialization in hip and knee pathology, hip arthroscopy, and osteoporosis management. He earned his medical degree from KU Leuven in 2003 and subsequently completed fellowships at renowned institutions, including the Hospital for Special Surgery in New York, focusing on pelvic surgery, hip arthroscopy, and complex hip procedures.

In his clinical practice at Orthokliniek and AZ Nikolaas, Dr. De Schepper emphasizes joint replacement surgeries and bone-preserving techniques. Since 2021, he has been certified in robotic-assisted surgeries, utilizing the MAKO system for hip and knee prostheses

Dr. De Schepper is also actively involved in clinical research, serving as the principal investigator at AZ Nikolaas for AgNovos Healthcare's CONFIRM study. This study evaluates the AGN1 Local Osteo-Enhancement Procedure (LOEP), a minimally invasive treatment aimed at strengthening osteoporotic bones. His is the highest enrolling center for this study.

Beyond his clinical and research endeavors, Dr. De Schepper contributes to academic literature, with publications addressing topics such as vitamin D levels in orthopedic patients and surgical techniques in joint arthroplasty.

He is an active member of professional societies, including the Belgian Hip Society, the European Hip Society, and the Belgian Association for Orthopedics and Traumatology, and the Belgian Bone Club, reflecting his commitment to advancing orthopedic care both nationally and internationally.

The inaugural episode of the Bone Health Basement Tapes: Originals Series delves into the rich history of bone health research through the lens of one of its most influential figures: Dr. David W. Dempster, Professor Emeritus of Clinical Pathology and Cell Biology at Columbia University and Senior Research Fellow at the Regional Bone Center of Helen Hayes Hospital, where Dr. Dempster has been at the forefront of bone biology research for over four decades.

Dr. Dempster's journey began with a First-Class Honors degree and PhD from the University of Glasgow, followed by postdoctoral studies in Switzerland and France. His pioneering work in bone histomorphometry has provided critical insights into the pathophysiology and treatment of bone diseases, particularly osteoporosis. With over 200 research publications and continuous support from the National Institutes of Health for the past 30 years, his contributions have shaped our understanding of bone remodeling and the effects of various therapies on bone structure.

Beyond his research, Dr. Dempster has held prominent positions such as Past President of the International Society of Bone Morphometry and has served on the Scientific Advisory Council of the National Osteoporosis Foundation. His iconic micrographs of osteoporotic bone have been widely recognized, including permanent display at the Smithsonian Institution. As Editor-in-Chief of the fifth edition of the authoritative textbook Osteoporosis (affectionately known as “Big Red”), he continues to influence the field's direction.

This episode offers listeners an intimate exploration of Dr. Dempster's career, highlighting the evolution of bone health research and the enduring impact of his work on current and future generations in the field.