In modern healthcare, bone health (and specifically conditions like osteoporosis and osteopenia) is gaining well-deserved attention. I recently sat down with Dr. Igor Wilderman, MD (CCFP, FCFP, DCAPM), a leading expert in pain management, osteoporosis, and interventional procedures, to talk about how patients experience and understand these conditions—and how best to help them.

Igor Wilderman - Accurate Imaging Diagnostics

Who Is Dr. Igor Wilderman?

Dr. Wilderman has been practicing medicine in Thornhill, Ontario since 2004. He is a family physician turned pain specialist and medical director at Wilderman Medical Clinic and Accurate Imaging Diagnostics, which is a multi‑disciplinary hub offering everything from imaging (DEXA scans, ultrasound) to chronic pain interventions and clinical trials.

His credentials include:

  • MD from Tashkent Pediatric Medical Institute (1985), certified in Family Medicine since 2003.
  • Extensive experience in clinical research, like managing trials and co-authoring numerous peer-reviewed articles (on fibromyalgia, migraine, diabetes).
  • Board certification as a pain physician with special expertise in interventional techniques like cortisone, PRP, and lidocaine infusions.
  • Owner of Accurate Imaging Diagnostics, offering BMD and DEXA body‐composition testing.

In short: a clinician-researcher with practical depth in bone health, pain, and prevention.

Most Common Patient Concerns with DEXA Results

At the core of our conversation was patient understanding of DEXA scans. Dr. Wilderman summarized:

“Some patients are very educated… others are much less,” leading to a wide spectrum of questions—from “What do I do?” and “Do I have a problem?” to “Is it osteoporosis or osteopenia?”

When bone mineral density (BMD) is within normal limits, questions tend to be minor. But when results show low BMD, the conversation becomes more serious:

  • Do I need treatment? What kind? Is medication safe?
  • If supplements are recommended, patients ask, “Is calcium enough? Should I take vitamin D?”
  • In Canada, vitamin D deficiency is common; Dr. Wilderman finds 90% of patients have low levels.

He also hears concerns about pain, physical activity, and lifestyle:

“Does it explain my back pain?”
“Should I run less and walk more?”

Awareness Shift in Bone Health

Dr. Wilderman shared how awareness about osteoporosis has changed—mainly over the past five years:

  • Historically seen as an elderly women’s disease, especially white women, but Canadian guidelines now recognize that men and younger adults are at risk too.
  • Risk factors are better appreciated. Beyond smoking and alcohol, doctors now consider diabetes, certain medications (e.g., steroids, PPIs), and procedures (like breast cancer hormone therapy).
  • Ontario’s provincial efforts, like the “OOS” (Ontario Osteoporosis Strategy) place more emphasis on nutrition and protein, moving away from defaulting to calcium supplements.
  • That said, primary care doctors still undertest. DEXA referrals are sporadic, as doctors still prefer active treatments, as opposed to preventive medicine.

Medications & Supplements: Myths vs Reality

A big part of our discussion focused on treatment strategies—where Dr. Wilderman stressed a nuanced, evidence-based approach.

Calcium & Vitamin D

  • While guidelines originally recommended 400–800 IU/day of vitamin D, current practice often involves 2,000–5,000 IU, adjusted to blood levels.
  • Calcium intake from whole foods—dairy, fish, leafy greens—is preferred over supplementation.
  • Studies have raised heart and kidney concerns with high-dose calcium supplements, especially in vulnerable groups.
  • Surprisingly, strong links between calcium/vitamin D and fracture risk haven’t been consistently demonstrated, whereas adequate protein intake shows a solid relationship to reduced fracture risk.

Medication Safety

Many patients worry about side effects, like osteonecrosis of the jaw, gastrointestinal issues, or hair loss. Dr. Wilderman acknowledges:

  • Osteonecrosis is very rare and overshadowed by the harm caused by untreated fractures.
  • Patients sometimes choose fracture risk over side-effect fears, highlighting the need for informed, individualized decisions.

Steroid Use: Oral vs Injectable

  • Oral corticosteroids significantly impact bone health and are consistently listed in osteoporosis guidelines.
  • For injectable steroids, commonly used in pain clinics, the impact appears minor and local, according to Dr. Wilderman’s observations and preliminary research.
  • He collaborates with endocrinologists and employs multi-disciplinary case reviews to balance pain relief against fracture risk.

Lifestyle & Exercise: Foundation of Bone Strength

Dr. Wilderman underscores that medical treatments must be paired with proper nutrition and exercise, tailored to each patient:

  • Stretching and strengthening exercises are essential, but osteoarthritis often limits patients’ range of motion. He first focuses on pain relief and flexibility.
  • The concept of “exercise prescription” is just as specific as pharmacology. You cannot apply generic workout routines to all conditions.

For osteoporosis, clinicians must carefully plan:

    • Type of exercise (e.g., resistance vs. cardio)
    • Sets, reps, load, progression
  • This is especially relevant for patients with advanced osteoporosis or co-morbid osteoarthritis.

Yet, access can be challenging:

  • Kinesiologists who provide exercise guidance can be effective but sometimes are not covered by insurance.
  • Many Canadians will spend $1,000 on a new iPhone but be unwilling to spend on their own health.
  • Interestingly, Dr. Wilderman observes that wealthier people are not always more willing to pay than lower-income ones. Values and priorities play a stronger role.

Misconceptions and Knowledge Gaps

Several misunderstandings persist—among both patients and clinicians:

  • Osteopenia ≠ Mild Osteoporosis
    A diagnosis of osteopenia doesn’t inevitably progress to osteoporosis, and some individuals revert to normal BMD with proper care.
  • Exercise will hurt if bones are weak
    Many fear that lifting or weight-bearing will break bones. In reality, appropriately dosed resistance training strengthens bones. Yes, jumping can be helpful, but it needs to be progressed appropriately.
  • Osteoporosis is painful
    Many patients mistake back pain for spinal fractures. But osteoporosis is asymptomatic until fractures occur. Pain usually signals osteoarthritis—not bone loss.

Final Thoughts

This conversation with Dr. Wilderman reminds us that addressing osteoporosis effectively means blending diagnostics, evidence-based medicine, nutrition, exercise physiology, and patient empowerment. His insight underscores the importance of proactive prevention, personalized treatment, and cross-disciplinary collaboration.