Interview with Dr. Kurt A. Kennel
Dr. Kurt A. Kennel is an accomplished endocrinologist and medical educator at Mayo Clinic, with a clinical and academic focus on optimizing bone health through lifestyle and medical management. His expertise centers on preventing and treating osteoporosis – a condition characterized by trabecular and cortical bone loss – leading to fractures. He also specializes in addressing complex bone and calcium disorders related to spinal cord injuries, spine deformities, malnutrition, and systemic illnesses. Dr. Kennel is dedicated to promoting patient understanding and empowerment by integrating lifestyle adjustments with medication tailored to individual values and preferences.
In addition to his clinical work, Dr. Kennel leads educational programs for residents and fellows at the Mayo Clinic and actively contributes to other institutions. His research explores the optimal use of bone strength assessments and fracture risk prediction in osteoporosis diagnosis and care, the impact of bariatric surgery and medical weight loss on bone health, and the role of nutrition and body weight in maintaining skeletal strength.
Dr. Kennel collaborates closely with neurosurgery, orthopedic surgery, and rehabilitation teams to enhance preoperative bone strength testing and develop innovative approaches for managing bone health in patients with spinal injuries and deformities. His work emphasizes the importance of effective bone density testing and fracture prevention strategies in improving patient outcomes across diverse clinical settings.
With this deep expertise and patient-centered approach, Dr. Kennel sheds light on the evolving understanding of osteoporosis and bone health, the complexities of weight management, and the vital role of interdisciplinary collaboration. We had the opportunity to speak with him at the EndoHub Conference to explore these topics and gain valuable insights that can benefit both clinicians and patients alike.
Dr. Kennel, Osteoporosis is often framed as a disease of aging bones, yet your work highlights it as a condition deeply intertwined with lifestyle, surgical histories, and systemic illnesses. How does this broader understanding change the way we should approach diagnosis and management in clinical practice?
Dr. Kennel: I believe the Minister of Health touched on an important point this morning regarding the role of the environment in osteoporosis. Much of this condition can be linked to changes in our modern lifestyle — particularly increased sedentary behavior and suboptimal nutrition. Some experts suggest that the issue is not only about bone loss with aging, but also about failing to achieve optimal bone mass during childhood and adolescence. If we focus on promoting proper growth and bone development early in life, the risk of osteoporosis later on could be significantly reduced. Of course, certain aspects of the disease are related to systemic illnesses and factors beyond our control, but from a lifestyle perspective, prevention is clearly a far more effective strategy than treatment.
When we talk about osteoporosis, almost instinctively women come to mind as the primary group affected. Yet, beyond this common association, what do you see as the most critical misconceptions/hardest challenges in this aspect? How can endocrinologists better empower women at different stages of their lives?
Dr. Kennel: We usually think of women as being more at risk for osteoporosis, mostly because of natural factors like menopause and the hormonal changes that come with age, especially around 50. That part isn’t likely to change. But women’s health as a whole is such an important topic, and endocrinologists are really well placed to talk about menopause and everything that comes with it — not just bone health. If the field keeps pushing forward in women’s health and healthy aging, that would go a long way toward managing osteoporosis and supporting women as they get older.
Let’s shift to bariatrics. Bariatric surgery is known to change lives but also carries risks to bone integrity. What provocative questions remain unanswered about balancing these risks, and how could their answers reshape preventive bone health in metabolic medicine?
Dr. Kennel:I think it’s important to remember that the original concern about bariatric surgery and bone health has now expanded to include any kind of weight loss. With the rise of GLP-1 therapies and similar treatments, we’re seeing the same pattern — significant losses in bone density and muscle mass, comparable to what we observed after weight loss surgery. So, we’re still facing the same trade-off: the clear short-term benefits of weight loss for things like diabetes and joint health, versus the potential long-term impact on bone health. What bariatric surgery taught us is that it’s not just about losing weight — it’s about maintaining that loss over time. Because when people regain weight, which unfortunately is common, they don’t regain bone density. That’s the real concern that’s carried over into this new era of GLP-1 therapy: the risk for people who go through repeated cycles of losing and regaining weight, potentially setting themselves up for poor bone health years down the line. So, while the link between bariatric surgery and bone health has been really valuable in drawing attention to this issue, I think we still have a lot to learn about what “healthy weight management” truly means — whether it’s achieved through surgery, medication, or other approaches — and how we can do it in a way that protects both bone and muscle health as people age.
There’s a growing obsession with weight loss across many fields. Do you foresee any successful new therapies in the next five to eight years that could improve weight loss and help people maintain it long-term?
Dr. Kennel: Absolutely. I feel like this moment is truly remarkable – not just because of what’s becoming clinically available, but also because of the growing understanding of the underlying biology and basic science. It’s fascinating. I’m very optimistic that we’ll continue to see even more innovative approaches – not only to the behavioral and biological aspects of weight management, but also to optimizing body composition, with greater attention to bone and muscle health, not just fat mass. Now, will it be accessible, affordable, scalable? Will we have people who still confuse what is weight and what is health? In terms of body image and other factors, these are challenging questions. But the future is very bright for anyone interested in bariatric medicine, as the foundational science has advanced significantly, particularly in our understanding of appetite regulation and other key mechanisms that were once poorly understood. In that regard, I’m very optimistic.
Are we moving away from surgery as the first choice for weight management?
Dr. Kennel: Absolutely. A thousand percent. I think this is not unusual. In many areas of medicine, surgery was the forerunner of better understanding of anatomy and physiology, hence its importance cannot be understated. We used to do all kinds of stomach surgery for ulcers, and now we give medication for it. But we learned a lot about the stomach’s function and physiology from the surgical experience. Similarly, bariatric surgery — or metabolic surgery, as it’s now called — will likely continue to have a role. However, as we’re already seeing in the United States, its utilization is declining with the advent of newer therapies. The main argument for metabolic surgery today is that it offers a more durable effect on long-term weight management compared to medications, which may be inconsistent in availability or adherence. That said, as medications become more accessible for sustained use, many younger surgeons I know are less inclined to pursue careers in metabolic surgery because they don’t see a long-term future in it. For those interested in procedural weight management, it’s likely that endoscopists will assume a larger role moving forward. I believe this will become an increasingly important area as pharmacologic therapies continue to reshape the landscape.
In collaborating with surgical and rehabilitation teams, your bone strength assessments challenge traditional paradigms that separate endocrine care from surgical outcomes. How do you envision this integrated approach evolving, and what does it mean for patient quality of life?
Dr. Kennel: Apart from bariatric surgeons, I also collaborate with spine surgeons — the dynamics are quite similar. It’s interesting you raised that question. Just yesterday, a general surgeon from Tbilisi asked me about differences in interdisciplinary collaboration. I think bariatric surgical practice in the United States has evolved to recognize that the involvement of endocrinologists, physical therapists, dietitians, and psychologists makes their work much easier. The reality is that surgery itself isn’t the hardest part of weight management, it’s the preparation and the follow-up. Most surgeons I know are highly motivated for their patients to do well, and they understand that successful outcomes depend on much more than just the operation. This perspective positions endocrinologists who are interested in bariatric medicine very well, they can play a vital role in both preoperative preparation and postoperative follow-up. Overall, I think most surgeons genuinely appreciate this kind of collaboration because, ultimately, it leads to the best outcomes for patients.
Empowering patients is central to your work, particularly in helping them grasp their risks and make informed decisions. What innovative strategies have you found most effective in helping patients truly understand and act on their osteoporosis risks?
Dr. Kennel: That’s a great question, and it really is something I’m passionate about. I believe that as clinicians, one of our key responsibilities is to serve as the bridge between knowledge, data, and evidence on one side and the patient, who ultimately has their own decisions to make, on the other. Our role is to support patients in making those decisions and to ensure they are active participants in the process. Information is power, and part of our job is to educate people about what a disease means, such as osteoporosis, and what it means for them personally. Beyond that, it is crucial for us as clinicians to truly understand what matters to each patient: what their life looks like, what their goals are, what gives their life meaning, and how a condition like osteoporosis affects those things. I believe this understanding is fundamental to how endocrinologists help patients make informed decisions about whether or not to pursue treatment. My view is that as long as a patient is making an informed decision, it is a good decision. But if their choice is driven primarily by fear, pessimism, or misunderstanding, without fully appreciating how treatment might benefit them, then I have concerns. The role of the endocrinologist in osteoporosis and broader patient care is really about bridging that gap, taking the wealth of available information and translating it into something meaningful and relevant for the individual patient. That, to me, is a central part of what we do.
Finally, what would be your best advice to future endocrinologists and general clinicians about practicing in this rapidly evolving field?
Dr. Kennel: Well, I think it’s fair to say that medicine is evolving rapidly. The amount of information available today is overwhelming – which is a good thing – but I would encourage the younger generation to continue valuing patient-centered care. It’s essential to recognize that all the information we have will not be sufficient unless we understand the patient’s perspective – their background, values, and preferences. That’s something a computer or AI can’t replace. It takes a clinician to truly do that. So that’s what I would encourage them to focus on.
