Stronger Bones After 40: Dr. Lisa Moore on Osteoporosis, Bone Health & Midlife Fitness

28:00Yeah. For, for someone who is really concerned about jumping and it isn't safe for them for whatever reason, absolutely moderate and high intensity doesn't even have to be high intensity, moderate and high intensity strength training and agility and power. If they can work power without the impact, they are getting great benefit and they're still going to be able to enhance their strength and benefit their bone density. The big thing to think about is we tend to get really focused on, can I increase my bone density? But what osteopenia or osteoporosis means is you have a risk factor for a fracture.

28:41So to me, the most important thing is to help people prevent ever having a fracture. Because if you never have a fracture, your osteopenia or osteoporosis doesn't change your life. And when we look at the effects of medications, and we look at the effects of exercise for fracture prevention, exercise is at the top. Strength training is at the top. So regardless of impact, they don't have to do impact, but strength training and muscle mass is going to be something that can improve your balance, improve your resilience and prevent you from ever having a fracture. What about nutrition and bone health?

29:16Outside of calcium and vitamin D, what are other nutrients or dietary habits that play the biggest role? I love it because this is critical. We can't build a strong house if we don't have the right building materials. We can give it the right, see, we can have all the construction workers we want, but if we don't have the right materials, we can't build a stronger body. So protein is right up there, you know, when we look at what the volume of our bone mass is, it's 50 % protein. So we have to have adequate protein. And these amino acids are also the building blocks for collagen. And collagen matrix is what the calcium and other minerals attach to, to create strong and flexible bone.

29:58So I generally recommend 1.2 to 1.5 grams per kilogram of ideal body weight. I know that's middle of the road, I find so many clients struggle sometimes just to get that and they struggle to get more. So as I look at the best gains for helping somebody to achieve that goal, that 1.5 mark is what I'm shooting for. So protein being right up there. Boron. So I like people to get things through food first. We have great studies that support prunes and eating five to six prunes per day is shown to increase bone mineral density. And I think it's the boron, but really it's not just the boron, but how it's packaged with the fiber and other micronutrients in the prunes and how it affects our gut microbiome to help create the right environment for increasing bone density.

30:51Oh, that's a two for one because then you can get the fiber too. It's fantastic. It's fantastic. Yeah, absolutely. All right. I'm revisiting. I know, me too. Yes, it's great. Yeah, and the fiber makes a huge difference. I know lots of people that will take the five out in the morning, and that's just kind of their snack throughout their day as they're kind of running around their house. And it's a simple thing to do that has great benefit. Yeah, you mentioned vitamin D, and vitamin D really needs to be in the sweet spot. Too low is associated with low bone density, and too high a vitamin D also can affect our ability to utilize calcium.

31:26So we want to keep that in the sweet spot. Vitamin K2 can be helpful. And it comes in two forms. We have MK7 and MK4. And vitamin K2 helps direct that calcium more into the bones than into the vessels. So it's kind of a gatekeeper on where the calcium gets utilized. Can everybody take calcium? I'm not saying that. You should talk to your physician and see and your nutritionist if vitamin K2 is right for you. But it can be beneficial. We have nice studies that support vitamin K2 for bone health. Another one that I often talk about is magnesium. And magnesium is another component of the minerals that helps form that matrix of good bone density.

32:06And we are often very depleted in magnesium, and our food supply doesn't always have a good source of it. So that's one of the easier ones to supplement. Different forms have different effects. So depending on your GI system, sometimes magnesium glycinate will be a little bit easier tolerated versus magnesium citrate that can have a little bit of a laxative effect, right? Okay. So those are the supplements to pay attention to. What are the myths that you hear about osteopenia, osteoporosis that you'd like to clear up? Oh gosh. Well, yeah. There's a whole bunch. Yes. Yes. We could cover a lot here.

32:43You know, one is that you can never lift heavy. You know, you can't lift anything again. You should never bend, never twist, never lift. And we do have movement precautions that we follow, but I think we've gone, we were at one too far of extreme where we scared people so much about movement that they stopped moving altogether. And scaring people to death is not a strategy, but empowering and educating them is. And so that's the difference that we have to make there. What are the strategies? Myths. Gosh.

33:13That it's all about, that you can't do anything about it. I think that's one that you think that you're, that you're stuck in this situation and that you're, and that you're fragile. And what I think people need to realize is we can take action steps to combat that and to be stronger and more resilient and prevent it from changing our life. So you talk about minimalist shoes and who should wear them and who shouldn't. So with that, I guess my first question is, do you start women that are healthy enough and ready enough to jump? Do you start them wearing a shoe or would you have them start barefoot?

33:56I do start with shoes on. And that is a bit of my own personal bias because I don't do barefoot well because I have a neuroma. So part of that is my own. I don't want them to have what I have. Um, but I do training in impact and balance shoes on and shoes off because I think we need to train for real life because in real life we're times in barefoot and we're times where we're in shoes and we're in different types of shoes all the time. But, um, to answer your question, if I'm starting impact, I usually start with, with shoes on. Yeah. Okay. And then when do you recommend the minimalist shoe? Um, minimalist shoes for people that are working and are having a, uh, that are doing well with the strength training program that don't have a bunion, that don't have an aroma, uh, that have, uh, that are comfortable.

34:42They already say they're comfortable walking barefoot. Then they can transition to that minimalist shoe style. It is great for improving foot strength and toe strength. Uh, and just that proprioception, that feeling the ground underneath your feet. Um, there's a lot of benefit to minimalist shoes for people who can wear them for a fall prevention and foot strength. For people that don't know what a minimalist shoe is, can you explain what a minimalist shoe is? Sure, sure. So like a normal tennis shoe will have a nice bit of cushioning, you know, between the toe and the heel. You've got that pad like a running shoe.

35:19Some of them will have a drop. So from the heel to the forefoot, there might be a four millimeter drop or a 10 millimeter drop. So it's like you have a little bit of a heel. A minimalist shoe has none of that padding. So it's kind of like wearing a sock, like the Vibram Five Fingers or some of those many, many varieties out there, but it's very thin, lightweight, almost like putting on a sock with a rubber coating on the outside that's just one layer between your foot and the ground. It can fold in half. You could probably roll it up like a taco because it is so flexible that it doesn't restrict your foot movement.

35:57It gives you a good feel of the ground, but it's not going to have padding and cushion. It's going to be laced or it's going to be attached to your foot really well, but no padding or cushion. So you change your gait speed when you have a minimalist shoe. You change how you walk. You're absorbing force a little bit differently, and it absolutely can help with increasing foot strength, which if you live a lifetime in shoes, we lose that if we don't train it specifically, right? Okay, this is going to go down a rabbit hole. But for for clients that I mean, because this is something that I see, not online, obviously, because I'm not in person training anyone, but in, you know, in the women that I do one on one train, so there's the pronate pronating and collapsing arch, and then like halus valgus.

36:47How do you like if somebody can't balance without a shoe, um, and then they're jumping or they're loading really heavy and they're collapsing that arch say down in a squat. Um, where would you have them wear like an, an insert, an insole in their, in their shoes so that they can have some of that protection if they're choosing to jump on their own or to, you know, be moving load. Great, great question. Yes, absolutely. To me, having better joint alignment. So if, like you say, that pronation where that inside of the ankle, that arch is flattening out, the big toe is really pushing over. I do recommend toe spacers to help with that, but an insert.

37:32And I'm not a fan of artificial support in general, but in specific cases like this, if we can help someone's ankle and foot alignment to be more optimal so that as they're doing a squat, then the position of their knee, hip, and spine over their leg is better, this is more protective. We don't want to be moving in such a way that we're increasing that direction of failure in that joint. So absolutely an insert in a supportive shoe is going to be helpful in that case. And I always want to put them in the most protected position possible. Okay. What about someone that's used an insert in their shoe for years and has never tried to work out barefoot or how Haley does in her socks sometimes?

38:22times what how do you go from always being massively protected and in a cushioned shoe to working towards getting there oh i love that that's a great question too you know i think it's all small bites and snacks and um like in the clinic or working in an exercise session there may be a time where i say okay for these three exercises or these three balance things we're going to work barefoot. And you can start in these small bites of building that strength. And then I would ask people to try to really slowly ramp up time barefoot. And when I've worked with clients that have had plantar fasciitis, they're often shocked when I'm telling them you need to spend time barefoot.

39:05And they'll say 30 to 60 minutes in a day, I want you walking around your home without your shoes on. I want your feet to start to adapt, but we're not going to do it at an accelerated rate. So I'll introduce it during exercise, but it doesn't have to be the whole program. And then I'll have them introduce it on a daily basis, but in small doses. And then how it progresses is based on feedback. How does it feel? Is there pain? Is there dysfunction? And so we have to get that movement confidence. But I think it's a wonderful thing to practice and train. We have to pay attention to the symptoms and the response, and that's how we progressive from there.

39:44Okay. I'm motivated to try. So let's break down some studies because there's a lot of the studies can be cherry picked or even, you know, somebody can misunderstand what the study was or it could be biased. So there's a lot of studies out there. Let's focus on the one that everyone knows, which is the Lift More study. What do you think about that study? And it's the one that always gets thrown around is the Lift More study. So yes, I'm curious your thoughts. Great. I think the Lift More trial was groundbreaking. I think it was groundbreaking to change our mindset around how we could work with postmenopausal women with osteoporosis.

40:38Because prior to that, we did not believe that high-intensity strength training was safe and reasonable. So just to change the mindset of knowing that this type of exercise can make a difference was huge. I think it can feel unapproachable to some women to think about barbell back squats and deadlifts. And also, the structure of the program doesn't have periodization. There isn't that variety that I think if we're looking at a year-long program needs to be part of our, you know, building phase and growth phase and recovery phase, deloading phase. I think those are important and that's not a part.

41:23But, you know, you can't make that part of a randomized control trial. So that's no fault to the study. The study was wonderful in how it empowered me to work with my clients. I think the context that it can be taken out of is that's the only answer. And we know we have research that says it doesn't have to be at that level to be effective. And we also know we can modify a back squat to be approachable for almost anyone. They can be doing a sit to stand at body weight to start if they need to. We can modify a deadlift, the range of motion, the load, all of it to make it approachable so somebody can learn a proper hip hinge.

42:02You know, so all of those exercises within the Lift More trial can be modified and then graded. You know, this is a lifetime program we do, right? We're doing this for life. So we don't have to have that one rep max 80 % thing right away. We can take years to build on that or even never get there and stay within our safe zone. Okay. So the periodization that you said, if you're programming for your clients, uh, you're, you're choosing periodization as the overlying, um, you know, that's the template for, for a year. You wouldn't just say only stay in low reps all the time year round. No, I don't think, I don't think we should stay at that level for every workout.

42:45No. And for what reasons? I think we need that change in tempo and load for joint protection, for ligament and tendon. I think it allows for recovery, but also adaptation likes the variability. And I think when we're doing the same exact thing over and over, it keeps us stuck in a pattern where maybe we're losing a little bit of the endurance side of that muscle performance, or maybe we're losing a little bit of that power side of that muscle performance. So I way prefer variety than just a one recipe over and over and over. Yes. Agreed. All right. So if we look at daily habits for women that can help with their, say someone that's, I mean, there's a wide range that listens to this podcast, but I think the numbers, Laura, are like mid thirties, probably to mid sixties.

43:44That might be the same group that you're working with somewhere in that as well. But just like good habits and routines that women over 40 can adopt now to prevent, potentially prevent any bone issues later in life. Great, great question. Well, you know, I think posture exercise is a great protective mechanism. So paying attention to posture, but not just attention to it, but building the muscles in the upper back that help us have. We have to lengthen the front body and strengthen the back body, and that will pay big dividends for years to come. Balance training. We can start to begin to see declines in balance in our 30s and 40s.

44:27And when you still have the ability, if you can start early at dynamic balance training, reactive balance training, things that really challenge you, that's going to be protective for a long time. If you don't train it, you lose it, right? Right? So balance and posture training, I think, are critical. Fuel your body for the activity you need to do. Okay? I'm not in the business of helping people be smaller. I want to help them be stronger. Fuel your body. It's not a daily habit. So fuel your body well, and then strength training three times a week. I think that's a great balance. You can work in your cardio on other days.

45:07And mobility, mobility training so that you have the mobility in your hips, the mobility in your knees and ankles that keep you moving really well. And that's another, you know, that's a lifespan thing that helps us feel good. And if you can move your hips and knees and ankles well, it protects your spine, right? When we see people with stiff hips and stiff ankles, where do we compensate? We compensate by bending back, right? You can see this in the moves. You can see this in a squat. So that mobility is really, really critical. Rest, sleep, optimizing your sleep is an important part of decreasing inflammation.

45:48There's a connection to poor sleep and poor bone health. So optimizing our sleep is something that we can do every day to help improve how we feel. Now, you mentioned something that I want to touch on. So you said, I'm not in the business of making women smaller. I'm, I'm in the business of making them stronger. And I, and I love that that message is, is, is kind of echoing in, in the space. Uh, with that being said, you know, the second, maybe most common question that I get asked all the time is, well, but I have, you know, 40 pounds to lose. That's a different conversation. But if we, What I want to ask you is, is not fueling your body and not, you know, always kind of being, trying to become smaller on fewer calories.

46:37Is that good for bone health, especially postmenopausal? No, being underfed is not good for bone health. It makes it more difficult to reach our goals. And we know that, and sometimes it's just your makeup of being really petite and smaller, but smaller women have lower bone density, being under fueled and constantly in a calorie deficit. If, I mean, if you're not at your ideal weight and you're trying to get to a healthy weight and you're exercising and strength training and maintaining muscle mass, to me, that's the most important feature. Um, you know, some of the physicians that are doing the medications to help with weight loss and they're focusing on muscle mass.

47:20And to me, that's the critical piece. If you are losing weight in a healthy way, but you're maintaining your muscle mass, and it's probably not as big of an effect because we know muscle loss and bone loss go together. Osteosacropagin, they go together. So if you're losing weight at a rate that's affecting your muscle mass, yes, you're affecting your bone. That is the mic drop right there that I think that most women don't think about because they think about, okay, I need to exercise for bone health. I can jump for bone health. I can take vitamin C, vitamin D, blah, blah, blah, calcium, you know, go on some of these medications.

48:01But if you're losing muscle, the bone is coming along with that. Yes. And we, you know, it's months and months for women that to regain muscle in the gym setting. We know that, but bone is even longer. So if somebody, if, you know, if somebody were coming in and they wanted to see a change in bone health and they were doing all the right things and controlling the controllables of what they can, what is the minimum amount of time that you would go back for a DEXA, that you would recommend to go back for a DEXA? Because some women are, you know, I even hear, I'm going to go back in three months.

48:44You're not going to find much. So save your money. It can really take a long time. The earliest I would have someone check is in a year and insurance covers it every two years. And it may or may not show a difference, but it may show a slight change. One of the important things to understand about DEXA, because there's lots of mobile devices running around doing these tests. But a true DEXA scan and to get true accuracy should be done on the same machine, same location every time. If you really want an apples-to-apples comparison, if you're going to one DEXA device and then you're going to a mobile device the next time, you're not getting an accurate representation of that change.

49:25So go to the same location each time. A year would be the soonest I would have somebody recheck. You know, with optimizing everything, nutrition, maybe hormone therapy, which we call pet therapy now, that's exercise, nutrition, eight months, you know, eight months to 12 months to see a detectable change. And two years. It can be even longer for that. But we want to stop the loss. No change. When normal loss is 2 % a year for a postmenopausal female, zero loss is a win. That is it. And I say the same about muscle, maintaining your muscle or even going up, you know, a pound or two a year. And somebody might think that they're, that's pointless.

50:15Why? Why did I even do all of that work for, well, you didn't lose any, that's the goal at this age, you know, especially post-menopausal. Are you a fan of hormone therapy? Dr. Yes, absolutely. I have personally been on hormone therapy for multiple years. I don't ever plan to stop it. We know hormone therapy is protective for bone density, because as we lose estrogen, the osteoclasts, these are the cells that break down bone. Estrogen is a gatekeeper for these bone breakdown cells. And estrogen leaves, and we start to see a rapid loss of bone density. So estrogen is absolutely protective when it comes to bone density and fracture prevention.

50:59Okay. So 2 % of bone a year postmenopausal is the average? We can lose 20 % of our total bone in that perimenopause-menopause transition. That is scary. Yes. Yes. And the unfortunate thing is they don't recommend testing until age 65. So at that point, you already may have osteoporosis and you've never had an opportunity to really address it if it wasn't tested sooner. I do recommend if people talk to their physician about any risk factors they may have to get an earlier test. We should know in our 40s. We should know in perimenopause what our baseline bone density is. This needs to change in America.

51:39I don't know about other countries. I know that it's easy to get a DEXA in Australia. but here it seems like okay there's the mobile carts but as you said I'm guessing that you test on the same machine for because it's calibrated differently but also I'm sure that there's different versions just like anything there's like a cheaper version of the DEXA an older model versus something that's hospital grade is that a fair assumption it is but also training training Training of the technician and certification of the people reading the data makes a huge difference. And we don't have consistency in the United States on that.

52:19Certified people that do the DEXA and as well as the trainer, the training and the, you know, the data you put in is the data you get out. If you get bad data in, you're going to get bad data out. So the training of the technician, the accuracy of the test, and then the training of the person that interprets that data makes a big difference. So how do you know you're going to a well-trained, certified place? That's difficult. That's really difficult. Dr. Lonnie Simpson is one of the prominent teachers in osteoporosis and bone health. And she's a certified dosometrist and has been doing this for years and years and years.

52:55And she talks about how asking if they ask if they're certified. That's one. and then whenever possible, you know, just checking in with your technicians because it's a technician, like an x-ray technician that does the test, you know, what's your training on doing these DEXA scans and do you do it the same way every time and what is the positioning that I need to make sure I do because the position of the joint is really what matters for them to get the correct view. You know, what's the proper position to make sure that the radiologist can read this correctly? And is the radiologist, are they trained and certified to read DEXA scans?

53:31Many times they're not going to be. Well, I'm going to tell you that the first one I ever had like 12 years ago in the JCPenney parking lot in Utah with the 18 year old, I'm positive that was not a hospital grade machine or technician that was certified. So that's hard though, because if you're, if you can't, I mean, money is the other issue. You know, it's easy to say, okay, well, everyone should be getting one every year, especially if you're, but for a lot of women, it's like, great, one more thing that I have to pay for that my insurance isn't going to cover. I'm angry about this. Yeah, it is unfortunate.

54:14It really does need to change. And I think the more that we talk about this, the more likely that is to happen because we can like preemptively help protect women from fractures down the line by having this test done much earlier. Because if you don't know that you need to address it, you may not create the change that needs to happen until you're 65. And then you wish someone had told you earlier. Yeah. We should be having it at 35 or 40 minimum. them. Yes, absolutely. Absolutely. Because if you didn't build peak bone mass when you were a teen in early 20s, then you maybe didn't start from the highest point possible.

54:52So yeah, we do need to know before we go through perimenopause and menopause. Okay. If we're wrapping this up and you could share one message with every female over 40 who wants to age well and stay independent, What's your message? Be kind to your body. Move it. Move it in ways that feel good. Move it in ways that bring you joy. Work on your strength. It doesn't have to look like somebody else. And don't compare your strength and your program to anybody else. This is not a competition. You know, we're not here comparing whose weight it's doing what. We're here to build our best body. This is what's going to give you joy for the rest of your life so that you stay active, you stay independent, and you continue to do the things you love with the people you love.

55:42Strength training is the elixir for positive aging. Oh my gosh. Lisa, I don't even want to wrap this up. I'm so mad. So where can women find you and find your Brick House Bones program? Oh, thank you. So drlisamoredpt.com, drlisamoredpt.com. That's where all my collections and programs are and my workshop that really goes into a deep dive on this information. I am in University Place, Washington. I'm in Washington State near Seattle. So my clinic is strongbonespt, strongbonespt.com if they want to email me or reach me there. And then it's at drlisamoredpt on YouTube, where I have hundreds of free videos and collections from the foundation series, which is for beginners.

56:30Just hit play, and I hold your hand through it, as well as the 4x4 and moderate intensity workouts too. Well, thank you, Lisa, for sharing your time, and everyone should be following you. Do you know what? I didn't even know about you. I found out about you in one of my Facebook groups. Somebody threw you out, and I'm so glad because now I can't get enough of your message and everything that you're sharing on your YouTube and Instagram platforms. So thank you for joining us today and sharing your time and your wisdom. This is going to be a fantastic episode for our audience. I'm really grateful you invited me and give me the opportunity to meet with you.

57:12Honestly, thank you so much for having me. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the BodyPod with your friends.

57:26Thank you.