Strengthening Bones: Osteoporosis, Cancer, and Beyond with Dr. Lisa Moore & Margie Bissinger

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi everyone. Welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond, founder and CEO of the Integrative Women’s Health Institute. Why should you listen today? Today we are going to have a fantastic in-depth conversation about bone health, osteoporosis, bone building, bone maintenance strategies, the conversation about estrogen and breast cancer, other cancers, chronic illness.

Dr. Jessica Drummond 00:01:32 This is a juicy one. If you’re a clinician working with women of any age, you have the opportunity to prevent the 25% death rate that we have from osteoporotic fracture. I want you to meet Doctor Lisa Moore and Margie Bissinger. We have a fantastic roundtable conversation. doctor Lisa Moore is a physical therapist expert in osteoporosis and cancer cancer recovery from a fully integrative perspective. She thinks about, oh my gosh, you’re going to love some of her clinical pearls. She thinks about not just which nutrients, what kind of strength training, but how to integrate strength training with cognitive training, how to help people fully recover their energy post cancer. And Margie Bissinger is a absolute ray of light and energy, and she has been working in the bone strengthening and osteoporotic space for 25 years now. As a physical therapist and health coach, she helps people truly integrate how to protect and build their bones at all stages. From we talk about what do we do for women in their 30s who are pregnant or postpartum? What do we do for women in their 70s? What do we do for women who have early osteoporosis, even in their 20s or 30s, early osteoporosis, and even early menopause? And Margie brings a depth of experience.

Dr. Jessica Drummond 00:03:07 She brings personal experience. She’s going to tell us exactly which vibration plate is safe to use and effective. We’re going to talk about the tools, the gadgets, the programs, the strength training. You’re going to learn so many clinical pearls from this episode. So let’s dive right in. And on the other side, I’ll share with you some of my absolute favorite tips from this episode. And gosh, the conversation could just expand and expand, and I’m going to tie it up for you at the end of our conversation. So you have something to take back with you, right to your practice tomorrow morning. Welcome back, everyone, to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond, and I’m here with doctor Lisa Moore and Doctor Margie Bissinger. Welcome, everyone. We’re going to be talking today about bone health. And I really want to focus this conversation on sort of the three times in life when the things we can do to optimize bone health, obviously the earlier the better in terms of laying a foundation nutritionally, lifestyle wise, from a movement and fitness perspective.

Dr. Jessica Drummond 00:04:26 Then in midlife, you know, as women have our hormonal shifts of perimenopause and menopause, and if something rattles our bone system, whether it’s cancer or chronic illness, we want to see what we can do to recover even if we are postmenopausal. So welcome to both of you.

Margie Bissinger 00:04:47 Oh, thank you so much for having us.

Dr. Lisa Moore 00:04:50 Yes. Thank you. It’s an honor to be here.

Dr. Jessica Drummond 00:04:52 Excellent. So, Margie, let’s start with you. When we’re thinking about bone health from a preventative standpoint, let’s say we’re talking to a professional or a client in her 30s. Maybe she’s in premenopausal, but potentially pregnant, optimizing her fertility, maybe postpartum. What should she be thinking about from a bone health perspective?

Margie Bissinger 00:05:17 You know, it’s so important, Jessica, because so often people don’t. It’s the furthest thing from their mind. You know, their bones really only become paramount, you know, after menopause or if they find out that they have osteoporosis. So it’s never too early. I mean, even earlier than that.

Margie Bissinger 00:05:34 But a 30 year old woman needs to, first of all, look at their overall health, because whatever they’re doing for their fertility and their overall health is also going to help their bones. So if they have underlying inflammation, if they have issues with food sensitivities, whatever it is that they’re working on, that’s also going to help their bones, because those factors can be responsible for bone loss. And a lot of times people don’t realize that. So number one, then their nutrition to optimize their nutrition, make sure they’re getting their calcium vitamin D, vitamin K2. You know, make sure there’s not any nutrient deficiencies. And their diet, you know, a lot of people are really not eating a diet that’s healthy for their bones as well as overall health. And then I think something that’s missing that I know Lisa agrees with me is exercise. You know, this piece of it in terms of they’ve found very specifically what increases bone and its impact in strength training. So it’s working at a much higher level.

Margie Bissinger 00:06:33 It’s not walking every day. It’s not doing yoga, which is all good for you. But if we’re really thinking of bones, we want to do high impact and resistance and jumping and things to that effect, which I don’t think people realize even if they do this twice a week, you know, it’s sort of like a bank. You keep increasing your bone, and then when you’re older and you lose it and around 30 you’re starting to get to peak bone density. So the more you can do in terms of the resistance and impact as well as balance, you know, anything you can do is going to completely, you know, not only change your bones, but your entire life.

Dr. Jessica Drummond 00:07:07 That’s great. Before we move on to the exercise piece, which I think is very important. Let’s talk briefly about calcium. Calcium supplementation, vitamin D and vitamin K, K2 in particular. You know, we know the research tells us that adding calcium supplementation is potentially problematic for vascular health. So Margie, what are some of your best sources for actually getting that calcium in?

Margie Bissinger 00:07:36 Well, it’s interesting because most doctors will tell people, all doctors will tell people calcium and vitamin D.

Margie Bissinger 00:07:42 That’s typically what the doctor will say. Well, doctor is conventional. And the problem is some people will think, oh, okay. You know, in terms of the guidelines in America it’s 1200, 1200 milligrams of calcium. But the reality is they found most integrative doctors that that’s not necessary. You know, 800 to 1000 is good, but people don’t realize it’s combination. It’s from your supplements and your food. And always everybody always says even the Bone Health and Osteoporosis Foundation food first. So it’s so important that people look at their food. I tell them to really see how much they’re getting in their food, but subtract high oxalate food, like calcium, like, spinach, Swiss chard, because that’s not going to be usable calcium. So get a good idea of your food and only supplement then what you’re not getting. So you know, I think, you know, subtract maybe the thousand from what you’re getting that’s not oxalate. And then you can supplement accordingly in smaller doses. You know, they have found that people do not absorb more than at least 501 times, but I even like to give people smaller doses of that.

Margie Bissinger 00:08:51 And the one that I don’t like, I don’t like calcium carbonate because people tend to have low stomach acid as it is, and calcium carbonate requires stomach acid, plus it can lower stomach acid. So yeah. So in a nutshell, that’s what I tell people. My favorite sources sardines are great. I love some of the leafy greens in terms of I love collard greens using those for wraps, I love kale, I love bok choy. You know, some of the ones we don’t think about, even salmon, even canned salmon that’s wild with the bones. So things like that. You can get a lot of good calcium from that.

Dr. Jessica Drummond 00:09:28 That’s great. So ideally we’re getting most of our calcium from the diet collard green wraps. We have a hack where if we have tuna salad we always add a can of sardines to it to make sure the kids will eat it and eat the sardines, canned salmon, that kind of thing. And then if you need to supplement with a small amount of calcium, being sure to balance it with about equal amounts of magnesium and then getting adequate stores of vitamin D and K2.

Dr. Jessica Drummond 00:09:59 Are you measuring that roughly annually?

Margie Bissinger 00:10:02 Oh, I think it’s so important that people get there, you know, I mean, I always have people work with their practitioner, but you must find your 25 hydroxy vitamin D because you can’t guess. And it’s so different. Some people have reasons they’re not absorbing vitamin D, so to just assume what you’re getting from the sun isn’t really good enough. It comes with, you know, with blood work it’s not expensive. So and most doctors will check. So I think that’s absolutely essential. People check. As I see so often, whether it’s a genetic, there are some people that have issues and then they really are not absorbing vitamin D. And so I think people I see it more often than not, they have very low levels. And even though they’re taking, you know, 5000, I use vitamin D. So I think that it’s really, really important to measure it and then work with your practitioner on what’s ideal for you. Yeah.

Dr. Jessica Drummond 00:10:54 That’s great.

Dr. Jessica Drummond 00:10:55 So Lisa, you have this same 30 year old client in your practice. And your goal is to build that peak bone mass. Can you talk specifically about what kind of exercise protocols you would recommend?

Dr. Lisa Moore 00:11:11 Yes, absolutely. The focus on the bone health to me is preventing fracture. So that’s primary. So in this 30 year old woman, we might, assuming they have no risk. But in my practice, it might be a woman that has had breast cancer. So often they will get a baseline Dexa scan to determine that. But assuming that they’re already in a healthy bone status, then we’re working on strength, because we know that there’s a strong association between muscle loss and bone loss. So I want them to maintain as much strength and doing, you know, weight bearing. What is weight bearing exercise? I want loaded exercise. I want them lifting weights in a range of 6 to 12 repetitions where we’re really challenging their system. So strength training is number one at least twice a week I usually recommend three because then we’ll usually get at least two right.

Dr. Lisa Moore 00:12:00 And then we do impact. So we’re doing things that increase ground reaction forces things that increase compression on our bones. So plyometric exercises impact skipping hopping heel drops box jumps. So in a healthy young 30 year old person, these are ways that we can be very proactive in helping them to maintain their bone density, strength, agility, speed, quickness, things that we lose over time. Right then. Also postural considerations. So many of my clients have had breast surgery and surgery for breast cancer. There’s often a very protective posture. There’s changes in the tissue from radiation that can cause a more rounding or kyphosis in the spine. So these issues need to be addressed so that we can help them strengthen and maintain better postural positions, and then balance and dynamic balance, not just standing on one foot balance because we don’t fall stork standing. We fall when we’re in movement and doing more than one thing at the same time. So we do very high level active balance activities for this 30 year old client, so that they can be very confident doing all the things that they want to do without fear of restriction.

Dr. Jessica Drummond 00:13:08 That’s great. You know, in my practice, I sometimes see an early fracture, as you know, maybe from a mild car accident or something as a warning sign of celiac disease. You know, when I see a lot of patients with endometriosis, which have many other. So endometriosis I believe is at least in part an autoimmune disease. And so it tends to be comorbid with other autoimmune diseases like celiac and Hashimoto’s. You have this nutrient absorption problem, then you have a lot of fatigue. And so with breast cancer, I’m sure you’re seeing similar things where you have nutrient absorption issues at the gut and you have a lot of fatigue. So it’s hard to start. So let’s say we have a client in anywhere from 30 to 50 with, you know, the midlife challenges of starting to move into perimenopause and maybe an underlying chronic illness, which could be cancer, could be autoimmune disease, could be some type of nutrient deficiency in terms of absorption, let’s say they don’t have the energy or capacity to do heavier strength training box jumps.

Dr. Jessica Drummond 00:14:17 Where might we start?

Dr. Lisa Moore 00:14:19 Oh, absolutely. Wonderful. So we can still start strength training, but we start at a level that meets them where they are. And we’re still looking for an intensity that 6 to 12 rep range where they’re working enough for intensity. The brilliant part about that and working with with my clients who are recovering from cancer, is that exercise helps improve their cancer related fatigue, but we can do it in smaller doses. It doesn’t have to be a one hour session. It can be a 20 minute session and we can break it up into smaller amounts. Squats. We’re still doing loaded carries. We’re still doing postural exercises, but we can take the intensity down now instead of box jumps. Maybe we’re doing heel drops, or maybe we’re just doing a sit to stand that has increased speed. So we’re doing, you know, 30s at the stand. We’re seeing how fast somebody can go. So just changing the speed and the tempo and modifying the load to meet them where they are.

Dr. Jessica Drummond 00:15:15 That’s great. Do either of you have an opinion on like vibration plates? I’ve seen pros and cons. What’s the research? What’s your experience?

Margie Bissinger 00:15:25 I have a lot of experience with it since I use one. Oh gosh, it must be seven years. So I think it’s a wonderful adjunct. There’s nothing negative. I mean, they’ve shown in the research that what happens is in the bone marrow, the mesenchymal stem cells actually turn into that. You have an option bone versus fat. And they found with the stimulation a certain stimulation of certain hertz. So low intensity high frequency it actually changes these mesenchymal stem cells. So that’s a wonderful thing. The research has been mixed with the studies. I mean certainly they have done studies on children with, you know, different diseases that they’ve shown. It helps what I do like and I’ve interviewed Clint Rubin, who did the research with NASA in terms of the one that I’m a big believer in safety first. So I am not an advocate of the real, you know, the high G-Force machines that really shake you because there have been incidents of people getting detached retinas and we don’t want the brain shaking.

Margie Bissinger 00:16:26 So I really believe in, you know, they’ve done studies on environmental. There’s certain studies on work, work related you know, vibration. And they found these aren’t safe, these high g forces. So the one I tend to like is the meridian it’s low intensity vibration unit. And I’ve used that with many people. But to say it’s absolutely, positively showing increases in bone density, it hasn’t. You know, the research is mixed. And so and I never use it in lieu of to me it’s expensive. So it’s not like the first thing someone should get. But if someone asks me it’s certainly a good adjunct. There’s nothing. It’s very, very safe. They’ve tested it on so many people and you know, so I think it’s certainly a good adjunct and that’s the one that I would use. I think the other high intensity G-forces are dangerous. You know, I think we just don’t know. And, you know, there have been people that have reported and I’ve been using with people in physical therapy for years, and, you know, people are doing better, but they’re doing so many other things.

Margie Bissinger 00:17:26 They’re exercising, changing the nutrition, getting rid of root causes, you know, dealing with that. So you can’t say you know for sure this works. But I am an advocate because there is animal research is good. And, you know, there definitely is some research on the vibration, how it helps the bones. And I’ve seen good results with people.

Dr. Jessica Drummond 00:17:43 So and so if you had a preferred setting in terms of frequency and intensity, what would be your limits? What would you already preset?

Margie Bissinger 00:17:52 I think it’s I don’t want to mess this up. I think I think it’s 40Hz. do you know, do you know Lisa. Exactly.

Dr. Lisa Moore 00:18:01 I thought it was closer to 30. 30 to 34.

Margie Bissinger 00:18:03 I think it’s 30 to 40. We could check that, but I would check if you just the meridian and it’s. I think 0.4 GHz is what I think it is. So it’s a very low you know, that’s the whole point. It’s not high G-Force. And they found they didn’t need that.

Margie Bissinger 00:18:17 It did. Certain stimulus was able you know to stimulate as I said, the mesenchymal stem cells. So that’s what they’re looking for. They didn’t need this intense vibration that could be damaging. So I’m not sure exactly as I think between 30 and 40Hz, and I think theirs is 0.4 GHz. I know it’s very, very low, like something in that magnitude which has been shown to be totally safe. So.

Dr. Jessica Drummond 00:18:39 Well, that’s good because I think my biggest concern was always looking at what is the brain impact. Yes, that vibration in women of this age. How about you Lisa? Any experience with that tool?

Dr. Lisa Moore 00:18:51 Yeah, absolutely. I actually I echo Margie’s statements on that. And you know, the research is mixed. But I do think the low intensity vibration has some great advantages as part of a comprehensive plan with my clients. It’s really beneficial also for neuropathy, if they have neuropathy from their chemotherapy treatment. And it can be helpful with lymphatic system flow too. So as part of a comprehensive plan I think that low intensity vibration is very useful.

Dr. Jessica Drummond 00:19:17 That’s fantastic. So actually I do want to talk briefly about the lymphatic system. So you work with so many cancer patients that I’m sure you also do a fair amount of lymphedema management and lymphatic systems management, generally speaking, in perimenopause and menopause. I do a lot of work to the lymphatic system to allow for sort of the day to day detoxification of the environmental toxins that we’re all challenged with that are impacting the endocrine system in perimenopause and menopause. So, Lisa, what are some of your favorite strategies for supporting lymphatic function, whether it’s through movement or anything else?

Dr. Lisa Moore 00:20:03 Yes, absolutely. You know, at the very beginning, the very basics, I talked to my clients that stretching in full body movement, even movements, yoga. But we need to do diaphragmatic breathing and we need to move our bodies in full movements and stretching. So just those simple things, even if they’re in pain or uncomfortable can be incredibly supportive aerobic exercise as well. Then I always talk about hydration, maintaining enough fluids in their system so that we can have adequate flow.

Dr. Lisa Moore 00:20:34 So versus sludge, right. But stretching even gentle movement is kind of my biggest emphasis. But then we have to really help support our clients and my clients who have had breast cancer reducing the risk of infection. So skin care is a really important part of that. Only on the involved part of the system that is at risk. So making sure they don’t get sunburns, making sure they wear gloves when they’re gardening. Being careful of mosquito bites and cuts and taking good care of their skin and preventing infection. It’s those small traumas that can create a bigger issue or overload the system. But on top of that, exercise needs to be appropriately dosed. And while it’s completely safe for a cancer survivor to go and exercise, and there’s no limit to how much they can lift or what they can do, We don’t want to overload the system by having someone jump into really vigorous exercise quickly without building up their tolerance to that. So it’s just that guided exercise program is a great way to go.

Dr. Jessica Drummond 00:21:33 That’s great. So it’s about really keeping safety to the skin and to the, I guess, aggressiveness of the exercise program so that it’s slowly progressive.

Dr. Jessica Drummond 00:21:44 It’s taking their fatigue into account. It’s taking potential bone weakness. So sort of circling back to our original thoughts on this, you know, when people go through chronic illness or cancer treatment, they utilize some of the bone stores of nutrients and can thus have, you know, be coming out of that treatment with weaker bones. And so we don’t want to progress this too quickly. We want to give the bone the time to absorb the nutrients, to remodel, to Adapt to the exercise stressor without injury. So talking about menopause, Margie. When we think about navigating through the menopause transition from a bone health perspective, what are some of the most important things? Because we do know that for women, I believe it’s over 75. The actual number one cause of death is fracture.

Margie Bissinger 00:22:44 Oh, so I think with menopause, I think it’s an area that for so long hormone replacement and bioidentical, you know people there was so much fear after the Women’s Health Initiative quite a while ago that doctors really stopped even looking into that.

Margie Bissinger 00:23:01 But it’s an opportunity. It’s an opportunity to really balance hormones. And I think it’s missed so often because people are afraid and I don’t think in conventional medicine. Still, it’s not the number one treatment, you know. Yes, guess you can use bioidentical and you can use hormone replacement if people have symptoms. But also it’s prevention. It’s that if people can balance their hormones and many different ways, you know, people, but regardless if they look at it at that stage before they lose the bone, it’s really can make a difference. And I think so many people, you know, we really couldn’t make a complete change in the trajectory of osteoporosis. So I think it’s an opportunity at that point to see how you want to maximize and optimize your hormones. Really early on at menopause, where a lot of people wait till later. But even things like stress and cortisol, there’s even things in your daily activities that, you know, go out of whack that you have control over, that you can do.

Margie Bissinger 00:24:03 And there’s there’s just a lot. And I think it’s something not to just sort of Pooh Pooh and, oh, I’m going through menopause. But I think and I know you teach so much of this, Jessica. You know, I think there’s so much. And health coaches and everybody, there’s so much we can do with these women in so many areas of their life, with everything, with exercise, with nutrition, with stress control. I teach happiness. So all those things as well as it’s an opportunity that’s missed, I feel, with hormone replacement and The bioidentical. So I think that yeah, it’s just something that people don’t have to sit and suffer. They can get help and a lot that can be done.

Dr. Jessica Drummond 00:24:42 Yes. I mean certainly more and more of the research now on kind of revising the poor science that was unfortunately done in the Women’s Health Initiative and the benefits of transdermal estrogen, estradiol. That gets slightly more complicated when we begin to speak about breast cancer. Lisa. So while I know that the most recent research has really corrected the kind of generally increased risk of breast cancer with hormone replacement therapy or estradiol therapies.

Dr. Jessica Drummond 00:25:15 There still is some, and particularly women who’ve already had breast cancer or have active estrogen positive breast cancer. What’s the conversation like in that world?

Dr. Lisa Moore 00:25:27 So learn some new research at the Bone Health and Osteoporosis Conference. Last a couple of weeks ago that women that do not have a personal history of breast cancer, though they may still have a family history, can safely take hormone replacement. And so this is still a good conversation that they can have with their physician. So for a long time, if they had a family history, they were hesitant to go that route. But with my clients, they cannot take estrogen. Even if they aren’t hormone positive breast cancer. They are not recommending a hormone replacement for clients who’ve had breast cancer. So, you know, we have to look at other ways to help create comfort in their body, because often they’re also on medications that even suppress their estrogen even further and then also accelerate bone loss, muscle pain, joint pain. So that’s a very challenging question because they have all the same symptoms of menopause.

Dr. Lisa Moore 00:26:18 Often it is initiated early. If it was a chemically induced menopause from ovarian suppression from chemo. So that hormone option is often not there. So other strategies which Margie you hit on them. How do we reduce inflammation. How do we reduce stress. How do we use movement techniques to help create comfort in the body? Those are all the strategies that I talk about with my clients when hormone replacement is not an option.

Dr. Jessica Drummond 00:26:45 Yeah. So, you know, adding that anti-inflammatory nutrition, optimizing nutrient absorption to the level of the bone. Obviously, we’ve talked about waiting and stressing the bone through strength training, through plyometric training, through vibration training, also balanced training, because when we get to the point, let’s say you have a woman who’s 60, 60, 65, 70 and didn’t have the opportunity to have the support of estrogen therapies to kind of maintain that metabolic and bone building, or at least lack of bone loss and or were pushed into menopause early as a part of the cancer treatment, which we also see with endometriosis.

Dr. Jessica Drummond 00:27:34 Some of our women are on, you know, gene or H agonists from a very young age. Even hormonal birth control at some level is estrogen suppressive in general. So if someone’s been doing that for years and years in their 20s and 30s, 40s, they’ve lost that estrogen support. And now they, you know, it’s unsafe for them to have that back from a cancer standpoint. That’s when so much of these other tools become even more important. And I think also we need to be talking about balance training. You know, my mom’s had two osteoporotic fractures at this point, and both of them were from kind of big falls. Like she tripped over a laundry basket, she tripped over a dog, like. And two women on my street last year had dog related wrist fractures that you could consider postmenopausal osteoporotic. And while there are somewhat traumatic, if you will, you know, I think there’s this fine line we’re always talking about, like, is it just because of the osteoporosis or was there a traumatic injury? If you have a weakened system, even if the injury seems traumatic, it still maybe wouldn’t have resulted in such a complicated fracture.

Dr. Jessica Drummond 00:28:50 Does that make sense?

Margie Bissinger 00:28:52 Yeah, it’s interesting because they call it a fragility fractures the term. But if you fall in fracture standing just standing height you know that’s usually attributed to poor bone quality or something going on with your bones. But I did want to mention if that was okay. One thing that I’ve seen over the years I’ve been doing this for over 25 years, working with people with osteoporosis. And when people do have something, whether it’s cancer, at a very young age, we don’t want fractures because once there’s one fracture, you know your likelihood of another and it’s just saying what’s going on with your bone quality. And so to just ignore this is not a good thing. And I’m very much I’m an integrative health coach, and I’m very much into integrative medicine and doing as many natural things as possible. But I don’t want anyone to fracture, and it’s very, very debilitating. The research on fractures and what happens is horrible. The statistics. So there is a place I really do believe it’s very important for everyone to get two tests.

Margie Bissinger 00:29:51 One’s a CT and one’s AP1 MP, their blood tests and the CT will tell them what is going on. Are you actively losing bone like what’s going on right now in your bone and your P one amp. So that’s like the osteo class A measure. So for all the people listening this is something I’d recommend because we don’t know. We just see a Dexa test. We don’t know what’s happening. Is it that you didn’t have bone or are you actively losing bone or you have a chronic illness? Something’s going on, you know, or something happening? Or is it just something that happens? Maybe you had anorexia as a long time ago. We don’t know. So the CT will tell us if we’re actively losing bone and the pump measures the osteoblasts, the bone building cells. So I think those two tests are just give so much information to people. And if you’re getting your first bone density, there’s also something called a Tribeca bone score, TBS, which will tell you the quality of your bone.

Margie Bissinger 00:30:48 So it’s not just giving you a number because two people could have the same bone density, one falls and has terrible fractures, and one is flexible because they have, you know, it’s a healthier bone and the bone quality is better. So anyway, I just wanted to say I wouldn’t be afraid of medication because if used properly, if someone has such low bone density, there’s now medications that they’re called anabolic that build bone, and you can use them short term while you’re working on everything else, while you’re doing everything just so that you don’t live a life of fractures. And I’ve just seen that in combination for certain people. If you’ve already had a fracture especially, it really can make a difference. So, so many people said under no circumstances am I using medication. But as the more I’ve been involved with this, the more I see that that doesn’t really work because then if they have a fracture, it could have been prevented with a combination. So I just wanted to let people know that don’t be closed minded to using that to get through a certain area.

Margie Bissinger 00:31:50 If you’ve really lost a tremendous bone and if you’re at risk for fractures.

Dr. Jessica Drummond 00:31:54 What about bone stimulators? Lisa? Have you seen that at all?

Dr. Lisa Moore 00:31:59 No, not familiar at all. But I want to make a one quick comment and I’m sorry about your mom. That highlights the point that close to 80 to 90% of all fractures are the result of a fall. So we can make a big impact on preventing fractures by impact, our balanced training and our strength training. We know there’s so much evidence to support those two modalities for preventing falls and fractures.

Dr. Jessica Drummond 00:32:24 Yeah. How about you, Margie? Yes, I agree, that’s one of the things I was wanting to highlight is even if those fractures were at some level traumatic, as you say, fragility, you know, sometimes, you know, it’s not like any of these people fell out of a tree. They were doing, like, basic things unloading the dishwasher, tripping over their dog. And that’s where that balance training can really be effective increasingly, because I heard a statistic recently on a podcast that said, after age 30, almost zero people ever again Sprint.

Dr. Jessica Drummond 00:32:59 So like, we don’t get this kind of short burst functional activity. We don’t challenge our balance. We don’t do some of these things outside of like more formal fitness environments. And so when we’re in real life and we get knocked up by our dog, we can’t recover. And I think that kind of training is really important, especially once people are at the point where they’ve progressed that the system is fragile. So we need to really protect it in other ways as well.

Margie Bissinger 00:33:26 I couldn’t agree more. It’s probably one of the first things I do, and it’s something everybody can do, because the good thing about the body is it does meet you where you are. So if you’ve been bedridden, anything, any type of exercise is more than you’re accustomed to. And so the bones respond to forces more than they’re used to. So for some person it might be just doing body weight. It doesn’t have to be intense for them, you know. So that’s what’s so good. You can gain bone from wherever you are.

Margie Bissinger 00:33:53 But regardless of that, you made such a good point because falls the majority of them happen because, you know, people fall fractures. And so in most people, what I found a lot of times is mindfulness is that people are just crossing the street and they’re looking at their phone and they’re thinking about 10,000 things. And that’s the first thing I teach people live in the present. You know, people just are going on and you’re not watching. And that’s when a fall can happen. How sad to have a hip fracture. And you know what? 24% now people will die within a year after hip fracture because you weren’t being mindful and you weren’t paying attention. But what I’ve seen, I work with the state of new Jersey and we have certain exercise programs. So what we did, we put Taichi in, which has been shown to be so effective. And so many people came up to me and thanked me, just like you said, Jessica. Because in Tai Chi, I think why it’s so effective.

Margie Bissinger 00:34:51 And they have done research on showing it’s effective in reducing falls and the reason and improving balance. And the reason, I believe, is because you’re moving back and forth, you’re moving side to side. I mean, things we do in physical therapy also teach weight shift so that you have these emotions in your system. So if you trip, you got this because you’ve been practicing it. I can’t even tell you how many people have thanked me. They said, you know, I was walking, I hit this rock, but I was able to correct myself. So I think everybody and just like Lisa said, it’s not just standing on one foot. It’s the dynamic balance. And there’s so much we can do. It’s not hard. I know they recommend at least twice a week. I like people to do it every single day because it’s easy and it works. I’ve seen people in their 80s who have fantastic balance. You know, if you don’t use it, you lose it. But it’s an area that we can really, at any age, start and then keep on progressing so that we don’t have to be at risk.

Margie Bissinger 00:35:52 and we can, you know, make a big, big difference. I think for everybody, it’s such an important area that I don’t think people pay as much attention to as they should.

Dr. Jessica Drummond 00:36:02 How about you, Lisa? What have you seen in that later stage? Prevention balance training. Any clinical pearls for that?

Dr. Lisa Moore 00:36:11 Absolutely. I love what Margie said. Tai chi is wonderful practicing that weight shift. But then we also have speed as we’re tripping over that rock or that curb. Can we move our leg with a quickness that can respond? So speed and agility ladder drills. These are fun things we do. But also how do they do with their eyes closed? What’s happening in situations where there’s darkness? When people are getting up to go to the restroom at night, you know, we can have the exercise safety, but let’s put a night light there too, so we’re not impacting that vision loss. I also do cognitive tasks. So as we get older, sometimes if we’re thinking of what we need to get at the grocery store, but also doing something that can affect our balance.

Dr. Lisa Moore 00:36:53 So training dynamic balance with a cognitive task or doing dual task activities can greatly enhance the improvement and the benefit. That’s what we’re doing in our real lives. We are busy. Like Margie said, that mindfulness in our movement, we’re so distracted by what’s happening all around us. So those are the things that I train in my clinic and doing it that way.

Dr. Jessica Drummond 00:37:15 Yeah, I love that. All of this conversation reminds me a lot. I was teaching in China years ago, and just walking around Beijing is like a crazy maze. You know, you’ll have a bus and then you’ll have like two elderly people, both on one bicycle. And in the park. There are these sort of meetup groups that people are a part of for decades, and they do tai chi in the park. They’re walking, you know, and even in if we look at like rural Mediterranean towns where elderly people walk on cobblestones on a regular basis during the day, I think the conversation recently around children is getting them outside more and playing and climbing and building that physical agility, and I think we have to continue that.

Dr. Jessica Drummond 00:38:11 The goal is for bone health in particular, build it as children, but then continue it well into older age, walking on unstable surfaces, walking and thinking, changing speeds, dealing with obstacles in a way that I think a lot of our modern fitness classes don’t challenge because the environment is almost too stable.

Margie Bissinger 00:38:35 And not such a good point. Jessica. Also, the amazing thing about that, what Lisa had said and about the dual tasking and learning to do that in a safe environment so that when you’re out in the world. But that’s what they do with Alzheimer’s. I mean, that’s how they’re really helping people. That type of exercise I found so effective for, you know, cognition and keeping yourself and preventing Alzheimer’s. So, you know, how great is that? It’s good for preventing falls. It’s good for your bones and also keeping your mind sharp. So it’s a win win.

Dr. Jessica Drummond 00:39:06 That’s wonderful. All right. So I think to sum up our important clinical pearls in this conversation is especially for most of my audience who’s working a lot with women in their 30s to 60s is, you know, we have nutritional certain nutrients that are very important for bone building that we want to make sure our clients are able to take in.

Dr. Jessica Drummond 00:39:29 We want to challenge them in a lot of different ways and a lot of different environments multi type tasking, balance training, strength training. And we want to be having a skillful conversation around hormone therapies. Views and really supporting people who lack the ability to either use hormone therapies or who have experienced early menopause due to cancer, cancer treatment, or any other kind of chronic illness. Because estrogen is such a huge part of bone health as well. All right. Anything else before we wrap up?

Margie Bissinger 00:40:06 I think one thing I just wanted to add for health coaches, you know, in everybody, I think when you see someone look at their posture, because posture, as we talked about for a minute before, is so important. And so many of us are rounded, you know, so many people today. And that’s going to change your position when you’re around it. It puts you off balance. So you’re more risk for fractures. And it also in terms of your exercises you can’t even lift your arm. There’s so many negative effects of a rounded posture.

Margie Bissinger 00:40:36 And there’s so many easy things in terms of exercises that people can do. It’s just awareness and body mechanics. So I think it’s just something, an area that I really believe. All practitioner. My husband is a gynecologist and ob gyn and I taught him years ago. So every patient he sees, if they come in, you know, he’ll mention and let them work on things because people just don’t know. They don’t realize. And I think it’s an easy tweak that can have profound, profound improvements, because forward bending and rounding increases your risk of vertebral fractures, as you know. So I think just it’s an area that we don’t look at. And when we’re looking at our patients, you know, even measuring measure their height, there’s some other tests that people can do. It’s called the occipital wall test. So there’s some other things that we can do. And even measuring their balance really there’s some tests by the CDC. So you could put those things into your practice and completely change people’s lives in so many ways.

Margie Bissinger 00:41:36 So I just wanted to add that piece.

Dr. Jessica Drummond 00:41:37 That’s great.

Dr. Lisa Moore 00:41:38 Yeah. The other thing is that I talk about with my clients is protein and how important protein is for building healthy bones. What are those minerals attached to? And they need to attach to that collagen matrix. So I do talk about getting portions of protein throughout the day to help support that. And Margie, thank you for the reminder to sit up straight.

Dr. Jessica Drummond 00:41:58 Yes. Yeah. Well, and especially I completely agree. I mean we need those amino acids stores, the, you know, muscle and bone work so collaboratively together that we have to build strong, strong and resilient muscle. We have to build collagen matrix. This is really the structure of the body. And then to your point, Margie, most people are kind of sitting, you know, behind the desk in that round position that it’s actually the normal position. Now we have to work to open that space, open the shoulders. And again, particularly for perimenopausal and menopausal women when they’re also at risk for frozen shoulder due to estrogen deficiency and joint changes.

Dr. Jessica Drummond 00:42:48 That posture that rounded up or back posture also changes the mobility of the shoulders. So all very, very important points for that I think are really under discussed in this population.

Margie Bissinger 00:43:02 So true.

Dr. Jessica Drummond 00:43:03 Excellent. Well thank you so much. I think we learned a lot today. I think this is a very comprehensive this conversation and all the tools you both shared is a very comprehensive way to help our clients through any stage of life, build, maintain, optimize their bone and myofascial structure, and have the balance and the cognitive agility to be able to reduce their risk of having a fracture, even having a fall. And then if they do have the fall, have the strength and resilience Plans to either not fracture or recover from that fracture more quickly, even if they’re dealing with an underlying chronic illness or cancer. So thank you so much to both of you.

Margie Bissinger 00:43:48 Oh, thank you so much, Jessica. It’s always a pleasure and good to see you again, Lisa. So yes. Thank you.

Dr. Lisa Moore 00:43:55 Yes, thank you, Jessica, and thank you, Margie.

Dr. Lisa Moore 00:43:57 I appreciate you both and what you share in your communities.

Dr. Jessica Drummond 00:44:00 Thank you, thank you. All right. See you everyone. Soon on our next episode of the Integrative Women’s Health Podcast. We’ll see you next week. So I promised you after that dynamic conversation, that I would share my favorite clinical pearls for you to take back to your clinic tomorrow and take back to your life tomorrow and improve your bone health. What an insightful idea. The integration of practicing mindfulness and dynamic Movement out in the world is brilliant. I really appreciate Margie for bringing that up. I really appreciate Doctor Lisa for talking about integrating dynamic movement with cognitive challenge. As much as we want our clients to be mindful in the world, sometimes they’re not going to be right. You know, things come out of nowhere. People, you know, answer a phone call dynamically while they’re walking and don’t see the dog in front of them. Practice dynamic movement and cognitive challenge at the same time to protect bone health. That’s my favorite clinical from this episode, but I also want you to go and follow both of these women.

Dr. Jessica Drummond 00:45:21 Margie Bissinger at Margie Bissinger. Com has programs for women at every age and stage to optimize balance, bone health, nourishment of the bones, the Skeletal system, including the skeleton, is an important system for the resilience of all of the other systems because there are nutrient stores there, and it’s a protective system of the rest of the systems, including the endocrine system, the immune system, the digestive system, the nervous system, what else? But your cranium protects your brain, right? So follow Margie Bissinger and follow Doctor Lisa Moore. She sees patients in Washington in person at Doctor Lisa Moore dpt.com follow both of their platforms because there are, like I said, so many clinical pearls from that episode. Practice integrative dynamic training including mindfulness and cognitive challenge. Speed challenge agility challenge various surfaces weighted challenge in these different environmental challenges. And then second, go back right down the list of screening tests and test blood tests for osteoblasts and osteoclasts activities. It’s not osteoblasts and osteoclasts levels do that blood work. Have your clients get the information.

Dr. Jessica Drummond 00:46:52 Get the information on yourself. Know not just your bone density, but what is the dynamic capacity of your bone? How flexible is it? Are you actively building bone or actively losing bone? Knowing this data is so important because generally the skeletal system, our bones do not give us any symptoms until we’re at a catastrophic, life threatening fracture level, and this can be prevented at any age or stage in life, or risk reduced or recovery optimized the more we know and the more we’re integrating all of the different things that impact bone health, cellular health for the long term. I hope you enjoyed this episode as much as I did. Go follow Doctor Lisa and Margie. They’re both just a wealth of information and I will see you next week on the Integrative Women’s Health podcast. Have a great week, everybody. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague. And if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients.

Dr. Jessica Drummond 00:48:21 Let’s innovate and integrate in the world of women’s health.