Episode 28: How to Build Healthy, Strong Bones to Prevent Osteoporosis, with Margie Bissinger

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Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health.

So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, and Insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist, so welcome. Hi guys, today we're going to talk about bone health. So this is a super important topic for us women, and I've interviewed an awesome lady named Margie Bassinger. But first, I want to talk a little bit about bone health and in particular osteoporosis. So osteoporosis is bone loss that is usually related to estrogen deficiency or increasing in our age. There is a strong genetic component, and unfortunately there's No clinical signs or symptoms until you have a fracture. So a vertebral fracture in your back is the most common type, and usually what we see is just loss in your height. So you start to shrink as you get older, and it's usually due to these vertebral fractures. So hip fractures are another concern. In the United States, women have twice the fracture rate of men, but they sustain 80% of hip fractures because older women far outnumber older men. So we tend to live longer, therefore we have a significant increase in our hip fractures. In 2005, the cost for direct care of osteoporosis-related fractures was $2 million. According to ACOG, the American College of Obstetricians and Gynecologists, morbidity and loss of function can occur with all fractures and consequently present a significant burden to the patient, the family, and society. So morbidity and mortality are significantly higher with hip fractures. Of women older than 80 years old having a hip fracture, only 56% could walk independently after a year. So that's a really big deal if you're an independent woman, like you're 82 years old, you're living on your own, your husband has passed away, and you have a hip fracture. More than half of those women can't walk a year after that hip fracture. That's huge. And approximately 3 to 6% of women actually die of complications while hospitalized for hip fractures. So it's a really important topic, and I am passionate about preventing osteoporosis. I don't want to wait and diagnose you with that in your 60s or even 50s for some women. I want to prevent it so that you never make it to that point and you don't have this— these type of risks. So that's what we're going to talk about today. So in addition to hip fractures and vertebral fractures, you can also get a distal radius fracture in your arm that increases risk with age, and it— those tend to occur shortly after menopause, so women in their early 50s. Osteoporosis is diagnosed a couple different ways. So you could get a fragility fracture, meaning A spontaneous fracture or one from minor trauma, like falling from a standing height. You could have a T-score of greater than -2.5 standard deviations on a bone mineral density measurement by a DEXA scan, or we could also diagnose it clinically based on a few parameters. But like I said, I don't want you to get to the point where you actually get that diagnosis. So some physicians use a tool called the FRAX, which stands for the Fracture Risk Assessment Tool, and this calculates your 10-year probability of a major osteoporotic fracture and hip fracture. And this can be done from women from ages 40 up to 90. So this is a good tool to use before menopause. And the major issue is that the bone density scans called the DEXA scan, That isn't indicated to be done until the age of 65, and most women go into menopause around age 50, 51. So you're looking at 15 years of possible estrogen deficiency before you're evaluating your bone health. And that is why so many women have osteoporosis, because it's not even addressed until It's actually a problem. We can try and order a bone density scan for you before the age of 65, but unfortunately most insurance companies don't pay for it, and that has been a huge frustration for me in my practice, honestly. There are some blood and urine tests that check for bone turnover markers. Those tell you the resorption rate that your bone is going through, so That equals bone loss. These are not standard lab tests that are ordered to check for osteoporosis, but I like to check them in women younger than 65 to see, is there a higher bone turnover rate? Are we at risk for developing osteoporosis? So one is called CTX, and that's a blood test, and then urine is NTX, and that stands for amino terminal telopeptides of type 1 collagen. So it's a mouthful, but just know that there are other ways to check your bone mineral activity. We also do lab work to check your electrolytes and other nutrients— your magnesium, your phosphorus, your calcium. We check your liver enzymes because that's important. We check for your total protein and albumin, vitamin D levels, and a complete blood panel to evaluate for anemia. We know that there are diseases associated with anemia that go along with malabsorption of calcium and vitamin D, and that can lead to bone loss. So those are other labs that we also like to So what are some risk factors for getting osteoporosis? This is important. Like I mentioned, malabsorption of your vitamins and nutrients from inflammatory bowel disease, celiac disease, cancers like multiple myeloma, hyperparathyroid disease, smoking— current cigarette smoking is a big one— and alcohol use. Drinking more than 2 alcohol drinks a week actually increases your risk of bone loss. A few medications significantly can affect your bone health, especially anti-epileptic medications or seizure medications like phenobarbital, phenytoin, valproate. These are also used for bipolar disorder as well. So if you're on those medications, sometimes they inhibit the absorption of those necessary nutrients and increase Um, your bone loss. Another huge one, ladies, this is super common— Depo-Provera. It's the Depo shot for birth control. It's medroxyprogesterone acetate, and it has now has a black box warning by the FDA because it does cause bone loss. So if you use Depo-Provera for birth control, You want to use it for the shortest duration and make sure that you're doing everything that I'm going to talk about here in a second for bone loss prevention. So bone loss prevention, it's about eating the right foods. So getting good amounts of calcium and vitamin D in your bones and phosphorus. That looks like eating dark leafy green vegetables. You're going to get a significant amount of calcium through oranges, dried figs, grass-fed dairy products like yogurt and kefir, sardines, raw kale and okra, almonds, and raw broccoli. You can get vitamin D in cod liver oil, wild-caught salmon, mackerel, tuna, sardines, beef liver, eggs, caviar, mushrooms, and sunlight. I would recommend that you get outside and see the sun for 5 to 30 minutes a few times a week so that you can make enough vitamin D. It's very hard to get enough vitamin D through diet alone. The food industry has fortified foods like cereal and breads with vitamin D. Unfortunately, there's phytates in those, and that decreases our zinc absorption. So if you eat too much of those, you get zinc deficiency. So I don't promote eating processed foods anyway. I don't love eating out of boxes and bags. So I would say stick with the fatty fishes and your eggs and get outside and see the sun. And unfortunately, most of us need vitamin D supplementation because we do not get enough sun. We are indoors the majority of the time in this day and age. I love to see a total vitamin D level between 50 and 70. I find that's where you're getting the maximum benefits, and for most people in the northern hemisphere, that requires upwards of 4,000 to 5,000 international units of vitamin D3 supplementation every day. Sometimes you can get away with 1,000 to 2,000 IUs In the summertime if you're getting outside and you're not slathered up with sunscreen all the time. But that's something— that's a lab value that your doctor should check and should be following for you. And another little caveat to being able to absorb calcium and to have it deposited into your bones appropriately, you need adequate vitamin K. So the newer research has realized that we don't want to just take calcium and vitamin D supplements because, yeah, your body absorbs it, but then the calcium goes and deposits into the wrong area. We can actually see increased deposits in arteries and contribute to heart disease and increase in kidney stones, which are made from calcium. So you don't want the calcium to just get absorbed and go wherever. You want it to specifically get into your bones, and vitamin K helps direct that calcium to the right place. So what I recommend is taking a vitamin K2 supplement with your D3. That makes the world of difference, and now you can find preparations where those are combined easily. So back to prevention. We talked about the food and not smoking and keeping alcohol to a minimum. We talked about the medications to be worried about. Another one is anorexia, which goes along with the malabsorption. I forgot about that one, but the biggest one is exercise. You need to use your bones if you want to keep them strong. Weight-bearing exercises, resistance training, walking is better than nothing. So your bones need to feel a little bit of stress on a regular basis. from movement and exercise to stay healthy. So you have cells that break down your bone and cells that build your bone, osteoclasts and osteoblasts. And so you want bones to be stressed and to be broken down and remodeled to make stronger, better bones. That happens with regular resistance exercise. So you want that throughout your life. It also helps with your muscle strength and your balance, which becomes super important later in life. You know, after menopause and onward, when you are at risk for osteoporosis, you need to have good balance because a simple fall is what can be enough to cause that hip fracture. So, you know, we tell older women to not have loose area rugs around, not have major stairs or impediments in their house, make sure their floors aren't slippery, that type of thing, not to have nightlights in the house so they're not walking around the dark when they go to the bathroom, etc. But balance is also a big one because if you do not have good balance, you're more apt So keep exercising, ladies. It's, it's so powerful for so many things. And since I explained how we diagnose it and prevent osteoporosis, let me just throw in a couple key points on treatment and management. Conventional medicine is quick to treat with pharmaceutical medications called bisphosphonates. Bisphosphonates are drugs that block the Those decrease the rate of bone turnover. They have a lot of side effects, and you know they have to be taken specifically on an empty stomach, and you have to sit upright for 30 minutes afterward because they can irritate your esophagus and cause GI upset. You can't take them if you've had gastric bypass or you have esophagitis or other issues. But here's a big concern. It can cause osteonecrosis of the jaw, so it can actually eat the bone away in your jaw. That's kind of a big deal. It's very uncommon, but it can happen, and you need to know that. And then there's something called the atypical fracture that you can get being on bisphosphonate. What we see is if you're on it, especially more than 7 years can get an atypical fracture in your thigh bone from over-suppression of bone turnover from that medicine. So bisphosphonates should be taken short-term, and your bone density should be reevaluated to see if you need to stay on that or not, and you need to know the risks of staying on it. A couple other medications that we use are called SERMs, or selective estrogen receptor modulators. So raloxifene is a really common one that's actually used for prevention of postmenopausal osteoporosis. So some women are put on it if their bones are starting to thin and they only have osteopenia. So raloxifene is also used in women who have had breast ductal carcinoma in situ because it decreases the risk of invasive breast cancer in postmenopausal women. However, you can develop blood clots and have worsening hot flashes on raloxifene, so be aware of the risks when you sign up to get on that medication. The other one is bazedoxifene with conjugated equine estrogen. So here's what I don't like. These 2 medications are have been shown to improve bone density individually on their own, but there have not been any studies with the combination therapy. So we don't have any fracture prevention data when you combine these 2 medications. The drug companies are assuming it's going to improve your bone health. The conjugated equine estrogen is a synthetic estrogen that has been known to improve your hot flashes and vaginal estrogen, but we don't know about breast cancer. There's significant research that suggests conjugated equine estrogens increase your risk of breast cancer. So I personally don't recommend this combination SERM, especially just for bone health, because I think there's other things that you can use. Most importantly, prevention. So my guest today, Margie Bassinger, she and I are going to talk about just that. So she is a physical therapist, an integrative health coach, and happiness trainer. Margie has over 25 years of experience helping people with osteoporosis and osteopenia improve their bone health through an integrative, comprehensive approach utilizing whole foods, exercise, supplements, mind-body relaxation techniques, and happiness training. Margie is the author of the book Osteoporosis: An Exercise Guide. She oversees all of the osteoporosis initiatives in the state of New Jersey as the physical therapy representative to the New Jersey Interagency Council on Osteoporosis. She teaches an online 6-week program called Happy Bones, Happy Life to give people the tools to naturally achieve optimal bone health. She's also the host of Happy Bones, Happy Life podcast. So Margie believes that happiness plays an integral role in our bone health and our overall health. She's been teaching her patients happiness habits for over 30 years and has seen the powerful effects of happiness on chronic pain and recovery. Margie created the Happy Me, Happy Life 8-week online program to help people increase their happiness level, energy, and overall health. Margie has lectured to Fortune 500 companies, government agencies, hospitals, and women's groups throughout this country. She's been featured in the New York Times, Menopause Management, OB-GYN News, and contributed to numerous health and fitness books. She's pretty awesome. So she received her Bachelor of Science degree in physical therapy from the University of Pennsylvania and a Master of Science degree in orthopedic physical therapy from Northwestern University. She furthered her expertise by studying nutrition and health coaching at the Institute for Integrative Nutrition in New York City. You are going to love her. She knows what she's talking about. She's definitely the bone health expert, and I'm just excited to share her wisdom and insight into how you can have happy, healthy bones and hopefully never be diagnosed with osteoporosis. So let's get on with this episode.

Welcome, Margie. Thanks for being on the Functional Gynecologist Podcast.

Oh, thank you so much. I'm really thrilled to be here.

Yeah, I think you have such important information for my listeners. I don't think that we talk about bone health enough as women, right? Like, as a traditional gynecologist, I was trained that you do a bone density scan when women turn 65 because that's when Medicare will pay for it. And so we don't really think about bones before that. And what a disservice, right?

Absolutely. It's so true because I truly believe one of the ways we can stop this, this horrible, you know, osteoporosis is by starting young. Because people think, just like you're saying, that it's something that occurs just for older people and we don't need to worry about it. But it's just the opposite because people really gain bone when they're younger. I mean, between 85 to 90% of an adult's bone women have by the age of 18, and for men it's 20. So what we do in those younger ages is so critical, and throughout life is so critical. And if we take care of our bones and do things that can help, I really believe we can really prevent osteoporosis.

Yeah.

Lots of things that— yes, I agree. My husband is also an OB-GYN, and I'm always amazed that it's just not something— I mean, I think it's changing, and that's sort of one of my goals is to educate everybody that just like we're concerned about our heart and we do preventative things for every other aspect of our body, well, why not when you're— even the pediatricians, Why not, when you're looking at kids, make sure they're doing things so that they can have healthy bones when they get older? It's not that hard, and prevention would be so helpful. So yes, I completely agree with you.

Yeah, it's so much easier to do prevention than it is to try and reverse osteoporosis. And you're right, I think that the conventional medical world has kind of taken notice, especially this study that came out that said Depo-Provera shots for birth control were thinning the bones of young girls, you know. Luckily, it's sometimes reversible once you get them off the Depo shot, but I think that kind of was surprising to people, like, hey, wait a minute, what we have, you know, do during our younger years affects our bone health? And so I just, I love that you're getting the word out and you're focusing on prevention, not only treatment. So how did you get down this path? I read So you had a story about your son developing diabetes, and it really got you into the functional medicine space. How did you get into osteoporosis, though, as a specialty?

Well, very interesting. So my background is orthopedic physical therapy. And so for years, I was working as a physical therapist with backs, necks, TMJ, chronic pain. And then we moved. We moved from Chicago to New Jersey, and I was working at an outpatient clinic. And then local doctors who had an osteoporosis prevention program— it was like a whole program— asked me if I'd be interested in seeing their patients with osteoporosis. And I said sure, because I, I knew about osteoporosis. I had taken a course on it, and I, I knew what to do. And in those days, it wasn't— there wasn't even Fosamax available. I mean, this is way back. And so I started seeing these patients, and I could not believe what I was seeing. People who were well-intentioned, you know, the doctors said exercise, but were doing things that actually increased their risk of fractures. So here they were well-meaning and hurting themselves because they just didn't have the knowledge. So as a physical therapist, I said, you know what, I have to get involved. And I just saw a need that wasn't being filled, and well-meaning personal instructors and People were just putting them on programs that were dangerous for them. They just didn't have the knowledge, and people didn't know where to turn. The newspaper— it wasn't the internet back then, not that that would have helped. Anyway, that's when I said, you know what? I'm going to get involved. Then I actually wrote a book, an exercise book, one of the first exercise books really written on osteoporosis. I got involved with my state. There's this New Jersey Interagency Council on Osteoporosis where really people from all over the state get together and what can we do? Then eventually also nationally, but just really trying to get the word out and started my classes and physical therapy I was doing. That was back then. I did always notice, because I also was involved in screenings for corporations. I would give a lecture and we would do heel different screenings. I saw that people who were eating the fruits and vegetables seemed to have higher bone density. I always noticed that there was a big difference in people, what they ate versus their bone density. Then my son, that's exactly what happened. My son, when he was in college, Wow. He gained like 25 pounds, but then this woman who was an integrative health coach helped him, completely changed his life. One day I'm driving and a light bulb goes off in my head that, you know what, that's really the missing ingredient in osteoporosis. Then I called her, where did you go to school? I found out and I came home that night and I said, that's it. It's non-negotiable. I'm doing this because I want to learn more. And so then I became certified as a health coach, but then studied a lot more in nutrition and really— and then added that to my program. So added that, and also stress and happiness are part of what I do. So really, I found that the combination of all of that can make such a big difference, and people do extremely well, and they don't have to be so scared. You know, when you get that diagnosis, you get your first bone density test and it shows you have osteoporosis. Immediately, people think, oh, my life's over. I can no longer play with grandchildren. I can no longer be the active person I am. That's so far from the truth because I look at it as a wake-up call. They feel fine. Nothing's changed. They've just gotten that bone density test.

Right.

It's a wake-up call, right, to look at all your systems because bones, as you know, especially with the work you do, the bones aren't in isolation. If something's wrong with your bones, typically something else is going on. And then when you address that, everything gets better. So it ends up that it was a blessing in disguise because there's so much that you can do.

Definitely. So how do most people find you? Are they coming and seeking you out once they already have a diagnosis of osteoporosis?

You know, typically there's different types of people I see. When I see people one-on-one in the office, Most of those people are referred from endocrinologists, like local endocrinologists, not functional medicine either. They usually refer them for physical therapy, but then they know I'll do all these other things with them. That's in terms of when people are referred to me by doctors. Usually, it's the endocrinologists or some of the OBs also will refer. That's when they find out. A lot of times, they'll say, no, I don't want to go on the medication. What else can I do? Then they'll say, why don't you see Margie? So I see that's one type of patient. Then other times, I give a lot of talks. So a lot of times I get people to see me through hearing me speak. I also have a podcast. So people find out from me. And I have online programs. So a lot of times word of mouth about my online program, people will hear about me. So different ways.

Yeah, that's wonderful.

How do you approach treating actual osteoporosis once they've gotten that diagnosis?

Well, we look at somewhat similar to what— in a functional medicine way. First of all, you need to find out the root cause. I think that's such a problem because let's say it's digestion. So many of these people that I see have serious digestive issues. Maybe they don't think it's a problem that they go to the bathroom every 3 days or that day. Yeah.

I'm sure you see this all the time.

People don't realize they have— so they're not— or they're not absorbing. They're not absorbing their nutrients. I sort of look at it like a hose. You're trying to get water out, and then someone's stepping on the hose. If someone's stepping— if your digestive system isn't working, they're not absorbing. I really address whatever the root cause is. There's so many. A lot of times, I'll work with their physician as well to really uncover what's the root cause because I think that's so important. Oftentimes people just will go on medicine when— to me, that's so sad. If they have inflammation or let's just take digestion, if that's a problem and they don't address that and they just go on the medicine, they're just missing something so important. I think that's one area. Then for everybody, really looking at their diet, making sure they're getting the nutrients that they need as well as supplements because there are certain things we just don't get enough in our diet. So really making sure that they're getting the nutrients they need. So diet and then exercise. What exercises are really stimulating bones? And so then we go over in terms of— and I can go into that in more detail with you if you want. But in terms of exercise is so essential. And most people, a lot of times they'll see the doctor and the doctor will say, oh, exercise, walk. Well, walking is good, but it's not enough. It's just not enough stimulus because the bones respond to the forces placed upon them. So it's certainly helpful. I mean, it will reduce fractures and there's definitely benefits. I mean, I believe anything you can do exercise-wise is certainly fabulous. But a lot of people think, oh, that's it? I'll just walk 20 miles a day. But that's really not enough. So we really go over exactly What to do in terms of exercise and posture as well, because a lot of times people might do— and this is dangerous, I think. So often when people do find a program, let's say they're going to, oh, I'll do this bone strengthening program online, the exercise part, and they have issues, whether they have tightness or whether they have postural problems, and then they're not using good form, so they could really hurt themselves.

Yeah.

So I'm such a big advocate of At least initially, if you can see a physical therapist or someone, you know, to just get an evaluation and make sure you're doing things properly.

So yeah, definitely.

I mean, I have so many patients running through my head as you're talking just because it's such a common scenario. You know, even my mother, who's almost 69, she had gut issues and she wasn't absorbing her minerals. And so she was moving less, and then she— her fascia became tight, and then her hip flexors became tight, and she's not using her bones. And it's just a slippery slope, right? Like, you lose function in one area and then all of a sudden it's affecting all these other areas, and the bone is usually the last thing we think about. But you touched upon so many important points, so let's Let's go back to the diet for a minute. You know, we want to have good gut health so that we can absorb our vitamins and minerals. Is there any specific diet that you find works well for women or that you are recommending, or is it all individualized?

You know, I truly, truly believe in individualizing and diving into— everybody's so different. You know, for one person They have adrenal fatigue. They can't take one. Someone else may have blood sugar issues. So there's so many— there really isn't, but there are certain common things that I see. And what I see is that people are getting too much calcium, believe it or not. And I don't know if you see this as well, because you probably don't because you're the person providing. But what I see—

No, honestly, can I just interrupt you? It breaks my heart because I was trained as a gynecologist to prescribe calcium and vitamin D for bone health. And here I am making the problem worse. And to think that I did that for over a decade is just heartbreaking to me. So once you know better, you do better, right?

But thank you for bringing that up.

Please explain to my patients, like, what's the deal with calcium and vitamin D?

Okay. So a couple of things. First of all, it's funny that you should say because I, you know, I'm part of the National Osteoporosis Foundation, and I've sat through meetings, and people are well-meaning. It's not that the doctors— you know, that's the thing. People think, oh, the doctors just don't know. It's not that they don't know. It's just that there's so many things that they have to be trained in that that's just not something that was in their curriculum. So when they learned about osteoporosis, that's exactly what they learned. And most people, when they see their doctor, they will get their vitamin D level, so they will make sure they're getting vitamin D, and they'll tell them. To go on calcium. And they typically might say, oh, let's go on 1,200 milligrams. So the problem is that it's not— what I find is then people are getting calcium in their food and then they're also taking the supplements. So they're getting way too much and more is not better. There have been numerous studies, nothing 100% conclusive, but have just shown increased kidney stones, Increased cardiovascular problems because there's too much calcium. The problem, I think, is that— and vitamin D is very, very important. Yes, for sure. We need vitamin D. It shows up in so many people I see, their levels are really, really low. I think vitamin D is essential. However, there's 2 other things that need to be— I mean, there's a lot of things. It's sort of like a whole kingdom. When we eat the plants and things, everything's together. It's not just calcium and vitamin D in isolation, but 2 things that I think are missing that that are absolutely essential and it's not really talked about is magnesium.

Right.

And, I think magnesium is needed to help with calcium absorption and people are very low in magnesium. So, magnesium is key. And then, another one that's so critical is vitamin K2.

Right.

Because vitamin K2, there's 2 parts. It activates 2 proteins. So, osteocalcin and matrix GLA protein. And, the osteocalcin, takes that calcium and gets it where it needs to in the bones and teeth. And then the other, the matrix GLA protein sweeps— this is key— sweeps the calcium out of the soft tissues where we don't want it. So, I think when people are taking all of this excess calcium, they're not getting the K2, they're not getting— I think that it's going to be in places that we don't want. And countries that have the highest Dairy and getting the most calcium have the highest incidence of osteoporosis. So it's certainly not a panacea like we thought, especially with dairy, which for so many people is inflammatory. So yeah, does that answer the question? Yes. I just think it's—

yes, it's so important for patients to understand that science advances and progresses and we learn new things, right? Like what I learned in medical school 20 years ago was already antiquated when I learned it. And we need to keep learning and be open to looking at the new evidence. And I'm just thankful that we're finally understanding what our bones really need and that it's not as simple as calcium and vitamin D supplements. So you're right, though, we, we get lots of calcium in our vegetables and in our dairy products.

Yeah.

And things like that. You know, I personally have a lot of patients with autoimmune issues, so oftentimes we're getting off the dairy, but we're substituting for high-dense dark leafy greens and good vegetables. So calcium really shouldn't be an issue, right?

Oh, absolutely. And I'm such a big component of food first. And even, I have to say, even the National Osteoporosis Foundation Food first and only supplement. And actually, the organization believes in that— only supplement when, you know, you're not getting enough in your food. And so yes, I believe just like the animals get their calcium, I'm a big believer in the leafy greens. And there's so many other benefits because there's so many nutrients that come with the leafy greens as well.

Yeah, exactly.

My favorite way. And then people feel so good because It's just a win-win situation.

Yes.

And their bowels get back on track, their hormones get balanced, the whole thing, right? So how— let's talk about resistance training. So, you know, that was what I would recommend as a gynecologist. You need to do weight resistance for your bone health. But you mentioned some people are doing things that actually increase their risk of fracture. I think of balance issues and I worry about You know, sending someone who's not normally physically active off to do these new exercises. How do you really guide a woman to do the right thing for her bones?

You know, it's such a good point because the research— I mean, there's been studies. There's this one LIFMORE study. And it showed really high weight, high resistance, which was less— it was actually between 80% to 85% of 1 repetition maximum. So, it was really high weight and it showed— and they did different things like overhead press and they were lifting weights and they lifted themselves up and went back on their heels. But they showed significant increase in bone density. However, I saw some of the pictures and some of the things to me were really unsafe. And I think you have to— first of all, what is the most— that's why I tell the listeners what is unsafe because most people don't know. What's really unsafe is rounding your back out if you have osteoporosis and forward bending. And they did this study back a while ago at the Mayo Clinic, and they looked at 59 postmenopausal women who had osteoporosis, but they looked at the fracture incidence over a 1 to 6 year period of time with different exercises. And so they found when people did extension, which is backward bending exercises, Strengthening the back muscles, they had a 16% fracture rate when they only did that. When they only did flexion or rounding, that would be like sit-ups, toe touches, anything like that, which are common exercises. You can see them and you see seniors doing them all the time. 89% fracture rate. Can you imagine?

Wow.

So such high fractures. The combination was 53%. And then The control group was 67, but the point being, and it makes sense when you look at it, that when someone bends forward, it's the front end of the vertebrae that's having where the fractures are occurring. And so it makes sense then when you bend forward that you're compressing an area that's already compressed and the shape has changed possibly. So, you know, when people— I show them a picture.

Sure.

Once they see that, oh my gosh, they don't do that. So it's not that you can't do exercises, you just bend from the hips, not the waist. So I think, you know, you can do everything. And people say, well, what about yoga? What about Pilates? No, no, you can do everything, just not the rounded postures. You make modifications. So I think safety is most important because you certainly— nobody wants to fracture. So yes, you want to be gung-ho and do an exercise program, but you have to be safe. So to me, the absolute safest thing is going to see a physical therapist and getting an evaluation. And usually it is covered. Most insurance do cover physical therapy for osteoporosis. So to me, that's the absolute best, just so you can make sure you're doing everything, um, you know, without putting stress in places that— or someone who really knows. You know, there are trainers who totally know. So, but, but so what I do that when I see someone is that I balance out First, I make sure they have really great posture and that they understand the concepts of exercise. Then, as we can progress, I do progress them to heavy weights if they can tolerate it, and not on their own. This would be initially, but if they can. Every person is different. Someone who has been very sedentary their whole life, they can't all of a sudden start lifting 5 pounds.

Right.

Even just lifting their arm is difficult. Each person, the resistance, it's more than they're accustomed to. That's where I start and then just take each one individually. There have been people— everyone's so different. I believe you have to love your exercise. There are people that I've worked with who absolutely— I can give them exercise, they will not do it on their own. There's a Pilates studio near me where I know the people. Totally great. And I've sent a couple patients there, and all they did was twice a week Pilates with resistance, and they increased their bone density. So I think there's many different ways to achieve it. I wouldn't start going gung-ho on your own without making sure your posture— I mean, there are easy things you can do, but I think if you can get the help of someone that can, you know, to work with That's really a good thing. You know, if you have a person without any problems, then there are instructors who've been trained that you can— there's a woman, Sherry Betz, who I know well. She's a physical therapist, and she on her website— it's B-E-T-Z— she on her website has a list of people that she's trained and been trained in Pilates for osteoporosis. So that's if Pilates is what you're interested in.

Okay.

Go to someone that's knowledgeable. If you can see a physical therapist, great, or then learn the principles in terms of learning what you really— like, I know in all my courses we go over so many different options for exercise, and some are easy. Some are qigong that everybody can do and not dangerous.

Yeah.

It's just a matter of balancing out. You want resistance, but you want safety, so you have to do it in a way that is— I mean, I think there are 2 ways because sometimes people then say, oh, I don't They're lifting 2 pounds forever. Well, that's not going to do it because your body gets accustomed to the weight. And so you want it to be more than you're accustomed to. And ideally, when people are starting out, they want it at 6— to really make a difference, just to begin, it's at 60% of 1 repetition maximum. So what that means, that means that you can do something 15 times, and like on the 15th time, It's sort of hard, like the last maybe 14 or 15. And then in terms of the resistance, how it feels, it feels that it's somewhat hard, where if you're doing harder than they suggest, going to 80% of 1 repetition maximum, and that is like 10 repetitions, and it's hard then. It sort of— it depends. But I guess, did I answer your question?

Yeah.

So you want resistance, but you want to get there in a really, really safe place. And so I think learning what's safe is most important. That's what I do first. I do major mechanics with everybody— how to sit, how to bend, how to do everything. And actually, if you want, I did a whole series of videos because people don't know how to sit. So if you're sitting All rounded, that's going to be the same problem. You know where we said rounding increases fracture risk?

Right.

Yeah.

So if you're sitting slouched and rounded, which how many people do, and then you're trying to lift weights, you're just compressing. So I did a series of videos that I'll be happy to share with all your listeners on how to sit, how to— just basic things. Have I not had texts yet? You know, from the fantastic iPad.

Yeah, yeah, my kids get that from their iPads. No, I would definitely encourage my listeners to go to your website and check out your programs because they are so comprehensive. And it's, you know, I think it's so important to realize that your diet plays a factor, your posture, your daily activities of living, and your emotional well-being, your stress management, right? And you tackle all of those in your program, which I just— I think is so impressive. And that's why it works, right? That's amazing.

You know, it's so funny that you said that because the stress part is so interesting because people will come to see me and they are so worried, are they doing the exact right exercises? And again, there's many ways to improve your bones. It's not just one way. So that's the good news and you have to love it. Even just dancing, you know, you're getting up and having fun. There's so many ways to make it enjoyable and a fun part. But anyway, and then they're worried, are they eating the right foods? But then they're so stressed, they don't realize that the stress itself is a risk factor. And they've shown that anxiety is linked to bone density as well. So that piece— and I know in your practice, because this is what you do as well, I love what you do.

Thank you.

That you need to deal with that, that people don't really heal and do well when they are living in fight or flight. I think the practices— and that's why when they do this work for their bones, all of a sudden they're more relaxed, they're happier, and everything changes. I think addressing that piece is equally as important as making sure you're eating the right foods.

Yeah.

And you're doing the right exercise.

Yes, I love it. Do you have any advice for women who are premenopausal, who are still, you know— so I was taught that you create bone and make bone until maybe your 20s, and then you kind of hold on to it, and then 30, 35, you start losing your density and it's all downhill from there. So What would you say to women who aren't, you know, menopausal, they're still hormonally, you know, reproductive, and they're at minimal bone loss at this point? What is your best advice for keeping those bones dense and healthy?

Okay, great, great question because this is the time not to forget about it.

Yes.

To really, really take action. So I think things like jumping, you know, where maybe someone— I mean, they did a study, and not that I recommend this for everybody, but of people like jumping on one foot. Okay. And they found that the leg that they had all that weight on had increased bone density. So there have been plenty of studies showing you can increase your bone density. So I would say do jumping, you know, or do jumping jacks, do different jumping as long as it doesn't bother you. There's lots of different exercises. You can do that high-intensity exercise as long as you're doing it in a safe way. Yes, for people who are premenopausal, go for it. Really do that kind of exercise where you're really getting forces on your bones. I think the exercise, eat well, make sure you're— all the things that we would address later, address now, and the things that you address with all your patients. Your patients are already going to be in much better shape because— You're already addressing all these things. All the digestion, but I think the exercise is key, at least twice a week. If you can just jump even every day, even a little bit, it's going to make— they've done studies showing just that. Doing the resistance training, doing the high-intensity jumping and different things, as long as you do it safe and it's not hurting anything, I think that's really important. Being active is so important. I think the exercise— this would be the time to really up your exercise as well as just really look at your diet. It would be a good time to evaluate everything, really make sure. There's also tests that can be done to see if you're getting your micronutrients. Some people aren't sure, but just a good diet that seems to have everything. I think then your stress, what are your habits? I also teach happiness. They've done studies showing life satisfaction is correlated to bone density. I think doing practices not only to reduce your stress but increase your happiness just will change everything. I think that's what I would tell people, that at that age, great. You're going to make such a big difference. It's so much better at that time. Stage to do things because they— it does help. I mean, most of the people— I mean, the people I work with do not go on medication. You know, they found that they can— as they know. And the other thing is the bone density is only one part. The bone density just shows how much bone there is. It doesn't show the quality. You know, so if you're eating well and exercising— I mean, there's some new tests, the trabecular bone scoring and some other things that are looking at the Quality that I think is really good. But you know, so many people are think, "Ugh, my bones!" Just because of the bone density. But there are two bone densities. One bone can be much healthier and able to absorb forces that if you did fall, you wouldn't fracture it. So I think that just looking at your life and all of those things that are going to affect your overall health are going to affect your bones as well. But the exercise piece, I think, makes sure you're just doing. things that put force, because the bones respond to the forces placed on it. So—

Yeah, and the joints do as well, right?

I mean, everything kind of works in tandem.

And when you are putting force on those joints, you're lubricating them, you're making those tissues moisture and more elastic. And the same goes for the bone. They stimulate those bone cells to grow new bones. So I, I think one of the biggest things I see with regards to bone health is that darn pop or soda, depending on where you live in the country. It just leeches your bones.

Yeah. Oh my goodness.

And women think they're doing themselves a favor drinking diet pop or diet soda. And I try to explain to them, it's just leeching the minerals out of your bones and putting it in places you don't want it. too, you know, and they don't usually believe me until they get a kidney stone. But I think that's to your point, like, you need to evaluate all aspects. You need to look at your diet and your movement and your stress management. Do you see POP as an issue often?

I do. I do see that as one of the issues, but yeah, I immediately say, you have to get off this because— and the other thing, yes, you're so right with that. But I think people have reduced that on their own. I mean, I think a lot of people that I see, maybe because they're older and they know how terrible it is versus younger women, think they— but yes, absolutely, there are people who— but the other thing that is so big, just like that, is sugar.

Yes.

Sugar just reduces your absorption of your calcium, your magnesium. It's such an anti-nutrient. There are people, and I was one of those people. I was truly a sugar addict. You just want more. It tastes so good. You just want to keep. I had real issues that I had to just stop. It's been years now. It's probably been 20 years since I've been off sugar, or a long time. Yes, I see that as a very big one, the sugar.

Okay.

As you said, some people, sure, with the pop, that's Yes, absolutely. I call it soda, so I'm not convinced that you're right.

Yeah, I think only in the Midwest we call it pop. I don't know where that came from, but that calls me out of where I'm at. Oh, man.

So— Yeah, I lived in Chicago and they called it pop there for several years.

Funny.

So back to my mom, you know, she recently took up tai chi, and I know that you use that as part of your programs as well for the balance And for the bone health, what other modalities are you incorporating into your practices?

So, so tai chi, I love. I mean, tai chi, they've done lots of studies actually and showing that. And I think the reason it's so good— and balance is critical because balance is one of those things, if we don't use it, we lose it. So I tell everybody to do balance exercises every single day because you don't just fall, you don't just break a bone.

Right.

Typically, it's from a fall. The more you can work on your balance and get yourself nice and stabilized— what I like about tai chi is that you're moving different planes. You're moving forward and back. You're moving side to side. Your body gets what's called proprioception, how you move in space. space. And, and so then if you trip, you have that because you've been practicing that motion versus— I also like standing on one leg, some yoga poses, the tree pose. I like all that, and that's certainly good. There's like so many different areas of balance. It's not just one thing to do. But I love Tai Chi because it's movement, so you're really getting balance in movement. And I think that's why in any of the research studies, Tai Chi has really shown to be one of the best. It's for improving balance. So I love tai chi, and there is some research now that you can even increase bone density with that. But, you know, that's still— or at least maintain. It's still ongoing. But yes, so I'm a very— and I love qigong also. It's similar, but just because it's relaxing and energizing. And anytime I'm a big person, positive, you know, bringing positivity in, And reducing negativity. So when I do all the qigongs, like, you're just bringing in positive energy, and I feel that that just carries you through the day and really helps with everything, you know, because oftentimes people— there's 2 different attitudes. Oh, I have to go on this treadmill because my bones are so bad. I have to do this exercise. That versus, oh, I get to do this. I'm bringing positive energy and I'm strengthening my bones, increasing my vitality. So there's different ways to look at it. So I do lots of things. So yeah, so I believe in traditional strength training, you know, with weights. I believe in— I mean, it depends on each person. You have to find what they like. As I said, I have numerous people who love Pilates, and that's great. There's resistance in that. I have other people who don't really love strength training, but they'll do it, you know, maybe for 20 to 30 minutes twice a week because they know it's strength, and then they make it to That's fun. And then they'll do— like, I'm a swimmer, you know, swimming doesn't really do much for your bones, or— but they can do other things that they do like, whether they like dance. Dance is great. So there's so many different things that you choose. And in terms of modalities, there's so many ways as well to reduce stress. I personally meditate, but not everybody wants to do that. So we have to find— even for some people, going in the woods, taking long walks, There's many, many different ways. Some people journal. In my programs, I teach so many different options. It's sort of like a smorgasbord. You can pick what resonates with you because if you try to do what's good for this person and it's not what you feel in your heart, it's not going to work. It's just going to be more stressful. I think that with everything, it has to be individualized and you have to sort of say, What's working for you? Because what works— a diet, one man's diet is another person's poison. It's really true. So often she'll say, oh, well, this one said I have to eat this, this, this, this. No. Yes, you need certain things. Yes, you do need the magnesium and you need all of the nutrients, but it can be in many different ways. So yeah. Did that answer your question?

I love it. So important to realize that we're individuals and what works for my sister might not work for me or for, you know, my best friend. We all have our own root cause issues that need to be addressed. And so I think it's super imperative to work with a functional medicine practitioner or certified health coach to really uncover the layers and figure out where your root cause is. And it's It's funny to me that every episode it all comes back to lifestyle, diet, gut health. Like, whether you're talking about healing your bones, balancing your hormones, losing your weight, you know, like healing from childhood trauma, it's all the same premise of you have to do the work. You have to make your lifestyle healthy and loving and positive. Like you said, you have to change how you think about it and look at it and change your mindset. And so I just love this functional medicine community because we're all working together, right? It's so awesome. But I would love for people to check you out because I think your programs are just so comprehensive that that's why they work. And women need this. And not only postmenopausal women who've already been diagnosed with osteoporosis, but tackle it before you get that diagnosis. Prevent that diagnosis, right? Like, get your bones healthy now. Do your exercise, get your balance up to par, get your diet on par. So I just love the work that you're doing and that you found your purpose through your son's health journey and everything. I just think that's so beautiful.

So, oh, well, thank you. Well, the funny thing is Just what you said, because I've been working with people with osteoporosis for over 25 years, actually. Exactly. It's individual. Every person is different. Everything, as you said, like with functional medicine, everything sort of falls in place. It was interesting way back when I was being a physical— I was working with chronic pain. I had just gone through a really bad situation. People were like, Marjorie, you're so happy. What are you doing? I thought, gosh, if they only knew what I had just gone through, they would never say that. But I realized it was an inside job at that moment, and it wasn't based on your circumstances. And then when I started teaching them some of the happiness tools that helped me, all of a sudden, like chronic back pain, chronic neck pain started getting better so much faster. It was amazing how powerful all of this is. And then— and so I've been doing that for like over 35 years. It's just so interesting that it's all— everything works together. I learned that really early on. But good for you that— I just love what you do because you bring that to gynecology. I mean, that's so fantastic and you affect the lives of so many women. So I think it's great.

I really do. Thank you. Yeah, I feel like I have so many more tools in my toolbox now, right? Actually help them and not just, you know, cover up their symptoms. So tell everybody where they can find you. And you mentioned that you have a free postural—

what did you call it? So my website is margiebissinger.com. So M-A-R-G-I-E, B as in boy, I-S-S-I-N-G-E-R.com. And I also have a podcast, which is called Happy Bones, Happy Life.

Yes.

And so that's been really fun. And, and so yes, the free gift. So go to happyboneshappylife.com/gift and you'll get the posture exercises. And there—

I will put the link on my show notes because that is great. I think everybody needs to work on their posture. I know I do. And you know, I was gonna mention earlier when you were talking about that, not only does it increase your fractures, but I think it was a huge reason I had a herniated disc in my lower back because of my bad posture. All my years of studying and, you know, sitting hunched over studying, you know, hours on end, I had herniated discs in my neck and my lower back. So I think— wow, everybody needs some postural help. So thank you for sharing that.

You're right with that though. When your back is Rounded. I used to teach back school and I also did ergonomics. I still do. But when your back and your low back is rounded, that puts your disc in that situation to push forward, back. And as you know, but yeah, absolutely. And now with us, you know, home so much, people are sitting a lot more.

Yes, definitely. So check out that postural exercises, super needed for everyone. Oh, thank you so much for being on today. You've just— you're so knowledgeable, and I think everybody needs to think about this.

Oh, well, thank you for having me. It's been such a pleasure, and look forward to staying in touch.

Awesome, thank you.

Thanks so much.

Bye.

Bye-bye.

Well, wasn't that great? Margie is just a wealth of knowledge when it comes to bone health. And I want you to start thinking about it.

I don't want to wait until you come to me when you're 65 and you have osteoporosis.

That is not when we need to discuss bone health. We need to discuss it now.

I want you moving your body. I want you looking at your diet and seeing how you're eating. Are you eating enough fruit and vegetables?

Are you getting enough lean proteins and healthy fats?

Are you still drinking pop or soda?

You got to get rid of that for sure. Sure you're not smoking or doing anything like that, but that all affects our bone health. Alcohol use, so you want to keep your alcohol like 1 to 2 drinks max for women because that can also leach your bones. So I would love for you to incorporate one little change in your life based on this podcast. You know, if you do that with every podcast, those little changes will add up significantly, and by next year you could be a new woman.

So shout me out on Instagram or Facebook and let me know what change you're incorporating. What are you doing? What are you adding? What are you taking way to improve your life and your health? I want to know. Keep me abreast of what's going on.

So I hope you have an amazing week and support your fellow women. Get out there, do your best, be your best, and never give up. Just keep starting over, keep trying.

That's what it's all about, is just trying to better ourselves and each other, right?

So have an amazing week.

Bye! Bye!