Bone Density Updates for Women Over 50

Welcome back, friends. Those of you who are OGs and you've been listening potentially since 2014 when we started this podcast— it, by the way, is the second of my podcasts, the first for health and fitness coaches on tips on how to grow your business or start one. So if that's you, you could head over to She Means Fitness Business and listen to that one. But for those of you who are brand new, hello also to you. I'm so glad that you're joining us, and we I cannot wait to actually dive into this one. I love this topic. I've been talking about and educating about bone health, osteopenia, osteoporosis, the exercise guidelines. But back then in 1995, it was all very segmented. Here's what you did if you wanted to prevent bone loss, prevent osteoporosis or osteopenia. Here's what you did once you were diagnosed, and it was very dramatically different. Thank goodness we are in 2025 because it is very exciting to be here knowing we can reverse bone loss. We are not fragile. We don't have to be scared, certainly, and Ideally, you're not, because that's actually when falls happen. We just don't want to take risks unknowingly. So this episode will be most likely the first in a series. I want to keep this digestible, so I want to give you enough content today and go deep enough on it so that you actually have practical, practical, applicable items, and that was hard to say apparently. When you're done listening, you know, okay, here's how I shape up my weekly workout so that I'm doing the best possible that I can. And we're going to go into multi-layers, so I'm going to lay it all out for you. Let's dive right on into this one. Here's the deal. Misinformed from perpetuating outdated information from both doctors and trainers since 2015 and beyond, 2015 and beyond, evidence of not only increased safety and viability of high-impact and high-intensity exercise for osteoporotic postmenopausal women is much more promising than prior goals of just stopping or slowing losses. But a lot of us are still misinformed. Doctors literally are telling you that you can't reverse bone loss, and I want to set this straight right now. So yes, you can reverse bone loss. You're not going to build bone, and there's a big difference between what I've just said, although it may not sound like it. Let's unpack it. You're not going to build bone beyond where the point of your peak was. Now, generally Naturally, we peak in our bone mass at about age 30, and then we coast for a little bit. You know, we, we aren't necessarily packing the bone on just as a natural part of growth, but we can coast without losing it. And the same happens to muscle. I'll go into that a little bit deeper, but that's building bone. That's at a point of our lives we're still building bone. We're still— I like to call it banking bone because those withdrawals can start to happen, by the Okay, but there is a difference between that, getting to the peak, and reversing losses. So let's say you got to your peak and then you're doing a bone scan later, as I did for the first time at 58. And I'll talk about that too, those of you who are feeling your doctors making you wait till you're 62 in some cases, or 65 in others. That's not your doctor, probably. That's your insurance. But when I realized, okay, compared to a healthy female, a young adult, I got scores of osteopenia in 3 sites— the 3 main— we call them osteozones at one point. They're now just called the most likely to fracture, like in high school. So that is your wrist or your forearm, it is your hip, and it is your spine. And when I realized, okay, that's where I'm at, I have successfully, between that and the next year when I did a follow-up test, been able to increase my bone density so that I'm now at normal again in two of those. One of those was going in the right direction, but I'm due for another update on a test. I just need to get it done. I'm, I'm packing boxes instead these days. I don't have time for that. That's not a good statement, by the way. I was illustrating how we can let life get in the way of taking care of our health. But I want to illustrate to you, yes, true, we're not going to build bone beyond the point where we once were at peak in our young adulthood. However, if you've lost since then, we will be able to reverse those losses. Now here's the caveat: you and I don't actually know where we got to. So that supposed normal bone of a healthy young adult of the same sex— so if guys did a DEXA scan, they would be compared to men. For us, obviously, we're going to be compared to females. But We don't know where we were, so we're just being compared to the average. Maybe we got higher than they did. Maybe we didn't get as high as they did. Sadly, today we should be worried about our youth because there are a lot of adolescents that are supposedly not increasing in their bone density. And so they are going to have far more likelihood of becoming osteopenic, osteoporotic. Earlier in their young adulthood, men and women, because they're not moving as much as we did. I want you to think about your own childhood for a moment. Just reflect on it. And I don't know where you grew up, but I'm sure that had a big bearing on what our childhoods were like. For me, I was in the middle of the Middle West and small town, and we knew everybody pretty much on the town, definitely everybody in the block. And after dinner, I would get up from the table, I would go out the back door and they said, where are you going? I would say, I'm going outside. That was the answer. And it got to be a joke because when I was younger, of course I didn't think about it. And then my parents were just like, whatever, you know, but I was going outside to the backyard where my big backyard bumped against my friend and neighbor's backyard. And all the friends would come over and we would play kickball or kick the can, or we would go to the old lady's house with the perfect garage and do Annie Annie over and probably irritate the heck out of her, but we didn't know it. And, you know, we would play hide and seek. We would ride our bicycles to the swimming pool and stay till close and ride our bicycles back. We were active almost constantly when we weren't in school. So for a lot of kids today, If you drive through neighborhoods, even in the middle of the Midwest after school, you don't see kids outside playing, and that is part of the detriment. So where are they? Maybe they're inside watching television, they're inside watching screens, maybe it's on a computer. Young kids also have phones, so there's a lot of things potentially going on that are interrupting kids' health and activity. But what it's also interrupting is the building of their bone for later, for now in their lives. Now forward, fast forward for them to the age we are now. So I want you to realize it is possible for us to reverse bone loss. We're not going to build beyond our peak. For you and I who may have children, grandchildren, children of childbearing age, is really important to encourage those kids to get away from screens, to entice them with activities, with games, with toys, and things that they can do actively, things that you can do with them. And I think it's gonna be part of our role, and I am very much looking forward to it. As I record this right now, in the next 5 weeks, 5 weeks from right now, I will be sitting in some office somewhere in Iowa where I am moving in order to be close to my grandchildren and my children actually, because it's a privilege to get to watch them be parents. So there's that. I say children, I have one biological son, but I feel like I got a daughter. So there's that bonus. So realize that we can do something, but I wanna give you some statistics that are quite alarming. 41% of women over 40 in, in a particular study— I'm sharing all the references— either had osteopenia, that was 31% of them, or osteoporosis, so greater than 14%. That was in a 2010 study. Let me say that differently: 30% of women over 40 had osteopenia, and more than 30% of women over 60 have osteoporosis. More than 30% of us. So if you and I are sitting in a group of 3 friends One of us, one of the three, has osteoporosis. The further we are from menopause, greater than 10 years, the increase in the prevalence of osteoporosis is 40% compared to just 5 years post-menopause where it's at 9% of us have osteoporosis. A lot of numbers, but Suffice to say, osteoporosis, low bone density, bone health should be a real concern. At the same time, I'm going to go down this entire rabbit hole and we're going to focus on bones, bones, bones, bones. But I want to make sure that you understand this, that muscle opens the door to being able to do the things you need to do for bone health. If you're weak, If you're frail, if you don't have much muscle pulling on the end of the bone at the origin and insertion where it goes, your bones are weaker. So muscle enables you to do the things that result in bone health. And that relationship is like, boom, it's tied so closely together and we cannot separate it. So very important distinction. And it all happens for females so much more rapidly than it does for males. Estrogen decline occurs, bone benefit stimulus are lost. There's just— it's your insurance policy. And we're okay up to a point, even though we may have started making it easier to lose bone density after the age of 35 when we start withdrawing from that bank. If we're not strength training, resistance training, getting high-intensity impact training, or we're, we're not eating high protein or adequate micronutrient density. I think that is important to, to, to be a consideration. So I hope you realize we've got to look at all of the things, and I'm not just saying bone, bone withdrawal, bone loss is imminent. Look, you know, it's easier to lose bone, but it's not mandatory. And yet I will say this, I've been lifting weights since I was 20 in college, uh, took a class and then became a PE major, and I never looked back unless I was injured. Actually, I mean, even through pregnancy, the, the week I was pregnant, see, I think Wednesday was the day I delivered. I probably did squats on Monday, and, you know, was probably back at it shortly after that, doing walking at least, not, not potentially squats. But realize I had a lot of stitches, by the way. That's why. So realize that, you know, you can't outrun your overall history and You know, I hesitate to say that because it's true that your epigenetics, your lifestyle habits matter so much more than genetics. However, you know, I've been lifting heavy, I've been doing high-impact, low-impact lateral movements, all the things in terms of jumping and stress for bones and muscles for decades. But there was probably a time in college where I was too thin, where I was doing so much cardiovascular activity that you can borderline going the wrong way, right? If you're— you don't have to have an eating disorder, but you can be borderline exercising so much that you're actually breaking down more muscle before then you can build it up because we didn't have the rest and recovery in between. Now remember, at 20 or 25, you can get away with it because you're at peak of muscle mass. You can kind of look at weights and be fine, right? I don't— you don't even have to lift them, you know, although yes, it helps. So realize that there's that. And you know, I can't remember how many Diet Cokes a day I probably had when I was in grad school. My, my schedule was crazy. I taught early morning aerobics, and I mean like really early morning. I don't remember if the class started at 6 AM I think so. So I think I, I want to say it wasn't 5:30, but it might have been. I think it started at 6:00. It was 6:00 to 7:00. So I had to be in my car by 5:30, and that was the start of my day. Like, I did that. I, 6:00 to 7:00, I taught a class and then potentially took a shower and went to class at 8:00, which wasn't my favorite, but I needed to go because it was statistics, you know. And, or I actually went to another club and taught another class at 8:30 if I needed to do that. And, you know, there were days that maybe I taught again on those 6:00 AM days, I also taught a noon class. And then there were days on that same day, I taught a 5:30 class, 3 classes one day, sometimes 4 classes one day. And I would get up in the morning and instead of having coffee, I would have Diet Coke. So I would have 1 or 2 Diet Cokes like at 4:00 in the morning before my day got started. By the afternoon, I was kind of shot. I probably had another Diet Coke. Not great for my gut is what I'm getting at. So you can't outrun that. So there was a period of time where I'm doing a ton of activity, probably not eating great. I don't know what your diet was like in grad school. You know, what I did eat was healthy, but I just, you know, it was here and there between 3 Diet Cokes a day. Nobody needs that, right? So lots of things that might have interfered with my absorption of whatever I might have been taking in that may or may not have been enough. You cannot outrun that, and I want you to remember that. Then it, you know, a couple years after grad school, I'm pregnant. Do you know what happens during pregnancy? Well, I'm going to talk to you about it because you and I probably are influencers of the generation of women who is having children, or maybe for you it's your a little bit older than me, you have daughters when you were really young and you're already watching granddaughters start to have children. That's a possibility too. So things to think about: how can we express our influence and help others understand how to take good care of themselves? But as our estrogen declines, we also have a decline of the benefit of of bone stimulus that we naturally would have had. So we have to work a little harder, eating more protein, getting more rest, decreasing stress, because any of those— not eating enough protein, not enough sleep, or high stress levels— will actually sabotage our overall bone density. 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See website for full details, important safety information, and restrictions. So there's that. All right, so let's chat just a little bit about what comes next, and I want to give some vocabulary notes to you. So osteoblast, osteoclast— here's where the estrogen kind of played well for us and where we don't have that playing well so much anymore. So remodeling and modeling of bone is happening constantly. My best description of this is— I love the analogy of making pancakes. You know how you pour in the batter into a warm griddle and basically it's like the bubbles come and then they go away? And it's kind of watching this happen in this matrix happen until you turn Turn it over, you're seeing this all bubbles and then fills in and bubbles. That's kind of like what happens with bone. And so osteoblasts are what build up and fill in the holes with new formation of bone. Osteoclasts are what break it down, like old worn-out bone is removed, and then that leaves those holes that we need osteoblasts to come in So they're key cells in bone remodeling, the whole process. They work together in a tightly regulated cycle of, okay, breaking down the old breaks down and there's a rebuilding, and that process is regulated by hormones like estrogen. And as it declines, the remineralization that occurs and the rebuilding process, which makes bone strong, it gets edged out by the breaking down and the removal of old bone. So it's like, okay, move it out, but nothing's filling that hole, right? Not great. Two types of bone, and I think of this like an M&M, although it's not soft in the middle, it's a little bit more soft and pliable, and then the M&M coating on the outside. I hope I'm not making you hungry for chocolate, but there's cortical bone and trabecular bone, and you kind of want to distinguish between the two. Cortical bone is the dense, solid outer shell. It's like the coating on the M&M. Trabecular bone is a spongy, more porous— surprisingly, it's metabolically active tissue. Like, it gives, and it needs to. So when we land from a jump, you know, you would expect if you had really bittle brittle bone, it would just break if you did something like that, but it doesn't. It gives a little and then extends. So the cortical, that, that dense outer shell, not going to give as much, but the trabecular bone inside is spongy. It's more porous. And how do we test and know how our bones are doing? Also an important thing. So when we're talking all about Well, what's your bone density? How are we— how do we know that? Like, how do you know you have osteoporosis? The gold standard is a DEXA scan. It stands for dual-energy X-ray absorptiometry. So it's reported as a T-score, and the T-score is easiest to understand. So you will also get specific marker numbers. They will be like decimal points, like 0.41, 0.45, for instance, you'll get that at each site. But what's really much more measurable to us and been presented to us is the T-scores that tell us, do you have normal bone or equal to normal bone? And do you have less than normal bone but not yet as bad to be diagnosed as osteoporosis than you're deemed osteopenic. And then if it's really bad, it's up to 2.5, -2.5 standard deviations from normal bone, it's lower, and that means it's osteoporosis. So let me give you those again. Just, you know, from 1.0 or higher, it's normal healthy young adult, same sex. So then you— -1 to -2.5 is osteopenia. And in fairness, that's really -1 to -2.4, but -2.5 or greater loss is osteoporosis. So that's where you're like on the scale. But you can reverse, right? So if you get to osteoporosis, doesn't mean you can't get back to osteopenia. If you're at osteopenia, doesn't mean you can't get back to healthier bone. Now, your score there, we're never going to know unless you test at 30. So TBS, a trabecular score— remember we talked about trabecular is the bone in the middle, the spongier, more porous side that gives a little. That TBS score is the quality of your bone's internal microarchitecture, which can independently predict fracture risk. Now, depending on your physician and what they've ordered, you may never get that score. You might ask for it, ask if they've done it or do it, but it is an independent fracture risk indicator. Now, probably they're only going to do that on those of us who are really frail, and let's just hope you never reach that category. So, you know, it's funny how, you know, they would only test if it was really that bad. Similarly to insurance will only cover this when you're 65, which is I'm sorry, stupid. Like, we're only gonna pay for it when we know you will be osteopenic. Like, we're not gonna pay for it if you're 40 and you shouldn't be osteopenic. Whether you are or you aren't, we're not going to pay you to find out when you could be more proactive, which is absolutely crazy. So if you are going to pay for something In regard to your health, this is one of those things that I would invest in. It's one of the things that I want to invest in for my daughter-in-law. I wish that we had done it before she got pregnant, but they were speedy, like they were fast. So they got married October 19th, and, uh, for my Christmas present, they showed me the pregnancy test. Like, they're like, can you see that picture? Look closely. They're like, expand it. I'm like, oh my gosh, are you kidding? So it was very early. We didn't obviously tell anybody, but I didn't have a chance to give it to her. So I would have loved to get her a DEXA scan, and I'll tell you why. So let me talk a little bit about testing, and then I'm gonna go segueing right into who should test. So that TBS score, again, probably only going to be given to somebody or recommended to somebody who's frail and we could already guess they're already at high risk for falls. Why do we need to confirm the fact? Doesn't seem to make sense to me. But I would also recommend, and sometimes it will be, sometimes it won't, that if you've done a test about osteoporosis, low bone density, and that got your attention, I would also recommend that you and I do something that tells us what is our nutritional status related to bone density. And I know so many of you go right to, I'm taking calcium. And there are a lot of people, self-included, that would say that's not the first thing that I would recommend. There are a lot of people that think we're getting adequate calcium in our diets. I mean, unless you're just absolutely— you're not drinking any milk alternative. And you don't have to be doing dairy, by the way. I haven't done dairy since I was 30. I, you know, I— and I take that back, I do it occasionally. So I will have some cheese, but I have goat cheese or I have lactose-free cheese. I have tried off and on to do Greek yogurt because, yeah, it's great, high source of protein, but it doesn't agree with me. I can either see, you know, right away difference in my skin and breakout, or my digestive system just doesn't like it. And, and that's really where I was. I stopped doing dairy because I was running. I was running, training marathons, and there's just so much mucus that you deal with, like runny nose, sniffing, stuffy, um, kind of phlegm. And sorry if you're being a little grossed out right now, but that disappears immediately when you go off of dairy. And so it just made, you know, running so much easier and less congestion, less sinus issue, fewer colds, less flu, clear skin. I mean, everything got better. And alternative milks, even then— so milk has 300 grams of calcium. The alternative milk, like almond milk, would have more, like 420 milligrams. And now I think it's even more than that, it's even higher. So if you have basically 2 cups of milk a day, alternative milk, you almost have your base covered. And then you have instant incidental calcium in a lot of other foods. And if you're eating a healthy diet, you're actually eating good combinations of food that help the absorption of the calcium as well. So it's really important. But a lot of people would say, don't just check your calcium levels. And if you check in your blood, you're checking for calcium levels in your blood. That's not where you need it. But check your vitamin D and your magnesium levels because they're what help get the calcium into bone as opposed to in your bloodstream where it can actually calcify and cause heart problems. I want you to hear that again. The thing that most people want us to do who are experts in bone health and nutrition will say, don't supplement with calcium, make sure you're supplementing with vitamin D, with 3 D3 with K and magnesium to be sure you're getting the calcium into bone and not just into your arteries. That's an important distinction for all of us to make. But I used to present a lot on osteoporosis and osteopenia when I was, um, back in 1995 when I was still working at a university. I was a kind of in a community where I was well known as a fitness expert And, and I would take around a list of foods and I would hand it out. You know, if you have salmon or canned salmon with bones and you have broccoli, an adequate serving, you can't just have a tiny little bit, and you sprinkle Parmesan cheese on the top of it. Now there's dairy, got it, got to give you that. Or cheddar cheese on the top of it. And you have sesame seeds, you know, if you've had a couple of cups of alternative milk, I mean, you are well over your quota for the day. That's just an example of some higher ways to get it purely from your diet, not necessarily needing to supplement. So something to think about there. Who right now is recommended to test doing a DEXA scan? And by that I mean, and covered by insurance. So all women 65 plus, men 70 and older, and menopausal women also between 50 and 69 with elevated risk factors. Or I would say this, you have a proactive physician, because I first was told by my doctor just at a normal routine checkup, she's like, well, we should do a bone density test too if you haven't had one. And there was nothing, you know, structurally wrong with me. I'm sure you could come up with a lot of things that might be arguably wrong, but nothing was, you know, suggesting that I was at high risk. I mean, if anything, I'm vibrant, strength train, do high impact, you know, I was the opposite of who you would suspect. But she was just proactive. So I also think probably a factor of insurance, but it's not like she stopped and said, what kind of insurance do you have? She— as long as your physician justifies it and writes it up, generally insurance will cover it. I'm just going to throw that out there. But also, who else should test? Because those are probably no surprise related to age, right? During pregnancy, 3 to 7% of bone loss is common because of the fetus's needs. They're going to be met first. So it's like if you're not drinking the milk and getting the high protein— and by the way, I did not drink dairy milk during my pregnancy either. So I had started or stopped dairy prior to that, and I just wasn't a big milk drinker, but I was doing alternative and realized that the calcium amount was greater anyway, so I, I didn't have any problems doing that. But had you known where was my bone density before pregnancy so you could look at what happened during and would— did you bounce back? So keep listening. During pregnancy, 3 to 7% of the bone loss that you've got, um, that peak is lost. During breastfeeding, losses can continue and they range from 1 to 3% per month. So imagine basically you are the sole source of nutrition for that child and it's pulling all of the calcium out for you. So, you know, if you breastfeed for a year, 1 to 3%, 3 times 12, wow, that's a lot, right? So, and go to those moms who do it, but you also want to make sure you know, you're probably continuing to take that prenatal throughout, and you're getting calcium-rich foods every place that you possibly can. Bone density recovery is pretty rapid for, for these young women. So there's not like they're in this status, but the body, the human body is so amazing. So bone density recovery is rapid after breastfeeding stops. It occurs between about 6 and 12 months months after stopping, returning to pre-pregnancy levels. So again, if though you are somebody who turns around on purpose or accidentally and happens to get pregnant again in rapid succession, you know what will happen. So you're going to be already in debt, you know, and go further in debt So then after that second pregnancy, will you bounce back? So it's an interesting dilemma and I haven't gone far enough down that rabbit hole to know that, but I would be really interested for you who are listening, who are moms who have done that, reply. I'd like to know if you did that, you got pregnant, maybe had a really young child within you know, the first 6 months of their lives, or even the first 9, 12, if you were breastfeeding and then went off or still breastfeeding and got pregnant again, you know, where, where are you now and what's your bone status? I'd be really curious to know that. So double-check. Let's, let's dig into that. But if your daughter, daughter-in-law, was measuring her bone density at her peak at about 30, which is exactly where we were with mine, we would have been able to take a little snapshot and then say, here's where you were at peak. So my goal is when she's done breastfeeding that we're able to do that after about 6 to 12 months so we can look at where are you now, because it's as close to peak as we're going to get to see ever. Before you're 50 or 60. And then when you do a DEXA scan at that point, you'll know I'm comparing me to me. I'm not comparing me to some quote-unquote norm. You'll know where you are and how you compared when you were that young adult yourself. So I want to open up this, and then after will take a pause. So want you to understand the ideal exercise. So bone density peaks at about age 30. We coast a little bit until about 35 when we will begin losing bone easier than we maintain it. And recall that muscle peaks at 25. We can coast a little bit till about 30. So remember, we probably preached this over and over in the last couple of years. With all the longevity experts, with myself— I've been saying it for 4 decades— but now that you're hearing from more than fitness experts, more than medical exercise specialists, you're hearing from physicians, you're hearing from longevity experts, that we peak at muscle mass at 25, we can coast about 30, and at 30 we start withdrawing on average about 3 to 8%. Of our muscle mass historically. Important to say historically. You and I don't have to. We can bump up our protein, we can lift weights at least twice minimum weekly, and we can get better sleep, stay away from stress, and hold on to our muscle. Those things do matter. So Note that we will lose strength before we lose muscle mass. There are some critical points, and at age 60, we tend to see— we tend to see at 50— let me back up— we tend to see strength begin to, to go down if we're— again, if we're not doing something about it. Now, at 60 or at 50 myself, I actually started to go the opposite way and lift heavier much more frequently. So by that, I still do a periodized kind of a program. I don't go up, up, up and expect it's going to be linear. We have to go up, up, up, got to take a recovery, and then I can go up, start a little higher, and take a recovery. And there are cycles of months and seasons where it's also a little harder, a little lighter. I'm playing more, doing other things, so it's lighter weight here to maintain. It all matters. You have to have a plan really. And the older we get, the more that's true because we only have so much time, but most importantly, we also only have so much energy and you wanna be sure that you spend it right. It's not that you're fragile. It's not that you have to do less because you're fragile. It's like, this is my budget of time and energy. I need to get it right. I can't like, "Oh, I might go to barre or I might go for a walk. I don't know. I'll move somehow." You know, not if it was a day you need to strength train. Make sure you get that in. Be on purpose when it comes to that. So let's talk in descending order the exercise answer to bone density. That means best or most important first. Number 1, and there are 4: resistance training. So resistance training, I qualify, and you should too, as anything where you're resisting gravity or you're resisting a load and something is preventing you from doing it. So it might be bands or tubing. It— we could qualify resistance training is yoga and resistance training is Pilates. If we wanted to. I don't— just saying. I really want you to reach muscular fatigue with a specific amount of repetitions. 6 to 30 is the answer. If you go to Pilates— and I am a Pilates registered Pilates mat and reformer instructor— it's more like a buffet. You do 10 of each thing except for the 100. Clearly. But you could do more if you wanted to, right? It's not that you're at fatigue or muscle fatigue. We're not actually taking the muscle to the point of muscular fatigue. Do you get a little stronger doing some of those things? Yeah, probably stronger than you were before you started, but then you're just kind of tuning up after that. You're maintaining that muscular endurance but not necessarily gaining a lot of strength. I think that's an important distinction We want you to gain strength by going to or near muscle fatigue, meaning you put it down, stop doing it, and a minute later you could go again. That means muscle fatigue. That's not exhaustion, it's not failure, and you're broken. You're just gonna need a rest. So we need to make sure resistance training starts light if you're a beginner. Because we have to lay the foundation for connective tissue, like your ligaments and tendons, so that you don't get injured. Your ligaments and tendons basically connect your muscle to your bone. The musculoskeletal system, they're all three involved, the muscle, the bone, and the connective tissue. That is that piece that kind of seals them together. We start with light and then we slowly over time progressively increase to a moderate weight. Moderate is, by definition of researchers, about 15, 16 repetitions. And for up to about 48 weeks, you're going to see improvements in bone density according to science. And after that point, there is often a plateau where you may need to go with heavier weights in order to see additional benefit. Now, at some point, you or me are probably going to find we're at a point where I can't lift anymore, or this shoulder old injury feels like I might get hurt, or this current shoulder, or I, I'm achy when I do that, and I feel vulnerable when I do that. We will find we all have a place where I've hit my limit. I can't go anymore. And the reason for progressing is slowly finding that, not sharply finding it, because we know that that is an injury, right? So with reps in reserve is reaching fatigue. So 2 reps in reserve, or RIR, for experienced exercisers, we need to get that close. For beginning exercisers 5 to 6 repetitions in reserve is actually enough for you. And intuitively you will know it. You may be asking, well, how will I know? How will I know if I'm there? You will. It's like when you're moving furniture and you're carrying one side of a couch, you know, you know what, I'm going to set it down before we go down those stairs. Just give me a minute. And you knew you didn't drop it, but you knew I needed that break. And similarly, your body intelligently knows actually, it's your brain. It will protect you, so you will, you will get there. Number 2 is impact training. So doing some kind of jumping— counter to previous conservative approaches to exercise— with impact or intensity, as in heavyweight training, postmenopausal women with osteoporosis experience no more fracture risk and high adherence rates and positive bone density improvement from a high-intensity— that's 5 exercises done 5 times— and high-impact jumped training. And they were— imagine this— drop jumps from an elevated height equivalent to, say, jumping off of your kitchen chair. So imagine what would that would look like. Don't try this at home if you haven't built up to it, because they didn't start with that. The recommendation from the studies is 5 to 7 days a week. So we can say most days a week, but it's probably good to count or X off the calendar. 4 sets of 10 to 20 jumps and allow a minute or more between and consider the value of intermittent stimulation throughout the day instead of all at once. But look, here's the deal. If you just need to do it and get it done and you weren't doing you've still gained great, a great deal. Intermittent tapping into the bone like this morning and at noon and the afternoon and in the evening might even be better, kind of like even distribution of protein throughout the day. So realize that you have ways that you can break that down. You make it what it needs to be, but try to get that. So for those limited to low impact because of of complications, maybe prolapse or incontinence, previous injury or joint replacement. Maybe you currently have no cartilage in knees and jumping is just not your friend. Heel drops. So raising to the toes, dropping down hard on your heels and stomps, like literally stomp your feet, stomp upstairs, provide ground force within a level that is called significant. So it's the lowest, and you cannot baby those heel drops. You have to be really dropping in order to get it, but they have been deemed significant in terms of bone density. So I will— inside our mini course that we're creating for those of you who are already in the VIP membership, you'll have access to this. If you want the mini course together with slides that is really an amplification and a broadened extension of this podcast. You'll, you will be able to get your hands on that at the Flipping 50 site when it's ready. There are 2 more categories. We've hit the top 2. Resistance training twice weekly, 3 times has minimal additional benefits, by the way. And if you're not recovering between the workouts, it may have less benefit because you won't be lifting as heavy. So resistance training and jump training. Number 3 is increased daily movement. Just that, it's like totaling it up over the week, at least 300 minutes of physical activity. But that includes movement, includes going for a walk, getting your steps in. Including the jump training here in this though, per week is correlated with lower risk of osteoporosis. Aim not only to exercise during short windows daily, but to be active throughout the day. Meaning don't just say, oh, I worked out today, and then sit the rest of the day. The more you are resisting gravity— so right now I'm sitting to record this, and I will get a desk, uh, I will get a desk elevation so that I can stand up, a standing desk. Yes, that's what I wanted to say. Say, so that I can move around just a little bit more. I have a desk bike sitting over there. This is a desktop structure though, so it doesn't work really well for this. But all of those little things from sitting to standing, from standing to marching, from standing to exercise biking, even if it's low level, the movement counts. And the more ways we can be movement through— in movement throughout the day, the better. Okay, the skeletal system is still resisting gravity in a bone-beneficial way. The fourth one is daily yoga poses. You might be surprised by that. I certainly was when I first heard it. Research by Dr. Lauren Fishman found that 12 yoga poses performed for 1 minute each— 1, meaning if it's right and left, it's 30 seconds, 30 seconds— no argument with that. With postmenopausal women with osteoporosis in a longitudinal study lasting over 7 years, increased bone density on average by 1% every year. 1% every year. So consider that average losses of bone if we're not doing anything or intervention are 1 to 3% after where postmenopausal That's a difference between the study subjects and what normally happens to a woman, or could, of between 1 and 4% in the right direction. That's really fantastic, right? So chances are the increase in mobility and maybe in mindfulness and somewhat in balance are also added benefits from the yoga poses. Dr. Loren Fishman was on a summit I did in 2023, and he admitted that one of those poses is corpse pose. And I sat there and I said, Dr. Fishman, do you mean to tell me that corpse pose causes bone density? I said, I'm gonna have to play devil's advocate here, and I'm so sorry. As an interviewer, I want you to be right, But tell me about this one. And he said, you know, that was just for a reward if they made it all the way through. So he was probably pushing 90, closer to that than 80. And so he did admit that they are underway with research to distinguish which of those 12 poses most contribute. To bone density. He said nobody wants to be in the group that doesn't, you know. But we're trying to say, you know, is it tree pose? Is it warrior 1, warrior 2? Is it triangle pose? What is it? So that we can really narrow it down. Because wouldn't that be great if they could not just give you a 12-minute thing, but they give you a 4-minute thing? So for those unable to do heavy or to do high impact You've heard already the heel drops may allow you to do some kind of impact. The stomping, another idea, and movement, simply moving more, but that's probably an added asset once you're resistance training and doing high impact alone. It's not potentially enough to increase bone density significantly, but then you do have here the yoga option. The other option, and I will open this up for you, would be whole body vibration where minimal movement is necessary. There are balance moves, they're very easy and gentle static poses, postures that you can do that could actually help increase and enhance your bone density. So I'm going to leave you with and tease just a little bit for next time. If you have questions about today, we're gonna dive in. We'll do a quick summary at the beginning of the next episode of everything we've gone over today, but so many things for you here. Number one, I have a favor. If you are one of those moms who had children very close together, and you wanna share your bone density status right now, or any concern that a doctor might have expressed to you about your bones at that time, I'd love to hear from you. And number 2, if you have daughters, young daughters-in-law, and depending on your birth order and theirs, maybe your grandchildren are beginning to be of childbearing age. Is encouraging them to get a bone density scan at 30, at about peak bone mass. Something that you'll consider doing? I'm curious to hear from you. And, you know, don't know what she might be thinking—fun mother-in-law or not—but I'm definitely giving one to mine. So just a little peer pressure, friendly peer pressure for you there. Until next time, friends, if this was helpful, I love to hear from you. Shout out to me in direct messages, those DMs in Instagram. I look at those, I see them myself. No one else is tending to that behind-the-scenes kind of stuff. And let me know if you would please share this with a friend or two. The more women that know we have more power than we've ever known and that we've ever had about our physical bodies, and that is the vehicle that you will be sharing the gifts that only you have in the coming decades. What are you waiting for? Let's start Flipping 50 today.