Build Bone After Osteoporosis

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What are you waiting for? Good night. Yes, you can build bone after osteoporosis. You can reverse bone losses. If you have osteopenia, yes, of course, for you. So if you were diagnosed years ago, you were told something far different. But today, research is showing positively that 3 unique exercise types contribute significantly to bone health. There's more, and I'll share another research resource at the end. But to get the recent update on research and put an end to fear about movement and exercise when you have low bone density, this episode is for you. I'm Debra Atkinson. You're listening to Flipping 50, where I address your top struggles and concerns. But most of all, we want to uplift and inspire you and give you the confidence to expect and demand better services and better products that are made for you based on research featuring women just like you. Because let's face it, the hormones that you have at midlife are not anything like a young athletic male's in 20, 25 years. So we can't expect that research done on males in the prime of their life will work exactly as they do for him for you. So we're all about using 100% of the research featuring just to you in our protocols. So let's dive into this and start talking about it. Stay till the end after the questions and of course the introduction of my guest today, Belinda Beck. This is, by the way, from the What, When, and Why to Exercise for Women 40 and Over Summit, and I will leave the link in the show notes for today about how to get access to that bundle if you missed the summit. The bundle and recordings were something that were scooped up by a lot of people who attended, so if you missed it You can still get your hands on that, and that means you have access to all 40 or 39 of the interviews with yours truly being the interviewer, and you have them to listen to over and over again. So there's no rush, but you can put them in going for a walk, and there are going to be some that have so many great nuggets in them you're gonna want to listen again. So show you how to get that, and I'll show you how to get another resource that will help you not just gain bone density, reverse osteoporosis with exercise, size, but be sure you're stopping the loss of bone density, which is something that not enough people are talking about. My guest today is Belinda Beck. She's a professor at Griffith University, Gold Coast, Queensland, and the Menzies Health Institute in Queensland. She founded the Bone Clinic as a translational research facility and clinical practice providing evidence-based exercise for patients with osteoporosis. Belinda graduated from the University of Queensland and the University of Oregon, and completed a postdoc research fellowship in the Stanford University School of Medicine. Her work, primarily related to the effects of mechanical loading on bone, has involved both animal and human models from basic to clinical research. Her particular focus have been exercise interventions across the lifespan for the prevention of osteoporotic fracture and the management of bone stress on injuries in athletes and in military recruits. Recent projects have included the LIFT MORE clinical trials, findings of which inform the HonorO exercise program implemented at the Bone Clinic and licensed for delivery by exercise physiologists and physiotherapists around the world. There are a lot of great questions that we answered in this episode, so I want you to stay tuned for things like the recent research, of course, on bone building after osteoporosis and how much the research has changed and why it was time for it change, kind of strength training exercises that are proven most effective, what strength training repetition range for bone density would be optimal if in fact your bones could safely tolerate that, and why is it so important if you're busy or low on energy that you know exactly what to do. All right, let's dive in. Belinda, thank you so much for joining me.

You're welcome. It's great to be here.

I love this topic. I think you're going to be one of the very favorites because I think any woman who's over 50 is either watching or watched her parents probably fall, get frail, worry about fracture if they didn't get a fracture, and now realizes that it's time to get serious about this and that she's at risk. So let's talk first of all about the type of exercise that builds bone. And one of the reasons I want to set you up with this is we've had a lot of speakers talk about the importance of finding exercise that brings joy. And then Debra is like, can I just insert something? But if you don't like exercise that builds your bone, you still need to do a little bit of that. You still, you know, if you want longevity and you want aging and optimally aging, we still need to address this. So let's really talk about First, is there a continuum of what builds bone density when we talk about exercise, and what is the best if we were giving the gold medal?

Yeah, that's a great question. There, there is a continuum, I suppose, but at the very low end, you know, it's probably— there is also some risk. So Likewise, at the very high end, there's also risk. So it is a little bit of a balance. In the main, because I, you know, I'm an exercise advocate because it's so great for all systems of the body. I tend to be a little obsessed with bone, but I'm conscious that the rest of the body is dependent on it for its health. So I have a little bit of a mantra that anything is better than nothing. Because moving and using your muscles, exerting forces on bones, is always going to be better than doing nothing. So even though I would say that exercise that is weight supported, such as, you know, swimming or cycling, is not what I would recommend for building bone, it's still good because you're still using your muscles, and those muscles are the ones that are going to stop you from falling. However, if you've only got a very small amount of time to do your exercise, you want to get the most bang for your buck. And I call bone the princess tissue because it's the one tissue in the body that really needs a very specific targeted exercise program, unlike the others which benefit from virtually anything. Bone needs a high-intensity kind of exercise because the way it responds to load is by bending. And it's that actual bending, those little micro strains in bone that creates the signal for bone to respond. So if you want to build bone, you have to load it as heavy as you can tolerate. And of course, there are some caveats in there if you have very weak bone.

And I think this is something that probably somebody that you know and have come across— I know he knows you— the bone coach Kevin Ellis is also here and talking a little bit about how you know the quality of your bone and are suited to it. But I think this is an interesting phenomenon that at least 20, 25 years ago, you know, when we were talking about exercise for bone density, at least to prevent bone losses, we would suggest, you know, high-impact activity. And, and then it was like as soon as someone was diagnosed, it was like, oh, don't do that. Because you might be hurt. And what I love about having you here— so spoiler alert, I'm going to give it to you right away, people— is that we no longer have that belief. If you were up to date in the science and what's happening now, which is why I want to know, did you feel like you were going out on a limb? Because not everybody has the same belief system you must have had. You know, given you made a hypothesis or had a theory about what was going to be best, you've actually done some rule-breaking or groundbreaking, at least, things in regard to bone density.

Yeah, we, we absolutely felt like we were going out on a limb. It was the most terrifying scientific moment of my career, I would have to say, because of course none of us want to cause harm and I suppose it was the way that we tested it was the safest way I could, I could possibly do it. Um, but the motivation for doing it was so great because I kept hearing people saying, oh, you mustn't load people with osteoporosis heavy because you'll break them. And I looked around and I couldn't see any evidence where anyone had actually tested it. And that's not science, that's that's sophistry, that sounds like a good idea, but there's no proof for that. So, but what we did know is there was proof from animal studies and from kids and young adult studies that you can load heavy and grow bone. So I thought, okay, well, we'll get some experts, some people who are very well trained in this particular kind of loading, and we'll have very small groups. We'll train them in technique so that their technique is perfect, so we protect the most risky structure, which is the back, and we'll introduce the program gradually and begin to load more and more heavily slowly. That's exactly what we did. And we tested over a period of 8 months because you need that amount of time for bone to adapt. And lo and behold, at the end of it, we grew bone. And we had, out of about 50 women, we had one minor back strain during one exercise, which she just did. Went to physio for a week or so, came back and kept training. So I would say the answer to the question, can you do it safely and effectively with people with osteoporosis, was a definitive yes. And then we went on and tested the same thing in men.

Love that. Okay, so can you give us an idea of what is how heavy? So for everybody listening, in terms of strength training, intensity comes from how heavy a weight is. The heavier the weight is, the fewer repetitions you can do. So talk a little bit about how many repetitions, what was the load, was it to temporary muscular fatigue, what was that like?

Yeah, and as you would be aware, it's— intensity is such a fraught topic because everybody's perception is so different. And we thought that maybe we would use Borg scale, and those of you who familiar with that. It's a— it's either a 10-point scale or a 6 to 20-point scale, strangely. And, uh, and you sort of— we were aiming up in the sort of 8 to 9 to 10 sort of range, or 8 to 9, I would say, and then on the 10-point scale, and probably above 16 on the 20-point scale. But people didn't really know what that meant, you know, what, what is that value? So then we talked about 85% one repetition max, but then with osteoporotic people, you don't really want to do a one repetition max test, right? So, so that's not, not useful. So what it, it distilled down to is we use reps in reserve. So we, we say that for a high intensity loading, you probably need to be able to lift it with good form 5 times and have maximum of 2 reps in reserve. If you've got any more than that, it's not heavy enough.

Good. Good. I mean, a lot of people can identify with that. I think a lot of times somebody wants to know what does that look like? Like, what does exercise to fatigue really look like? And that's like, oh, that's an interesting question. But I think there is that description of you're getting to— this is really the last couple that I could do, or I know I'm going to start cheating, you know, and, and if it's supposed to be with one muscle, I'm going to start doing some of this and getting the shoulders up to the ears with that kind of cheat. Love that. So why 5? What made you choose like 5 as opposed to— notoriously, National Strength and Conditioning Association would associate 10 reps or fewer with 80%, and now that has been associated with best for bone density. Why 5?

Probably because the person that I was working with was training in Olympic lifting, and that's what they considered to be sort of high intensity. And in the literature, there is actually a paper published. It's a consensus statement, I think, American Heart Association, where they have a little rubric which shows that high intensity Resistance training is less than 6 repetitions, moderate is 8 to 15, and low is above 15. Now, of course, that leaves a little hiatus between sort of 5 and 8, which I don't know how that managed to get through the editorial.

Poor 7. I know, right?

So I think the point is, and one of the reasons why it's so important that aside from the inherent risk, it's so important to have supervision for our program is because a lot of times people are not really aware when their technique is going to heck. And so having someone say, yes, your form is great to 5, you've tried 7, and on the 7th one you looked a mess, you're lifting the perfect weight. But if they get to 7 and their form is fine, we say, well, let's put 'Another 2 kilos on and see how you go.' And, um, and psychologically, that works very differently for different people. You know, there are some people who are so nervous about increasing their weight because particularly terrified of having a fracture if they've already had one. Yeah. Um, but then there are others who are so competitive, self-competitive, and, you know, just want to keep lifting, so they're just anxious to put on more weight. 'Yes, yes, please do.' So they're the ones you have to wait or watch and make sure that their form is not deteriorating.

Talk about the variety of moves. So you— we actually started this, you know, with if you have a limited amount of time. And I think we can also say to the, the group of women that we're talking to, a limited amount of energy, right? Because we're still like all the things, um, and, and everybody's got their hand up. Yes. That's me. So we all want to know what's the best use of that time. If you were going to do a workout and you've got a short amount of time, what exercises would you focus on if bone density was your primary goal?

Well, if I told you, I'd have to kill you, Debra. So because the program is protected by intellectual property, of course. So yeah, Onero is a licensed product. So we don't give out the specific exercises, not just because of actual property. But it's because I do worry that when people learn it, they will go and do it in their garage without proper supervision. And we'll see vertebral fractures like crazy. And the worst thing in the world would be for our program to cause the fractures I'm trying to prevent. So I don't tell— talk about the precise exercises. But I do talk about, you know, you're probably going to want to do compound movements where you're using, you know, whole body if you can, make them functional, make them something that you would be, you know, you're constantly using in day-to-day life. That one of the most common problems people have where, as they age and become sarcopenic, or, you know, considerable muscle loss and weakness, is getting in and out of the car, up and down off the sofa, particularly if it's a soft sofa, getting on and off the toilet, in and out of bed. So obviously squats is going to be, you know, that is a, you know, a quintessential movement movement that you are going to want to preserve. And so I'll give you that one for free.

Well, and I think we can— so we know in the literature, right, the zones or the osteozones are the wrist, the spine, and the hip. And so that lends back to, you know, a squat, you know, wanting to work on that hip, hip fractures, downward spiral, right? And if you if you actually are headed for a fall, breaking your fall with your wrist, everybody puts their hand out, right? You know, and so that's a very small joint. And a lot of times that's how somebody finds out they actually have low bone density or osteoporosis for the first time, is they're going in to get that fracture X-rayed, right?

Exactly. Yeah. And the great thing about some of these compound movements is if you're holding onto a bar, you know, and it's heavy,, then you are automatically loading your forearm. So you're also working your wrist, which is, you know, so you get this double whammy. And the important thing, I suppose, is that we're not— it's, although I love bone to my very core, the, I have to remind myself and everybody that muscle is also— if bone is king, muscle is queen, or whichever order you want want to put those in. And it's so vital that we keep our muscles intact. We don't want to lose muscle. The more muscle you have, the stronger you'll be. But we also want it functioning. So you just want to exercise it in those movement patterns that you're going to use. There's another thing to remember, even as you do get stronger. And we've had people doing our program with us for over 7 years, and they're they're, they're different people from when they first came. But, you know, they're, they're feeling wonderfully strong. They've got their life back. They're doing all sorts of things they haven't done before. But I do have to remind them that we're doing safe lifting with our body in a position where particularly the spine is being protected. That doesn't mean that they can go home and move the fridge, or, you know, which, believe me, they try. They feel so strong and confident, and they probably can move it, but they're not doing it in such a way that they're protecting these osteoporotic bones. So lifting your grandchild up onto a slippery slide, you know, that's a really awkward movement, and kids' arms and legs going everywhere. You know, that's not the sort of thing that even though you probably could do it, you probably shouldn't be doing it. When you're carrying your groceries, I'm sure you can pick up a grocery bag that is 15 kilos on one side, but you shouldn't. Put those groceries into 2 bags of 7 kilos and carry them in both hands because that way you're protecting your spine. So you still got to be spine smart even though you're getting strong. Your muscles are telling you you're strong, but your bones still need to be a bit protected.

Yeah, I love that. And I think that goes to so many movements we could probably throw out, you know, reaching over into the trunk, right, and pulling something out, or Not thinking. I think because we've done things so automated our entire lives, but some of the most complicated things we do are getting out of bed, right? I mean, we're flexing, extending, and rotating within seconds of just waking up and then in and out of a car. And until you're hurt or injured, you take that for granted.

And one of the classic ways to hurt yourself, you know, we all carry handbags that are probably way too heavy, especially if you've got a laptop in there. It's in the back seat and you're driving and you discover that you need something out of your handbag. You know, that movement, turning around between two seats, groping for your handbag and lifting at great distance from your trunk, this very heavy weight while your spine is twisting. It's the worst possible thing you could do for your spine. BLT.

So talk a little bit about that. So other, other programs will— back prevention programs, back prevention or back pain prevention programs will mention BLT, like bending, lifting, and twisting. Each of them independently can be a risk for the back, but you put them all together, now we've got even more. Do you want to, you want to talk about this just a little bit. Hopefully you don't have to kill me for this one. Or I mean, I'm really going down here, but yoga, yoga for bone density. So there is a study with Lauren Fishman that proves 12 yoga poses, 30 seconds each, can improve bone density. It's got longevity even.

But, you know, I haven't seen a good quality study that has shown that yoga poses per se can improve bone mass. I'd be very interested to see that. Most of the ones that I have seen, the sample size has been small, or there's been a level of bias that has sort of reduced my confidence in the program. I think yoga is a fantastic exercise, and if people love it, they should do it. But there are certainly some exercises poses that are included in, in the yoga repertoire that you would want to avoid. So deep forward flexion, particularly loaded, particularly really forced flexion, is something that somebody with a fragile spine wants to avoid because the fractures tend to happen at the front of the spine because it's not as supported as the back. So there's definitely some evidence that, that certain yoga poses do increase the risk of fracture, and those I, I am familiar with.

Great. I'm so glad we touched on that at least. And, and actually, for all attendees, I tried to reach out to Dr. Fishman to actually come on and talk about that, you know, to open up my eyes and/or to dig into the controversy and to talk about whether this is on a continuum. So we could say that coming off the couch and doing yoga is definitely better than nothing, but maybe not as good as walking, or that's then skipping, or then lifting weights. And where do does it fall in and who most benefits? I think there's a lot of questions there.

Yeah, and if I would put it in the same category as Pilates in terms of the loads that the bone— Pilates, probably slightly larger loads that the bones are being exposed to because the forces are probably greater during the muscle contractions. There's plenty of evidence showing that Pilates is not a particularly it's not an effective bone stimulus. And so because I'm aware there is a Pilates-like program that is marketed as a bone program, we actually tested it against the Onero program and showed that across the year— it was an 8-month intervention, as we always do— where the high-intensity loading, the Onero program, grew bone. The people in the Pilates group lost. So it's not an effective bone stimulus. But again, you know, remember, it's not all about bones, about staying on your feet. And perhaps Pilates— and I would be, I'm certain Pilates will reduce your risk of falling if you're doing it systematically. So it's not all bad, but it— but don't do Pilates if you're trying to grow bone. It's not going to work. And, and I, I would I would be very surprised if yoga grew by very surprised.

Yeah, similarly. But I mean, there is some significant research. I'm going to send that to you, by the way. And I will put that actually in your resources too, for you who are attending. So you can see that question for you about impact. So talking high intensity, talk about impact a little bit. So there's several studies out with series of exercises progressively getting more and more greater impact, but from dancing to walking to stepping to stomping to jumping to hopping to big jumps, jumping jacks, and the value there and the stress to joints. So talk about the impact. Obviously, we land on our feet. The majority of us do anyway. I'm not doing any handsprings anymore. I don't know about you. So the impact comes through the feet. So by the time it comes upstairs to the knees, to the hips, to the spine, talk about impact and benefit to bone as that load travels up.

Let's talk about in a healthy population, and particularly in kids and young, robust, healthy adults, impact is is fantastic and necessary. It's the thing that we— our skeleton perceives even relatively low impacts just from, you know, walking around, walking very, very low impact, but maybe running up and down stairs and walking, carrying something and so on. All of those impacts add up to a signal throughout the day that tells our body that we're walking in Earth gravity and our bones need to remain this strong to maintain that. We know this because when you send people into microgravity, we lose bone like crazy because that gravitational force on our bones, which comes from those micro impacts, is so important. So unloading, putting somebody in bed rest also has the same effect. You know, spinal cord injuries has the same effect with the bones below the injury. Losing a tooth,, you know, you'll— the bone around the, the tooth above and below will result because it loses that force. We know that removing force is bad. What we have to do is achieve a balance between what is healthy and safe for our bones, uh, from those— that continuum that you just described. So in kids and healthy young adults, any kind of impact is great. And the more the better. Well, that's not technically true. Running marathons every day is not necessarily— it's not good for your bones. That you'll have a wear-out kind of effect. A bone will wear just like concrete will wear.

Yeah.

So you have to give bone time to recover from that. But certainly you need at least 50 impacts a day of some kind to keep yourself, um, your bones, you know, operating the way they're supposed to, and it's at the mass that they're supposed to Now we add Impact into our program, but we definitely titrate according to the person. I'm not sure if your listeners are, are not, um, familiar with T-scores, osteoporosis T-scores. They're essentially a standard deviation, and osteoporosis is defined as -2.5 standard deviations of bone mineral density from a young normal. This is somebody who's 20 years old of your same race and sex. Now, if you're down in the -2.5 sort of range with osteoporosis, you're immediately at much higher risk of fracture. So we have to be very careful how we introduce the impact. And we would start with, yes, marching on the spot and increase that to a stomp. So individual feet, and then we would probably progress to maybe heel drops., and then little jumps with bent knees and hips landing. And then we just progress that as, as you, um, become bigger, stronger, we go to full jumps. And the stiffer the body, the more that impact stimulus is getting throughout your body. So the more you stiffen up your ankles, knees, and hips, the more you're going to feel.. So if we're looking at somebody with a T-score or a standard deviation of -4 or worse, I'm probably never going to be doing stiff-legged impacts jumps with that person because we just can't improve their bone mass to a point where that would ever be safe. So they're probably back at heavy stomping, maybe heel drops, and then we just keep track of their pain. And of course, we have this huge population with osteoarthritis who have been told ever since they had their first symptom that they should do no impact. Um, we know it's not true. Um, in fact, there's a really good study showing that impact is good for mild to moderate osteoarthritis. So pain is their guide. You just start really gradually and your, your cartilage, the, the musculature around the joints will adapt to accommodate it. And eventually you'll be able to tolerate much more than you originally could, even if you do have OA.

Very good. So I want to come back to something. So with somebody not with OA, so just osteoporosis, so if we take arthritis out of the equation, is there a point where you see— so a lot of, a lot of us call this also like hypertension, you know, like the silent killer that a lot of people have no pain, although they do have osteoporosis. In fact, they're shocked and somewhat insulted to find out that they have it if they've been active people. We just don't like that.

Yeah.

Is there a point if you see a T-score where there often is an association with pain has set in?

Bone is typically not painful unless something is wrong with it. You know, if there's an osteosarcoma or, you know, some kind of growth, or in the spine if there's a protruding disc or something and the pain radiates to the bone. Fracture is what causes pain in osteoporosis, and quite often fractures are undetectable.. And so, you know, people will have these micro fractures in their spine which are not detectable on an X-ray. There's no change in shape. It's just the whole thing is slightly more compressed than it was before. So those little micro cracks are probably what's causing this transient pain. Or as the bones do become more compressed, then they're going to encroaching on the nerves that come out from the, the intervertebral foramen. Now, if somebody does have an acute sort of really noticeable fracture that is detectable on an X-ray, sometimes they don't even notice that pain, but most people would. If you had a wedge fracture where it just collapsed at the front and you've got a really noticeable— you would feel that, and that would be painful for a number of weeks. Eventually it goes away. The bone won't grow back into its original shape, so you're stuck with that wedge fracture unless you have surgery. But, um, it— the pain is in response to some kind of injury or condition. Fantastic.

So question: so most of the people that you see at the Bone Quest Bone Clinic, are they taking medications or are they opting to come and see you instead of taking medications, or are you seeing combination of both?

They're doing, they're doing everything they possibly can? Yeah, another great question. The answer is, is it totally depends. Probably about 20% of people who come to us are on medication, and about 15%, let's say, maybe even 10%, want to stay on their medication. So many times people are coming to us because they're on meds, but they need to do more. Either the meds aren't working, or they're just so low they need to do more, or they realize that exercise is going to be good for them. Others are coming to us because they're on meds and they don't want to be on meds and they want a reason, an excuse to come off. Now, we really discourage them from coming off their medication. If they're on there, their doctors have put them on there for a reason. We tell them they should stay on, but of course they don't listen to us, and so they come off their meds. So it's a bit of a moving feast. If they do that, we just counsel them. We watch them very carefully. We give them their results after 12 months and say, you know, and did we manage to, to still improve their bone mass, in which case they're happy. If we didn't, then maybe they need to go back on their meds. And, and that's—

it's a constantly moving number. Got it. Thank you for offering that. Okay, so I want to ask you one more question because I think you've alluded to this, but, you know, a woman gets a diagnosis often of osteoporosis, and sometimes it just, you know, it's like somebody pulled the rug out from under you because often that comes at a moment in life where you are really looking forward to what's next. So you're looking forward to some freedom and some travel and life the way you dreamed about it feels like it may have just been taken away from you because there is this unknown. So you alluded to, I mean, there are changed people, right, after they've trained with you for 8 months or for a year. Talk a little bit about that. I mean, and the maybe missing confidence or feeling of loss they might be feeling when they first find it versus the transformation they experience?

Yeah, I definitely witness people with really the wind taken out of their sails with this diagnosis. They look at it as some kind of weakness, and of course it is, but it's genetic. Most of the time it's nothing you did, except perhaps not exercise enough, which which you probably didn't know. But absolutely, your life is not over. It absolutely should not stop you from doing anything you want to do. It probably will just change the way that you do it. And you can— the minute you start exercising, becoming stronger, and growing bone, you're going to recapture the old you. And you'll believe it and feel it. But there's no need to feel like you are going to break at any moment. That's not what osteoporosis is. If it's very, very low, you're probably a very frail older person anyway, and probably, you know, not at early retirement stage. But even if you are, there is absolutely something that you can do. You can definitely make yourself stronger.

Your life is is absolutely not over. Beautifully said. Well, Linda Beck, thank you so much for the— number one, for the work in the world that you're doing and the eye-opening that osteoporosis is something that we all probably will have to deal with in, in one way or another, especially those of us that are going for triple digits. You know, it may, may be something that we want to definitely prevent and, and may or may not have to deal with. But thank you for being kind of at the forefront of leading, you know, a willingness to stand up for all people who are dealing with it. Where can, where can our viewers find more about you, follow you?

I should have had an answer prepared for that, shouldn't I? Probably the first place to go is just to type in The Bone Clinic, and, and so, uh, that information will come up so you can sort of learn about the program. Um, certainly I'm on, um, LinkedIn and ResearchGate and, and, um, I'm at the, at the Griffith, um, University website. There's an experts panel there. Um, so yeah, you can easily find me if you type my name in. I'm the crazy Aussie who works in Queensland and is obsessed with bone health.

Well, thank you so much for being here. There you have it. Gold, right? So now you've got much more, I hope, of an uplifted, optimistic viewpoint of, okay, look, I can't do anything about the past. I've lost bone. I know where I am now and I can reverse it. So it's a trifecta at the very least of doing the right exercise. And there are 3 types of exercise, not just strength training, but there's other impact and there's other ways to fit in types of exercise that you can safely do. So every day of the week you could be doing something positive. More podcasts are here this month in Menopause Month in October of 2023. So if you're coming to this after, it's not too late. You can always go to the search icon in the upper right-hand corner of the Flipping 50 website and search for the content you want. Bone density, osteoporosis, osteopenia will bring up a huge amount of new and recent resources, content that you can access for free—podcasts, blogs, and Flipping 50 TV shows. So if you're looking for more research and more resources, so I mentioned first of all the recording bundle to the What, When, and Why to Exercise for Women 40 and Over. That bundle is available, I'll put that in the show notes. But the second thing I want you to take advantage of, and again, it is also Osteoporosis Day occurs this month on October 20th every year annually, so it's a perfect time to be thinking about this. And because it also happens to to— this is a female-laden month for sure. It happens to be Breast Cancer Awareness Month, and we're not ignoring that this year. We're just focusing a little bit more on the broad-based. If we're observing all of these health practices for our bones, for our muscles, we are also pouring right back into breast cancer risk reduction and support for recovery and survivorship. But the other core that I'm going to offer to you is, of course, a masterclass by the Bone Coach, my good friend, uh, Kevin Ellis, delivering a free masterclass. I'll put the link to that to join it in the show notes. And that is an eye-opener about not just what is happening in terms of the losses in the bone and the exercise, but how you prevent losses. So if we're wanting to reverse losses, that's great, but we don't want to have continued losses occurring. How do we know that that's not happening? What's the best way to measure we're talking a little bit about testing, we're talking about your gut health and what's happening there. So if you've been ignoring signs or symptoms like bloating, gas, constipation, diarrhea, they're not just irritating, but they could actually be sucking some of that bone density right out of you. So we'll put some of the details in the show notes, and let's put a stop to that right now, and so that you can also share that with other younger women and men in your life. Show notes today will be at Flipping 50 flipping50.com/buildboneafterosteoporosis.

Flipping50.com/buildboneafterosteoporosis. And what are you waiting for?

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