156: Women’s Bone Health: A Conversation with Dr. Lisa Moore, DPT on Osteoporosis

Get ready to be empowered during this episode with Dr. Lisa Moore, a doctor of physical therapy and founder of Brick House Bones®. She shares essential insights on preventing and managing osteoporosis through practical, accessible strategies. 

Together, we explore key topics in bone health, the role of nutrition, and how to equip yourself with the knowledge and tools to take charge of your long-term bone strength.

Spoiler alert: Don’t miss Dr. Moore’s advice to her 30-year-old self, it’s a powerful reminder for any age.

We dive into:

• What age should you get a bone density scan (DXA scan)
• The three nutrients you should focus on for bone health
• Prevention in your 30s, 40s, and beyond
• Effective exercise strategies you can incorporate today
• The critical shift from fear to strength, a mindset for lifelong bone health
• How many prunes should you eat a day 

Helpful links

• Dr. Lisa Moore’s Official Website, Instagram, YouTube, and Facebook group
• Clean Food Dirty Girl Meal Plan Club
• Protein Recipe Collection
• Calcium-Rich Creamy Amaranth Breakfast Porridge
• Iron and Calcium Rich Smoothie

About

Dr. Lisa Moore is a Doctor of Physical Therapy and the founder of Brick House Bones®. Her mission is simple: to help people with low bone density or osteoporosis rebuild confidence, strength, and resilience so they can keep doing the things they love with the people they love.

She is trained in bone health exercise through BoneFit™ and the Institute of Clinical Excellence, and she uses the latest research to provide modern, evidence-based management for older adults. She is also a certified yoga instructor, bringing together science and movement to create safe, effective workouts that truly make a difference.

Transcript, auto-generated, may have errors

Molly Patrick:
Hey there, and thank you for listening and/or watching this episode of the Clean Food Dirty Girl podcast. I have a treat for you, and I know that a lot of you out there are going to be familiar with my guest today. We have very similar communities with a bunch of overlap, and I know a lot of people in our community have found her.

We have Dr. Lisa Moore with us today. She is a doctor of physical therapy and the founder of Brickhouse Bones, a global movement helping people with osteoporosis move from fear into strength. I love that. Her mission is to help over a million people around the world build the confidence and capability to do the things they love with the people they love. Dr. Lisa, welcome to the episode. Thank you for talking with me and for taking the time. I think this is going to be a really helpful conversation. I have a lot of questions, and I know the community will get a ton out of it. Thank you for being here.

Lisa Moore:
Thank you very much for inviting me. It’s my pleasure to be here.

Molly Patrick:
Your mission is to help people go from fear around osteoporosis to empowerment and knowledge. Can we just pretend we’re talking to people who don’t know what osteoporosis is? Can we start with a basic definition of what that is and any information you can give us?

Lisa Moore:
Absolutely. Osteoporosis is a decrease in density—that’s how much bone you have—and the microarchitecture, which is how that bone is organized. This can happen for a variety of reasons. That decreased density and decrease in microarchitecture means we have a risk factor for a fracture. It is tested with a DEXA scan (D-E-X-A), which tells us what our bone density is. From there, we figure out if we are at risk for a fracture and how to proceed.

Molly Patrick:
Thank you for that. At what point would one get a DEXA scan? I’m going to be 46 this year and I’ve never heard my doctor talk about a DEXA scan. Is there an age where people should start getting these?

Lisa Moore:
The standard recommendation in the guidelines is that most physicians won’t recommend you get one until age 65. However, in women’s health circles, we are recognizing that is often too late; we want to have this information as early as possible. We are understanding that bone loss is connected to perimenopause and menopause. Being a postmenopausal female is one of the highest indicators that you may have osteoporosis.

We lose a lot of that bone density in the last year of perimenopause and the seven to ten years following. Those last two years before we even enter menopause, while we’re still having cycles, bone loss is accelerated. Therefore, people should get tested sooner. The sooner we can get a baseline, the better. At your age, I would absolutely have a conversation with a physician about getting a DEXA scan now so that you can take action. It is better to prevent bone loss than to try to recover it after it has already happened. There is absolutely good reason to have these conversations in our early 40s.

Molly Patrick:
I’m going to contact my doctor and do this ASAP because I am really curious. You bring up a good point that we talk about in the whole food plant-based community: there’s a wonderful window of time to prevent lifestyle-related illnesses. If someone is my age or a little younger, what can they do to preserve as much bone as they can before they reach that point of major loss?

Lisa Moore:
Hopefully, as young adults in our twenties, we are building peak bone mass by getting enough calcium, protein, and impact exercise. Once we hit peak bone mass at about age 30, we can maintain until perimenopause.

If you are in your 40s and hitting perimenopause, it is a time to have a conversation with a menopause specialist. Hormone therapy is FDA-approved for the prevention of osteoporosis, which is a tool many in the generation ahead of us did not have. Beyond that, we need to look at nutrition. Are we getting enough calcium (1,000 to 1,200 milligrams a day)? Is our vitamin D level adequate to help absorb that calcium? Are we getting enough protein? Bone is significantly made up of protein—it’s the collagen matrix that the calcium and minerals adhere to. The collagen matrix makes bone strong and flexible while the minerals make it hard.

On top of good nutrition and minimizing highly processed, inflammatory foods, we need to give our body the right stimulus through exercise. For someone in their 40s with normal bone density, there’s no limitation. If you want to lift heavier weights or do impact exercise, you’re in a prime opportunity to maintain your density. A multimodal approach—resistance training, impact exercise, and weight-bearing activities like walking, jogging, or Zumba—is the best way to go.

Molly Patrick:
What about someone who is older and postmenopausal who hasn’t been focusing on these lifestyle factors and just received an osteoporosis diagnosis? What should be their first focus?

Lisa Moore:
The first thing is to know that you can do something about this. Clients tell me every day that they suddenly go from living their life to worrying about everything: “Am I going to break if I pick up my grandchild?” or “Will I fracture stepping off a curb?”

What I want people to know is that you can take control with specific steps. There are specific exercises to improve posture, which decreases stress on the vertebral bodies of the spine. We can also work on balance. These are two of the easiest entry points to reduce fracture risk quickly. There’s a “principle of initial values” which tells us that people who come in at the lowest functional level actually have the greatest potential for improvement. People can go from being below average in strength scores to above average in a matter of weeks. We just have to start at a reasonable pace, build movement confidence, and learn modifications—like how to bend over or pick things up smartly—to reduce risk.

Molly Patrick:
You mentioned balance and posture as entry points. Do you have some specific tips for posture in general?

Lisa Moore:
Regarding posture, a hundred years ago in physical therapy school, they taught us to analyze every symmetry and asymmetry. We have since discovered that much of that isn’t necessarily connected to back pain or dysfunction; we may have overthought posture to a degree.

However, specifically to osteoporosis, posture is very important because it changes how stress is placed on the vertebral bodies. This is the area of the spine most vulnerable to low bone density. This can be the difference between having an extra curve in the thoracic spine (hyper-kyphosis) versus normal kyphosis. If you’re flexed forward, you can’t raise your arms very high; if you lift your heart, your arms can go all the way up. Posture is tied to shoulder health and fracture risk.

Exercises that have us extending up are protective. These can be passive, like lying flat on your back with support for your head and reaching overhead. It’s very gentle, but it allows for lengthening of the spine, which is the opposite of the “forward” position we are in all day with computers and devices. I ask people to do “posture snacks” every day. I’ve seen people in their 50s through 70s gain a quarter to a full inch in height just because they corrected their posture.

Molly Patrick:
That’s amazing. Let’s talk about balance.

Lisa Moore:
Eighty to ninety percent of all fractures happen because of a fall. Balance can be static, like a tree pose in yoga, but that’s not how we typically fall. We fall when we’re moving—when we’re distracted, turning our head, or catching a toe on a curb.

Balance training needs to be dynamic. It needs to involve the vestibular system (inner ear), the kinesthetic system (joints and muscles), and the visual system. This means sometimes balancing with eyes closed or while changing your gaze. Practical things like stepping over obstacles—like a baby gate or into a tub—become difficult as we age if we don’t train those movements.

Molly Patrick:
Janet asked about the difference between osteopenia and osteoporosis. What is that distinction?

Lisa Moore:
Bone density is calculated on a scale. Minus one to plus one is considered normal. As the number becomes more negative, the bone density is lower. Minus one is the threshold for osteopenia, which is a precursor to osteoporosis. Osteopenia is between minus one and minus 2.5. Once you hit minus 2.5, that is the threshold for an osteoporosis diagnosis.

Molly Patrick:
Janet is 59, takes supplements, exercises with weights three times a week, and eats whole foods. She wants to know if there is anything more she can do and if the condition can improve.

Lisa Moore:
Yes, things can improve with the right environment. At her age, she should discuss hormone replacement risks and benefits with her doctor. Her exercise routine is great, but the amount of effort matters. If you finish a set of exercises and it felt like a four or five on a scale of ten, you aren’t getting the stimulus you need. You want to get closer to a six, seven, or eight.

I’d also ask: is she doing balance and posture exercises? If not, those need to be components. We have to meet people where they are. Even if someone is in their late eighties, a slow, progressive, targeted program can increase strength scores from below normal to above normal in eight weeks. It’s not rocket science; it just needs to be deliberate and not overwhelming.

Molly Patrick:
Tammy is 59 and just had her first DEXA scan. Her doctor’s nurse called to say she has osteoporosis, told her to take calcium and vitamin D, but didn’t give her the scores. Now the doctor is on a leave of absence. Tammy read online that calcium supplements cause heart problems and that osteoporosis medications are even worse. What is the truth there?

Lisa Moore:
Research tells us it is optimal to get calcium from food first. Regarding coronary issues, those studies involved excess supplementation. If you are aiming for 1,000 to 1,200 milligrams a day, you should track your food first using an app like Cronometer and only supplement what is missing.

There are two general synthetic types: calcium carbonate (which needs stomach acid and can cause constipation) and calcium citrate (which is more easily absorbed). Also, remember that you only absorb about 500 milligrams of calcium at one sitting, so you have to spread your intake throughout the day.

For the medication portion, as a physical therapist, that is not my lane. That’s a conversation for a skilled provider who knows her full context. I am not anti-medication—it can be life-saving—but there are many things you can do to reduce fracture risk regardless of whether you take it.

Molly Patrick:
Other than jumping or lifting heavy, are there specifics we should incorporate into our routines?

Lisa Moore:
Everyone wants “the one” exercise, but comprehensive programs make the biggest difference. You should be doing resistance training two to three times a week. Power training should also be a part of that, which involves speed. We lose type-two muscle fibers as we age, so we need that explosiveness to get a foot out in front of us if we trip.

Power moves include kettlebell swings, dumbbell cleans, or even doing the “up” phase of a deadlift quickly. Impact exercise is also great—things like box jumps, star jumps, or moving jumps. Bones like variety rather than the same movement pattern over and over. On other days, do weight-bearing exercise like hiking, or simply do what you enjoy, like swimming or cycling. But the target is two to three times a week of resistance, power, and impact.

Molly Patrick:
Sally asked if eating five to six prunes a day helps bone density.

Lisa Moore:
Yes, I eat five to six prunes a day as well. It’s something I share in my workshops.

Molly Patrick:
If you could go back and give your 30-year-old self bone advice, what would it be?

Lisa Moore:
One would be eating less processed food. I would also tell myself to pay attention to calcium and protein; at 30, I just ate to feel satisfied. Lastly, sleep and recovery. We feel invincible at that age, but sleep is vital for optimization.

Molly Patrick:
What does your typical week look like for your own bone health?

Lisa Moore:
When I found out I had osteopenia, I felt fragile immediately. I looked for guidance but found mostly “frail older person” programs. It wasn’t in my standard physical therapy training either. I hired a trainer because I knew I needed to change from mostly aerobic exercise (running and triathlons) to targeted strength training.

Now, I prioritize strength training two or three days a week. I do full-body workouts including pushing, pulling, pressing, hinging, and carrying. I work at an intensity of about eight out of ten. I never “max out” because I have no ego and I need to stay in the game. Any bit of resistance training is better than none.

Molly Patrick:
You were a physical therapist before your diagnosis. How did that happen?

Lisa Moore:
I was working as a cancer rehab specialist. Many clients were breast cancer survivors who were at increased risk for osteoporosis due to chemotherapy and estrogen suppressors. They asked me how to protect their bones, and I didn’t know. Finding out for them led me to check my own density. I spent three years sorting through the “muddy water” of conflicting information.

My message to anyone is: you don’t have to do the perfect thing. You don’t need the perfect program. You just need to do something to help your body be stronger.

Molly Patrick:
Where can people find you?

Lisa Moore:
DrLisaMooreDPT.com is my website. You can find me on YouTube as well. I have a free playlist for intermediate levels and a program called “Build” which consists of eight videos for moderate to advanced levels. It’s balanced and covers all the components—including impact—without any “risky” moves. Pretty soon, Brickhouse Bones will be the largest collection of bone-health-friendly exercises available online. If you don’t ever fracture, osteoporosis doesn’t have to change your life.

#PlantBasedBones #BoneHealth #Osteoporosis #Osteopenia #WomensHealth