Podcast: Play in new window | Download | Embed
Subscribe: RSS
Dr. Belinda Beck discusses Exercise for Osteoporosis with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
Dr Belinda Beck is a Professor in the School of Health Sciences and Social Work and a member of the Menzies Health Institute Queensland at Griffith University, Gold Coast campus in Australia, where she has taught musculoskeletal anatomy and conducted bone research for over 20 years. She has a PhD in Exercise Physiology and she has dedicated much of her research into the effects of mechanical loading on bone. She has published over 100 scientific papers, including the LIFTMOR, LIFTMOR-M and MEDEX-OP clinical trials which re-established the benchmark of exercise as therapy for osteoporosis and low bone mass. Here is a link to her LIFTMOR trial: High Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women with Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Dr Beck has established ONERO, which is an evidence-based exercise programme designed specifically to prevent osteoporotic fracture by stimulating bone development and preventing falls in at-risk individuals based on the evidence from the findings of the LIFTMOR randomised controlled trial published in the JBMR. The website for her exercise program is ONEROAcademy.com
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
_____________________________________________________________________________________________________________________
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, dr whites.com.
Thanks for joining me, and let’s jump into the podcast today. I’m very excited to be speaking with Dr. Dr. Beck Beck, all the way from Australia about how to use exercise to improve bone strength. We have had a number of talks on the podcast about the nutritional and supplement aspects of improving bone density and reducing fracture risk with Dr. Keith McCormick, Dr. Lanny Simpson, Dr. John Neustadt, Laura Pizzorno. But this will be our first detailed discussion about how we can use exercise to promote bone strength. Dr. Dr. Beck Beck is a professor in the School of Health Sciences and Social work. A member of the Menzies Health Institute Queensland at Griffith University Gold Coast Campus in Australia, where she has taught musculoskeletal anatomy and conducted bone research for over 20 years.
She has a PhD in exercise physiology and she’s dedicated much of her research into the effects of mechanical loading on bone. She’s published over a hundred scientific papers, including the LIFTMOR, LIFTMOR-M and medics, OP clinical trials, which established the benchmark of exercises, therapy for osteoporosis and low bone mass. Dr. Beck has established Onero, I’m probably not pronouncing that properly, which is an evidence-based exercise program designed specifically to prevent osteo product fractures by stimulating bone development and preventing falls in at risk individuals. And I noticed that there’s a franchise at a PT clinic in Pasadena, where I live in Los Angeles. So Dr. Beck, thank you so much for joining us today.
Dr. Beck: My pleasure, and you did pronounce it correctly.
Dr. Weitz: Okay, good. So how did you first become interested in researching bone and osteoporosis?
Dr. Beck: Well, to go way back, that was actually related to my own chronic leg pain as a runner. And so my original research was based in medial tibial stress syndrome or what people used to call shin splints and tibial stress fracture. So moving on probably about 10 years or so after, after dabbling in that it became very obvious to me that really the major bo burden for bone conditions is [00:03:00] osteoporosis. And whereas stress fractures, bone stress injuries will heal themselves if you just leave them alone. Osteoporosis is not something that’s gonna heal itself. And and it, and because bone is amenable to change when you load it, then it was really a great candidate for an exercise intervention. And as an exercise physiologist, it seemed like a. Like a problem that we could tackle. And I could go on, but I suspect you’ve got another question for me.
Dr. Weitz: Well, actually I wanted to mention to the listeners and you I’m especially passionate about this topic because a little over a year ago, I fell and had a traumatic femur fracture, and after four months was diagnosed as a non-union, and I managed to get it to heal. So I used a five month intervention Forteo, human growth hormone, bone stimulator, sufficient amounts of vitamin D, vitamin K, boron, vi, [00:04:00] calcium, magnesium, et cetera, et cetera.
Dr. Beck: You threw everything at it in there.
Dr. Weitz: I always do.
Dr. Beck: Glad and now I’m good. Right. That is good. There’s they can be. The worst thing about a bone stress injury for an athlete or for just a recreational, a athlete is the loss of fitness that you suffer when you have to stop doing what you’re doing. So it’s so stress. I always say bone stress injuries or a public health in, you know, problem because they stop and it’s even worse for a chiropractor because then you can’t adjust patients and do a lot of the other things.
Dr. Weitz: That’s part of my practice. So, perhaps you can tell us about some of the highlights of bone physiology and structure. What are some of the things we need to know about?
Dr. Beck: Well, I suppose the the main things bone bone is made up of two different sort of structural types of tissue. It’s got, if you think about a chicken drumstick that, that, that chicken bone has the long narrow shaft that’s mainly dense. Cortical bone that creates the shell around all bones, but it’s particularly thick in the shafts there. And otherwise it’s hollow. But at the ends of that chicken bone, if you’ve ever seen inside there, there’s this sort of mesh, what’s called trabecular bone. Correct. Bone in bone. In humans, it’s like that. The bones in your spine are mainly trabecular bone. The bone at the end of your femur or your thigh bone is mainly trabecular bone. And it is those trabecular bone sites that are most affected by osteoporosis because they are the sites where there’s the largest surface area of bone for the bone cells to act on. And speaking of the bone cells, that’s the other probably important bone 101 message is there are a number of bone cells, but when it comes to bone remodeling, there are osteoclasts, which are the bone resorbers, and there are osteoblasts, which are the bone builders. And when you load bone up it tends to suppress the osteoclasts and stimulate the osteoblasts. And that’s why exercise is good for bone because it’s really it builds bone by that mechanism. And the very cool thing is the stimulus from loading happens in the place where the bone needs it the most. So it’s a really wonderful Meno sensor, so it knows where to put the bone that it needs.
Dr. Weitz: Interesting. I think the story about bone today is a little, like the story about the brain. We used to think that you had all the neurons you were ever going to have by the time you were 20. And throughout the rest of your life, you’re always you just losing neurons and hopefully you have enough to hold on. I think the same story was told about bone, which was that you were gonna have all the bone you were gonna have by [00:07:00] the time you hit your teenage years or 20 or some somewheres around there and throughout the rest of your life you just a question of losing bone at a faster or slower rate. And now we know that there’s this constant building and losing and building and losing, and it’s a teeter totter. And it’s a question of the balance. Just like with the neurons, we’re forming new neurons throughout our entire lives and we’re forming new bone cells and losing bone cells. And it’s a question of the balance that occurs throughout our life.
Dr. Beck: Correct. Yeah. You know, those, that two sort of cell group is a reperforms a remodeling unit. Normally remodeling occurs from the osteoclast, resorbing first, and then osteoblasts coming along and replacing bone and that is a beautiful mechanism for any material that is subject to loading that can cause micro damage. So we do just in the course of every day, cause little micro cracks in our bones. So those bone cells are this wonderful little cleanup crew that operate without us even thinking about it and make, maintain our bone tissue strength and health. But the other thing is we have to think about the skeleton as being a big calcium reservoir. It’s like the skeleton is the calcium bank and we use calcium. All through our body for all manner of things, not just to strengthen our bones. So at times when you don’t have enough calcium, you haven’t just had a glass of milk or something, but you need some calcium, what do we do? We go to the bones and the osteoclast release a bit of calcium into the blood, and that’s regulated through hormones. So, so it absolutely is important. We remodel 5% of our skeleton every year. And whether that’s for. Replacing micro damage or whether that’s for metabolic reasons. It’s a constant process. And what we have to be certain is happening across life is that we have a balance. [00:09:00] And so not too much more is resorb than is being formed because that’s what will ultimately cause you to end up with osteoporosis at the end of your life.
Dr. Weitz: I’d like to point out also that the most common medication used today for osteoporosis are drugs that block. Bone resorption, they inhibit the osteoclast. We’re talking about the bisphosphonates and there’s a bunch of these drugs and a couple of other similar ones. And while these drugs can be beneficial at the right time for the right person simply blocking the cleanup crew, the osteoclast that need to clear out that bone microfractures that happens from daily life can not always be the best thing. ’cause we get a house filled with junk.
Dr. Beck: Yeah, that’s right. And it’s this accumulation of micro damage. That is the reason why there’s, after a [00:10:00] long period of being on certain antiresorptive drugs will cause the most common one would be the atypical femoral fractures. So you are then more susceptible of these fractures that actually occur because ironically, of the drugs that you’re taking to strengthen your bones. So that’s when doctors start talking about the need for a drug holiday to, to allow those osteoclast to go in and do their cleanup, click. Crew duty. But oftentimes when people come off one drug, they will suggest that they go on another. So this is not a pretty cycle. And and certainly in, you know, I know that I’m not anti-drugs and I’m not saying that you shouldn’t go on them if your doctor recommends them, but it’s certainly something to consider. And I also always throw in here that exercise doesn’t have that effect.
Dr. Weitz: Right? Absolutely. If you’re not doing the right exercise, you’re not eating the right diet, you’re not taking the effective [00:11:00] supplements than simply taking medication is not your best strategy. And when it comes to medication, you might want to talk to your doctor who simply recommends a drug that blocks bone breakdown, if that is really the best course. And there’s also tests we can do now. What do you think about some of the labs that can tell us about bone breakdown versus bone formation?
Dr. Beck: Yeah, so the bone turnover markers are how some clinicians choose to track bone remodeling. So this is the tests that you’re talking about are looking at how active the osteoclast and the osteo Yeah. Like the
Dr. Weitz: CTX for the bone breakdown and like the P1NP for the bone formation. That’s right.
Dr. Beck: Yeah. So, like I say that probably is a clinical decision. It’s not, we never use them. I for me, they, they don’t provide me more information than [00:12:00] I already have to make a clinical decision. But some doctors like to use them to see if the drug is actually working. If you give somebody an anti-resorptive, is it you know, inhibiting resorption? And that can be useful for them. It’s important to note that those tests need to be. Highly standardized. If you are ta doing them in series, like you’ll have one at one point in time and then you’ll have another in six months time and so on. You need to make sure that the conditions under which you have that test are the same. And normally you do it first thing in the morning yes. And before you’ve eaten anything and you’ve had a normal amount of sleep and you haven’t had a big night on the church beforehand or something like that. So you, yes.
Dr. Weitz: There, there are a number of precautions to make sure those tests come out so that
Dr. Beck: they can
Dr. Weitz: be comparable or Yeah, consistently. Yeah. It can also help with the management of medications because if you take a drug that stimulates bone formation, it may inhibit bone [00:13:00] breakdown and then you may have an increase in bone breakdown.
And so you need to know what’s going on. So you and I think. Today you probably are gonna wanna track what you’re doing if you’re taking medication, ideally, so you can know if the drug is doing what it’s supposed to be doing and how to counter that.
Dr. Beck: Yeah. Well, your doctor will be the best person to guide you on that. And as I say, it is a somewhat of a a personal preference with doctors whether or not they track bone turnover markers.
Dr. Weitz: It’s usually, unfortunately not done in the United States. Unfortunately, many of the tasks that ideally should and could be done or not done because a lot of what gets done in the United States has to do with what insurance feels like paying for.
Dr. Beck: Sure.
Dr. Weitz: So, why do so many people in the modern world have bone density problems? Why is osteoporosis osteopenia is so [00:14:00] common.
Dr. Beck: There’s a couple of answers to that question and I suppose you know, the first answer is that nobody knows exactly, but my, my, probably my initial thought is because we are a different society than we used to be, we are far more sedentary. So we are not exposing our skeletons to the kinds of loading that it needs throughout its whole life. But that’s been happening for, you know, quite a while now. Some might say a couple of centuries now, and in actual fact, when we were evolving many centuries you know, a long time ago, probably people didn’t.
Last, as long as we last. So, so this is evolutionarily we probably never had the pressure to, for ex to evolve out of an osteoporotic, protic sort of phenotype at the end of our life. So that’s one possible [00:15:00] reason that, that we just didn’t evolve having to deal with osteoporosis because the saber-tooth tiger would’ve got the very frail old person.
And but you know, the first thing that I mentioned, which is we are not active enough through our life. And if when you look at the trajectory of bone growth and loss across life, it completely after growth, after you’ve got to the full height that you’re ever gonna be, that. Process of loss almost completely mirrors the the pattern of sedentism of people becoming less and less active and doing less of the kinds of exercises that are important to bone.
And of course, for women, there’s also that little period of menopause, which hasn’t changed. And that is the period where women lose a lot of bone because estrogen is withdrawn and estrogen inhibits osteoclasts and those resolving cells we were talking about.
Dr. Weitz: Yeah, hormones can be very important and I [00:16:00] think that’s a big factor. But I do think we’re getting more and more sedentary as we move from the industrial age into the technological age. And people do less and less even physical chores at home.
Dr. Beck: Yeah, that’s right. We, you know, these I mean, energy drive to the grocery
Dr. Weitz: store and let the bags of groceries into your car and into your house. You just call Amazon now.
Dr. Beck: Well, exactly. But I lived in the US 20 years ago and it used to drive me crazy that I would go to a shopping area. I would park my car and then I’d think, oh, I just need to go to that shop over the road. And there was not even a sidewalk that I could get to, to cross that road. I would have to get in my car and drive across the road. So, in some circumstances, you know, our cities are not designed for movement which is a shame, right.
Dr. Weitz: [00:17:00] That’s definitely the case. So, there have been a number of attempts over time to set up an exercise program that would improve bone density and reduce fracture risk, and most of them have been unsuccessful, but your lift MORE program in your studies is the first program that succeeded. Why is that program successful when others have not been?
Dr. Beck: It’s all about the intensity of the loading. So bone is the skeleton that we have is adapted to the loads that we normally are exposed to. So, if all you are doing is getting up in the morning, walking around your house, getting in your car, going to work, doing a little bit of walking around at work, getting in your car, coming home, walking around your house a little bit, your skeleton is adapted to be able to tolerate [00:18:00] those walking and sitting related loads.
If you want to increase your bone mass, you have to put more load on it than that. Now we used to think that just going to the gym and lifting some weights would do that, but it seems like bone is sort of, it’s like over-engineered, if you like. We are actually more, it’s able to put up with more load, a considerably more load than just what we’re adapted for.
It has to be even more load than that. Now, this brings us into the territory of concern because if a doctor is faced with a very frail person with osteoporosis, the idea of referring them to some to do a very high intensity loading. Is scary. And so they think that is not wise and that’s not what they would recommend.
So what they do is they say, well do a little bit of walking and do some [00:19:00] balance training because then you won’t fall because falls are what cause most hip fractures. And those were the recommendations for until we came along. That is pretty much including me. That is what we told people. When you’ve got osteoporosis, too dangerous to do heavy lifting, you might break something.
So then it’s all about false prevention. In actual fact, no one had tested that. It was just what we thought was the case. So fear was driving this not science. And so this is where we decided, well, we will try to do a heavy lifting intervention. We will be very careful conservative with how we introduce it and how fast we progress the loads. And when we did that and actually loaded people heavy. They grew by, and this was, as you say, this was a step change. We didn’t think we could do it safely, but we tested it and we could.
Dr. Weitz: Right. So [00:20:00] some of the most important parts of your program are that they are doing heavy loads, not, oh, I’m using these five pound dumbbells. They’re lifting as heavy a weight as they can lift for, say, five reps or so, and there’s also some ballistic loading as well.
Dr. Beck: Yeah, that’s right. So bone bone likes high lows. Bone will adapt to high load, but it also likes rapid application of load. Now, if you are lifting heavy and you apply that rapidly, you actually will put yourself at risk of fracture. So we don’t recommend that when you’re lifting, you do it fast. But in order to also get this this effect of rapid loading, we added an impact activity. And that if you have a sudden load landing on your feet with impact, that applies the load quickly. And and so we sort of hitting it from both angles. The strain magnitude and the strain rate, those things are both important. [00:21:00] Again, it’s really important, the fact that we had people expert. Supervising this and implementing it because these are not things that you should do on your own if you have osteoporosis.
Dr. Weitz: It’s interesting what you say about the sudden loading, because I talked to somebody else on the podcast about trying to duplicate what happens with ballistic loading, and the argument was ballistic loading loads the bones to, I think he said three or four times the body weight in the amount of load by the fact that it’s ballistic. And if we can just recreate that. That extreme amount of loading that we can duplicate what you get from ballistic loading. And that’s the basis, as I understand it, of the of the Osteostrong program where you go and you get on a machine and you push and it’s sort of a almost [00:22:00] isometric fashion and you can supposedly load the bones to, I don’t know, three or four times your body weight.
Dr. Beck: So probably need to define the word ballistic or how you’re using the word ballistic. I was just using it as something that would be Right. Actively and rapidly right. Putting a load on.
Dr. Weitz: Right. So the argument that was made was the reason why that was beneficial is because the amount of load and that we can create that same amount of load using a certain type of machine. But you’re saying that one of the benefits of that. Type of movement, ballistic activity is the sudden loading, not just that you create more load.
Dr. Beck: Yeah, we’re sort of, probably heading into some not necessarily supported area here. Okay. So it’s. The amount of load is not determined [00:23:00] by the rate of loading. The amount of load is determined by the actual amount of load. So what’s on the bar? So that’s what the bones are actually being exposed. Right. But
Dr. Weitz: If you ballistically load, isn’t that potentially creating a lot more load?
Dr. Beck: No, no. The load is finite. It is what it is.
Dr. Weitz: So if you weigh a hundred pounds and you jump down, it’s a hundred pounds of load. That’s right. Is that right?
Dr. Beck: Yeah. Yeah. It’s just the speed of loading that, that is different. Okay. It doesn’t create more load. So the, like I say, the rate of loading is important, but it has to be. Titrated carefully. It’s not always appropriate because if for people with low bone mass, if I think of an analogy of if you have a stick, just a regular stick, you know, from a tree and you bend it slowly, you can probably bend it quite away before it will break. But if you have the same stick and you bend it quickly, it will probably break quite quickly. So this is what you have to have in mind. If you are going to do fast loading with people with low bone mass. You know, you have to be extremely careful. That’s why our lifting is not done in a power fashion. It’s not the rate of loading is not important. The impact loading is important for a number of things. The rate of loading is high, but it’s not a huge amount of load. And, but the other thing is it’s weightbearing and that is what is crucial for bone. We know that if you take weightbearing out of a somebody’s a daily exposure that they lose bone, put somebody in space and they will lose bone, put somebody on bed, rest, or cast their leg, or yeah, if they swam for nine hours a day, you know, they’re gonna ha lose bone.
As for Osteostrong, this is a different kind of loading, and as you say, it is essentially isometric being the whatever you’re trying to move is not moving. So you’re pulling against something or pushing against something. So that is, you are [00:25:00] developing force sort of against an an object right now that is not gonna be finite because it’s whatever you can apply to that. Object. We tested the Osteostrong device and the four exercises at as a parallel group in our LiftMor study.
Dr. Weitz: Oh, interesting. I didn’t notice that.
Dr. Beck: And so if you compared the Onero program to the OSTEOSTRONG program it, it was not effective. And actually there were five fractures in that group. So in the Osteostrong group, so interesting. We don’t advocate for that kind of loading because we don’t see it as safe and we don’t see it as effective. It’s much more effective to actually do a movement that is more functional. You’re actually moving through a range of motion and you’re moving a weight that is defined with very with technique that you can keep a little more safe.
Dr. Weitz: Right. Especially important that that clients are using good form.
Dr. Beck: Yeah, that’s right. And, you know, I challenge anyone to be able to find some high quality evidence that Osteostrong works. And I’m, look I have a product, I have Onero, so I have a clear conflict of interest. And so I’m not saying, you know, necessarily listen to Dr. Beck saying that Osteostrong doesn’t work. Listen to other experts who in bone and certainly Laura Rio has created a nice little video summary of their program and of the evidence around it. And it’s worth having a look to, to see what she says. And she does not have a conflict of interest.
Dr. Weitz: Okay. Part of preventing reducing fractures is balance training, which is important because that’s, we stimulate those appropriate receptors and that whole ability to control your body in space.
Dr. Beck: Yeah, that’s right. So, very [00:27:00] important. The I dunno how many times I’ve said this in my life, but 90% of hip fractures are a direct result of a fall. So, meaning if you hadn’t fallen, you probably wouldn’t have fractured the, these are not things that tend to happen spontaneously. So what you wanna do, if you do have low bone masses, stay on your feet. I definitely don’t fall to the side, you know, on the side of your hip. ’cause that’s your classic fracture mechanism.
Dr. Weitz: That’s what happened to me.
Dr. Beck: Yeah. And you know, classic example and it can take a long time to heal and it really messes with your quality of life. Hey how about that Mobility would not have been fun.
Dr. Weitz: I’m all good. I’m doing my deadlifts in the gym and jumping as well.
Dr. Beck: Excellent. But the thing about balance is I think in the past we have underestimated just how crucial it is to do high challenge balance training. You can’t just stand on one [00:28:00] foot for five minutes and think, right, that’s it. I’ve done my balance training. It has to be more than that. It has to be something that actually challenges you to the. Extent that it, you could fall over if you did this because what you’re doing is training your body to prevent you from falling over. That’s the key. So if you are at risk of falling, you don’t do these balanced training exercises in a place where you can’t catch yourself. Do it in the kitchen, where you can hold a kitchen bench if you start to wobble. But you do need to put yourself off balance and really challenge yourself. ’cause otherwise it’s not effective. Right?
Dr. Weitz: Yeah. I like to use wobble boards and devices that go rotate, go back and forth and use one leg, use two legs.
Dr. Beck: Yeah, reduce your base of support, put in, go into a tandem stance, which is, you know, heel to toe. Right. When you put, when you stand in that, I think a lot of people, of [00:29:00] your listeners, if they tried that right now, they would fall. It’s a it’s a very. Precarious sort of position to stand in if you’re not used to it. And you can do a half tandem, like stand with the ball of your foot beside the heel of the other one and work your way into that. But that is a way of challenging your balance.
Dr. Weitz: Yeah. Yeah. I like to work on that while I’m hitting a golf ball. It’s actually a good training for having a better golf swing. What about using weighted vests and going for a walk? That’s something that’s very popular these days. You know, it’s even has a whole name and everything. They call it rocking and
Dr. Beck: yeah. So, again, as usual, Dr. Beck has a couple of responses to that. The first one is a lifetime of walking is helpful for preventing bone loss, but once you have osteoporosis. Walking as a therapy [00:30:00] will not increase your bone mass. It’s just not high enough intensity. So I guess what I’m trying to say is be as active as you can, and if walking is your thing, you like doing it, then you should do that all your life. But don’t think that walking alone is going to improve things. If you put a weighted vest on, you’ve got more chance of walking being beneficial for your bones because that will increase the load. But I haven’t, I have yet to see a good quality study. Proving to me that walking in a weighted vest notably increases bone mass. I’m very open to seeing that, and certainly the chances are greater than just walking without one. But I, I need to, I’m a scientist. I need to see data.
____________________________________________________________________________________________________________________
Dr. Weitz: I’ve really been enjoying this discussion, but I just want to take a few minutes to tell you about a product that I’m very excited about. Imagine a device that can help you manage stress, improve your sleep, and boost your focus all without any effort on your part. The Apollo wearable is designed to just to do just that, created by neuroscientists and physicians. This innovative device uses gentle vibrations to activate your parasympathetic nervous system, helping you feel calmer, more focused, and better rested. Among the compelling reasons to use the Apollo wearable are that users experience a 40% reduction in stress and anxiety. Patients feel that they can sleep. Their sleep improves up to additional 30 minutes of sleep per night. It helps you to boost your focus and concentration and it’s scientifically backed. And the best part is you can get all these benefits with a special $40 discount by using the promo code Weitz, W-E-I-T-Z, my last name at checkout to enjoy these savings. So go to Apollo Neuro and use the promo code Weitz today and now, back to our discussion.
____________________________________________________________________________________________________________________
Dr. Weitz: So when I read your LiftMor program and you talk about people doing exercises at 85% of their one rep max it seems like that would be dangerous to figure out what someone’s one rep max is. How can you estimate that without actually having somebody lift one rep with as much weight as they can handle.
Dr. Beck: Yeah, I agree. We would not tell people with low bone mass to do that. So we this is where the expertise comes in and this is why you know, we always say Onero should be done under supervision because your [00:33:00] coach is trained to be able to determine that. So without actually doing a one rep max test, which absolutely could be cause a spine fracture for example. They have different means of doing that. And there are certainly standard ways for for exercise practitioners to determine what somebody’s you know, 60, 70, 80 percent of one repetition max and they can do it during an actual session. It’s not a, it’s not something that would need to be specifically formalized for a test.
Dr. Weitz: Okay. So, for example, if you wanted them to do five reps at 85%, you could have them do as much as they can say, let’s say 10 reps is 60%, then you have ’em just continue to do as much weight as they can at 60 at for 10 reps.
And then you could extrapolate from 60% to 85% what their five rep max would be.
Dr. Beck: [00:34:00] The. Probably the better way to do that is to do an amrap. It’s called an amrap because it stands for as many reps as possible. So that is okay. That is not stopping at 10, just doing as many as you can. And there are online calculators where you can put that number in and it will generate the number. The trouble is what happens typically when you do an amrap is that it will generate a number that is considerably higher than what you’re already doing. So then the process to get there would not be right from, you know, perhaps you’re lifting 20 kilos, but AMRAP tells you should be lifting 40. You don’t go from 20 to 40 overnight. You have to work your way up to there by which time you may have increased again. But but that’s okay. It’s, you know, it’s a work in progress and in the meanwhile you’re lifting weight, which is good.
Dr. Weitz: Right. And if you do multiple sets with the same weight, you may not be able to do the same amount of weight by the, say, let’s say you’re gonna do five reps. By the time you’re at your fourth or fifth [00:35:00] set, you might not be able to do the same amount of weight
Dr. Beck: you should be. If you’ve got the number right, you should be able to do your five sets. Yeah. It it if you can’t, it’s too heavy. But yeah, normally we don’t have that problem.
Normally with people are underweight, under loaded because they, they think they can’t do it, but they actually, right. Yeah,
Dr. Weitz: yeah. I know most of the patients I talk to with osteoporosis are very afraid and they tell me that they’re five pound dumbbells is all they can lift.
Dr. Beck: Yeah, absolutely. People are afraid with good reason, you know, who wants a fracture? You know, they’re painful, they change your life. If it’s a variable fracture, they change your height. They can set you up for a cascade of other fractures. Yeah, we, that is our number one, you know, pre prevent, avoid fracture. We don’t wanna hurt anybody, so we are not cowboys and we know that the program is risky. That’s why we have to supervise.
Dr. Weitz: What do you think about vibration plates? They’ve been touted to increase strength and also bone density.
Dr. Beck: Well, you’re asking exactly the right person because we just, we finished a vibration plate study. We are just in the middle of analyzing the data, re-analyzing. We’ve been looking at it all different ways because we had so many outcome measures. At the moment, we’re not seeing any effect. But we haven’t finished sort of digging deep into the data, looking at the effect of how compliant somebody was with it. But at the moment it’s not looking that promising.
Dr. Weitz: Right. I used the vibration plate when I was recuperating from my femur fracture early on when I couldn’t do a squat or a deadlift with any amount of weight. ’cause I was still healing, but I got on a vibration plate. And so I’m thinking that it may have benefits at points at which you can’t do heavy lo loading.
Dr. Beck: Yeah. And remember there’s vibration and there’s vibration. So, the vibration technology for bone was based on the work of Clint Rubin and Ken McLeod years ago, where they saw in animal studies that there was an actual frequency at which bone responded. So the animal trials did show that it, you know, this 30 hertz frequency of vibration, just a very small perturbation, vertical perturbation, was enough to have an effect. The human trials have not been have not shown the same efficacy. But as I say, we’re still sort of looking. There may be certain people who respond to it more than others. But if you’ve got, for example, a Galileo and I have done a test on a Galileo before that is the oscillating plate where the sides go up and down. That creates a pretty severe vibration, which is quite different. And the frequency of the vibration is lower. So I think there’s less evidence that would be a good bone stimulus, but it might be a [00:38:00] good muscle stimulus. And that might have been what was helpful for you.
Dr. Weitz: Interesting. So the way we monitor. Bone density strength is apart from whether or not you fracture and some of the bone turnover markers is with the dexascan. Can you talk about the DEXA scan? What it tells us, what it doesn’t tell us some of the important things about DEXA scans. We’ve talked before in this program about the fact that a lot of DEXA scans are not actually done properly. The patient isn’t always positioned the right way. They’re in the way. They collated the way they explain it is there’s a lot of issues with DEXA scans, I think.
Dr. Beck: Yeah. Well, I go backwards and forwards a little bit with dexa. You know, I’ve used it all my research career. It’s. A really useful device. It’s very simple. It’s [00:39:00] it’s highly validated. It is the relationship of bone mineral density to risk of fracture is a very close one. So it is predictive. And it has been extremely helpful in this field of osteoporosis for tracking interventions and the efficacy of that. So, and for telling us who is most at risk of fractures. So I don’t think we should throw the baby out with the bath water because, oh, no.
Dr. Weitz: I think DEXA scans are good. I just think they, you need to make sure the person is positioned the right way. And then I, so that’s, think a clinician like me or you? Well, if you were a clinician, I, you’re a researcher, but you need to look at the complete printout and make sure what they’re measuring is you’re comparing apples to apples.
Dr. Beck: Right. So that’s where I was going. ’cause I mean, I know I sounded like I was giving it a glowing wrap. There are definitely problems with it and it, those problems as a researcher drive me insane. Because, [00:40:00] you know, there is error in the measurement and it is highly dependent on positioning. And of course that is highly dependent on the training and the expertise of the DEXA technician. And, you know, we see poor scans on the daily and you can easily see it if you see the actual, if they print out the image of it as well, we can see the hip hasn’t been properly rotated, we can see it’s been over abducted. All of those things will basically, you know, nullify the believability of the measure.
Dr. Weitz: If the person has osteoporosis, if the person has scoliosis not osteoporosis, if they have scoliosis, if they have osteoarthritis, those can effect findings.
Dr. Beck: They do. But a, an expert technician who is analyzing should be able to account for that. So for example, if somebody has scoliosis they will be able to analyze the scan with an angulated analysis so that the, they can still separate the [00:41:00] vertebrae. But the results may be slightly difficult to interpret because oftentimes people with scoliosis have densities in unusual areas because of the loading through the spine. In which case you can see those, you can see those densities on the spine, in which case you would report that and say how much faith you should be putting in the spine.
Also, I agree, arthritis, you know, these arthritis and osteoporosis coexist in. Probably the majority of people with osteoporosis, but in some more than others. You can also see where this is occurring. So you can see osteophytic growths that come out of the joint line and lie over the vertebral bodies, what we call bone spurs.
Yeah, that’s right. And you can’t use that particular vertebrae. You would take that out of the analysis. And so the ISCD, the International Society of Clinical Cytometry has guidelines as to how to manage that. So how many vertebrae you should be using in your final report if OA is [00:42:00] evident. So certainly I agree with everything you said in terms of the fact that there are challenges according to technical expertise, positioning, and other comorbidities that can result in a an erroneous outcome. I think that’s probably the reason why. The World Health Organization used the hip as their standard for the definitive definition of osteoporosis and not the spine, because the spine can be so messed up.
Dr. Weitz: I’m sorry. Us in the United States, we no longer have anything to do with the World Health Organization. I’m just kidding. I said nothing. Yikes. So I, I was, listen, I listened to your podcast with Peter Atia and. I thought it was interesting that you remarked that the DEXA scan is a 2D [00:43:00] view of bone. When most of us don’t think of a CT scan as 2D.
Dr. Beck: No. CT scan is three DA DEXA scan is 2D. DEXA is not ct, it’s just a dual energy X-ray absorb geometry. Ah, okay. It’s an x-ray source in the machine and the bottom of the machine and the arm above you has the detector and it just projects, its x-ray through the body and up to the detector and it’s to do with absorption of that. Yeah. Okay. So it’s only, it’s X-ray, not ct,
Dr. Weitz: so it’s 2D. But you said you have software that allows you to see a 3D.
What is that software?
Dr. Beck: So that is called, well I call it 3D hip, but I. I think the company has called it something else since. But 3D hip analysis allows us to look at change in structure of the proximal femur, the femur that articulates with the pelvis. And that has been really essential for us to be able to [00:44:00] tell that people who lift very heavy, you would expect them to change the strength of the bone at the hip.
And we don’t see very much change in BMD. We do in some, but most people don’t change the BMD, the bone mineral density of the hip as measured from a regular DEXA scan. But when you look at the 3D hip analysis, you can see that the structure and the shape of the bone is changing to the extent that it is actually becoming stronger because the thickness of the cortex is increasing.
Dr. Weitz: Can you tell us what the results of your study showed in terms of improvement?
Dr. Beck: Yeah, so in the Lior study are you talking BMD and 3D hip or just 3D hip?
Dr. Weitz: Both.
Dr. Beck: So, for DEXA scans of the spine, there was about a 3% improvement at the spine. That was the mean difference. For some that was considerably more than that, but the average was about 3%.
[00:45:00] The difference between control and the intervention group was about 4%. ’cause controls lost at the hip, there was not quite a 1% increase in BMD at the femoral neck. As I said that we didn’t see a massive change in BMD, but it was about 2% different from controls. ’cause controls lost quite a bit, but in 3D hip analysis, the.
Cortical thickness of the femoral neck. So this is the place that normally breaks on a hip fracture was about 13% greater in total of the whole femoral neck in the intervention group, the heavy lifting group. But just looking at the, out the lateral side or the the part of the femoral neck where the breaks start, there was an almost 30% improvement in the intervention group compared to control.
Wow. So this is, yeah, it was pretty impressive. We were pretty happy with that.
Dr. Weitz: Do you also look at the trabecular bone [00:46:00] score?
Dr. Beck: So at that time we did not have trabecular bone score app on my dexa, so we have not looked at that yet. I’m very excited to be acquiring a new DEXA with that software in the next couple of months. So we’ll start looking at that. I.
Dr. Weitz: Yeah. ’cause that tells you about the quality of the bone and about that trabecular bone that you were talking about.
Dr. Beck: That’s right in the spine. In the spine.
Dr. Weitz: Well, isn’t there trabecular bone in it, in the femur as well?
Dr. Beck: There is, but I’m pretty sure trabecular, this is an ignorant statement ’cause I haven’t tested yet, but I’m pretty sure TBS is just tested at the spine. It may also hit, but I’m pretty sure it’s just at the spine.
Dr. Weitz: And so there’s 3D software, is that available in the United States? I hadn’t heard about it.
Dr. Beck: It absolutely is, but it costs a little bit. I think it’s about 10 grand and because it’s not clinically sort of familiar to most people, they dunno what to do with it when they get the results.
So I, I don’t know what these numbers mean. You know, it’s [00:47:00] not well accepted yet, but, you know, researchers like me are using it and it may eventually pick up steam. I hope that it does because it’s a really, I think it’s an addition to DEXA that people are looking for. Just like TBS.
Dr. Weitz: Yeah, it makes sense to me.
Dr. Beck: It does take a bit more to analyze, so we have it at the clinic, my, my bone clinic. But I have to put staff dedicated onto that. Once the client has gone, my staff then have to go in and do this analysis and so many clinics are not gonna want to absorb that cost.
Dr. Weitz: Yeah, it would be, it may, it would seem to make more sense for the for the radiology lab to incorporate it
Dr. Beck: again.
It’s the analysis is done on the dexascan, so it is something that you can easily do. Once you’ve done the, and given the BMD results from the hip you then just do reanalyze the exact same scan. Right. So it’s it’s pretty straightforward to do. It just takes time.
Dr. Weitz: Now, [00:48:00] did lift more also show a reduction in fracture risk?
Dr. Beck: So if you are testing to test fracture risk or fractures. Per se, absolute numbers of fractures. You have to have a sample size that is in the thousands because even though we are seeing osteoporotic fractures everywhere they are still relatively rare events. So it’s pretty unlikely in a sample size. So, for example, lift More had a hundred people that you would even see one fracture that would be very rare. So we had none in the control group and none in the intervention group. So you just need thousands of people to be able to measure that outcome. And we’re getting close at at the bone clinic. ’cause we, we are sort of up in the thousands, but we still need more data. There’s definitely a signal. You know, we just, even in the first couple of years we could see that there was this massive reduction in numbers, but we’re comparing something like 14 in the previous year to two once they started [00:49:00] doing Onero. Now that’s a clear difference to me, but that is not statistically significant yet.
Dr. Weitz: Right. Say, of those, what do you think is the most important? If those are okay, remind
Dr. Beck: me of what those three things were. This is going in your bloopers reel, Ben.
Dr. Weitz: Bone density leg strength balance or stability.
Dr. Beck: What’s the most important thing? Yeah. For and
Dr. Weitz: I guess if the fourth one would be is if there’s a bone flexibility or qual or, you know,
Dr. Beck: yeah. It’s the million dollar question. But I think looking at the numbers and that stat that I quote all the time, about 90% of hip fractures occurring after a fall. I think we probably have to say stopping people falling is going to be one of the most powerful ways of stopping fractures. There’s just no two ways about that. That, [00:50:00] but I think they go hand in hand because it’s actually impossible to know the answer to that question. If the more bone you have, the less likely you are to fracture when you do fall. So, falls are ridiculously important. Difficult to stop in certain populations, like patients with dementia who, you know, do silly things. My mother has a habit who has dementia, has a habit of curt seeing as a joke when she meets people and she’s being funny, but that will increase her risk of falling.
Okay.
Dr. Weitz: When someone’s doing exercise to stimulate their bone strength to overcome osteoporosis do you find that certain medications or supplements should be part of that program?
Dr. Beck: So, yeah, a million dollar question. Probably the most common question I’m [00:51:00] asked at the clinic by patients, they wanna know that should I be doing everything? That is almost certainly the only answer to give is that it depends on the individual, it depends on the severity of the problem, and it depends on the quality of their diet. There is very little evidence that supplementing or even adding more food sources of a nutrition, a nutritional element to someone who is already replete is going to add anything in terms of protection. I would be, I think we can say with confidence that the people who already have enough of vitamins and minerals and protein don’t need more. That’s all you do. It’s a, it’s an expensive intervention that is not gonna be effective. See,
Dr. Weitz: I would argue that very few people are in that category.
Dr. Beck: Well, a lot of the people who come to our clinic are because they’re, I wouldn’t call ’em the worried, well, because their bones are in a mess, but they are very proactive [00:52:00] with their diet and they have taken good advice and they’re acting on it, but it’s not enough. So, so they are. But I mean, you’re probably right for the va the vast majority of the label, especially if
Dr. Weitz: we go from normal to optimal.
Dr. Beck: Yeah. And also, you know, I think we would find in certain settings for example, in aged care where people don’t get outside very much, their vitamin D is very low and supplementing has been shown to, to be effective. Food sources of calcium and protein in aged care have been shown in Sandra Iliana’s recent studies to actually reduce fracture, which, and kudos to her. That was a brilliant study. So yes, there are situations where it can be effective. But I would say. If somebody is extremely low, their T score is extremely low. You’re probably throwing everything at it. Taking the Ben approach, we want everything, you know, cover [00:53:00] all our bases, but if somebody is in the sort of, you know, mildly osteopenic range and they are not a high falls risk, so they’re quite fit and healthy I don’t know that’s the time when people are gonna be thinking about taking medication. You know, that’s probably what they need is a really good targeted exercise program. That’s the perfect person for an OHNE program. And they may find that not only do they prevent themselves from becoming osteoporotic, but they might actually shift themselves back into the normal range again.
Dr. Weitz: And ideally, how many days a week should this program be done for?
Dr. Beck: Well, all of our clinical trials have shown that two days a week are effective. My current research program is trying to figure out dose response. The most common answer question with regards to dose is if I can only come once a week, it will that be enough? I dunno if it’s enough to get them back to where they need to be, [00:54:00] but it is certainly better than nothing. Absolutely better than nothing, and potentially doing three times a week. We’ve got a little bit of data that is suggesting it may be better three times a week, but this is not clinical trial data. So it could be biased by other things that people are also doing. If they’re so driven that they’re doing O neuro three times a week, then they’re probably doing other healthful things that are contributing to that.
Dr. Weitz: What about periodization? The concept of I. Building up, dropping down, building up again, and also using exercises for different parts of the body on different workout days
Dr. Beck: now where we have a very simple program and all we’re concerned about is getting people doing it as, as clo as close to that program as possible with as much weight as they can tolerate and increasing that weight as much as we can. They will. [00:55:00] Just organically go up and down because they’ll go on a three month European holiday and come back and they’ll have to drop their weights and then they’ll come back up again. Or they’ll be sick for a couple of weeks and they’ll come back and they’ll have to drop down and then they’ll come back up again. So it, it is a constant flux. Plus you would know yourself. Sometimes you go into the gym and you look at the weights and just go, not feeling it today. Right? That is not the day to put your weights up. That is the, if anything, to put them down, right? Because the worst thing you can do is put yourself off. Just go and do what your body’s willing to do that day and the next day when you’ve had your cup of coffee before you’ve turned up, you might, no I’m on, I’m back up to where I was and away you go. Right?
Dr. Weitz: Yeah. What I do on those days is find another way to challenge myself, like maybe do more reps or super set two different exercises, so I still feel like I’m getting a good workout with using a little bit less [00:56:00] weight that day.
Dr. Beck: Well, keep in mind that Onero is, it’s designed to be a targeted, feasible. Intervention, which is, it’s very specific for bone. We are not there to make people into power lifters or to slim them down to spelt little nuggets. We, this, we’ve got one goal and luckily, while we’re achieving that goal, we’re also building muscle, preventing falls, and we are actually reducing their blood pressure and proving their mental health and all those other things come along with it. But they’re not our goals. They’re wonderful ancillary benefits. So the periodization and different strategies that, you know, are very well recognized are more performance based strategies for training rather than what we’re doing. And we want it to be brief targeted. Appealing and it’s we’ve got this recipe and it just seems to be working [00:57:00] for the specific demographic that it’s targeted for.
Dr. Weitz: Keep it. And so Onero is a program that’s available in Australia all over the place. It’s now available in the United States
Dr. Beck: and That’s right. Yeah. It’s because the training for it is all online. It doesn’t matter where you are, you can be in on, near a licensed provider. And I do get on planes and go and visit people and do quality assurance checks, and I do in-services. I help them with, you know, how they’re doing. And yeah. So there’s a lot of support behind it. And it is a network. And these are people who have just, you know, they’ve embraced the fact that there’s something more they need to be doing for their people with osteoporosis, of which. There are thousands, millions and they’re getting lots of inquiries. And so we’re all basically on the one page. This is not for most people, this is not just a moneymaking venture, although it is a revenue stream. This is about helping their clients the best way they can.
Dr. Weitz: And so, [00:58:00] patients who want to improve their bone density, who are listening to this, they can look up O Niro, go to an O Niro center if there’s one near where they live, and they can go and take this group class several times a week for, did you say 45 minutes?
Dr. Beck: Yeah, it’s 45 minutes.
Dr. Weitz: Yeah. Roughly. And they’ll be using a proven program to improve their bone density.
Dr. Beck: Yeah, that’s right. They, if you google a neuro locations, the map will be the first thing that comes up and you click on the map and you just navigate to where you are. There’ll be little red tags, click on the tag and the contact details will come up. If there’s not one near you, go to your local physical therapist or exercise physiologist and just, and say, you know, seriously, you need to be doing this. Contact Dr. Beck, and just send them to me and I’ll give them the information. That’s how the majority of licensees have started because most people aren’t aware of it.
I’m not a [00:59:00] sales, they don’t, I don’t sell it. I don’t advertise it.
Dr. Weitz: Well, hopefully we’ll help to spread the word. Dr. Beck,
Dr. Beck: I appreciate it.
Dr. Weitz: Thank you so much for joining us today. My pleasure. Any other contacts? Should people go? Is it Onero.com or where do they go?
Dr. Beck: That’s a really good question. If you type in Onero Academy that’s where the the physical therapist can go. Onero Academy will have all the breakdown of what the program sort of looks like and how it can be accessed. And there’s also a link there to contact me.
Dr. Weitz: Okay. Great. Thank you so much, Dr. Beck. My pleasure.
____________________________________________________________________________________________________________________
Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for Functional Medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.
