Second Helping: Your Bones Are More Than A DEXA Score with Rebekah Rotstein

I'm bringing back one of my favourite conversations this week because May is Osteoporosis Awareness Month, and this topic is too important to let it gather dust in the archive.

If you've ever left a bone density scan feeling more confused than when you walked in, or got a result that said "osteopenia" and weren't quite sure whether to panic or carry on as normal, this episode is for you.

In this conversation, I'm joined by Rebekah Rotstein, Pilates instructor, movement educator, and founder of the Buff Bones method. Rebekah was diagnosed with osteoporosis at 28, which means she has been living with and studying this topic for nearly two decades. She brings a perspective that is part patient, part expert, and very relatable.

We get into what bone density testing actually measures and where it falls short, why osteopenia is not something to brush off or ignore, what strength training for your bones really looks like (and why you do not need to be standing in front of a weight rack to do it), and the important difference between your bone density conversation and your fracture risk conversation. They are parallel, but they are not the same thing.

I also share my own take on calcium and why the "just take a supplement" approach has underperformed, and what it really means to nourish your bones with the whole capsule, not just one ingredient.

About Rebekah Rotstein: Rebekah Rotstein is a Pilates instructor, integrated movement educator, and founder of the Buff Bones method, a medically endorsed exercise system for bone and joint health with certified instructors in more than 30 countries. She serves on the Society for Women's Health Research Bone Health Roundtable and has been advocating for earlier bone screening since her own diagnosis at 28. Find her at buff-bones.com or on Instagram at @gotbuffbones.

Related Episodes You'll Love:

• #114 - Beyond the Metrics: Getting Intuitive About Bone Health with Rebekah Rotstein
• #65 - The Impact of Movement on Bone Health in Menopause with Niamh Daly 

📚 I wrote a book! Eat To Thrive During Menopause is out now!  Order your copy today and start thriving in midlife.

Looking for more about midlife,  menopause nutrition, and intuitive eating? Click here to grab one of my free guides and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Why Bone Health Gets Ignored

Jenn Salib Huber 0:00

Hey friends, welcome back to the Midlife Feast. I'm serving up a second helping today this week because May is osteoporosis awareness month. And this conversation with Rebecca Rothstein of Buff Bones is one of my favorites. Whenever we talk about menopause, we're often talking about hot flashes and sleep and mood and body changes. And sometimes it feels like bone health gets a polite nod, but shuffled to the bottom of the list because it feels like it's a problem for future you. And I really want to push back on that. Because as we talk about in this conversation, we need to be talking about bones long before any DEXA scan tells you that there's a problem to fix. And calcium, of course, is one of the key ingredients in that work. It's one of the pillars of the nutrition capsule wardrobe I write about and eat to thrive during menopause. But here's the thing bones aren't built by calcium alone, and they aren't built by exercise alone. It really does take the entire capsule. So today's conversation is with Rebecca Rothstein. She's a Pilates instructor, movement educator, and founder of the buff bones method, and someone living with osteoporosis since she was 28. So we get into what bone density actually means, why osteopenia isn't something to brush off, and what strength training for your bones actually looks like. And more importantly, why your bones are so much more than one number on a screen. So quick update before we dive in. We recorded this back in 2023, and while the information is still current, Rebecca's going to be back soon to talk about some of the updates that have happened since then. So enjoy the episode. And if you have any bone health questions for me or Rebecca, let us know. Welcome to the Midlife Feast, the podcast that helps you make sense of your body, your health, and menopause in the messy middle of midlife. I'm Dr. Jen Selie Huber, intuitive eating dietitian, a naturopathic doctor, and author of Eat to Thrive During Menopause. Around here, we don't see midlife and menopause as problems to solve, but as invitations to live with more freedom, trust, and joy. Each week you'll hear real conversations and practical strategies to help you feel like yourself again. Eat without guilt and turn midlife from a season of survival into a season of thriving. I'm so glad you're here. Let's dig in. Welcome, Rebecca, to the Midlife Feast.

Rebekah Rotstein 2:25

Thanks so much for having me, Jen. I'm excited to be here.

Jenn Salib Huber 2:28

Yeah, so and it is May when we're recording this, and it's May when it will come out. And May is, of course, osteoporosis awareness month. And I really wanted to focus on this because, you know, as I kind of move through my own menopause, postmenopausal now, and as I have conversations with, you know, women in all stages, there's so much emphasis on heart health, there's so much emphasis on brain health, there's so many conversations about that happening. But it feels like the osteoporosis one is a little bit of like an afterthought. It's like, oh, well, that doesn't happen till later. But um, as I hope everyone is going to know by the end of this month, after I talk about it ad nauseum, now, whatever now is for you, now is the time to start thinking about bone health. And the earlier the better, so that it doesn't come as a shock and a surprise later in life, which is often how it happens.

Diagnosed With Osteoporosis At 28

Jenn Salib Huber 3:21

But I would love to start off with your story, a little bit of your story, which was a diagnosis of osteoporosis at 28.

Rebekah Rotstein 3:29

Yes. And I appreciate also you mentioning how people think of this as just this down the road when I'm in my senior years. And it's really not the case for many reasons. But mine was also a little bit earlier than often happens. But I was 28 years old, as you mentioned, when I was diagnosed, and the reason I found out was actually not because I had a fracture. The reason I found out was I was a Pilates instructor and taking some additional coursework and specifically about osteoporosis. And I decided to take this, and actually, I decided to get a bone density skin after learning in this course that the statistics differ, but at that time they were saying it was 98% of your bone density is developed by the time you're like 18 to 20 years old. And so I had been a ballet dancer in my teenage years, and at that time, and I also knew that osteoporosis ran in my family. So I and when I was a teenager as a ballet dancer, I was not menstruating. And one of the things I learned is that you build a majority of your bone density in that time, but also because of your menstruation and estrogen, which also comes back to us later in life, which is why you lose bone mass, bone mass up to 20% in those first five to seven years after menopause, because we lose estrogen. So estrogen is this major factor, and I hadn't known that. And since I wasn't menstruating, I didn't have uh sufficient estrogen levels, and I was a menorrheic, meaning I wasn't getting my period, which then predisposed me to not building up that peak bone mass. So I decided to get a DEXA scan, which is a bone density scan. It's considered the gold standard usually. And lo and behold, I was told, you know, you have osteo, full bone osteoporosis, you need to go on medications, etc. And I said, well, hold on a second, let me back up. Um, let me see if there's something else going on. I wanted to research and find out what was going on. And it turns out that medications hadn't been tested on premenopausal women, especially of childbearing age. And additionally, my problem was not that I was losing bone mass, which is what at the time the medications were really addressing, that osteoclast or bone breakdown activity, but rather I really didn't ever build up that peak bone mass. So I took a different route and I was able to restore some of my bone mass. But other things that I discovered at that time were that, well, you are really tiny. I'm five feet tall, I'm very small boned. I'm gonna be predisposed to having small bones and low bone mass just by my bone structure alone. So it took me down this whole other path, also exploring all the research that was out there and learning from physicians and physical therapists as well, and eventually led me to try and help other people uh that were not seniors with osteoporosis or with low bone mass.

Jenn Salib Huber 6:47

Wow. Yeah, that's I mean, it's definitely something that I think there are more people in your situation than we hear about. So being, you know, kind of in the space that I work in and having worked with people who, you know, have had the type of amenorrhea that you have had, along with people who've maybe had, you know, periods of let's say undernutrition for whatever reason or on medications, you know, we do see people who are diagnosed with low bone density or osteoporosis before menopause. But certainly the vast majority, if I had to like lump it together, would be people who have a fall and a fracture and get diagnosed because of the fracture, right? Um, you know, surprise that they fell and broke their wrist and that it, you know, were like, I didn't fall that hard. And it's because they had lost some bone density. Or the people who go in for a scan thinking that everything's okay. They're like, oh, I'm just going in for a scan because I'm 55 or 65 or whatever it is. And then they find out that they're, you know, either osteopenic or osteoporotic. So I'd love to break down a little bit the

Osteopenia Vs Osteoporosis Defined

Jenn Salib Huber 7:54

terms. What is osteopenia? What is osteoporosis? And what are we talking about when we talk about bone density? Absolutely.

Rebekah Rotstein 8:04

So, first of all, osteoporosis is the loss of bone mass and technically accompanied by changes in the structure and the architecture of the bone, that's it, which makes it all susceptible to fracture. That is supposed to be the definition. That was the World Health Organization definition. But kind of got lost in this muddle over the last few decades where it's really just measured based on loss of bone mass, or I should say, low bone density, because unless you've had a previous DEXA, you don't really know that you've actually lost bone density. You just know that it's lower than that of uh what is average epidemiologically, around 30, 35 year olds. Um, and the challenge with this, first of all, is that especially here in the United States, it's not recommended that you get a bone density screen until you're 65. Well, at 65, as we were talking about before, you've already been most likely you're more than a decade past menopause. And so you've already lost a lot of your bone mass to begin with. So there's no baseline to compare it to. And then that brings me on to a whole other discussion that we can come back to of baseline screenings that would be really helpful around perimenopause, for instance. And I work with the Society for Women's Health and Research, Women's Health Research on the Bone Health Roundtable, and that's something that we're trying to advocate for, is earlier screenings. But going back to this definition, basically you're determined or diagnosed with osteoporosis based on either a DEXA. So this DEXA score, this bone mineral density, it's um it's a screening that's very low radiation, it's very simple. You don't even need to, I mean, you can the technician can still be in the room, unlike with a radiation, high radiation X-ray. But with that, it's based on a certain number of standard deviations away from what is considered normal or that peak bone mass of the average like 30 to 35-year-old. So it's we've lost the second part of that definition, right? About changes in the architecture. The only way we really know about that is going to be through certain CT scans that are really only used in not in clinical settings, but in research settings. So you're not going to know, and that's okay, but we're basing so much on bone density alone, which does have some shortcomings. It's not to say it shouldn't be used, but I do think that there can be too much overemphasis or there's too much emphasis at times on it. Um, the other thing though that people don't realize is that if you've had a fragility fracture, so from standing height or below, and you have you've broken your bone from that, say you've just fallen, that constitutes you or classifies you as having osteoporosis. So I've had many clients approach me or even family members say, Oh, you know, but I don't have osteoporosis. And I have to say, well, actually, you technically do because you have had that fracture. So there should be two parts to this definition of what makes somebody osteoporotic. Now, secondarily, there's a term called osteopenia. Osteopenia is the considered the precursor to osteoporosis. It's really just that you have low bone mass that is not to the degree of osteoporosis on that number scale of minus 2.5 standard deviations, if you really want to get technical, but it's also not at the degree of what's considered healthy bone mass. So you're kind of in this in-between state. The challenge here is that there are more fractures that actually occur in those with or more fractures for those in osteopenia than osteoporosis. Now, this could also be because there are many more people with osteopenia than osteoporosis. So in the United States, there are uh there are estimated to be 10 million people with osteoporosis, and then another 44 million people with osteopenia. So you could say, okay, well, there's a lot more people with osteopenia, and that's why there are more fractures, because the actual rate of fractures is higher in osteoporosis. But we still can't ignore this whole osteopenic range, and we can't also ignore the fact that there are some concerns with the research, or research has pointed out some concerns about these higher number of fractures that are occurring in osteopenia.

Jenn Salib Huber 12:57

This is fascinating. I have never heard this. So sorry to interrupt. I'm just kind of like I'm going through my mind here. Yeah. Everything that I thought I knew was that osteopenia is a risk for osteoporosis, but having osteopenia doesn't technically increase your risk of fractures. But what you're saying is that we are actually seeing fractures at a higher rate in people with osteopenia.

Rebekah Rotstein 13:24

Not at a higher rate. So that's where it gets confusing with the epidemiological. Uh the rate is in epidemiology is like a percentage, basically. Yeah. But it's like out of a thousand people. So the rate of fractures is higher in osteoporosis, but the number of fractures is higher. Yeah. Well, more fractures in osteopenia.

Jenn Salib Huber 13:43

So the the take-home is really that you know you shouldn't you shouldn't ignore having osteopenia, or you shouldn't assume that you're not going to break a bone. Um, just because you're not osteoporotic yet.

Rebekah Rotstein 13:57

Exactly. So osteopenia should be like a yellow light. It's like a warning signal. I mean, osteoporosis should really be the big signal, but osteopenia should be a warning signal to you. You don't take that lightly. And yet, I also want to flip the script on this so that we're not all freaking out and panicking.

Jenn Salib Huber 14:18

Um, if this I can already think of about 10 people who are gonna be like, oh my god.

Rebekah Rotstein 14:24

Exactly. If this is making your listeners uh run to their doctor and ask for a bone density test, that's great. You know, get that baseline. But before you start panicking, let's now uh let's look at this in a little bit of a bigger picture and what's happening.

Bone Remodeling And The Bone Bank

Rebekah Rotstein 14:40

So um I was talking before about bone density. So maybe if we identify sort of what bone density is and means and how this all works, it'll calm us down a little bit and the coffee. So basically, the way all this operates is that throughout your entire life, you're always building new bone and destroying bone. So I was just giving a webinar yesterday where somebody was really panicked about the fact that they're um in their late 50s and that they're they're no longer uh able to have any any bone changes. And that's actually not the case. There's a process known as bone remodeling, and I like to think of it like you get a facial. So basically, you just foliate all the old skin cells, if you will, for new skin cells to grow. And it's kind of similar in bone metabolism. So essentially, you have these bone breakdown cells known as osteoclasts, that are you want them. You want to clear away the old debris because you want to have a new foundation to grow upon. And then osteoblasts, these bone-building cells, come in and they turn into actual bone cells, known as osteocytes. And this process happens throughout your entire life, it never actually stops. So that's one thing to keep in mind. Now, what happens is the rate at which that occurs differs at which point you are in your life. So, in those teenage years that I was talking about previously, you're actually building more bone than you're destroying, building more bone than you're breaking down. And that's why you're building up your peak bone mass. So it's kind of like a bone savings bank. You're putting away for retirement because around your 30s, actually, it levels off, it evens out. But then for women, at menopause, we lose more bone than we're building. So that's kind of like our bone retirement age. So we're starting to withdraw from our bone savings bank. And if we haven't built up enough savings, we have perhaps a deficit. So that's how all of this operates.

Jenn Salib Huber 16:53

That's a great, great way to describe it. Thank you for that.

Rebekah Rotstein 16:56

Yeah. And then when you think of it this way, you start to also realize that part of this is natural. So it's not your body breaking down. It's that this is just changes that happen physiologically that are natural. The challenge is if we haven't built up enough of that savings. It and that's when it can uh lead into osteoporosis. Of course, there are other reasons you could get osteoporosis. Secondary osteoporosis comes, arises from certain medications or medical conditions. So, like say you have celiac disease, or for instance, you've undergone radiation or certain chemo. Um, if you've been under glucocorticosteroid use, like heavy doses, pregnose, say for Crohn's disease or colitis, etc., all of these can lead to altered bone mass and altered structure of the bone. So if that is your case, that is something to be talking to your doctor about and being proactive in terms of lifestyle. Um, especially, you know, nutrition comes in, exercise, where both of us live our lives. But I think the important thing to also remember so that we don't freak out, is that the reason that the bone is gets depleted also is because calcium, which is you are you you as the nutritionist are so aware of the benefits of calcium, calcium is so important for major organ functioning. So it and it occurs because we need, or I should say, we need it for muscle contraction and for the transmission of nerve impulses. So we can't live without that. And if we don't have enough of it, the body's going to borrow it from the silo, from the storage warehouses, which is our bones. And that's cool. That's fine. As long as you have enough and it can get replenished. But when it can't, that's when it becomes a problem. So again, it's it's important for us to recognize that this is not like our generally, this is not something like a cancer where our body has gone into some kind of dysfunction, if you will. This is the way our body is designed to operate to enable us to live and for homeostasis for the body to function. It's just it's at the expense of the bones.

Calcium Beyond Supplements And Vitamin D

Jenn Salib Huber 19:26

Yeah. And you know, it's so it's so important, I think, to just kind of touch a little bit on that calcium discussion because for so long, and I mean, I've been studying nutrition since 1995, it has always been calcium and vitamin D, and you're good. Like if that was the bone conversation, right? And so over the last five, 10 years, as we've looked at, you know, data, especially with supplements, you know, people who are taking calcium supplements, and I keep saying supplements, emphasis because there is a difference there, that people who are taking calcium supplements and vitamin D supplements aren't getting the benefits that we thought should be there. Based on how important we know that calcium and vitamin D are for bone, that still remains true. And yet the supplements and studies have underperformed, right? It's kind of been underwhelming. It's been like, oh, well, that's kind of disappointing. And so what has happened is that a lot of people have just said, well, calcium is not important. And they've just kind of, you know, because when media reports on these things, it's always just this like single line like calcium shows no benefit in bone density. So then people just see that. Don't talk to their healthcare practitioner about it, and then, you know, 10 years later find out that, oh, actually, it is still important. We just can't say for sure that the supplements are going to save you, is kind of what I tell people. So, and because we need calcium for our heart and all of these other things, it is still so important to be focusing on getting enough calcium. And ideally through diet, if you can, because that really is probably the way that our body can use it most easily, most efficiently. And it's usually with other things that also, you know, potentially could benefit us. So, one of the things that I'm talking about all month long, especially in the midlife feast community, is that it's calcium, it's vitamin D, but it's also magnesium, it's also protein, it's also strength training, it's the whole package of providing the ingredients and also the movement that your bones need in order to kind of stay young and active, right? It's not just taking a supplement. So I'll get off my little soapbox.

Rebekah Rotstein 21:48

No, but I love that you mentioned this because what you're also speaking to is the reductionist approach that I find is going to be the end. Of

DEXA Limits Plus FRAX Fracture Risk

Rebekah Rotstein 22:01

our society if we don't address it, which is let's distill everything into something that's overly simplistic. And what are the top three blah, blah, blah, blah, blah, and not seeing the bigger picture. And that really speaks also to exercise and the bone density conversation. It's the exact same scenario that you that you experience in the nutrition world, which is that, okay, for uh, first of all, all we need is to think about bone density. And that's actually not the case, because bone density is one factor that will determine whether you fracture or not. Do we want strong or high bone density? Yes, but it's not the end-all beal because there are shortcomings to the bone density tests. Again, somebody like myself is smaller, is going to automatically be predisposed to having low bone mass. Additionally, if you have arthritis, say you have arthritis in your spine, I've seen this many, many times, it gives you a false reading. So arthritis in your spine will incorrectly be read as higher bone density. So that's not an accurate picture. Exactly. Then there are different shortcomings to the ways that the bone density screenings can be done. And that it's also just an aerial view. It's not giving a full volumetric picture of what the true density is. And then there's more than just the density in terms of strength. It's the actual bone turnover, it's the quality elements of the bone, it's the structural integrity of the bone. And some of these can be determined actually in bone marker blood tests. So those are other things that can be used in conjunction with uh just a DEXA scan. But then also when you look at certain things, uh, there's something called a frax, which is the 10-year fracture risk. That for anybody listening, if you if you are going to go or thinking about going on medication, you should definitely be talking to your doctor about your fracks score in addition to your DEXA. It's a very simple algorithm. You can find it online, F R A X, and it'll give you your 10-year probability of a fracture. Well, interestingly, you punk it, and it's it's based on epidemiological data based on country. Um, so you punch in these numbers, including your density for the bone density for your hip. And it doesn't look at your spine, it doesn't ask anything about your wrist, which is not surprising, but it is interesting, it doesn't talk about your spine. It wants to know about alcohol units per day, your height, weight, if a parent had a hip fracture, uh, use of glucocorticoids. But the missing element from my perspective, my professional perspective, not just as a patient, but as a professional, is well, what is your activity level, your activity history, your exercise level, your balance score, and certain functional tests? Not that that would necessarily be appropriate or able to be applied in here, but you have two different people, A and B. One hasn't done any kind of exercise, their balance is very poor, the other one is off the charts with it. You really want to tell me that they have the exact same identical fracture risk? I can't believe that that could be the case. So there are a number of other factors that come into play. And as I was giving an example, there's the bone density side. But then there are so many things that we can do. And along that, strength training is a very critical element, and yet we tend to think of strength training as only lifting weights, and there's more to it than that.

Jenn Salib Huber 26:05

Oh,

Bone Strength Training Without Intimidation

Jenn Salib Huber 26:06

let's dig into that because that I love talking about because that is a huge barrier. So, you know, so many of the people who listen to this podcast and people that I work with are people who are trying to redefine their relationship with food and movement. And so they're trying to find a sustainable, joyful way to move and eat and live that isn't based on a prescriptive set of rules. And I can pretty much guarantee that when somebody says strength training, they picture going to the gym, they picture standing in front of a weight rack and not knowing what to do, unless they've already had that part of their life. And it's intimidating for people. They think, well, I can't do that, and I certainly can't start that at 45, 55, or 65 if I've never done it. So, yes, talk to us about strength training, Rebecca.

Rebekah Rotstein 26:53

Absolutely. So, and I don't want to repeat too much of what uh Neve had mentioned, and I listened, I was so excited yesterday to listen to Neve's podcast. Um, and you know, the certification that she had done was our buff bones training. So, and she's fantastic. So, the the things that you have to keep in mind is what does the research show? Well, the research shows that the way you strengthen bone is through weight-bearing exercise, upright positions, basically standing against gravity, but that doesn't include for your wrist, the wrist is the third most common side of fracture, and for us in midlife, the most likely area to fracture. You know, we always think about a fracture of the hip, which is the most dangerous, is the most costly, but that's usually more in a senior or elderly situation. At midlife, it's the wrist. So if we bear weight through our wrist by being on our on our hands, planks, push-ups, crawling even, that's going to strengthen the wrist. That's the weight bearing. The second part is the resistance training. So resistance is literally just getting to use your muscles and the pull of the muscle against the bone. There's a lot in between. You've talked about the periosteum covering of the bone, which then becomes the tendon. And then the tendon then becomes the muscle. But if we just want to simplify it, that pull of the muscle helps fortify and strengthen the bone. So that's the second part. And then along with that, we want to try and get some impact through the bone. So studies on young men have identified that running is a great way to build bone density in young 20-something men. Well, it's a little bit different than our, you know, late 40s, mid-50s, late 50s female population. And then we're not taking into account, you know, arthritis or different other joint conditions that might come into play at that point. But we can still get impact from something such as heel drops. So you're just standing while you're brushing your teeth and you lift and drop your heels. Just drop, drop, drop, keeping your knees straight, not bouncing, but that's a simple way to get impact that can also be safe if running is not for you or not appropriate for you. But when we talk about this resistance against the bone, it gets a little bit complicated and nuanced. Okay, so in postmenopausal women, as you were talking in that other podcast, our goal is to halt bone loss. It's not really to try and build new bone density. Until recently, it was thought that you can't really build bone density postmenopausally just through exercise alone. That has actually been debunked in recent research. However, the type of exercise that is required to actually build bone density in a postmenopausal state with osteoporosis is very, very high intense. It's great if you have access to the gym. We're talking about 80 to 85% of a single rep of the most that you could do with a with one weight. You have to be supervised at least for a while. Um, there are various barriers to that. If you can do that, that's fantastic. But where I come with buff bones is that is not your starting point. You're gonna injure yourself if you try and start with that. What you need to do is condition your body to the point that you could either eventually lift very heavy loads or do whatever is most appropriate for you. Because the big thing is if if you're thinking, oh, this is what I have to do, I don't want to do it, you're more than likely going to avoid it. That's why diets don't work, right? And so if we think about doing the things that we enjoy doing and bring in the appreciation, that's where we're gonna start to actually have commitment and uh and avoid

Impact Work Wrist Loading And Heel Drops

Rebekah Rotstein 31:08

these uh issues with attrition. So where it comes in with buff bones is the conditioning in the body organization and the embodiment, the appreciation of your body, and especially something that's never talked about, or I should say I don't hear ever talked about, that should be talked about when it comes to weight training and heavy lifting, which can be great if it's appropriate for you. And I I love that. But I also have a number of conditions in my body where I have to do a lot to organize my body, otherwise, I will injure myself very easily. And I've been moving for years, and the thing that I was going to mention is tendinopathies. There's a very high rate of tendinous injuries, menopause, and after because of changes in estrogen. And so it's not uncommon for women to experience irritation and inflammation around their tendons, specifically in the hips, hip tendinopathies, and rotator cuff injuries with tendons that occur at this time. And then you start adding in heavier loads, and especially if you have poor mechanics and the joint is not well positioned, when you add on external load, it goes under extra pressure, it becomes more irritated, becomes more inflamed in the different tissues, and then the injuries can set in. And I think that's largely ignored, which is a great problem because then if you're injured, you can't do much of anything.

Jenn Salib Huber 32:45

No, and I think that is a really, really important point because you're right, injuries do those types of injuries are more common. Also, just general knee injuries. You know, I was a runner, had my meniscus repaired, had a root repair done. Running is no longer part of my life. I'm okay with that now. Um, but you know, I definitely have that, you know, awareness uh around my knee. And certainly with my needs in particular, you know, one of the reasons why I feel motivated often to kind of continue moving regularly is because I know that if I have any period of time where I'm not, it's literally like a go back to go and start all over again, right? I can't go on vacation for two weeks and come back and jump right into my lifting. And so, and I lift at home, you know, I have a kind of a home set that, you know, is is is adjustable. I can definitely get pretty heavy with it, but I don't jump back into it like I would have 15 years ago, right? You know, if I was away, I'd come home and it's like, oh, I'm gonna do a big workout. Uh no, I'm gonna I'm gonna start with like a bodyweight workout the first day, and then I'm gonna, you know, jump build up because yeah, the injuries, it just, you know, it's just I think something we do have to not only expect, but to a certain extent accept, right? That we're not 25 anymore. Um that's part of it.

Rebekah Rotstein 34:04

And that's a great point. It's that are we trying to make our bodies operate like they did at 25? Why aren't we doing things that are critical for us now? And that comes into a lot of the work that I do with people that already have osteoporosis or low bone mass, where you know, you were talking in the last podcast about contraindications and certain movements

Heavy Lifting Research And Safe Progressions

Rebekah Rotstein 34:26

that shouldn't be done. And especially in, say, a Pilates or yoga setting, there are a handful of things that need to then be adapted, modified, or just changed altogether. And so rather than thinking, oh, well, I can no longer do X, Y, Z types of movements that I could when I was in my 20s, let's think about, okay, well, what are the things that I need to focus on and want to focus on now for my bones that'll be beneficial because I don't have eight hours a day to exercise. So, in this limited time that I have, if I want to give it in certain bursts, or you know, if you want to do it throughout the day, little things, that's fantastic. But if you're setting aside a certain amount of time in a day to practice working on your body, then let's be really smart about this and let's be time conscious and let's be efficient. What are the things that I should be focused on? And that also allows you to shift the mindset from this sense of mourning of, oh, I can't do this anymore, to okay, what's the task at hand? What are what is going to empower me, my body, my bones? And let's get to it.

Jenn Salib Huber 35:37

Yeah. Before I think that's so important, before we wrap up, I just want to touch briefly on the discussion around HRT or menopause hormone therapy. And, you know, this is in neither of our wheelhouses, technically, but I think probably both of us, you know, have a fair amount of working knowledge around it. And I know the question will come up. So what I tell people is that if you go into menopause early, prematurely, before the age of 40, or early before 45, the evidence is very clear that, you know, using estrogen therapy in particular until above the age of natural menopause, which the average is 51 or 52, will protect your bones. That's really clear. If you don't have a period for any other reason, that's also an important discussion to have with your doctor. And for everyone else who goes into menopause, naturally, surgically, or medically, there certainly is evidence that HRT can also improve bone density in those populations of people. But it's not the only thing that you can do. And I think that that's a really important part of the conversation because there are so many people like me who, you know, try different types of hormones and can't tolerate it and just can't take it for whatever reason. Do you have anything to add to that discussion?

Rebekah Rotstein 36:51

Well, I think that actually, I think, especially from all the controversy over the women's health initiative and such, I think that evidence for bones actually is very positive that even postmenopause, now I can't say more than 10 years post-men-menopause, although they were actually older. But the the evidence is there that that uh HRT will be protective for your bones. However, as you mentioned, it's not appropriate for everyone. Um, I have to say, for myself, I do plan on doing it. I'm 47 now, I'm perimenopausal. Um, it's almost 20 years since I was diagnosed uh with low bone mass. And um, because I already am predisposed, also from my history, I do intend to do estrogen replacement or hormone replacement therapy with estradiol. But that's my own personal choice. And who knows, maybe I also will discover if I try it, and and maybe it's not going to work for me. Um, I think it's a very personal choice. And as you're saying, regardless, um, it it it's it takes us into a whole other conversation because in the UK, it actually is a treatment for osteoporosis, whereas it's not FDA approved in the United States. And it's it's interesting, and that and that actually brings us into a whole other conversation. But um, I think you bring up a great point that there is this huge discussion now, pro or

Injuries Tendons And Smarter Mechanics

Rebekah Rotstein 38:21

against HRT. And, you know, regardless of whatever somebody chooses, to understand that there are very specific lifestyle tactics and strategies that you can take to benefit your bones. And yes, is the best thing you can do for your bone density to be lifting heavy weights? Yes. But that's not all there is. We have to think about balance, we have to think about mobility. There's more than just bone density, there's also muscle strength. And of course, of course, muscle strength has a correlation to bone density, but there's there are many other skills and I should say skills, especially that mobility and balance and coordination parts that are really overlooked when people are just thinking heavy weights. And how do you condition and work your body? And how do you use your own body weight? And how do you work your body efficiently? Because I've seen people who just have great bone density and have awful balance. So, you know, there's a lot more than just the density to how do you protect the bones?

Jenn Salib Huber 39:34

And I have that in the in the module this month for for the membership. I said there's a there's a bone density conversation and there's a fracture risk conversation. They're parallel, but they're different. Like you can't just think about bone density as the be all and end all, right? You have to be thinking about all those other things.

Rebekah Rotstein 39:51

Yeah. Well, I mean, is your goal in life to have high bone density? No, why do you want high bone density? You want it so that you don't live or you don't fracture. Why do you want to not fracture? Because you want to live a long independent life. So let's really talk about what you want. You want a long independent life. How do we get you there?

Jenn Salib Huber 40:10

I love it. I could talk to you forever. I feel like this might be a part one of part two at some point because I feel like you are a literal wealth of knowledge. Thank you so, so much. Before we get to my, you know, famous, infamous last question. I know people are going to be dying to learn about where they can learn more from you. Or like, do you is there a course that you have for, I know you teach practitioners, but kind of what what where can people find you and and what can they learn from you?

Rebekah Rotstein 40:37

Sure. Well, in in addition to our instructor training certifications, we do have uh, so you can actually find one of our instructors. If you go onto our website, you can find an instructor anywhere around the world. But we also have online options. And then, of course, we also are on Instagram. You can find us at got buffbones. Uh Facebook is BuffBones as well.

Jenn Salib Huber 41:01

Awesome. And we're gonna have all those links in the show notes. So no worries, you can find them all there. So thank you so, so much. And as I always ask my guests, what do you think is the missing ingredient in midlife?

Rebekah Rotstein 41:16

I would have to say appreciation. We talk a lot about gratitude, and gratitude is that element, the basis of appreciation, but sometimes gratitude gets a little lost in this bigger um word soup. And so it's really appreciation. And I think that's also what I try to strive for with embodiment and appreciating this body that we live in, but moving it. Not because we want to have a six-pack ab or abs or we want to lose weight, but because we want to we want to enjoy how our bodies move and being in them.

Jenn Salib Huber 41:53

Yeah. You know what I've started calling my body? I call it my meat suit now because um, you know, that's what it is. It's literally, it's just my meat suit. Um, body carries so much, like I think there's a lot of, you know, it can be a heavy term, especially if you're working on understanding, accepting, living with a changing midlife body. Yes. Um, so now I'm like, it's just my meat suit. It just gets me from A to B. It moves me through this world. And I want it to be strong and I want it to be, you know, the best that it can be. Um, but it doesn't

Hormone Therapy Plus Lifestyle Basics

Jenn Salib Huber 42:26

have to be, it doesn't have to look a certain way. And that's not the point of it. It the point of it is to work as a body as best as it can.

Rebekah Rotstein 42:34

Love it. I love it.

Jenn Salib Huber 42:36

Awesome. Thank you so, so, so much for sharing all of this. It has been lovely talking to you.

Rebekah Rotstein 42:43

Ugh, I I would love to talk more. There's so there's so much we have to discuss. Thank you so much for the pleas.

Jenn Salib Huber 42:52

Thanks for joining me for this episode of the Midlife Feast. If you're ready to take the next step towards thriving in midlife, head to menopause nutritionist.ca to learn more about my one-to-one and group coaching programs, free resources, and where to get your copy of Eat to Thrive during menopause. And if you've loved today's conversation and found it helpful, please share it with a friend who needs to hear this and leave a review wherever you listen to podcasts. It helps so many more people just like you find their way to food freedom and midlife confidence. Until next time, remember midlife is not the end of the story, it's the feast. Let's savor it together.