Got Buff Bones? How to Improve Your Bone Fitness & Reduce Your Fracture Risk with Rebekah Rotstein

Bone health has become one of those topics we add to our to-do list around our 60th birthday. That’s when it will really start to matter, right? The truth is that bone health really matters for our entire life if we want the chance to prevent those nasty breaks and fractures. In this episode, I’ve invited Rebkah Rostein, founder of Buff Bones to share with us why menopause is the perfect time to become an expert on the state of your bones! 

While you’ve likely heard plenty about the importance of bone density, Rebekah wants us all to know that so many other factors such as bone turnover, bone quality, and the structural integrity of our bones determine our fracture risk. Bottom line-we’ve way oversimplified this conversation and Rebekah is here to take us deeper!

In midlife, we know by now that strength training has to be customized to activity that is accessible based on our risk factors, appropriately challenging, and is actually fun if we are going to stick with it. Trying to check all those boxes is pretty overwhelming. That’s where Buff Bones© comes in handy and why Rebekah is offering the Midlife Feast Community 20% off the Buff Bones© 10-Day Challenge with the code Bbfeast23! If your goal is to be active and independent beyond age 60, this is the perfect episode to learn how to invest in the future version of yourself! 

In this episode, you’ll learn 

• Why our focus on bone health needs to begin in adolescence and continue through our entire lives
• Osteopenia: what it is and what this diagnosis is telling you
• Why bone density isn’t the only factor of bone health we need to focus on
• How advocating for bone screenings can empower you to be more preventative 
• Examples of small lifestyle changes that can make a big impact on bone health 

To learn more about Rebekah and her work, check out her website at www.buff-bones.com or follow her on Instagram @gotbuffbones and on Facebook @BuffBones. Also take advantage of 20% off of the Buff Bones© 10 Day Challenge using the code:  Bbfeast23

TRANSCRIPT

Jenn Salib Huber 0:02
Hi, and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Selena Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi, everyone, welcome to this week's episode of the midlife feast. I'm really excited to be welcoming Rebecca Rotstein, who is a movement educator to talk about a really important topic osteoporosis, we're still talking about that this month, because it's us your breast this awareness month. But one of the reasons why I'm drawing so much attention to it is that we talk about things like hot flashes all the time, we talk about the risk of heart disease and high cholesterol and all of the other risks associated with this age and stage of life. But we tend not to think about bone health and osteoporosis until much later in life, you know, often in our, you know, 60s Or maybe late 50s, when we start to think about the risk of falling, and when we start to hear about or maybe experience, you know, fractures on our own. So the reason why I want to bring this up, and the reason why I wanted to have this amazing conversation with Rebecca is that there's so much we need to know about before we hit menopause. And certainly long before we're well into post menopause. And there's a lot of myths that I think hold us back from being really proactive when it comes to bone density and reducing the risks of fractures. This is a great conversation, I learned a lot there were a couple of things that I was surprised about. But I think that what I took away the most from this conversation with Rebecca and when I think you will as well is that there really is so much that we can do. So Rebecca was diagnosed with osteoporosis in I think it was 28 Two in her late 20s. And since then, she's been on a mission to make bone health appealing and accessible to everyone. So once you listen to this information once you've listened to this episode, I know that you will want more information. And Rebecca has generously given us given our listeners to the midlife feast 20% off of her 10 Day Challenge. So you can find all the information for that in the show notes. But you will certainly come away from this episode, having learned a few new things. Welcome Rebecca to the midlife feast.

Rebekah Rotstein 2:42
Thanks so much for having me, Jen, I'm excited to be here.

Jenn Salib Huber 2:45
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, or 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 as I hope everyone is going to know by the end of this month after I talked about it at nauseam 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. 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 3:45
Yes, and I appreciate also you mentioning how people think of this as just as 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 expand 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 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 As 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 sufficient estrogen levels. And I wasn't Minarik, 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 scans considered the gold standard usually. And lo and behold, I was told, you know, you have asked you full blown osteoporosis, you need to go on medications, etc. And I said, Well, hold on a second. Let me back up. 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 where that will, you are really tiny, I'm five feet tall and very small bone, I'm going to 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 that were not seniors with osteoporosis or with low bone mass.

Jenn Salib Huber 7:04
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 a Maria that you've had, along with people who've maybe had, you know, periods of let's say, undernutrition, and 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 in a fracture, and get diagnosed because of the fracture, right, you know, surprise that they fell and broke their wrist. And that it, you know, rely 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 osteo product. So I'd love to break down a little bit the terms, what is osteopenia, what is osteoporosis? And what are we talking about when we talk about bone density?

Rebekah Rotstein 8:18
Absolutely. So first of all, osteoporosis is 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, what is supposed to be the definition that was the World Health Organization definition. But we've 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 what is average epidemiologically, around 30 to 35 year olds. 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 screening until you're 65. Well, it's 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 have baseline screenings, that would be really helpful around perimenopause, for instance. And I work with the Society for women's health and race, 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 die I've noticed with osteoporosis based on either a DEXA. So this DEXA score this bone mineral density, it's, it's a screening that's very low radiation, it's very simple, you don't even need to you 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 a 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 over emphasis or there's too much emphasis at times on it. The other thing that people don't realize is that if you've had a fragility fracture, so from standing height or below, and you have you broken your bone from that, so you've just fallen, that constitutes your classifies you as having osteoporosis. So I've had many clients approached 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 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 higher number of fractures that are occurring in osteopenia.

Jenn Salib Huber 13:14
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. 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 of people with osteopenia

Rebekah Rotstein 13:40
not of a higher rate. So that's where it gets confusing with the epidemiological. The rate is is in epidemiology is like a percentage, basically. Yeah, but it's like out of 1000 people. So the rate of fractures is higher and osteoporosis, but the number of fractures is higher, or more fractures in osteopenia.

Jenn Salib Huber 14:00
So 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 bone. Definitely, just because you've not lost your product yet.

Rebekah Rotstein 14:14
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 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 14:35
If you can already think of about 10 people who are gonna be like, Oh my god.

Rebekah Rotstein 14:40
Exactly. If this is making your listeners 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 know. Let's look at this in a little bit of a bigger picture and what's happening so I was talking before a 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 in 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 in their late 50s. And that they're, they're no longer 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, rolly ate 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 osteo class, 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 osteoblast, 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 17:10
That's a great, great way to describe it. Thank you for that. Yeah. And

Rebekah Rotstein 17:13
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 this is just changes that happen physiologically that are natural. The challenge is, if we haven't built up enough of that savings in that's when it can 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 if you've been under glucocorticosteroid use, like heavy doses, prednisone, 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. And 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 your you as the nutritionist are so aware of the benefits of calcium. Calcium is so important for major organ functioning. So it occurs because we need or I should say we need it for muscle contraction and further transmission of nerve impulses. So we can't live without that. And we don't have enough a bit, 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.

Jenn Salib Huber 19:43
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 I like it that that was the bone conversation, right. And so over the last 510 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 health care 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. Also, you know, potentially can benefit us. So one of the things that I'm talking about all month long, especially in the midlife peace 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 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 22:04
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 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 blipped up 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? 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 be all because there are shortcomings to the bone density tests. Again, somebody like myself, who is smaller is going to automatically be predisposed to having low bone mass. Additionally, if you have arthritis, so 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 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 it's just a an aerial view, it's not giving you 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 naturally in bone marker, blood tests. So those are other things that can be used in conjunction with just a DEXA scan. But then also, when you look at certain things, there's something called a fracs, 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 fracture score, in addition to your DEXA. It's a very simple algorithm. You can find it online fr 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. So you punch in these numbers including your density for the bone density for your hip. And it doesn't look at your By now, 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, 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 your activity level, your activity history, your exercise level, your balance score and certain functional tests, not that that wouldn't 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 they have the exact same identical fracture risk, I can't believe that that could be the case. So there are there are a number of other factors that come into play. And the as I was given example, there's the bone density side. But then there's 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 26:22
oh, 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 the 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 4555 or 65. If I've never done it. So yes. Talk to us about strength training,

Rebekah Rotstein 27:09
Rebecca. Absolutely. So and I don't want to repeat too much of what Neve had mentioned, and I listened. I was so excited yesterday to listen to news podcast. And, you know, the certification that she had done was our buffed bones training. So she's fantastic. So 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 elderly situation. At midlife, it's the wrist. So if we bear weight through our risk 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 pole 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 pole 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 and 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 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 another 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, postmenopausal 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, you're not going to have these kinds of weights at home, we're talking about 80 to 85% of a single rep have the most that you could do with with one weight. So you're not going to have that home, you have to be supervised, at least for a while. 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 going to 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. Yeah, and so if we think about doing the things that we enjoy doing, and bring in the appreciation, that's where we're going to start to actually have commitment. And, and avoid these these 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 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 was a very high rate of tenderness injuries at 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 in 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 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 33:05
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 roof repair, done, running is no longer part of my life. I'm okay with that now. But you know, I definitely have that, you know, awareness around my knee. And certainly with my knees 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 lived at home, you know, I have a kind of a home set that, you know, 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. I know. I'm gonna, I'm gonna start with like, a bodyweight workout the first day, and then I'm gonna, you know, 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, except, right, that we're not 25 anymore. And that's part of it.

Rebekah Rotstein 34:24
And that's a great point. It's that, are we trying to make our bodies operate like they did it? 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 contra indications and certain movements 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 XYZ 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 what to focus on now for my bones, that will 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, 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 is what is going to empower me my body, my bones? And let's get to it.

Jenn Salib Huber 35:57
Yeah. Before, I think that's important, before we wrap up, I just want to touch briefly on the the discussion around HRT or menopause hormone therapy, and, you know, this is in neither of our wheelhouse is technically but I think probably both of us, you know, I 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 about the age of natural menopause with 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, tried different types of hormones and can't tolerate it and just can't take it for whatever reason. So I think that there ends up being so much fear around people who can't or don't want to take hormone therapy, and what's going to happen to their bone. So I'm so glad that we're having the conversation about the other things that we can do. And because we know that not everyone can or wants to take hormone therapy, there's a lot of fear. And I think that a lot of shame that comes in if people can't or don't want to take it. And they think well, should I and maybe that, you know, maybe I should consider it. And for someone like me who had you know, I had my last period at 44. But I just can't take hormones, they just don't agree with me. You know, I want people to know that there are so many other things you can do. If you can and want to take hormones, great. No one's gonna say that that's a bad choice. But don't feel like you're doing something wrong if you can't or don't want to, because there are so many other things like what we've been talking about on this episode of what you can do. Do you have anything to add to that discussion? Well,

Rebekah Rotstein 38:03
I think that actually, I think, especially from all the controversy over the Women's Health Initiative and such, I think that the evidence for bones actually is very positive that even post menopause now I can't say more than 10 years post menopause, although they were actually older, but that the evidence is there that that HRT will be protective for your bones. However, as you mentioned, it's not appropriate for everyone. I have to say, for myself, I do plan on doing an M 47. Now I'm pre menopausal. It's almost 20 years since I was diagnosed with low bone mass. And because I already am predisposed, also from a history, I do intend to do estrogen replacement or hormone replacement therapy with extra dial. But that's my own personal choice. And who knows, maybe I also will discover if I try it, and maybe it's not going to work for me. I think it's a very personal choice. And as you're saying the guard lists 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.

Jenn Salib Huber 39:21
That may be where my messaging is kind of a little bit different to is that maybe I'm following more kind of Canada in the US where it's not a primary intervention. So I'm reading on that

Rebekah Rotstein 39:32
and and it's it's interesting, and that actually brings us into a whole other conversation. But I think you bring up a great point that there is this huge discussion now pro or 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 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 no, there's a lot more than just the density to how do you protect bones? And how do you

Jenn Salib Huber 40:57
and I have that in the in the module this month 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 is the be all and end all right. Especially because,

Rebekah Rotstein 41:13
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? If you don't fracture? Why do you want to not fracture? Because you want to live it as long independent life? So let's really talk about what you want you want along independent life, how do we get you there?

Jenn Salib Huber 41:34
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. Thank you, 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 Is there a course that you have for I know, you teach practitioners, but kind of what what, where can people find you? And what can they learn from you?

Rebekah Rotstein 42:01
Sure. Well, in in addition to our instructor training certifications, we do have, 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 so the place that I would recommend people start is we have a 10 day challenge that walks you through 10 days on demand at your own pace, you have access for 60 days, to understand all these elements that you need to build the strong and resilient body that you want to tackle osteoporosis before you even start adding in weights. So I really think it's your true starting point, true starting point on how to move your body when you want to protect your bones.

Jenn Salib Huber 42:49
Amazing. Mom, if you're listening, I'm sending that link to you.

Rebekah Rotstein 42:53
And then Oh, please, we also are on Instagram, you can find us at got buff bones. Facebook is buffed bones as well.

Jenn Salib Huber 43:01
Awesome. And we're gonna have all those links in the show notes. So no, 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 43:15
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 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. Moving not because we want to have a six pack abs 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 43:52
Yeah, you know, when I started calling my body, I call it my meat suit now because you know, it's what it is. It's literally it's just my meatsuit 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. 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. But it doesn't 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 as best as it can. I love it. I love it. Awesome. Thank you so so so much for sharing all of this it has been lovely talking to you.

Rebekah Rotstein 44:43
I would love to talk more there's so there's so much we have to discuss. Thank you said was really

Jenn Salib Huber 44:51
thanks for tuning in to this week's episode of the midlife D. For more non diet health hormone and general midlife support. Click the link in the show notes till Learn how you can work and learn from me and if you enjoyed this episode and found it helpful please consider leaving a review or subscribing because it helps other women just like you find us and feel supported in midlife