Beyond the Metrics: Getting Intuitive About Bone Health with Rebekah Rotstein

When it comes to bone health, especially during menopause, many of us rely heavily on T-scores from DEXA scans. But there’s actually much more to the story than these numbers if we want to feel strong in this midlife and beyond. To help us understand how to develop confidence in an intuitive approach to bone health, I invited Rebekah Rotstein, founder of Buff Bones back on the podcast to lead this conversation. 

What I appreciate about Rebekah is that her work with clients is deeply informed by her own journey with an osteoporosis diagnosis. She resonates with anyone who might feel defined by a recent diagnosis of osteoporosis or osteopenia and is seeking hope and guidance.

One of the key takeaways is the importance of looking at bone health holistically. We discuss the idea of interoceptive awareness—using your internal sense to gauge your health and strength. Developing this internal awareness can improve your movement practices and overall bone health. Practically, this means we avoid jumping to the worst-case scenario when we feel an ache or limitation and instead adjust our approach to movement in order to feel safer in our bodies.  

Strength training plays a big role in maintaining bone health. Rebekah and I debunk the myth that one-size-fits-all exercise programs work for everyone. Instead, we advocate for personalized strength training that takes into account individual health histories and abilities. This approach empowers you to build strength and confidence while also reducing the risk of fractures.

This episode is a reminder that we are more than our T-scores. By adopting a holistic and intuitive approach to bone health, we can lead more empowered and fulfilling lives. We can also learn to become experts in making observations about our bodies without judgment or fear. Whether it's through strength training, intuitive movement, or just listening to our bodies, there are many ways to take control of our bone health journey.

How do you feel about your bone health? Have you felt anxious after a DEXA scan? Share your experiences and thoughts with us. Engaging with others who understand your journey can be incredibly reassuring and empowering.

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.

Additional Resources:

#68: Got Buff Bones? How to Improve Your Bone Fitness & Reduce Your Fracture Risk with Rebekah Rotstein
#69: How to Un-Diet Your Relationship with Movement in Midlife with Christine Chessman
#80: Movement for More in Midlife with Jamie Carbaugh

TRANSCRIPT
 

Jenn Salib Huber: 0:00

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 Salib-Huber. I'm an intuitive eating dietitian and naturopathic doctor and I help women manage menopause without dieting and food rules. Come to my table, listen and learn from me trusted guest 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. And if you're looking for more information about menopause, nutrition and intuitive eating, check out the Midlife Feast Community, my monthly membership that combines my no-nonsense approach that you all love to nutrition with community, so that you can learn from me and others who can relate to the cheers and challenges of midlife. Hey everyone, welcome to this week's episode of the Midlife Feast.

Jenn Salib Huber: 0:53

So this is May, inching towards the end of May, but it's May and we're still talking about bones and osteoporosis and bone health.

Jenn Salib Huber: 1:01

So I get emails from people often and they often start out with oh my goodness, I just had my first bone density scan, my first DEXA scan, and I'm terrified because my results tell me that I have osteoporosis or osteopenia.

Jenn Salib Huber: 1:18

What do I do? And oftentimes, whatever we're told to do, we still feel like it hinges on. Does it? Has it made my T score better? Or, you know, am I doing? Am I doing everything that I can, and I wanted to invite Rebecca Rothstein from Buff Bones back on the podcast, because she was here last May as well, to chat a little bit about some of the other metrics.

And so, yes, we talk about what a T-score is, what a DEXA scan is, why it does matter, but also why it's not the be all and end all and some of the other things that you can learn to measure and pay attention to that will help you to feel more confident, even if you have a diagnosis of osteopenia or osteoporosis. So, tune in, settle in and, as always, let me know what you think. Hi Rebecca, welcome back to the Midlife.

Rebekah Rotstein: 2:12

Feast. Hi, Jen, I'm really happy to be back here with you.

Jenn Salib Huber: 2:16

So we're going to dive into something that I'm excited to talk to you about, but why don't you just take a minute and tell the audience a little bit about who you are, what you do and why bone health is kind of everything that you do?

The Founder of Got Buff Bones: Rebekah Rotstein

Rebekah Rotstein: 2:30

Well, I'm the founder of Buff Bones, which is an exercise program for bone and joint health that encourages midlife women on how to protect their bones and prevent fractures so we can live long, resilient lives independently, and I think the last time that we spoke, we were talking about bone health specifically, and there are so many other elements to the discussion of bone health than just what your bone density report shows, so I'm excited to have more conversations about other elements today.

Jenn Salib Huber: 3:10

Yeah, so we want to talk about metrics. So everybody loves a good number, everyone likes to you know, have that number, whether it's a blood test or you know a personality test, like we all like to just know where we're at. I think there's safety in feeling like, okay, I have a reference for where I'm at. But when it comes to bone health, we really need to be thinking about metrics beyond just what defines osteoporosis, what defines osteopenia. Those can be useful pieces of the conversation.

The Fear That Can Follow DEXA Scan Results

Jenn Salib Huber: 3:44

But the reason why I was excited to talk to you about this is because at least once a week somebody will send me a message and either feel really scared and confused about what this T-score means and oh my goodness, does this mean that I'm about to crumble into into dust and really feel like they hang the success or failure of all of their efforts on this one number right, and I think that it is understandable because that's human nature, but also, you know, it feels kind of disempowering.

Jenn Salib Huber: 4:19

I don't have personal experience with that yet, partially because I'm still trying to advocate to get one before the age of 55 here in the Netherlands. But I don't have personal experience with that yet, partially because I'm still trying to advocate to get one before the age of 55 here in the Netherlands, but I don't have personal experience with having to like navigate the results of a number. But there's so much more to bone health. So what, what, what? What do you think about all of that? I just kind of blurted a bunch of stuff, so why don't you just go no, it's, it's great we.

Why You Are More Than Your T-Score

Rebekah Rotstein: 4:42

We have a saying at Buff Bones that you're more than your T-score. Because, for those who don't know, your T-score is the measurement of bone density. It's the score that you get when you get a DEXA, which is a dual x-ray absorptiometry, which is basically just the gold standard for bone density imaging, the gold standard for bone density imaging, and so the result comes to you in what's known as a T-score. So we like to say yes, you're more than your T-score. Just don't be measuring your self-worth and even necessarily how strong your bones are, necessarily by that scoring. Because, first of all, a whole other side topic that I'll give you just a 30-second rundown on is that there are shortcomings to bone density scoring and that can bring us into a whole other conversation. But there are more fractures actually that occur in those with higher bone density than lower bone density. So the bone density scoring is not an end-all be-all. It is an important metric to use as part of the entire picture, but it's not everything.

Speaking From Experience: Rebekah's Journey with an Osteoporosis Diagnosis

Rebekah Rotstein: 5:52

So, keeping that in mind, I think I can also speak very personally about what it's like to live and breathe by your T score, because I did that for years. So when I was first diagnosed with osteoporosis it was 20 years ago I was given a quote low T-score that was determined to be osteoporosis. I was able to improve it over the years, but there were times throughout that when it would go up and then it would go down a little bit and it's like you're holding your breath every single time. Oh my gosh, what's it going to show? And again, there's value in monitoring it over time. But to put all of your emotions essentially into the outcome of that can be really detrimental to our health, and I've done it, so I can speak personally to what that feels like.

Osteoporosis and Osteopenia: What's the Difference

Jenn Salib Huber: 6:44

I think again a little bit. So T-scores can be used in the diagnosis of osteopenia and osteoporosis. Can you kind of just give us a recap of the differences between those two Sure?

Rebekah Rotstein: 6:58

So when your T-score, again when you get a bone density test, a DEXA, it will churn out a report and it will give you in grams per centimeter squared but also a T-score, and if it is minus 2.5 or lower, remember we're on the negative side. So minus 2.5 to minus threes and such that is classified by the World Health Organization as osteoporosis. If it's between minus one and minus 2.5, it is classified as osteopenia. Osteopenia is just considered low bone mass and essentially the precursor to osteoporosis. If it is anywhere in the positive numbers all the way down to minus one, that is considered normal healthy bone and it's comparing you as a postmenopausal woman, specifically to somebody that is around 30 to 35 year old, considered peak bone mass.

Jenn Salib Huber: 8:02

Yeah, okay, thank you very much for that. Okay, so we get these T-scores and they either provide us with reassurance or instill a deep fear of breaking a bone at the slightest little thing. When you say that, like T-scores aren't the be all and end all, tell me more.

Why There is More to the Story of Your Bone Health

Rebekah Rotstein: 8:21

Well, this is a whole long conversation that involves a lot of years of data and there are certain shortcomings, so downfalls. In other words, if you for one thing, there is variability from machine to machine, so if you're not going to the same machine, you're adding an extra variable the same machine, you're adding an extra variable.

Jenn Salib Huber: 8:46

Remember you mentioned that last time and that's an interesting piece of information that I had not heard before, so I'm sure there are others who have not heard that as well.

Eliminating Unnecessary Variables in Your Results

Rebekah Rotstein: 8:52

Yes, and it's something that we advocate. Try and go to the same facility, for instance. There can be variation even from technicians. If you have osteoarthritis, you can have a misreading that it can show your bone density much higher than it really is, because it's misreading what's happening within the tissue as actual bone density, when it's really not. You are essentially having a discrimination against you because you're going to have less bone mass than somebody with larger bones.

Automatically. Maybe the bones aren't necessarily poor quality, and that's the other thing that I wanted to point out is it's only looking at a quantifiable amount of bone. It's not looking at the quality of the bone, and this is becoming a bigger discussion, and there are newer technologies that are coming out, but they're certainly not as widely available and we don't have as much data for them. So at this point in time, the DEXA is still the gold standard.

Jenn Salib Huber: 9:56

Okay, so, and ultimately, the reason why we even measure bone density is to try and identify people who are at risk of a fracture. Right, that is kind of the end goal of figuring out who has lower or low bone density, to try and estimate the risk of fractures. And so why is that important? What's the implication of fractures as we kind of get into the meat of our postmenopausal years?

Understanding the Risk of Fractures

Rebekah Rotstein: 10:27

So it depends on which we're talking about. Are we talking about societal, economic, physiological, functional, psychological? Like every single one of these aspects of life is affected. So there's a huge economic burden on the healthcare system from fractures. There are psychological implications, there are physiological changes that can occur, there are emotional elements and then also just pure function. So, like we could, we could tap into every single one of these, but let's just talk about function.

So if you have fractured a wrist the third most common side of fracture you can't even dress yourself, you can't feed yourself, you can't bathe yourself, and I experienced this firsthand with my mom when this happened. And I mean, I've been teaching this stuff for years and I was never firsthand experiencing what that was like as a caregiver to witness how it affects every aspect of your life. If you have had a hip fracture, the rate of mortality surges that. I think it's one in four people only one in four people have experienced a hip fracture, regain full mobility and don't need to move into independent or I should say, assisted living situations.

Jenn Salib Huber: 11:57

And I think, the risk of dying if you have a hip fracture over. Is it 70 or 75? Is something like one in five?

Rebekah Rotstein: 12:04

Yes, and that's actually the biggest concern healthcare wise is that once there is a hip fracture, the rate of mortality increases such and it's specifically not because of osteoporosis, it's because of that sedentary element it increases the risk of blood clots as well as pneumonia, and then that is what leads to mortality.

Rebekah Rotstein: 12:33

If you've fractured a vertebra in your spine, that can have really devastating consequences as well, because your posture can be completely altered, because then the vertebra above that no longer are sitting on a solid foundation and it can lead to a hyperkyphosis or that stooped posture rounded back.

Taking Too Many Precautions with Bone Health

Rebekah Rotstein: 12:47

Also, the things that people don't talk about are other physiological changes that occur. So, especially when there is a vertebral fracture or multiple really vertebral fractures, there can be a repositioning of the organs or the viscera, so the lungs, the stomach. Positioning of the organs or the viscera, so the lungs, the stomach, digestive organs, everything can get compromised. So I mean there are so many different ramifications and then even just the psychological one and emotional that I think doesn't get enough attention is the element even of being told that you're fragile, right, that your bones are frail, and I've worked with so many people who have lived in fear, just walking even though they're probably fine, but they're concerned that they're going to break at any moment in time.

So then they take other precautions and often unnecessary precautions and are extra cautious and careful and maybe also stop moving, and then that leads to even more problems down the road.

Jenn Salib Huber: 13:50

Yeah, I think the frailty piece is the one, you know, that I really see so much as having this big impact on quality of life. I recently heard of someone it was, I think, a relative of someone that I was talking to who canceled their like trip of a lifetime trip to Europe because of a recent diagnosis of osteoporosis and they were too afraid to fall on a cobblestone sidewalk in England. You know, and it's like you think of how much life doesn't get lived out of fear and it really makes you want to change the conversation so that we see it as information that we can act on instead of information that, like, paralyzes us Right.

Rebekah Rotstein: 14:32

And I think that's a negative use of information right.

Trading Fear For Information About Bone Health

Rebekah Rotstein: 14:37

It's true that paralysis is so rampant I mean, this is the biggest thing that we see talking to people is they're terrified, and rather than being terrified, just be informed. And that's part of our goal is to help people, equip them with the tools and knowledge so that they can take necessary precautions and perhaps avoid certain activities or movements that might be contraindicated or advised against, but also to take the necessary actions so that you know not only just what you might want to avoid, but really what you should be doing, and also understand the realities of what leads to a fracture and what likely doesn't.

Jenn Salib Huber: 15:23

Yeah, Okay, so let's talk about other metrics. So we've explained the T score. We've talked about, like, why it matters and what it is score. We've talked about, like, why it matters and what it is. What are some of the other metrics or things that people can pay attention to that will give them some, I guess, idea that they're moving in the right direction with reducing the risk of fracture, with reducing the risk of frailty, of like, being able to say, like hey, what I'm doing is working or what I'm doing is making a difference. What are some of the other metrics?

Other Bone Health Metrics That Matter 

Rebekah Rotstein: 15:55

So let me first point out that there are qualitative metrics. There are tests, as I was mentioning, so I don't want to go into those, but I want to acknowledge that they do exist, but it's still rather rare to encounter them in a broad basis. So you know you could look at strength measurements. Those are things that are measurable. And I think other things that people can look at is if they are doing things like sets and reps with strength training. That's obviously very measurable, you know. You can identify that you are.

Rebekah Rotstein: 16:28

You know you're going up in volume, you're using higher weights, you're doing more reps. You're going up in volume, you're using higher weights, you're doing more reps, you're doing more sets. Those are all things that are easily measurable. I think one of the things I don't think, I feel strongly that one of the things that doesn't get enough attention is your internal state and your interoception, and I know this is a key part of what you do with intuitive eating and your programming, because that is what intuition is. Intuition is based on interoception, and so it might be worth having a conversation around this idea of what it's like to have an internal barometer, as opposed to your, your Apple watch.

Jenn Salib Huber: 17:16

Yes, let's talk about that, because we um you came into the midlife feast last year and um and did a great recorded session for us on on that, on interoception. But I think that because we tend to externalize measures of health especially what is my blood pressure, what is my cholesterol, what is my T score we devalue those or deprioritize those interoceptive measures of safety, of strength, of whatever. So, yes, tell us more. I want to hear more about this.

Developing Interoception in Midlife

Rebekah Rotstein: 17:51

Well, I think you made a self-correction which I think actually doesn't even need to be made. I think we do devalue, I think our society really doesn't value enough of intuition and internal state, and I think that it does relate to the metrics and analyzing everything, and I understand from a scientific point of view it's all about measurement, but it's almost like a yin-yang or yin-yang. It is absolutely, and it's part of that, intuitive, feminine qualities that are talked about that I don't think are respected or valued enough in society, and I've seen it firsthand also with people that don't value that and witnessing how it plays out in their bodies.

So, whether it's the way they treat their bodies or just the way they move, there's a disconnect. I think that also what makes somebody a really good mover is that interoceptive state. I think there are so many different elements of value across the spectrum of life that doesn't get enough attention and the value that it deserves to being able to tune in to your internal state.

Rebekah Rotstein: 19:17

People will say, oh, I can't meditate, I just have to be moving. Well, I don't think that's just a preference. I think that's something that should be addressed. I think that it's something that everybody has the capacity to do. We just might not be able to tap into it yet because we don't have the tools or the capacity to do. We just might not be able to tap into it yet because we don't have the tools or the understanding to.

But I don't think it's a matter of, oh, you can meditate or you can't, or, oh, you know, you know how to move slowly or not, or you have an ability to just sense things or not. I think everybody has that capacity. It's just a matter of where it is on the dimmer switch, how much is treated versus how much it's amplified, and I think it's a skill that deserves as much value and attention as so many other skills that are greatly lauded in our society.

Jenn Salib Huber: 20:11

And I totally agree. And how can working on those skills help with bone health? How does kind of learning to listen and pay attention, you know, help us? Help our bones maybe not directly to be stronger, but to reduce that risk of something happening to our bones that will get in the way of living our best life?

The Impact of Interoception on Quality of Life

Rebekah Rotstein: 20:32

something happening to our bones that will get in the way of living our best life. Well, part of this relates to recognizing your internal state right and just being more aware and amplifying essentially that communication highway between your brain and your organs, which is really what interoception is. And so the more that we can just tune into what we're sensing, the greater ability we have to be present. Just on a totally different level, I guess I would say it's about the ability to sense what's happening in your body. It allows you to distinguish between catastrophizing,

if you're somebody who's anxious already, and recognizing something that is just a little physiological shift. It's the distinguishing between when something feels slightly off and recognizing, oh, it feels a little bit off today, versus panicking and thinking, oh my gosh, I have a fracture right, that something just fractured. It's the ability to maybe even in balance, to help you sense oh, I'm aware that such and such feels a little bit different in my body today, and I'm not fearful of falling now like I was before, because research has shown that the fear of falling increases your risk of falling.

Rebekah Rotstein: 22:04

So I don't think it plays out in these big measurable elements. I think it plays out much more in our quality of life and our quality of movement, and these are things that may or may not play out in measurables for research, but play out in how you live your life. And also I would argue again, I can't say this with research, but I would argue that the more connected you are in your body, the more connected and ability you have as a mover, so moving throughout whatever your exercise or movement practice is, and the more connected you are this goes back into the concepts of biotensegrity as well that you're having a full body integration also a full body response through not only receptors in your body, but also that the way that forces get distributed through your body and also will be optimized by your bones. So again, not a bone health example, but if you just think about, think about any great athlete or dancer, who's who's a great, who's like your favorite athlete, or if you a dance fan dancer that comes to mind.

Jenn Salib Huber: 23:33

Yeah, so thinking I was trying to think of, like this person who told me about I think it was like an aunt or something anyway who canceled their trip, right.

Understanding a Need for Safety vs. a Need for Control

Jenn Salib Huber: 23:42

So instead of focusing on my bones are brittle and frail, I have to, like reduce any risk in my future life. Having that interceptive awareness would be. I trust that I can assess the situation when I get there, that I can step out onto that cobblestone pathway and determine whether or not I feel stable, whether or not I feel like you know I have balance and be able to course, correct and make adjustments based on how you're feeling right, like that is.

You know, with intuitive eating, we talk about learning to trust your hunger and trust your fullness and trust that you know what to eat and how to eat based on the situation that you can adjust it. Like if I'm you know, I just got back from a week in Spain where we were active and busy and walking and out in the sun and all that. I was hungrier and being able to just be like I'm hungrier, I need to eat, instead of oh my goodness, I need to control this situation perfectly, because that's the only way I can feel safe.

Rebekah Rotstein: 24:43

Right, and I think what you're talking about then also relates to what they say in the scientific world of self-efficacy.

Jenn Salib Huber: 24:51

Yeah, because you know, again, I don't have the personal experience of, you know, having a diagnosis of osteoporosis, but I absolutely hear it all the time in my community, in my work, and that you know, the fear is really. It's real, obviously, but it also feels like a doomsday. It's like, oh my gosh, you know here it is.

Jenn Salib Huber: 25:14

I'm, you know I'm I'm not even 50 and look at this, I now have osteoporosis. What is the rest of my life going to look like? And that's so disempowering. And if you're hanging all of your confidence in life on this T-score, you know it's it is it's going to be suffocating. So, being able to learn to trust yourself and focus on balance and I love what you talk about as well about you know, there's the bone density conversation, but there's the fracture prevention conversation, which we really do have a lot more control over than just our bone density Like how can we make, how can we build muscle, how can we feel more aware of our body position in space and how can we make, how can we build muscle, how can we feel more aware of our body position in space, and how can we make sure that we do feel solid and like we're on solid ground those are really important metrics too.

Rebekah Rotstein: 26:03

And it goes back to the question that you asked previously of how else can we measure. It goes back to that sense of intuition. You know when you feel stronger than you did the day before. If you're holding a plank and you know that it was tough a month ago and now you're actually able to hold it, and whether you're timing it for 10 seconds or you just sense, I feel really steady. That's another element I would say almost a parallel of your intuitive eating. It's almost like intuitive movement.

Jenn Salib Huber: 26:39

Yeah, which is a thing?

Rebekah Rotstein: 26:41

right, it is a thing, that's awesome Whether you feel steady doing something. I mean, even if you're at the gym and you're recognizing that, gosh, I just feel stronger today than I did last time, or it feels like I don't. I feel kind of weak today. I had this. Here's an example. I just had this yesterday. I hadn't been able to get into my heavy lifting for the last couple of weeks because I've been on the road, teaching and conferences and such, and I felt weaker. Right, it wasn't even a matter of looking at the weights. It was like I don't feel as good and also I was really tired. That was another metric in my mind. I was like I just don't feel that I have the same energy level, and that's okay.

Learning to Make Observations Without Judgement

Rebekah Rotstein: 27:23

I'm not criticizing myself, I'm acknowledging it, and it's like you're feeding your body information. It's like, oh, am I hungry? I'm not sure, yes or no? You know, am I feeling stronger today? I'm not sure. Am I feeling weaker? It's not that, and you might take action. You might do something as a result. Right, you might eat because you are hungry, or you might go work, shorten your, curtail your workout, because you know you're going to injure yourself if you push yourself too hard. And it's it's. It's about nonjudgment. In my mind, it's about taking in that information, processing it, and then you're going to do something with it, but you're not critical. You're not critical about it observation without judgment.

Jenn Salib Huber: 28:05

Absolutely. We talk about that intuitive eating all the time too, this kind of anthrop called the food anthropologist voice kind of like why, why am I doing this? Why do I eat this? Why do I skip lunch every thursday? Like it's really trying to observe thoughts, behaviors and actions, but without the judgment. Because as soon as you step into a place of judgment, you immediately go down that like good bad road, right, and it's very difficult to change a behavior. Make a positive change to behavior if you're feeling bad about yourself, so so hard. That's why I say you can't hate yourself into a body that you love, right, like it just doesn't work.

Rebekah Rotstein: 28:45

It's like we lose that objectivity right as soon as that the judgment comes in. We're no longer an observer, so true.

How Strength Training Protects Our Bones

Jenn Salib Huber: 28:53

Oh my gosh, so true. So I want to like diverge for the last little bit to to talk about a question that I had sent you by email, which was a question that I had come up in the community, which comes up a lot, so I feel like this would be like some added value for listeners. But really talking about the role of weights and lifting heavy weights if you have a diagnosis of osteoporosis, so everyone knows that, like, lifting weights helps to protect your bones. But when you get a diagnosis of osteoporosis, sometimes you're told don't lift heavy weights, don't lift more than X amount of pounds, and that I think can be really confusing, especially for people who have had a practice of lifting heavy weights. So in 30 seconds or less no, I'm just kidding, but can we chat a little bit about that, or is that putting you on the spot too much?

Rebekah Rotstein: 29:44

No, totally good. So the answer is that it just depends that the research has pointed toward the fact that I should say the research has pointed toward heavy weight heavy weights, excuse me and high intensity, specifically resistance impact training being beneficial to bones in the sense that with women with osteoporosis postmenopausal, it can increase the bone density.

Jenn Salib Huber: 30:16

Yeah, it stimulates the bone right Like. It's the tension and the traction on the bone that stimulates it to get stronger, right?

Rebekah Rotstein: 30:23

Yes, and that's what's known as osteogenesis. Now the challenge is that there are many people with comorbidities or different conditions that are excluded from the research because it complicates the data. So if you are people, if you are a person with various conditions and issues, it may not be appropriate for you. So it depends on the individual, no matter what, and you know what your fracture history is as well. So, no matter what the research shows, still the major consensus papers from the different osteoporosis societies are not advocating that for those that have had a fracture history. So it depends on what your medical history is. And I look at it in a very specific way.

Doing a big intake. I want to know, get ideas of the quality of the bones as well that, for instance, even if you don't have a qualitative measurement, we know that if you've had chemotherapy or radiation or you've been using prednisone, say, for eight months or a year or more, that there's going to be an implication to the quality of your bones. The bones are going to be affected. They're not going to be as strong. You know the fracture history. Have you lost height, et cetera.

The Need to Customize Strength Training Goals

Rebekah Rotstein: 31:41

These are all things that I take into account in entire movement program and exercise programming and entire movement program exercise programming, but when it comes to, uh, heavy lifting ideally, what does that even mean? It's really about? It's very personalized. It's what is your, what is your own threshold, and so you're you know what somebody can start off with at, say, 50 pounds with a deadlift.

Somebody else may need to start off at 20 pounds, and when somebody else can go up to 150 pounds on a deadlift, somebody like myself, even in the greatest condition that's more than I weigh I might not get up to 150 pounds ever. So it depends on all sorts of individual characteristics, but also how you work up progressively to that threshold.

Rebekah Rotstein: 32:33

So I'm all in favor of weightlifting and, ideally, working the heavy lifting. It's a matter, though, of what your own body can do and what is possible, but at the same time, you know there are so many options that every single person has even somebody who's experienced a fracture. There are certain things that they can be doing, but it's just not the set standard necessarily for that person, and so, to answer the, to summarize, your initial question that you'd had for me was related to somebody being told by their physician oh, because you have osteoporosis, you shouldn't be lifting more than 20 pounds and my eyebrows raised at that, because my initial question was okay, well, what's the circumstances?

Has she had multiple vertebral fractures? That's probably why this physician saying that the answer was no, the person was quote young. The answer was no, the person was quote young, I would say. I think she was in her 50s. She was in good health and condition absence of any fractures, no other comorbidities that we're talking about.

Jenn Salib Huber: 33:39

There was no reason that that should be the case and was already heavy lifting, like had been heavy lifting for a while and already heavy lifting.

Rebekah Rotstein: 33:44

It didn't make any sense.

Jenn Salib Huber: 33:50

Yeah, it didn't make any sense. Yeah, so I think, kind of the the Coles notes of that is that there isn't a one size fits all answer and that, you know, really working with an informed, not just physician but trainer as well, somebody who can design that program for you, is probably going to be your best bet, because you know, I think at the end of the day, it strength training, regardless of what that looks like, not only helps your bones but helps with that strength of you know, inter interoceptive awareness and feeling stable and strong and that you can move through your environment, whatever that looks like, safely and confidently. Right, and you know there are so many other reasons. So I really want people to kind of hear, hopefully, that, like, don't be afraid of building strength, right, and I think there's, yeah, well, I think there's and that, like it can be.

Jenn Salib Huber: 34:40

See, we have so much to say. We just keep talking over each other, but, yeah, so I'm just going to finish by saying that I just want people to know that, like, I'm just going to finish by saying that I just want people to know that strength is empowering and that you do not have to be afraid of the methods of building strength, but you do need to be informed and that jumping into a gym that you've never been to if you're newly diagnosed with osteopenia or osteoporosis may not be the best idea, but neither do you have to be afraid of it, because there's so many ways to do it safely. That's kind of my take home.

Rebekah Rotstein: 35:14

I totally agree and I think, as it ties back to this idea of intuition and interoception yeah, strength training absolutely can alter your interoceptive state and I think there's ends of the spectrum that both need to be embraced that strength and power training for those who are fearful of it deserve to understand that this can be incredibly empowering and it can also be very preventative for fractures.

Rebekah Rotstein: 35:45

Also want to talk to those who only are adrenaline junkies at the gym to acknowledge that you also have the ability to slow down and go into your body interoceptively in that manner and to pause and to move at a different pace and a different rate and to identify what those sensations are like, so that we really cover the whole spectrum, so that it's not just one form of exercise. There's all sorts of forms of exercise that are part of even the definition of what it means to move your body and that we can speak to people on all, in all parts of the spectrum, so that we can really hold space for everybody in all parts of the spectrum. So that we can really hold space for everybody.

Jenn Salib Huber: 36:29

Yeah, I think that's a great place to kind of end. Thank you so much for this conversation, for answering random emails that I send you with questions about bone health, for the work that you do Before we get to kind of the last little bit, what?

Rebekah Rotstein: 36:50

do you think is the missing ingredient in midlife?

The Missing Ingredient in Midlife According to Rebekah

Jenn Salib Huber: 36:52

Trust. Oh, I love that, so true, and we deserve it right. Like we have so much lived experience, we should trust ourselves.

Rebekah Rotstein: 37:02

We do. I mean, trust is really. Isn't that what intuition is? Isn't that what we're talking about with anteroception? I think we lose a sense of trust because obviously, our bodies are changing and we're like, oh my gosh, what's happening? You know, this thing that I had maybe or maybe didn't have confidence in previously is shifting, but at least it was familiar to me right Now. It's what is this unfamiliar terrain to me right Now? It's what is this unfamiliar terrain. And also, I think we lose trust because of societal changes and societal, I should say, expectations. And so, yeah, I mean gosh, all this wisdom that we have, why aren't we imparting it more?

Jenn Salib Huber: 37:41

So very true, amazing. So where can people find you if they want to learn more about you and the work that you do?

Rebekah Rotstein: 37:48

So our website is buff-bonescom, so buff-bonescom, and on Instagram it is at got buff bones and on Facebook it is still buff bones.

Jenn Salib Huber: 38:04

And we'll have all those links in the show notes as well. Thank you once again, rebecca. It has been fabulous, as always, chatting.

Rebekah Rotstein: 38:12

I always love speaking with you, Jen. Thanks for all the work you do.

Jenn Salib Huber: 38:17

Thanks for tuning in to this week's episode of the midlife feast. For more non diet, health, hormone and general midlife support, click the link in the show notes to 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.