Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.118 Rebekah Rotstein and Your Bone Health: Overcoming the Fear of Osteoporosis With a Holistic Approach

• Michele Henning Folan • Episode 118

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Have you already been diagnosed with osteoporosis or have a strong family history for fracture? Join me as I sit down with Rebekah Rotstein, the inspiring founder of Buff Bones, who shares her personal journey of overcoming an osteoporosis diagnosis in her twenties. She offers invaluable insights on bone health, especially through menopause. Discover the early interventions and consistent self-care strategies that Rebekah's own mother has employed, which played a profound role in bouncing back from a hip replacement. 

We debunk common myths about osteoporosis and osteopenia, stressing that these conditions aren’t just concerns for the elderly. Tune in to understand the critical risk factors and proactive measures necessary for maintaining bone density at any age, and learn why physical fitness is pivotal for daily activities and caregiving.

What’s the secret to better balance and muscle health? We break down the three primary systems of balance and discuss the importance of joint alignment. Rebekah shares her personal tips for enhancing balance through daily exercises. From the complexities of vitamin D supplementation to the overlooked role of fascia in muscle health, Rebekah offers a holistic view of maintaining bone and muscle integrity. Don't miss the chance to connect with Got Buff Bones on social media for more expert guidance and community support. This episode is packed with empowering advice to help you take control of your health journey.

You can find Rebekah Rotstein at:
https://buff-bones.com/
https://www.instagram.com/gotbuffbones/
https://www.facebook.com/BuffHealthyBones/

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling rundown. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
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Michele Folan:

Bathing suit shopping was far less painfu I this year. I hit 200 pounds and I haven't seen this weight in a really long time. I'm not craving sugar like I used to, and the energy I have is off the charts. Yes, these are just a few comments from my clients, but they all have one thing in common Each of them decided it was time to stop making excuses and to prioritize their health and well-being. We are in the driver's seat when it comes to fitness and nutrition. Let me show you what worked for my many clients and me. This is not a diet. These are sustainable strategies you can take with you for a healthier, fitter future.

Michele Folan:

Join me for my next six-week Midlife Reset. Go to the show notes of the episode or reach out on Facebook or Instagram. I'll be waiting for you. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is Asking for a Friend. She's back. Rebekah Rotstein came to us last year in episode 63 and was a top five show and, as with everything midlife health, things are constantly changing, and the area of osteoporosis is no exception. We are living longer, so the chances of you having osteoporosis also increases. Here are some stats for you 22% of women ages 60 to 69 and 39% of women ages 70 to 79 will be diagnosed with osteoporosis. But maybe more frightening is the prevalence of osteoporosis when you get into women who are 80 years old and older. That increases to 70%. Yikes, Rebecca Rotstein is the founder of Buff Bones, the osteoporosis exercise method, and she's guiding your bone health through menopause and beyond, making women more confident and reducing their risk of fracture. Rebecca Rothstein, welcome back to Asking for a Friend.

Michele Folan:

Thanks, Michele, I'm really happy to be back here with you, nice to have you, and I think the timing of this I think we kind of did this on purpose because you just came off of a conference and so we'll get into that. But what else would you like the audience to know about you?

Rebekah Rotstein:

audience to know about you. Well, I think it's that I got into this area because of my own personal experience. So I like to think that I walk the walk and talk the talk, or however that phrase goes. That was right, but that I understand what a lot of people are going through, because I've been there myself, but actually at a much younger age and now in midlife, I'm taking the information that I've been working with for 15, 20 years now and bringing it through a whole new lens of actually going through perimenopause myself.

Michele Folan:

Ah, lovely perimenopause, but you were a dancer and so you probably had some endocrine health issues that maybe contributed to your osteoporosis early in life.

Rebekah Rotstein:

Yes, so I had stopped menstruating as a dancer. It's just really common with many dancers maybe not as much now because there's a lot more attention to health and relative energy deficiency in sport which is essentially what I had where you're exercising so much and in some cases not my case, but in some cases also restricted eating, and therefore you stop menstruating and then it has bone implications. This also can happen in high intensity athletes as well, and so it basically set me up for what was a diagnosis later in life of osteoporosis. But essentially, yes, there were some endocrine issues and the time these things weren't really talked about, and now we're fortunate to be in a time where it's largely discussed and also for younger people, there's a lot more attention and awareness and, I'd say, watchdogging to make sure that this sort of thing doesn't happen for younger people.

Michele Folan:

Well, I think there's also the group of people who have had some disordered eating at a young age. We can have those issues, maybe even a celiac diagnosis can contribute to osteoporosis and then we've got a lot of women who may go through menopause very early and that lack of estrogen. So you know, it's just really creating some awareness, I think, is so great in terms of what you've been doing. You had a story to share with us and I want to make sure we get to this before I forget about it. You recently spent some time with your mom and you have a little message to share.

Rebekah Rotstein:

Yes. So my mom is a very special woman in this set. I mean, she's special for many reasons, but one of the things that makes her unique, I think, is that at 78, she is in great condition and she's been taking care of her body and exercising since her I guess since her late forties, even since she really my age, so 30 years essentially. And it's paid off is a part of the big message. So she just two weeks ago had a hip replacement.

Rebekah Rotstein:

And first thing I want to tell people who think, well, wait, that means you can't be in great shape, no, there's, there's a hereditary element of cartilage degeneration. That happens for a lot of people. I have a lot of osteoarthritis myself. So anyway, it demanded that she have a hip replacement and so I spent about 10 days there with her post-op, with her recovery, and it gave me a really fascinating firsthand look into all that is demanded and required just to function on a daily basis. And it was so eye-opening for me to see how much all of her exercise and taking care of herself over the years paid off, because if it hadn't been for all of this, she would likely probably have had to go into an inpatient rehab facility.

Rebekah Rotstein:

I don't think she would have been able to do this by herself at home with myself and with my husband, and even things like lower, like the things that you don't even think about, that you take for granted.

Rebekah Rotstein:

You know, you're just having to use a walker because you have to after a hip replacement, and just the upper body strength, for instance, to be able to move herself, sometimes with the walker, but also we had these handlebars to lower herself to the toilet.

Rebekah Rotstein:

Well, it was like she was doing tricep dips, basically Things that she's done before, and so she had that upper body strength but also even the lower body strength to be able to use at least the non-operated hip to help descend and also get up. Other things, like just scooting in bed. I would normally, if she didn't have the upper body strength to literally just scoot herself forward something you don't even think about I wouldn't have been able to move her in that capacity. And then for myself as well as the caregiver, it was huge, because there was a time I actually had to catch her. No, and if I didn't do all the lifting and all the body work that I do, I would not have been able to catch her. So it was just a fascinating, almost like a case report, for me to experience and to recognize everything that we preach and we talk about seeing that in action, literally in daily life, but also how much it can make a huge difference before and after a surgery.

Michele Folan:

Well, okay, it's so nice to hear this from somebody other than me, because I preach this all the time and I know people get tired of it. But all of that work you do now, all the core work, upper body, lower body, all those things that we do to build that foundation, will pay off later in life so that we can be like Rebekah's mom and be a little more self-sufficient when we have to have that hip surgery or knee surgery or whatever it may be.

Rebekah Rotstein:

She likes to say that she's 78 and doing great.

Michele Folan:

Oh, that's cute 79 and doing fine next year. Yes, I love that 79 and doing fine next year. Yes, I love that. You did a post recently about the myths of osteoporosis and I think that would be a really great place to start.

Rebekah Rotstein:

Well, actually, there is a number of posts we've done about this. Because there are so many, I mean I feel like that could even be an entire book. I mean, speaking of books, actually there is a new book coming out this fall called the Myths of Menopause, and I contributed the chapter on bone health to it. It's by Dr Nikki Key out of London, and I mean it depends on where we even want to begin, but I think one of the biggest to address is this idea that you are destined to fracture if you've been diagnosed with osteoporosis, and it's not the case. I know so many people and clients and myself at one point diagnosed with osteoporosis who've never had a fracture. But what it does mean is that you really do have to take action in some form. You can't just sit by, because your bone density will decrease at least usually at least a percent a year if you're not doing anything, and so we do have to intervene, and how you intervene has a variety of different ways that that can look, but you have to do something about it. And additionally, though, it's that it's not even just osteoporosis, so what is often termed as osteopenia, which may or may not be out of favor is essentially low bone mass, the precursor to osteoporosis, and there are more fractures that occur in the osteopenia category than in osteoporosis. So I want to also clarify that myth that it's just osteoporosis and if you have osteopenia, you know, don't worry about it so much. You need to take action in either. And then also, even if you don't have anything, you want to make sure that you don't even start falling toward that category later in life. So I think it was in 2020, the American Association of Clinical Oncologists identified there were more than 80% of fractures occurring in women in the osteopenia range, not osteoporosis. That's fascinating. So that's another one that I kind of want to debunk.

Rebekah Rotstein:

Other things is you know you touched on it earlier it's not an elderly condition. Sure, there is an age-related correlation, because we do lose more mass and it declines essentially as we get older. But at the same time, you know, you can easily be premenopausal and have osteoporosis from a number of secondary conditions, such as what you mentioned before, like you have celiac disease or some other malabsorption syndrome. Also from things like rheumatoid arthritis. Things like you've been on glucocorticoid steroids for at least eight months can put you at risk. So, for instance, prednisone right or you have like Crohn's or colitis and using that From breast cancer for instance, they can be at risk breast cancer survivors, especially when they've had radiation chemo. So I think it's important to recognize that this is not just something that is an elderly issue.

Michele Folan:

Yeah, and then genetics too. How strong is the genetics correlation, rebecca?

Rebekah Rotstein:

It's definitely a factor I mean. So there's something called the FRAX, which is a fracture risk algorithm giving you a 10-year probability of a fracture, and one of the questions for that algorithm is related to some of these things that we're talking about, but also we do want to know if a parent has had a hip fracture, and also just any kind of fracture, to be honest, is going to be an additional risk factor for you. However, you know, one of the things that is not considered in there is okay, well, what's your exercise capacity and what's your balance and what's your strength levels? Because even if a parent did have a fracture that doesn't destine you to, especially if you're taking course, taking action now, you know you do have an ability to change that future path.

Michele Folan:

I do want to talk about balance a little bit, because this does come up from time to time and in regard to as we lose estrogen, we know with the estrogen receptors in our brain, it can also affect our balance. How does your method work with balance Like? How does it help your clients with balance?

Rebekah Rotstein:

Sure A couple of things. One is in the Buff Bones method, we're working on various skill sets throughout, no matter what your level is. So it's not like, oh, we start you off working on such and such and then at some point you get into balance, and then at some point you start getting into strength, like we're doing that at every from baseline, like from base camp, if you want to call it that. And when it comes to balance, there are three different systems of balance. There's your visual, through your eyes, your vestibular, through your ears, and your proprioceptive, or known as somatosensory aspect, and this has to do with the receptors, especially in your feet, to help you understand where you are in space. But also sensory input. But then the motor output, like what are the changes that you would even do, perhaps unconsciously, to maintain your upright position? So we're working with all three of those to maintain your upright position. So we're working with all three of those. But another thing that we're addressing is the alignment, because how well you are aligned in your joints is going to play out in how well you balance, and I don't think that gets enough attention, and this has to do with something called joint centration.

Rebekah Rotstein:

So I'll give you a very, very personal example for myself. I have a ton of injuries and conditions in my body, so people often think, oh, you know, yeah, but you can do things because you don't have xyz. And I'm here to tell you, no, I do, I have xyz and abcd as well. It's why I got into this in the first place and it's it's how I maintain my function. So every day, one of the things I do every morning is an exercise that helps me center my joint that is not very well positioned, is not that stable, and of my hips I should explain, and after positioning, that my balance is 10 times better and my foot actually addressing that it's 10 times better than it is before I do that. So that's like my little N of one study for you, but it relates to also in the development of this method, why we do things in the sequential order, that we do within a sequencing, because it improves the outcome for your balance by the end of your workout.

Michele Folan:

Okay, all right, that makes sense and I'd like the fact that you do this every day and it's just part of your routine. I did get diagnosed with osteoporosis and osteopenia last year and, just speaking from experience, I think it can be a little emotional for some of us to get that diagnosis because we've seen maybe a great aunt or you're a mother that has suffered greatly and we don't want to be in that camp, right? So, beyond the DEXA scan, what other tests are out there that will help us better define our risk for fracture?

Rebekah Rotstein:

So, in addition to the DEXA, I mentioned before the fracture risk algorithm, the FRAX. This is available to anybody online. You can just plug in into the internet into your Google search FRAX, f-r-a-x, and it's an algorithm that gives you a 10-year fracture risk. That will be useful, especially when you're meeting with a physician. It helps you and your physician often make treatment decisions. And the biggest, when I've played around with the algorithm, the biggest change that modifies for those of you who are data geeks, the biggest data point really that makes a change is age, and that's really interesting, right? But in addition to the FRAX, there are other tests that are not as widely available, but one is called the REMS. It stands for radiofrequency echographic multispectrometry. I have to trip over my words to say that, but essentially, one of the things that is very fascinating about this is it will give you a bone quality as well as a microarchitecture idea, and it also gives you a five-year fragility risk. So, backing up, the DEXA provides information about your bone density, which is amount of bone. It's an aerial view, aerial bone density grams per centimeter squared within a given area, and it's looking at your hip and your spine and sometimes the wrist as well. But it's not giving you a qualitative indicator of how is the micro architecture and the structure of the bone. So you actually can also have a false reading if there is a presence of osteoarthritis, for instance. So I've seen this before with clients where it's suddenly between a period of, say, three years that their bone density just improved so dramatically it was off the charts, which is something that should make you skeptical. Very intense I shouldn't say very intense but very high increases or great increases are not typical. You can have small increases but such a large increase makes me wonder and I do the same thing and this is something that also that somebody was talking about at the conference of shortcomings of the DEXA and when you have to look and question some of these quote-unquote improvements. So for instance, that can be a shortcoming of a DEXA is the presence of osteoarthritis and the spine can suddenly make it look like you have a much greater reading than you really do Doesn't mean you're really truly not going to fracture just because the higher density reading on there.

Rebekah Rotstein:

So the REMS is a newer technology. It is not widely available. I was just talking at the conference to one of the reps from there about how and what their plan is to get more available, because I think it's really promising. So, while we're also, though, waiting for more availability of the REMS, something that is more available is called the TBS, or trabecular bone score, which is a software that is used in conjunction with the DEXA that does give you a qualitative indicator of the bone. It's specifically for the spine, but that can be very useful, as it can tell you more about the architecture and the quality of the bone, and it can be, in some ways, I guess I would say, more reliable, because it's another data point, but also it gives you more information beyond just the density. So it can go either way, though it could tell you hey, based on what your TBS is, you actually have a higher quote score, or it could be the opposite, that actually your quality is appearing poorer than we thought. And the other way that you can get a little more information actually is from your surgeon, which just happened last week, so, for instance, two weeks ago.

Rebekah Rotstein:

So my mom, whenever she's had a surgery, I do want to know what the surgeon has to say about what do you find of the quality of the bone, because the surgeon can tell right away whether that bone is super soft, or, yeah, it actually has a structural integrity super soft, or you know, yeah, it actually has a structural integrity. So I was talking to her surgeon prior to the surgery to find out a little bit more of how he operates no pun intended. And you know he was saying it's really it's not until he goes in there that he knows it, because for some people when you're having a hip replacement, he can tell, and any surgeon can tell, if it's going to require, essentially, a cage, it's going to require support because this bone is not going to be able to withstand the prosthesis and the pounding. Essentially that is demanded. Okay, I don't recommend having a surgery to find out your bone quality?

Michele Folan:

Oh gosh, no, no, we definitely don't want to do that. I mean, you know you brought this up and I don't know if we talked about this the first time we recorded last year. But the bisphosphonates I'm going to say it wrong. Bisphosphonates like Fosamax and some of those other drugs, that, of course, that's what they recommended for me, but I did not go that route. Do you have any thoughts on that? Like from the conferences that you attend? What are your thinking about these drugs? I do it's interesting.

Rebekah Rotstein:

So especially this and other scientific conferences are usually geared toward physicians and there's a ton of data that is presented, and so I hear it from both sides. I hear the physician side and then I also hear the patient side. That is concerned. The physician side, and especially the data that is presented, shows the efficacy of the drugs like the bisphosphonates and actually newer drugs that, to be honest, are used as more of a first course of action very frequently, and also it depends on whether you've had a fracture or not, and what the guidelines are now is actually, if you've had a fracture, the course of action is actually not to start with the bisphosphonates, it's to start with the anabolic medications, which are the bone building drugs. That's a whole other conversation.

Rebekah Rotstein:

The data as it's presented shows the fracture risk reduction and the concerns that people have of the atypical femoral fractures are so slim and that's the physician point. Slim and that's the physician point. So I don't remember the offhand what the percentage is, but those cases are very slim and so the endocrinologist take is you wouldn't worry about that same percentage when you're taking some other medication? Why are you freaking out about this and that the media really made it out to be more than it was. On the flip side, I have worked with people who've had an atypical femoral fracture and I know what it's like when you are part of that tiny percentage that does experience whatever is the side effect of XYZ medication and you don't care that it was only that tiny percent if you're part of it. So I think the whole thing is to take it into account of cost-benefit ratio, looking at it as part of the bigger picture as what is your real fracture risk. I think there's a conversation to be had with the physicians and this is part of what I do also in coaching people to understand how you have that conversation with your physician and looking at the big picture and really charting out what were your DEXA scores and any other scores that you have over the course of a certain amount of time.

Rebekah Rotstein:

What are the various medications that are being recommended, what do those do? What do those not do? What are the questions to really sit down and ask your physician and identify all the other parts of the picture of the lifestyle, of exercise and nutrition and sleep and everything else that you're doing for your bones, so that it becomes a more holistic approach, but not necessarily saying no to medications, but recognizing they have a time and place. Is this a time and place? So I take, I would say, a pretty middle of the road approach, but helping you make a really and advocating for you to make a very informed and educated and wise decision that is appropriate for you.

Michele Folan:

All right. And then also in terms of supplements, and I know you're not a doctor, nor am I. We're not making any recommendations here for anyone, but what supplements do they typically discuss when you are attending these conferences? You know it's interesting there.

Rebekah Rotstein:

So, for instance, at this conference the one on supplementation I wasn't able to attend because it was at the same time as one that was another. It was an exercise one that I was attending, but there was an interesting, a very interesting conversation. It's funny, it's ironic that you asked this. There was not a conversation. There was a fascinating presentation on vitamin D specifically, and so vitamin D, I should also preface, is the one supplement that I do think most people need to take. Again, speak to your physician, because it's going to be very individual and I'll come back to that in a second, but it's definitely a conversation that you need to have with the physician. That's based on your blood work, but most people don't have enough don't get enough vitamin D to support their bones. But what's interesting is that this presentation that I attended was from Dr Neil Binkley of the University of Wisconsin, and he was talking about circulate. So one of the things was identifying that circulating vitamin D levels will lower from inflammation, illness and surgery, which is really fascinating.

Rebekah Rotstein:

And, secondly, that the amount of supplementation is individual and that a lot of studies are flawed, and there was a 2022 study that he referenced showing that it didn't significantly lower fracture risk among midlife as well as older adults.

Rebekah Rotstein:

And so one of his big takeaways is gosh, we still don't know, we have a lot of mixed data on vitamin D, but that it is very individual, and also that we probably don't want our blood test levels above 60 nanograms per milliliter, which is interesting because I see a number of people out there purporting you know, get it as high as you can.

Rebekah Rotstein:

And that's not what was recommended at this conference, especially because it was related to, because I had a conversation with him afterwards and he said something about specifically if lifeguards in certain studies were having it at this amount, like they're out there in the sun and this is healthy, why are we pushing it even higher? So that ties into your question about supplementation. It's very individual, so I don't think that people should be claiming oh, you need X amount of vitamin D, you should be testing it, see what your blood levels are at and base it on that, and that, I thought, was also really that's something that I've always believed in and I think it was great that there was a really backed and purported just a couple weeks ago at this conference.

Michele Folan:

Wow, that's really interesting because you know we hear about calcium, calcium, calcium and and I know, vitamin D, specifically vitamin D3, maybe even magnesium there's. You know, I hear all these things and I just want to know what are they talking about in your circles, because I think it's very different than what we're getting sometimes on social media.

Rebekah Rotstein:

Yeah, and actually another interesting one on calcium is so we run webinars these free public webinars, with UCLA Health as the health sponsor, and in May we had one of the endocrinologists from UCLA Health who's also a professor at the Geffen School of Medicine there talking about everything up to date on osteoporosis, and she was just talking about the conflicting information and conflicting research on calcium and one of the big things that comes out is really get your calcium as much as you can from your diet. We're figuring out the value of supplementation, but no matter what, try to get and this goes for everything really try and get as much as you can from food sources before you start supplementing. The challenge with vitamin D is it's not widely available in a lot of food sources, whereas most other things are, so the supplementation route becomes interesting. But aside from that, yes, you know, getting your calcium, getting your magnesium, getting your vitamin K as much as you can from food sources and then having a discussion about supplementation from there.

Michele Folan:

I forgot about vitamin K too. Okay, that's another one.

Rebekah Rotstein:

Yeah, vitamin K didn't used to get much attention. When I was first diagnosed 20 years ago, I didn't hear it much. I didn't even hear about vitamin D. It was rare that I was diagnosed with a vitamin D deficiency because it wasn't publicly talked about. So it's, you know, everything goes on its little cycle and everyone talks about vitamin D. Now vitamin K is starting to get more attention as well. We'll see what's next along the along the path.

Michele Folan:

Do we get tested for vitamin K? I don't think I've no, Not that I know of. Yeah.

Rebekah Rotstein:

All right, I'm due for an appointment here soon.

Michele Folan:

I should say, not that.

Rebekah Rotstein:

I know of. But vitamin K has gotten a lot more attention in the sense that we're recognizing that that can also be part of the pathway that is missing when excess can lead to arterial calcification and problems. So that is an important route for the calcium pathways. But another thing to keep in mind with vitamin K is some people have issues if they're on older forms of blood thinners like warfarin and coumadin. So this comes into a whole other discussion. All right Of clotting factor.

Michele Folan:

Okay, that's going to be a topic for a whole other show someday. We ain't got time for that. You do a lot of yoga and Pilates. I think Pilates is really the base of what you teach. Tell me the difference between yoga and Pilates in regard to building muscle and ultimately helping with our bone support.

Rebekah Rotstein:

So Pilates is the basis of the method from which we then branch off. We use it because it is so useful in terms of the elements of the breath, the whole body connectivity, a lot of key elements for motor control. But then we bring in all these other elements, including strength training. For sure, versus Pilates, I don't advocate one versus the other, I love both. I am certified in Pilates. I'm a yogi at heart, so I do yoga. Don't ever want to teach it, I just want to keep it as my personal love.

Rebekah Rotstein:

I think they both have terrific benefits. They both have a mind-body basis. They both have a strong emphasis on the breath. They do differ, and yet I don't think it's one versus the other. I think that people should try both, but also recognize if you have osteoporosis or osteopenia, there are a number of movements that you may need to modify because they would not necessarily be advocated if you have low bone mass because of the possibility of inducing a fracture. So I don't recommend you do one versus the other, but I think that both can be very different and both have some great benefits and I love them both.

Michele Folan:

I think, because they are not high impact, that people may not think of them as being helpful, because we always talk about the impact and walking or doing heel drops or whatever the case might be, but that those types of exercises where you're challenging your body, like you do with Pilates, is very helpful. And I did want to ask you this I Last year, when I got diagnosed, I did get a little coaching from a physical therapist just because I wanted to make sure that I was moving appropriately. I really wanted to minimize any risk because I really don't know what my risk is, which I need to figure that out. But she and I talked a lot about fascia as we were working through things, and I would love for you to talk a little bit about fascia and how that plays a role.

Rebekah Rotstein:

Ah, yes, Fascia, the long-ignored stepchild of the medical world and fitness world until more recently. So fascia is the connective tissue of the body and the definitions change a lot. There is a fascia research society that is sort of the leaders of the discussion and the research and the definitions also of this changing tissue. It is the largest tissue of the body you think the skin is, but the fascia is even larger. So it's this connective tissue of the body that comprises everything from what you think of as the adipose to tendons, to ligaments, to cartilage, and there's a question of whether bone is part of that. It still isn't usually considered part of it. Bone is connective tissue but it's really just mineralized, so we're talking more about the unmineralized, and blood is also part of connective tissue, is not considered fascia, but it's pretty much everything else and people used to think, and sometimes still think, incorrectly. I would say that it is just the wrapping structure and it's far more than that. It does wrap structures and penetrates. So it wraps around muscles and penetrates muscles. But it's more than just that. It's more than just the muscles. It's also the lining essentially of organs and it has a great deal of properties and one of which is an elastic recoil. So it's especially when you think of different types of jumps, certain types of jumping or bouncing. Really, I should say bouncing is leveraging the fascia You're not relying on your muscular effort for that and therefore it allows you to endure much longer because you're not having the same energy expenditure or fatigue for that matter but also it provides force transmission. That's a huge element of it. We also need to think about the hydration of it.

Rebekah Rotstein:

Something interesting is that without moving, we get stiffer as we get older, just in general. But also the lack of movement changes the thixotropic state of the fascia so that it becomes stickier, and that stickiness is often what leads us to feel stiff. The gliding, sliding motion of the fascia is when you feel quote unquote well lubricated in your joints right and you feel looser quote unquote that's the fascia that you're experiencing. So you know we want different types of load, different types of variability with the fascia, in the same way that we want for the bones. And so we talk a lot in our Buff Bones Method about the importance of the fascia and working through the fascia, because essentially bone and fascia have a lot of similarity. Just bone is mineralized and you want these different vectors, you want these different actions, these different directions of movement that are helpful for the fascia, that are also helpful for the bones. So there's a lot of similarity. I mean, I could talk, and do talk for hours about that, but that might be the briefest little explanation for you.

Michele Folan:

Okay, she just wanted me to be aware that you need to make sure your fascia is healthy, because it can be the thing that may put pressure on a joint that you don't need. And I think kind of what you talked about earlier in the show, about some of those routines that you do in the morning to help free some of that up so that you are balanced.

Rebekah Rotstein:

Totally. My morning practice is a combination of, you know, fascial movements, fascial gliding, motor control, like setting up the sequencing and activation of certain muscles so that they can then go sort of instinctively, and other elements of muscle activation, elements of muscle activation. So yeah, what your PT is talking about makes total sense that basically you want to make sure that you're addressing restrictions of the fascia. That can implicate everything else that you're doing in your body.

Michele Folan:

Okay, we did talk about the Interdisciplinary Symposium on Osteoporosis that you just attended. Was there anything else that you learned there? That is really changing up how you and your peers are doing things.

Rebekah Rotstein:

Well, I think one thing was more I would call it almost validity which was by a colleague of mine, dr Deborah Cato, out of Stanford. She and I serve on the Bone Health Working Group for the Society for Women's Health Research, and her presentation at the conference was fantastic because she was proposing that muscle may be more important than bone density in determining fracture risk, which you don't hear physicians talk about. So that was a fascinating presentation. And, along those lines, what is looked at? Fracture risk? Well, that fracture risk algorithm.

Rebekah Rotstein:

One of my biggest complaints of the algorithm is there is not a single question about your balance, a single question about your exercise history, about strength, so there's nothing that relates to exercise, and yet it's giving you a 10-year fracture risk for your hip, as well as a major osteoporotic fracture based on all these other things, but not even a single one that has anything to do with muscle. And so, wow, are we possibly overlooking a major predictor of fracture risk? And also, I found it fascinating that she was pointing out that low bone density is unlikely to affect fall risk, whereas muscle weakness does, and she also pointed out this one. This was really fascinating that we can lose 5% of our muscle strength if we're healthy in just one week of immobilization. I would say that was the biggest eye-opening thing to me, because it's not that surprising, but it's really startling to think that if you're on bed rest for one week, you could lose 5% of your muscle strength.

Michele Folan:

And how hard is that, if you think about it, to gain that back, and any of my clients listening right now who are so tired of me about lifting and lifting heavy and building your muscles and you know building your foundation, what you know building your foundation, I'm telling you there's reason why I really beat that drum, because I think it's so important. And now what Rebekah is telling us is that it could really help, not just with reduction in fracture, but you know, it's just about overall strength and keeping us balanced and everything else.

Rebekah Rotstein:

Yeah. And then, even along those lines, say you are sidelined from an injury. It's important to recognize that, while for bone density, lifting and perhaps heavy lifting is the best thing that you can do, there is a study going on to identify well, does it really have to be heavy versus moderate? But while those are what you want to be doing, a that's not where you start. How do you build the foundation for your body to get there? But also, if you are sidelined from an injury, don't despair that it means that oh well, I can't do my deadlift, so there's nothing I can do. Say you have a foot injury. There's so many other things that you can be doing, that may be seated, that may be lying on your back.

Rebekah Rotstein:

I just had a great experience last night with our coaching program. We had a Zoom with people and after 12 weeks we were watching them perform a number of exercises, both lying down on the ground and also standing, you know, using weights and heavier weights and such, and it was so gratifying to see the changes, these motor control changes, just in the things on their back. That are the things that I really harp on as the beginning of like. You have to be able to do this before you're doing X Y Z. The beginning of like. You have to be able to do this before you're doing X Y Z.

Rebekah Rotstein:

And I'm noticing I say X Y Z a lot here, but it was, it was incredible watching over these 12 weeks these changes that people have made, and it's it's literally just by dedication. So even if, even if you're sidelined from an injury, it doesn't mean that there's things you can't be doing. There are still so many exercises in ways that you probably haven't even thought about. So it doesn't necessarily mean you're losing all your muscle mass. So I want to give you the flip side, so it doesn't freak you out as well.

Michele Folan:

Okay, thank you for that, and I have to bring this up because this is a little proud moment you won an award, okay.

Rebekah Rotstein:

Tell us Thank you. So I'm guessing you saw that on our social media. I did Thank you. Yes, I was really honored and really touched, to be honest. So it was called the Robert Gagel Community Leadership Award from the Bone Health and Osteoporosis Foundation. So it was presented at the ISO conference a couple weeks ago and it was a nomination by peers.

Rebekah Rotstein:

So my peers that are healthcare professionals that are working in the bone health space, and it was Heidi Skolnick who nominated me, who is a sports nutritionist, and there were a number of different sports nutritionists and actually exercise physiologists as well over at Hospital for Special Surgery and she works with Juilliard and SAB and such, and then there were a number of different nomination forms that needed to be submitted from others as well.

Rebekah Rotstein:

And so, yeah, I was just, I was really, really honored, I think, because you know, when you work in a space and as an advocate for many years and even run a business related to it, you know there's you're not doing it for the financial rewards and often financial rewards are minimal right, you're working your butt off to get a message across and to help people and to be recognized for the work that you've done and the devotion and a lot of blood, sweat and tears. That doesn't get, you know, attention that is under the radar is a really special thing, and especially when it comes from your peers and from other professionals in the space. Especially, you know, there was the board of directors that had to decide upon so many other wonderful applications that were and nominations that were provided, because there are a lot of terrific people that are doing great work in this space, specifically also working with the Bone Health and Osteoporosis Foundation. So, anyway, it was a real honor and I'm really humbled by it and grateful. So thank you.

Michele Folan:

Well, congratulations, rebecca. That's tremendous and you really do care about your clients. You care about people's long-term health and it shows in these conversations that I have with you and you train other professionals, so you're not just working with clients, you train other professionals to teach people like me how to be healthier and build our bodies. How do you work with them and then how do you work with your clients?

Rebekah Rotstein:

So we started in 2009. Excuse me, I should say 2011 was the start of the training for exercise professionals. So the Buff Bones instructor training has been going on for a while and we offer courses that are in person as well as online. So live stream and no matter what, there's always an online element to start the learning, and then you either meet through Zoom or you meet in person. And then we also have an advanced training as well, which is called the Buff Bones Stepping Stones. So we've been doing that for many years.

Rebekah Rotstein:

I'm actually heading to London and to Leuven, which is outside of Brussels, in September to be teaching that next, but we offer them the live stream several times a year as well. And then we also have a membership for those who have taken the course so that we keep them up to date on the research. We provide them with ongoing education. There's more than a decade worth of continuing education videos in our portal and then we do biannual live streams bringing in different specialists and different speakers also business support, as well as speakers that are related to areas of the body whether we just had somebody come on Laurie Nemitz recently, who's a fascia specialist and has a book that came out as a dissector as well, fascia specialist and has a book that came out as a dissector as well. And then, in terms of working directly with clients, we have several options. We have on-demand options. We have a 10-day challenge. That is really the starting point that we want people to begin with, so they get that solid foundation, they know how to do the things properly without the old habits that they might be coming into the picture with.

Rebekah Rotstein:

And then we also have an online subscription site. But then we also have a coaching program as well, which is a 12-week program that they can continue onwards after that. That is for people who are looking for more intense guidance along the entire spectrum of bone health, so that it's beyond even just the exercise side. But it's both one-to-one, individualized, as well as group coaching. And so we're just finishing the first of our 12 weeks of that and it's been a really big success and it's myself as well as one of our faculty members as the coach, and we're bringing in also the guidance on what you do, of understanding the lab work and understanding what these medications are and how you can speak to your physician about all of these, so that you're really getting the education that you need, and then we have a nutritionist as well and it's been a pretty robust program. Yeah, it's very full service. Yeah, it's really good and in terms of myself, you know I have just a small bit of availability for the clients online and consults that I do as well.

Michele Folan:

Very, very nice. I have a question for you. What is one of your most important pillars of self-care? It is movement.

Rebekah Rotstein:

And it goes back to what I was saying before because I have a morning practice. It involves meditation, it involves movement, but no matter what, it doesn't matter where I am in the world, it doesn't matter if I've woken up late. I have to at least get a tiny bit of my movement in, even if it's just two minutes, because it helps me function, helps me walk, it helps me so that I'm not in pain, but it also helps me with my mindset, because it just clears all the clutter, I guess I would say, out of my mind, so that it's a mental focus and it changes my attitude as well, so that I can really face the day and whatever is coming my way.

Michele Folan:

I knew this was going to be a very robust conversation, which is why I had you back, cause I'm like we talked about so much today that we did not even get close to last year. Rebekah, please tell the audience where they can find you.

Rebekah Rotstein:

Sure, well, our website is buff-bonescom, so it's with a hyphen between buff and bones B-U-F-F. And also Instagram is. The handle is gotbuffbones. Also on Facebook, you can find us as buffbones.

Michele Folan:

Perfect, I'll put that in the show notes. Rebekah Rotstein, thank you so much for being here.

Rebekah Rotstein:

Thank you, Michele. I really enjoyed our conversation today. We definitely covered a lot.

Michele Folan:

I am so grateful for the ratings and reviews from our listeners. Did you know that your reviews help other people find Asking for a Friend? If you like what you hear, won't you please leave a review on Spotify or Apple? Thank you from the bottom of my heart.