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E118
January 22, 2026
Strong Bones, Strong Body, Stronger Second Half with Dr Jocelyn Wittstein - Part 2
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In this continuation of their conversation, Dr. Jocelyn Wittstein and Dr. Mary Claire Haver shift from understanding why menopause affects bones and joints to what actually works for building stronger bones and preventing fractures. If you've been told your bone density is declining, or you're worried about falls and fractures, this episode delivers the practical protocols you need.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

They tackle the questions women ask most. How much exercise is enough? What types build bone? Is jumping necessary? They discuss the LIFT More trial and EFOPS trial, research showing women in structured exercise programs had a fifty percent reduction in fracture risk, even as bone density eventually declined. This reveals something crucial: preventing fractures goes beyond bone density numbers alone.

The conversation addresses estrogen levels and bone protection. Dr. Wittstein explains why there's confusion about dosing, discussing how different amounts of transdermal estrogen affect bone density and what this means during perimenopause and menopause. She shares her personal protocol including strength training, jumping exercises, balance work, and nutrition with fiber, anti-inflammatory eating, and supplements like creatine monohydrate.

The discussion addresses a risk factor many women don't know: the connection between urinary tract infections, genitourinary syndrome of menopause, and hip fractures. Dr. Wittstein explains how untreated GSM leads to recurrent UTIs, causing confusion at night and falls. Up to forty percent of hip fracture patients have UTIs before or after surgery, contributing to serious complications. Vaginal estrogen could be preventive, and the box warning has just been removed.

Dr. Wittstein emphasizes self-advocacy, discussing why women's musculoskeletal pain often isn't taken seriously when imaging looks normal. She shares how she's training orthopedic surgeons to ask about menopausal symptoms and refer to women's health providers, breaking down silos between specialties.

Whether you're concerned about osteoporosis, dealing with joint pain, or want to maintain strength and independence, this episode provides evidence-based strategies for a stronger second half of life.

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Chapters

00:09 — Disclaimer + Part 2 setup (bones, joints, hormones in midlife)
01:13 — Meet Dr. Jocelyn Wittstein + what this episode will cover
02:09 — Pivot to the core theme: hormones, pain & musculoskeletal health
02:50 — How estrogen + progesterone can modulate pain (what the data suggests)
03:38 — Fibromyalgia: what it is, and why it shows up so often in midlife women
05:52 — Testosterone in women: a possible link to knee/hand arthritis risk
06:47 — The cartilage “rebound” MRI study: measuring joint resilience in real time
10:24 — EFOPS trial: long-term exercise and real fracture-risk reduction
13:02 — Estradiol levels for bone protection: “60” vs ultra–low dose (Menostar)
19:58 — Exercise vs meds vs HRT: ROI, timelines, and fracture-risk impact
23:06 — Hip fracture reality: dementia, falls, and why prevention matters now
28:44 — UTIs/GSM → falls → hip fractures: vaginal estrogen, advocacy, and next steps

About the guest

Dr. Jocelyn Wittstein

Dr. Jocelyn Wittstein is an orthopaedic surgeon specializing in sports medicine and a mother of five. A former collegiate gymnast, she brings a lifelong perspective on athletic performance, injury, and recovery to both her clinical practice and research.

She is currently an Associate Professor of Orthopaedic Surgery at Duke University School of Medicine, where she serves as a clinician, NIH-funded researcher, and educator of medical students, residents, and fellows. Her research focuses on the female athlete across the lifespan, post-traumatic arthritis following knee injuries, frozen shoulder, and the musculoskeletal syndrome of menopause, among other areas.

Dr. Wittstein is the President of The Forum: Women in Sports Medicine and a core leadership member of the Duke Female Athlete Program. She is also a member of the Milken Institute Women’s Health Initiative. In addition to her academic and leadership roles, she is a co-author of The Complete Bone and Joint Health Plan.