Strong Bones, Strong Body, Stronger Second Half with Dr Jocelyn Wittstein - Part 2

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.

Guest links:

• Jocelyn Ross Wittstein, MD (Duke Health)
  
• Jocelyn Wittstein, MD (Instagram)
  
• Duke Female Athlete Program
  
• Milken Institute Women’s Health Initiative

Books:

• “The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD

Articles:

• Associations Between Youth Sport Participation and Bone, Muscle, and Fat in Adulthood: Iowa Bone Development Study (International Journal of Environmental Research and Public Health)
  
• Understanding the importance of peak bone mass (Journal of the Pediatric Orthopaedic Society of North America)
  
• Anterior cruciate ligament injuries in female athletes (The Bone & Joint Journal)
  
• Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review (PLOS One)
  
• The role of relaxin in anterior cruciate ligament injuries: a systematic review (European Journal of Orthopaedic Surgery & Traumatology)
  
• Oral contraceptive use and anterior cruciate ligament injury: comparison of active comparator new user cohort and case-control study designs (Injury Epidemiology)
  
• Poster 188: Is Hormone Replacing Therapy Associated with Reduced Risk of Adhesive Capsulitis in Menopausal Women? A Single Center Analysis (Orthopaedic Journal of Sports Medicine)
  
• Menopausal Hormone Therapy Use Among Postmenopausal Women (JAMA Health Forum)
  
• Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics (Osteoarthritis and Cartilage)
  
• Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women: A Systematic Review and Meta-analysis (JAMA Network)
  
• Postmenopausal hormone replacement therapy modifies skeletal muscle composition and function: a study with monozygotic twin pairs (Journal of Applied Physiology)
  
• Association of muscle disorders in late postmenopausal women according to the type of experienced menopause (Menopause: The Journal of The Menopause Society)
  
• Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women's Health Initiative Study (The Journal of Bone and Mineral Research)
  
• Risk of hip fracture following a wrist fracture—A meta-analysis (International Journal of the Care of the Injured)
  
• High Risk of Hip and Spinal Fractures after Distal Radius Fracture: A Longitudinal Follow-Up Study Using a National Sample Cohort (International Journal of Environmental Research and Public Health)
  
• A Prospective, Single Arm Study to Evaluate the PK, PD and Usability of Abaloparatide-sMTS in Postmenopausal Women with Low Bone Mineral Density (Radius Health, Inc.)
  
• High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial (The Journal of Bone and Mineral Research)
  
• Effectiveness of whole-body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials (Osteoporosis International)
  
• Disuse Osteoporosis: Clinical and Mechanistic Insights (Calcified Tissue International)
  
• Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial (Menopause)
  
• Associations between testosterone and knee and hand osteoarthritis among males and females from the general population (Osteoarthritis and Cartilage)
  
• Benefits of 2 Years of Intense Exercise on Bone Density, Physical Fitness, and Blood Lipids in Early Postmenopausal Osteopenic Women. Results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS) (JAMA)
  
• Minimal levels of serum estradiol prevent postmenopausal bone loss (Calcified Tissue International)
  
• Perimenopausal Bone Loss Is Associated with Ovulatory Activity-Results of the PeKnO Study (Perimenopausal Bone Density and Ovulation) (Diagnostics)
  
• Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial (Obstetrics & Gynecology)
  
• Endogenous estrogen levels and the effects of ultra-low-dose transdermal estradiol therapy on bone turnover and BMD in postmenopausal women (Journal of Bone and Mineral Research)
  
• Effectiveness of Alora estradiol matrix transdermal delivery system in improving lumbar bone mineral density in healthy, postmenopausal women (Menopause)
  
• A High Dose of Creatine Combined with Resistance Training Appears to Be Required to Augment Indices of Bone Health in Older Adults (Annals of Clinical Nutrition and Metabolism)
  
• Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women—A Randomized Controlled Study (Nutrients)
  
• Association of vitamin D with risk of dementia : a dose-response meta-analysis of observational studies (Frontiers in Neurology)
  
• Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women's Health Initiative (Journal of Bone and Mineral Research)
  
• Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post‐Fracture Treatment, and All‐Cause Mortality (Journal of Bone and Mineral Research)
  
• Urinary tract infection (UTI) at time of geriatric hip fracture surgery increases the risk of experiencing adverse 30-day outcomes (Journal of Clinical Orthopaedics and Trauma)

Other Resources:

• Making the Case (Again) for Gender Equity (American Academy of Orthopaedic Surgeons)
  
• Anne C. Ford, MD (Duke Health)
  
• Miho Tanaka, MD, PhD (Massachusetts General Hospital)
  
• Women’s Health Initiative (WHI)
  
• Estrogen and Progesterone Stimulate the Body to Make Opioids (UCSF)
  
• Scientific basis of dietary inflammatory index (DII): A dietary tool to metabolic syndrome risk (Clinical Nutrition Open Science)