unPAUSED with Dr. Mary Claire Haver
Strong Bones, Strong Body, Stronger Second Half with Dr Jocelyn Wittstein - Part 2
22 Jan 2026
Chapter 1: What is the main topic discussed in this episode?
The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.
In our last episode of Unpaused, we started a conversation with Dr. Jocelyn Whitstein about what really happens to our joints, bones, and muscles as we move through midlife, why osteoarthritis hits women harder, why frozen shoulders seems to love this life stage, and how hormones weave through all of it. It was one of those conversations that made a lot of invisible dots suddenly connect.
And we had far too much to talk about for just one episode. So today we're back with part two. Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor of orthopedic surgery at Duke University. Her work focuses on female athletes across the lifespan, post-traumatic arthritis, frozen shoulder, and what she calls the musculoskeletal syndrome of menopause.
She's president of the Forum for Women in Sports Medicine, a core leader in the Duke Female Athlete Program, and a member of the Milken Institute Women's Health Innovation Initiative and co-author of the Complete Bone and Joint Health Plan. She's not just treating fractures in patients.
She's asking the bigger questions about why women's joints and bones behave the way that they do and what we can actually do about it. In this episode, we get into hormones, pain, and cartilage in a way that most of us have never heard before.
Jocelyn explains how estrogen and progesterone modulate pain, why fibromyalgia and diffuse joint pain so often show up in midlife women, and the role testosterone plays in arthritis risk for women.
She walks us through her current research to understand how aging and sex hormones change the resilience of our joints, and whether hormone therapy might one day help narrow the arthritis gap between women and men. And perhaps most important, She outlines a real-world prevention plan, including what she does to protect her own bones and joints.
This conversation is detailed, hopeful, and incredibly actionable. If you missed part one, I hope you'll go back and listen. And if you're ready to rethink how you move and take a 360-degree approach to protecting your bones and joints, then you need to listen to this conversation. All right, let's move on to pain. Hormones, pain, and musculoskeletal health.
So you've talked about estrogen and progesterone as pain modulators. How does that work?
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Chapter 2: What happens to our joints and bones during menopause?
How do you think these hormones actually influence our pain?
And this isn't my own research, just things that I... you know, read that makes sense. There's a study out of, and again, a lot of this relates to animal data, which is where we learn so many of these things and maybe hopefully eventually apply to humans and learn more. There was a study done on UCSF on mice looking at
Basically, cells located like centrally in the spinal cord and showing that estrogen and progesterone stimulate these cells to create like an endogenous analgesic, basically. Okay.
Which is a pain reliever.
Pain reliever. There are some studies on people with fibromyalgia showing relationships between progesterone levels and pain. What is fibromyalgia? That's a tough thing because the actual definition of fibromyalgia relates to these very specific number of painful points on myofascial tissue. I think we'll learn more about fibromyalgia over time because I half wonder.
We see it a lot in a lot of menopausal women get diagnosed with fibromyalgia.
So some people, Vonda, you know, has stated to me that she wonders how much of fibromyalgia is just musculoskeletal syndrome of menopause. I mean, it's a clinical definition based on you're having pain in certain areas.
You have pain in myofascial tissue.
She thinks a lot of it, rather than just being this de novo condition, could just be a symptom of menopause.
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Chapter 3: How do hormones affect pain in midlife women?
you know, that may be another indication or it may expand our thoughts about like, what is hormone therapy for? But we haven't clearly shown, and a lot of the old research, again, is on like different forms of hormone therapy.
Right. And only for the presence or absence of hot flashes.
Yeah. Related to arthritis, though, it's kind of, It's not necessarily looking at the actual health of the cartilage. And so we're, yeah, so that we've submitted another grant to the NIH. I just applied to another private foundation. And yeah, so if anyone wants to help me solve arthritis and women call me, you can come to our lab. I can show you how we do everything.
And I really, really hope we get funding for this because that is one of the studies I'm extremely excited about.
You mentioned that in your previous writings that, and help me say it, EFOPS trial, E-F-O-P-S, which studied the effect of long-term exercise on bone density, fracture risk, and osteopenic women different than the LIF-MORE trial. Did it show fracture prevention?
Yes. One of the reasons why I like the EFOPS trial is, you know, we have all these studies that show, OK, jumping helps with hip bone density. Strength training helps, you know, improve especially lumbar spine bone density. Again, what we really want to prevent, like, yes, maintaining bone density is great and nice.
And we presume in most cases, like we know from many medications, you know, that improving bone density reduces fracture risk.
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Chapter 4: What does current research say about joint resilience and hormone therapy?
But what that trial did was they followed women. I think most of them were on average when they enrolled them, like, 55. And then they followed them for 16 years. So now off to, like, age 70-ish. This is really interesting. I mean, they... they had these supervised sessions, then independent sessions, and they carried this out all this time.
And then they followed their bone density over time, but they also followed, obviously, their fracture risk. And so there are a lot of trials that really show you the impact of an exercise program on long-term fracture risk. Because it takes a long time to measure. Yes. Again, I just feel like Sometimes I feel like, why don't we have these trials in the United States?
Some of them are just not this good. But in any case, what they found was over time that the women who participated in the exercise group as compared to the control group had approximately a 50% reduction in fracture risk.
Yeah.
But interestingly, near the end of the trial, you know, at first, the women who were doing the strength training, it included strength training and impact, and they kind of used periodizations. It wasn't always intense. Sometimes it was like less intense, but they did have periods of higher intensity. And what they found was obviously a major reduction in fracture risk.
And earlier on, there were larger differences in bone density. The exercise group was like gaining, whereas the other group was losing, as you would expect. Yeah. But over time, those gains trailed off. And near the end of the study, the exercise group was losing bone density, but at a slower rate.
But my point is, and why I like that study so much, is it shows the effectiveness of exercise for fracture prevention, even as bone density is declining maybe at a slower rate. But there's more to exercise than just the bone density. It's like your coordination and your balance.
And there's more to fracture than just your bone density. Yes, yeah. So if you don't fall, if you're more, if you're less stiff, if you have better mobility, better balance, like less likelihood of falling out.
So I like that trial because I think they did such a good job of following through with the fracture risk.
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