The Science of Joint Health: How to Keep Your Bones Strong for Life | Dr. Jocelyn Wittstein
In this enlightening episode of The Dr. Gabrielle Lyon Show, host Dr. Gabrielle Lyon engages in a comprehensive discussion with Dr. Jocelyn Wittstein, a Duke orthopedic surgeon and sports medicine expert. Together, they delve into the intricate science of joint health, emphasizing the critical steps individuals, especially women, can take to maintain strong bones and healthy joints throughout their lives.
1. Early Bone and Joint Changes: A Call to Action
Dr. Lyon (A) opens the conversation by highlighting the significance of bone and joint health beyond the age of 30. She warns, “If you're over 30, your bones and joints are already changing. And if you don't act now, you could be setting yourself up for arthritis, osteoporosis, and chronic pain later in life” (00:00).
Dr. Wittstein (B) underscores that many overlook bone health until pain or injury occurs, which often means the damage has progressed. She emphasizes the proactive approach needed to prevent such outcomes.
2. Gender Differences in Bone Health
A substantial portion of the discussion centers on the disparities between men and women concerning bone density loss and arthritis risk.
Dr. Wittstein (B) explains, “Women become more at risk for loss of bone density over time. Before menopause, women lose 1% of their bone density per year. After menopause, that jumps up to 2%” (07:39). She elaborates on how estrogen plays a pivotal role in maintaining bone density and controlling inflammation, factors that are less pronounced in men until much later in life.
Notable Quote:
“Women are 30% more likely than men to have arthritis. And that doesn't even up again until we reach age 80.” — Dr. Wittstein (31:57)
3. The Role of Estrogen in Bone Density and Inflammation
Estrogen's multifaceted role in bone and joint health is a key topic. Dr. Wittstein (B) discusses how estrogen acts as a major anti-inflammatory hormone and influences bone metabolism. The decline in estrogen levels during menopause leads to increased inflammation and accelerated bone density loss.
Dr. Lyon (A) probes further, asking whether receptor density varies between genders, to which Dr. Wittstein (B) responds that while men have lower estrogen levels, testosterone plays a more significant role in their bone health.
4. Frozen Shoulder: Prevalence and Treatment
Dr. Wittstein (B) introduces the topic of adhesive capsulitis, commonly known as frozen shoulder, which predominantly affects women aged 40 to 60. She notes, “Frozen shoulder typically occurs in women age 40 to 60” (13:07).
She explains the pathophysiology, linking estrogen deficiency to increased inflammation and tissue fibrosis in the shoulder joint. Early intervention with steroid injections can effectively reverse or mitigate the condition, especially if addressed within the initial stages of pain and stiffness.
Notable Quote:
“If you catch it early, it does... reverse really nicely.” — Dr. Wittstein (17:48)
5. Exercise and Bone Health: Debunking Myths
A significant myth addressed is the belief that activities like running cause arthritis. Dr. Wittstein (B) debunks this, stating, “Running doesn't cause arthritis. Runners are less likely than non-runners to get arthritis” (35:44).
She emphasizes the importance of strength and impact training in maintaining bone density. Activities that load the bones, such as jumping or resistance training, stimulate bone formation and prevent density loss. Conversely, lack of activity leads to disuse osteopenia, where bone density diminishes due to insufficient loading.
6. Supplements for Joint and Bone Health
The conversation explores various supplements that support bone and joint health:
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Collagen: Dr. Wittstein (B) discusses two types—undenatured type 2 collagen (UC2) and hydrolyzed type 2 collagen. She mentions, “There is evidence regarding collagen supplements for joint health” (44:24). UC2 works through an immunologic response to reduce cartilage breakdown, while hydrolyzed collagen helps alleviate symptoms in early knee arthritis.
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Omega-3 Fatty Acids: Omega-3s are highlighted for their role in reducing inflammation and supporting joint health.
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Vitamins and Minerals: Vitamin D (2,000 IU/day) aids in reducing joint pain, while calcium and magnesium support bone density. Vitamin K assists in calcium incorporation into bones.
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Curcumin: An anti-inflammatory agent shown to reduce joint pain in early arthritis.
Notable Quote:
“I would say, people could try taking both [types of collagen].” — Dr. Wittstein (46:22)
7. Hormone Replacement Therapy: Benefits and Risks
The episode delves into menopausal hormone therapy (MHT) and its implications for bone and joint health.
Dr. Wittstein (B) advocates for MHT as a preventive measure for osteoporosis, stating, “Menopausal hormone therapy could be considered a life-saving thing. It reduces your risk of a hip fracture by 30%, reduces your risk of a vertebral fracture by about 40%, and reduces your all-cause mortality by about 30%” (92:36).
She contrasts oral contraceptives with transdermal estrogen, noting that the latter does not increase clotting risks and is safer for bone health.
Notable Quotes:
“If you can gain, you're winning. Because the natural history would be to lose 1% of your bone mass per year or postmenopausal women, 2% per year.” — Dr. Wittstein (75:42)
“Women are more likely, this may not surprise you, to present farther into the disease process than men.” — Dr. Wittstein (32:33)
8. Genetic Factors and Early Bone Density Maintenance
Genetics play a role in osteoporosis risk. Dr. Wittstein (B) mentions the importance of early bone density accumulation, especially before age 30. She references a study following gymnasts into adulthood, demonstrating significantly higher bone density compared to non-athletes.
Dr. Lyon (A) adds, “If you get a DEXA scan, you're 65 and you already have osteoporosis. No one told you at 52 that menopausal hormone therapy can help prevent osteoporosis” (87:52).
9. Future Research and Ongoing Projects
Looking ahead, Dr. Wittstein (B) shares her ongoing research endeavors:
- Menopause Arthritis: Studying cartilage health in women post-menopause and the effects of hormone therapy.
- ACL Injury in Women: Investigating why female athletes are more prone to ACL tears by examining hormone levels and ligament geometry.
She is also co-authoring a book titled The Complete Bone and Joint Health Plan, which aims to provide a comprehensive guide for individuals seeking to understand and improve their musculoskeletal health.
10. Concluding Insights
The episode wraps up with Dr. Wittstein (B) emphasizing the critical need for awareness and proactive management of bone and joint health, especially among women approaching menopause. Early interventions, proper supplementation, strength training, and informed use of hormone therapy can significantly mitigate the risks of osteoporosis and arthritis, enhancing quality of life and reducing mortality associated with fractures.
Final Quote:
“Menopausal hormone therapy could be considered a life-saving thing. It reduces your risk of a hip fracture by 30%, reduces your risk of a vertebral fracture by about 40%, and reduces your all-cause mortality by about 30%.” — Dr. Wittstein (92:36)
Key Takeaways:
- Proactive Bone Health: Initiate bone health strategies before the age of 30 to build a robust bone density foundation.
- Gender-Specific Risks: Women face a steeper decline in bone density post-menopause compared to men, increasing their risk for osteoporosis and arthritis.
- Role of Estrogen: Estrogen is crucial for bone density maintenance and reducing inflammation; its decline accelerates bone loss and joint pain.
- Frozen Shoulder: Primarily affects middle-aged women and can be effectively treated if addressed early.
- Exercise is Beneficial: Strength and impact training promote bone density and joint health, debunking myths that activities like running cause arthritis.
- Supplements Support Health: Collagen, omega-3s, vitamins D, K, calcium, magnesium, and curcumin play significant roles in maintaining bone and joint health.
- Hormone Replacement Therapy: MHT is beneficial for preventing osteoporosis and reducing fracture risks but must be carefully managed to mitigate risks like blood clots.
- Early Intervention: Genetic factors and early bone density maintenance are vital in preventing long-term musculoskeletal issues.
- Ongoing Research: Continued studies are essential to further understand and address gender-specific bone and joint health challenges.
For those seeking an in-depth understanding and actionable plans to protect their bone and joint health, Dr. Wittstein’s upcoming book, The Complete Bone and Joint Health Plan, is a highly recommended resource.
This episode serves as a crucial resource for individuals aiming to safeguard their musculoskeletal health through informed choices and proactive measures. By understanding the science behind bone and joint health, listeners are empowered to take charge of their well-being and lead healthier, more active lives.