285. Musculoskeletal Syndrome of Menopause

Summary

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Podcast Summary: You Are Not Broken

Episode 285: Musculoskeletal Syndrome of Menopause

Host: Dr. Kelly Casperson
Guest: Dr. Vonda Wright, Orthopedic Surgeon and Longevity Expert
Date: October 6, 2024

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Overview of the Episode

This episode centers around the newly recognized "Musculoskeletal Syndrome of Menopause," a collection of debilitating musculoskeletal symptoms that affect the vast majority of women during perimenopause and menopause. Dr. Kelly Casperson is joined by orthopedic surgeon Dr. Vonda Wright, who sheds light on the prevalence, misdiagnosis, and profound impact of this syndrome. The conversation aims to validate women’s experiences, advocate for better nomenclature and education, and empower listeners—and their healthcare providers—with actionable insights for prevention, management, and self-advocacy.

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Key Discussion Points & Insights

Recognizing Musculoskeletal Symptoms as a Menopausal Syndrome

• 70–80% of women starting in perimenopause will experience musculoskeletal symptoms (01:08).
• Historically, these symptoms have been dismissed as aging, "all in your head," or misdiagnosed as other conditions (01:49).
• Dr. Wright stresses the need for proper terminology: "Words matter... We need words for women to be able to articulate what's going on so they can say, 'I think I have the musculoskeletal syndrome of menopause.'" (02:32)

Common Misdiagnoses & Polypharmacy

• Symptoms are often mislabeled as rheumatoid arthritis, osteoarthritis, or other musculoskeletal disorders—sometimes leading to unnecessary, potent treatments (03:43–04:09).
• Doctors untrained in hormonal health typically prescribe nutrition or pain management protocols, overlooking the hormonal origins (04:13–06:41).

Whole-Person Approach & Hormone Replacement Therapy (HRT)

• Dr. Wright describes her approach: anti-inflammatory nutrition, building muscle mass to unload joints, activity modifications, and stress reduction—all before considering medication (04:42–06:01).
• With better awareness, she now incorporates a discussion about HRT, connecting hormone health to musculoskeletal well-being (06:01–07:08).

Quote:
"Now what I do, I put the icing on the cake. And I ask women to make their hormone replacement decision to go along with [lifestyle changes]." — Dr. Vonda Wright (06:41)

Hormones and Pain Relief: Anecdotes & Data Gaps

• While large studies are lacking, Dr. Wright reports women often see rapid symptom improvement (sometimes within a week) after starting HRT (07:35).
• She highlights the need for formal studies tracking symptom change after HRT (07:35–08:09).

Estrogen, Bones, and Soft Tissue

• Estrogen’s role extends beyond bone density—it maintains tendons, ligaments, discs, and the broader connective tissue matrix (08:09–09:15).
• Osteoporosis medications may help bones, but do not maintain discs; estrogen does (08:09).

Quote:
"If you want to talk about preservation of the spine, you've got to be thinking of disc, which the other drugs don't touch." — Dr. Kelly Casperson (08:23)

The Cost of Mobility Loss & "Sedentary Death Syndrome"

• Dr. Wright introduces the concept of Sedentary Death Syndrome: 33 chronic diseases linked to lack of movement, contributing to 250,000 deaths yearly (09:41).
• Mobility—encompassing more than just exercise—is the single most impactful "medication" to prevent these diseases (10:49).

Quote:
"The one pill that will save you from all of these diseases is mobility. So let's get up and go." — Dr. Vonda Wright (10:38)

Stretching, Mobility, and Aging

• With age, collagen cross-linking increases stiffness; muscle building alone isn’t enough—dynamic movement and stretching are essential (11:21–12:53).
• Dr. Wright prescribes dynamic warm-ups before activity and static stretching after (11:21).

Quote:
"When I said exercise, people's faces glazed over. They didn't want to have a conversation. But when I say mobility, it's a new word." — Dr. Vonda Wright (11:21)

Empowering Patients & The Need for Education

• The need for open-access research to arm patients with knowledge and empower their health decisions (13:17).
• Many women remain unaware of perimenopause and its symptoms due to lack of education (14:50).
• Bringing printouts to doctors ("Have you read this paper?") is advocated as a form of patient empowerment—even for providers who can’t keep up with journals (13:17–14:26).

Periods, Hormones, and Flawed Medical Thinking

• The myth that a woman must have stopped menstruating before discussing hormone declines excludes many (e.g., women with IUDs, hysterectomies) and delays treatment (15:36).

Spotlight: Frozen Shoulder

• First major study linking frozen shoulder to hormones only published recently (16:54).
• Women on HRT had less incidence of frozen shoulder, underscoring estrogen’s anti-inflammatory benefits (16:54–19:50).
• Explanation of frozen shoulder phases and why it’s so disproportionately seen in middle-aged women.

Hormones and Joint Surgeries: Evidence in All Genders

• Both low estrogen and low testosterone increase risk for tendon injuries and joint surgeries (20:21–21:47).
• For men, orthopedic surgeons often check testosterone after tendon ruptures; analogous attention is lacking for women and estrogen (20:47–21:47).

Preventive HRT for Women: Rationale & Barriers

• Dr. Wright strongly supports preventive HRT for women—even in the absence of overt symptoms—based on bone health, cognitive, and cardiovascular data (23:07–25:06).

Quote:
"What is the worst thing that's going to happen if I'm wrong? ... What if I'm right? That I can save your bones? That I can save you from lying in bed in a pool of your own pee?... I'll take that pill." — Dr. Vonda Wright (24:26)

Hip Fractures, Mortality, and the Reality of Aging

• Hip fractures are often a “death sentence”—30% die within one year; 50% never return to prior function (25:56–26:51).

Quote:
"We are one fall away from devastation if our bones are that weak." — Dr. Vonda Wright (27:35)

Low Bone Density in Younger Women: Modern Causes

• Dr. Wright sees low bone density in women as young as 24. Causes include dieting, sedentary lifestyles, loss of periods (often masked by birth control), and delayed screening (28:39–30:36).
• Call to challenge frailty and promote proactive, healthy aging (30:36–31:20).

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Notable Quotes & Memorable Moments

• “Words matter… We need words for women to be able to articulate what’s going on so that they can say, ‘I think I have the musculoskeletal syndrome of menopause.’” – Dr. Vonda Wright (02:32)
• “There’s nothing just about arthritis.” – Dr. Vonda Wright (09:29)
• “The one pill that will save you from all of these diseases is mobility.” – Dr. Vonda Wright (10:38)
• “Frailty is not inevitable.” – Dr. Kelly Casperson (31:20)
• “We are one fall away from devastation if our bones are that weak.” – Dr. Vonda Wright (27:35)
• “I’ve never believed that aging is an inevitable decline from vitality to frailty.” – Dr. Vonda Wright (31:20)

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Timestamps for Key Segments

• The Scope of the Syndrome & Nomenclature: 01:08 – 03:43
• Misdiagnosis & Polypharmacy: 03:43 – 04:42
• Whole-Person Approach & HRT Integration: 04:42 – 07:08
• Anecdotes on HRT Efficacy: 07:08 – 08:09
• Estrogen in Discs, Tendons, Ligaments: 08:09 – 09:15
• Sedentary Death Syndrome Explained: 09:41 – 10:49
• Why "Mobility” over “Exercise": 11:21
• Patient Education & Advocacy: 13:17 – 14:26
• Problems with Period-Centric Hormone Thinking: 15:26 – 16:33
• Frozen Shoulder and Hormones: 16:54 – 19:50
• Hormones in Men's Orthopedic Practice: 20:21 – 21:47
• Advocating for Preventive HRT: 23:07 – 25:06
• Hip Fractures as Death Sentences: 25:56 – 26:51
• Low Bone Density in Young Women: 28:39 – 30:36
• Challenging Frailty—Aging with Choice: 30:36 – 31:20

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Resources, Actions, and Next Steps

• Dr. Wright’s new paper on musculoskeletal syndrome in menopause is open access—print and bring to your healthcare provider.
• Follow Dr. Wright on Instagram and look out for her upcoming book, Unbreakable: How to Go Strong, Live Long, and Age with Power (2025) (31:51).
• Advocate for your own healthcare—bring research, ask questions, and demand more nuanced care for midlife changes.

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Final Note:
This episode’s tone is supportive, energetic, and empowering, blending straight talk, scientific rigor, and advocacy. Both hosts encourage listeners to demand better understanding from providers, champion prevention, and reject the myth of inevitable decline.

“You are not broken.” — Dr. Kelly Casperson

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Transcript

[Dr. Vonda Wright]

Foreign.

[Podcast Host Intro/Outro (Dr. Kelly Casperson)]

Welcome to the you are not broken podcast. I'm your host, Dr. Kelly Casperson, a

[Dr. Kelly Casperson]

board certified urologist, thought leader, and conversation

[Podcast Host Intro/Outro (Dr. Kelly Casperson)]

starter on midlife living, hormones, and sexuality. Enjoy the show.

[Dr. Kelly Casperson]

Hey, everybody. Welcome back to the you're not broken podcast. Today I'm very excited to have my good friend, practicing orthopedic surgeon and founder of precision longevity, Dr. Vonda Wright, back on the podcast. Welcome back.

[Dr. Vonda Wright]

Thank you so much. I love being with you.

[Dr. Kelly Casperson]

You were on eons ago. We were talking about sleep.

[Dr. Vonda Wright]

We were, we were. And I love sleep. We can talk about it more. I'd rather do it than talk about it frankly. But, yeah, love sleep.

[Dr. Kelly Casperson]

Let me just show you how this, how this is supposed to go. But today you. You just probably were so excited for this to come out because we knew it was coming out in the world. And then it came out. The musculoskeletal syndrome of menopause. We've now drawn a line in the sand and declared it a thing. This is not like a minority, rare autosomal recessive issue. Can you tell us how big this is?

[Dr. Vonda Wright]

Yeah. 70 to 80% of all women starting in perimenopause will manifest a musculoskeletal symptom. And we've identified five or six of them. As we explore more. There will be probably more as there are as we learn more about this. But I thought, as I was thinking about it, it's important to put names to things. Words matter. Because you know what? Frankly, Kelly, I've polled my social media audience and I am horrified at the things women have been told by their doctors. It doesn't exist. It's all in your head. You're just aging. Why don't you just accept it?

[Dr. Kelly Casperson]

Is it really that bad? No. Just stop doing the things that you do that make it hurt.

[Dr. Vonda Wright]

Yeah. Or if I even. I mean, I just had clinic today. I'm in my clinic to a woman, they say to me, and you know, I have a really high pain tolerance. I normally don't complain. And I, at this point, because of where I am in this whole process with you and the other friends in the menopause space, I am fully on to why do women know they can suffer so much? Why do we even know we have a high pain tolerance? Because, listen, we're surgeons. I don't like people who are man be. I love people. But I think there's a certain resilience and toughness we all need to live in. But that does not mean that every single woman has to swallow her complaints and say to me, you know, I have a really high pain tolerance. So that is what. Look at me, we haven't even started this. And I am so revved up about. We need words for women to be able to articulate what's going on with them so that they can say, you know, I'm in. I know that I'm in perimenopause. I'm in the right age, my body hurts. I think I have the musculoskeletal syndrome of menopause. Instead of going to their doctor and saying, my hands hurt, my body hurts. Instead of saying 12 things, which frankly, in 15 minutes that insurance pays doctors for, it's never going to fly. But if we have a nomenclature that doctors can talk about, that patients can talk about, that women can talk about, people who love women can talk about, it puts us all on the same playing field, doesn't it?

[Dr. Kelly Casperson]

It makes it real. What was crazy to me, I started reading these papers. The misdiagnosis of rheumatoid arthritis, the misdiagnosis of osteoarthritis. And that a lot of, you know, and women will say, they're like, I have seronegative rheumatoid arthritis. And I am not a rheumatoid arthritis expert. But it's like all the tests are negative. But we still. But they told me I still have rheumatoid arthritis. And you're put on these very strong drugs.

[Dr. Vonda Wright]

Yes, Right. Talk about the polypharmacy of midlife.

[Dr. Kelly Casperson]

So let's pretend you never learned about hormones, estrogen, testosterone, midlife. Like now, I mean, now between your and my lens, like everything we see, we're like, oh, yeah, that started at 48. Yeah, right. Like, like we can't not see it because we're so trained to see it now. But let's back up and be like, what if you never learned about or cared to learn about midlife hormones? What would you be offering these women? What would you be telling them?

[Dr. Vonda Wright]

Yes, I love that you started there. I am a whole person surgeon. There are surgeons who just love the blue room. Eat, drink, sleep, die. That's the whole. And for those of you who aren't surgeons, most sur ors are blue or something like that. But I am a whole person surgeon, meaning I am likely to talk to you about your nutrition and your muscles and your whatever. So if I didn't know a thing about hormones and someone came in with one of these things, I would have started with, well, let's talk about your anti Inflammatory nutrition. Because many things in the musculoskeletal system are due to high levels of inflammation, such as frozen shoulder. I've treated frozen shoulder for my entire career. I knew it was a condition of inflammation. Diabetic people get it, diabetic men get it, diabetic women. When you're glucose is just out of control. So I start talking about anti inflammatory nutrition. Cutting out simple sugars, not cutting out carbs, but focusing on the fiber. You know, all the things we talk about all the time. Fiber carbs, the complex carbs. And then I'll move on to. And I hand write all these notes for each and every patient because I want to send them home with something that connects us. So I write the same thing 40 times a day. But I anti inflammatory nutrition. Then I talk about building lean muscle mass because muscle unloads the joints. For instance, if somebody has joint pain or arthritis, we talk and we talk about how to do that. I talk about if they can tolerate it, we talk about impacting our bones. And if they can't tolerate it, I have all the answers to how to impact your bones without running on the road, which hurts some people. So those three things sometimes we talk about before we ever get to medications or, or the medical side of it. We talk about rest and relaxation, overstimulation of our sympathetic nervous system. I mean, it keeps us buzzing, right? And amplifies pain. I would have talked about all those things. But now what I do, I put the icing on the cake. And I ask women to make their hormone replacement decision to go along with it. And then I give them the resources to find clinicians who can evaluate and manage those drugs for them.

[Dr. Kelly Casperson]

Beautiful. When you see people go on hormone replacement therapy, they'll say, if you're on the right dose of estrogen and progesterone, your hot flashes should decrease by 80%. Do we have that for the musculoskeletal syndrome of menopause? Like, should we be like, it's going to decrease. It should decrease by the 50%, as subjective as that is. Like, do women come back and they're like, I'm pain free. How dramatic is it when hormones were the reason and then they get their hormones back.

[Dr. Vonda Wright]

I don't have a lot of big studies about that. Anecdotally, sometimes as quickly as a week, they're saying, oh my God, it's so much better. I just, I'm not crawling out of bed anymore. It's amazing. And so that's one of the big studies that needs to be funded is to track musculoskeletal symptoms. I mean, and it's something one of the big menopause platforms could easily do, and not many of them are tracking musculoskeletal symptoms at this point. Maybe I had to talk to them about that, but they could quickly then recheck in a survey manner.

[Dr. Kelly Casperson]

Totally. People think about estrogen in bones. It's another step to get people to be thinking about tendons, ligaments, collagen. I read a paper talking about the intravertebral discs and the role of estrogen on intravertebral discs. And it's like osteoporosis drugs can help vertebral bones, but they don't help the discs. The estrogen helps the discs. And it was the first time I had really thought about, like, oh, if you want to talk about preservation of the spine, you got to be thinking of disc, which the other drugs don't touch.

[Dr. Vonda Wright]

Well, and when you think about it, the pain that comes with spinal collapse is partly from bone collapse. But when you have loss of the disc. I'm making a fist right now, for those of you can't see, with this annular ring in between the bones, then hit each other, and it's arthritis. And the same kind of bone spurs that happen in your knees grow in your spine, and then you impinge nerves. So you've got this cascade of pain creators, if you will.

[Dr. Kelly Casperson]

Yeah, I mean, I think so. What I hear from so many women is the doctor's like, it's just arthritis. It's like this wave of hand of just arthritis. And it's like. It's debilitating, and we don't have a lot of treatment for it.

[Dr. Vonda Wright]

Oh, yeah, it's devastating. It robs people of mobility, which then makes them die of sedentary death syndrome. There's nothing just about arthritis.

[Dr. Kelly Casperson]

Tell me, what's sedentary death syndrome?

[Dr. Vonda Wright]

Yeah, so I wish I had made this up. Kelly. I've been using that term my whole career.

[Dr. Kelly Casperson]

Dude, I'm today years old. Here he is.

[Dr. Vonda Wright]

Oh, you're gonna love it. So there's a. I can't remember his name. Some doctor in Columbia, Missouri, at University of Missouri. Again, words matter, right? He said there are 33 chronic diseases that kill us to the tune of, like, 250,000 people a year. And do you know what cures them all, or do you know what modifies them all? Mobility. Getting up off our chairs, purposely moving every day. And they're all the things you ever thought of. Heart disease, stroke, Dementia, arthritis, hypertension, all the disease, diabetes. Did I say that? All the diseases we die of. And I in my. Because I'm a mobility doctor and from many multiple dases, I would say if you're hypertensive, you take a drug for that. You diabetic, take several drugs for that. Cardiovascular disease, another drug for that, another pill for that. The one pill that will save you from all of these diseases is mobility. So let's get up and go. And that is just so true today. It can save us from the ravages of chronic disease.

[Dr. Kelly Casperson]

I think the role of. When I say mobility, I mean like stretching, flexibility exercises. I think people think it's yoga or nothing, but like the. I think at age 40, if you're not doing range of motion and stretching, you get stiff quick. What do you see in people who are like, they only want to run or they only want to do like these one trick pony. I only want to lift heavy weights. But it's like there's just like this range of motion activities I think are super underappreciated.

[Dr. Vonda Wright]

Well, and I'll answer that. But do you know why I started using the word mobility early in my. I wrote my first book in 2008. The reason is, is because when I said exercise, people's faces glazed over. They didn't want to have a conversation anymore. But when I say mobility, it's a new word. Right. So to your point, with age, the collagen cross linking the covalent bonds between collagen in tendons and ligaments get stronger. And so you lose the natural pliability that make us Gumby as children and make us stiff. Hunched over. And with heavy lifting, I see people getting stiffer and stiffer. So true. Mobility, stretching. And the way I prescribe that is before an activity, whatever your cardio or your lifting, you dynamically warm up, meaning in a mobility way. With walking lunges, hip circles. I do this whole routine to activate the muscles and joints I'm going to use to lift. So dynamic warmup. Then you go do your activity and then you can statically stretch afterwards. Right. So that's how I prescribe this for people so that we don't become so stiff. And I had a guy in the OR the other day who, I mean, he's such a successful executive, but from years of doing this, has a very

[Dr. Kelly Casperson]

large kyphotic, the computer hunch.

[Dr. Vonda Wright]

That's right. Kyphotic thoracic spine. I couldn't even sit them up straight. So we get stiff if we don't reverse course.

[Dr. Kelly Casperson]

Yeah, totally. How do you think with your paper coming out and women getting. Because how I see this happening is women are going in and then advocating for like it's not. The change is not happening because doctors are having all this free time to get new education. But how do you think the, the healthcare system can better support women during. During musculoskeletal syndrome of menopause. During the menopause transition.

[Dr. Vonda Wright]

Do you know why I'm laughing briefly at myself? Because I envisioned this. That's the way I made it. Open access, people. You got to pay for that. There's a big fee to make it. But we did it because I had this vision of every single woman printing it off and saying, have you read this paper yet? This doctor? Blah, blah, blah. But you know what? I love it when people actively participate in their health care. It is no longer okay to say, you're the doctor. What do you want me to do? I like when people participate. So that's what I envision, is that women will help themselves by printing off this paper, listening to all the things we say and come in educated so it can be an educated discussion. And if they have to hand their doctors the paper, because I'm not a doctor hater, we're busy. We can't care for people the way we want to. You know, it's hard to find the time to read every journal that comes to my house. So if a patient wants me to read something, I'm happy to receive it. I'll put it in my pocket with the rest of my papers.

[Dr. Kelly Casperson]

Yeah, when you come in to your doctor and you're not afraid of hormones, you've already done the education to not be afraid. It's a much higher level. Like, okay, what do you want to try? How should we try it? Blah, blah, blah, blah, versus like if a doctor has to like get over that part first, it's just a much more fruitful. So I think patient education is 80% of it at least.

[Dr. Vonda Wright]

And I. Maybe the patients who come to you to talk about this have done that work. I'm continually surprised at the number of women who haven't even heard of perimenopause. Because a 47 year old will come into me and she'll be having all the things and I'll say, well, you're in perimenopause, you're 47, your hormones are changing and some of them have never even heard the word. So I think it goes beyond. That's why I think this digital work we're doing is so important because women don't read medical journals. How are they going to know? They don't go to NAMs. How are they going to know?

[Dr. Kelly Casperson]

Yeah, totally. I mean, in your paper you talk about the musculoskeletal syndrome of menopause is present in 50% of perimenopausal women.

[Dr. Vonda Wright]

It starts then.

[Dr. Kelly Casperson]

Yeah, that's when it starts. And I think the thing, what I hear a lot from women is I went to my doctor and they said, well, this can't be what it is. And you can't have hormones because you're still having periods. And I think that myth, or that like very arbitrary bleed prevents women from getting health care. The women with hysterectomies and ablations and IUDs, they don't get told that.

[Dr. Vonda Wright]

Right.

[Dr. Kelly Casperson]

Because they don't have a period. That's like messing up doctors ability to think about hormones.

[Dr. Vonda Wright]

I just think probably not being in a subspecialty that deals with the gynecourinary system, which is what people think women's health is. It's not, but that's what people think. Unless you take the time to put it all together. I don't think people take the time to put it all together. Like what you just said. I bet nobody's ever thought of that. Wait a minute. Lots of women don't have periods. Periods do not define a result of hormone fluctuations. They do not cause hormone fluctuations.

[Dr. Kelly Casperson]

Yeah, I think a lot of people don't think it through because then I'm like, what about the people with IUDs? You give them with the hormones and then you're like, oh, right, right. It's like it doesn't, it doesn't make sense. Talk to me about frozen shoulder. The first. Correct me if I'm wrong, but like the first published article on frozen shoulder and hormones, like literally came out last year or something.

[Dr. Vonda Wright]

Yeah. Jocelyn Whitstein. Thank you from Duke. Yes. She's a, an amazing doctor. The good thing about Jocelyn Whitstein's clinic is it's right down the hallway from the OB Institute. Isn't that amazing? So they mined their insurance database associated with Duke and recognized that women on hormone replacement therapy had less frozen shoulder than the population of women they served who were not. So frozen shoulder is an inflammatory. It's not a disease. An inflammatory problem with the capsule of the shoulder. So the shoulder, the skin on the outside, it goes. Skin, subcutaneous fat, muscle, three layers of muscle, and then the capsule, like the inside skin. I like to say that is very subject to inflammation. And so frozen shoulder, out of nowhere, when you're too sugary or too high inflamed, the capsule starts being inflamed and it's extremely painful. So pain presents first, pain out of nowhere, you don't know what happened. You did not wake up in the middle of the night and hit your shoulder on the doorway. It's all suddenly painful. And then you do the most. The logical thing is you protect it, you hold it to your side, you don't use it and within a week it's frozen. You can't lift it above your arm, above your shoulder, you can't hook your bra. And it progressively gets more and more hot and painful and many, many women with their high pain tolerance will just wait it out. Six weeks, two months and then you can't sleep. When is this going to end? So Dr. Joe Hannifin from the university from hospital for special surgery, who was my mentor there when I was a fellow, actually went to the trouble in 2011 and identified four stages from initial freezing to thawing. And by the time you progress through those four stages, it's gone from pain to fibrocyte infiltration, which is like spindly cells that make fiber in your body. And the capsule actually contracts due to the number of fibrocytes in the tissue. And that's what the thawing is. You have to eventually, over two years, replace those with healthy capsules, synovial cells. Again that's what the process is so long. So Dr. Whitstein identified, oh, that doesn't happen quite as much when estrogen has been on board because estrogen is a huge modulator of inflammation in the body, both with its modulation of something called tumor necrosis factor, its interaction with a part of the immune system called the inflammazone, which is a multiprotein complex. You never think of estrogen as playing that role, but it's a critical role and it manifests in the shoulder when you have inflammation the same way it would if you're a diabetic with an out of control inflammatory process due to your high sugars.

[Dr. Kelly Casperson]

Yeah, and they call it the 50 year old shoulder.

[Dr. Vonda Wright]

Even Dr. Hannifin's paper in 2011 was too early. No one was talking about menopause then, but she even recognized, she's like very in the discussion. Really interesting. This seems to happen in middle aged women, but again, unless you're thinking about it, you don't put together. This happens in many diseases. We're now identifying as oh, what's happening in midlife and middle aged women, what is the common thread that's happening? Interesting. Right.

[Dr. Kelly Casperson]

There's other data in all genders that people with low hormones, whether it's testosterone or estrogen, have a higher rate of rotator cuff repair, have higher rates of joint replacement. They're starting to talk about the role that having normal hormones can define that. But like basically low hormones makes you more susceptible to joint issues and joint surgeries.

[Dr. Vonda Wright]

You'll love this, Kelly. So testosterone has long been recognized in orthopedics men, amongst orthopedic surgeons as low testosterone as a contributor to tendon and ligament rupture. We've been talking about that since I got out of my fellowship in 2004. Right. One of my colleagues, Victor Pristine, started studying it in Achilles tendon. He's like, why are all these men rupturing their Achilles when they're in their mid-40s? Oh, because they start having testosterone fluctuations that they normally don't have. We've known it a long time. We happily draw testosterone levels in men and then send them somewhere to be supplemented. Because, listen, I don't want to stop somebody from making sperm because I'm not an expert in that, but I send them on to her. But you know what, we've known that a long time. And I think the pieces went together easier because 94% of all my colleagues are men. These poor guys were not born with the gift of ovaries. And so they're not going to get it.

[Dr. Kelly Casperson]

Yeah, they don't see it as relevant. There's this one study and it's a small group of men, and it was men, I believe, after hip fracture or hip replacement. It was an orthopedic study. They actually put them on very high dose testosterone immediately post op. I don't know if you remember this study.

[Dr. Vonda Wright]

I gotta look it up.

[Dr. Kelly Casperson]

High dose testosterone, like off the top of my head, 400 or 600 a week. And they were looking at like rehab, how quickly they got out of the hospital and that it wasn't statistically significant in getting out of the hospital faster. Which is why I'm convinced this study didn't go anywhere because it was not going to save the hospital money. But they did significantly better in like rehab that they just got put on testosterone immediately post op. I'm going to look it up. I thought that was a clever study.

[Dr. Vonda Wright]

That is clever.

[Dr. Kelly Casperson]

As a thought leader in mobility hormones, midlife. At what point? I don't, because I don't think we're there yet. But at what point I Don't want to set you up. But at what point can women say, I don't want to worry about Achilles tendons, I don't want the rotator cuff surgery that my mom had. I don't want to lose my muscle mass. I just want to start on hormones when I'm 50 for health, for prevention. Where do you think we are with that?

[Dr. Vonda Wright]

Well, listen, I, as an orthopedic surgeon, the bone doctor, have the easiest time of anybody suggesting preventive hormones. Because here's why. One in two, one in three women will have some kind of osteoporotic fracture. And 70% of hip fractures are in women. And I have been tracking DEXA scans in all ages of my women. And I had a 24 year old last week with low bone density. And we can talk about why I think that is. So if the FDA has approved hormone replacements for prevention of osteoporosis in women with a risk factor which can be as simple as your mother is shrinking or you smoked for a while, that's enough reason for me. Now I personally, and I'll probably get a lot of hate for this, but I personally believe the data. When Lisa Moscone says that my brain is full of estrogen receptors and that my starving brain that could not identify an atcin pickup. I just had to say I need my thing like this when I had brain talk. I choose to believe that. That my estrogen receptors are starving. I choose to believe the cardiovascular data that at the right timing, estrogen is gonna save my heart. Cause all of my family dies of cardiovascular disease. What is the worst thing that's gonna happen if I'm wrong? Well, I'm gonna have the slightly increased whatever risk of. I don't even wanna say it out loud. Cause we know that HRT doesn't contribute in a mind blowing way to cancer. What if I'm wrong? Well, that's the worst outcome. What if I'm right? That I can save your bones? That I can save you from lying in bed in a pool of your own pee with a heart so bad that I cannot even get you cleared for surgery. Swimming in dementia. I'll take that. I'll take that pill. Not that pill.

[Dr. Kelly Casperson]

Yeah, I mean, I think you and I, we're obviously on a hero's journey because we've seen how this ends. And we're coming back to tell the midlife people. Like I see 84 year olds with raw skin between their thighs from bladder leakage that's so severe they can't leave the house we see this happen and you see this happen with the hip fractures. And it's like we're coming back to be like, we know how this ends, we wanna do something about it. And the culture change of prevention versus just let's deal with it when you're down the road is happening. It's slow, but I think it's happening. I think the Gen X people are taking care of their parents, which certainly they're seeing how it ends. Is it too strong a statement to say that an elderly hip fracture is a death sentence?

[Dr. Vonda Wright]

No, because listen, 50% of the time you do not return to pre fall function and 30% of the time you outright die in one year. The rest of the time bones are silent until you break them. People don't even know they have bones. I mean, I sometimes ask people, look at your wrist, that's a bone. Look at this, this is a bone. You know, people don't even know they're silent. But I am telling you for sure, a fractured bone, especially a big bone like a hip, femoral neck, is excruciating.

[Dr. Kelly Casperson]

Yeah.

[Dr. Vonda Wright]

And so if you don't die, if you do manage to get back into the house you raised your family in without getting a bed sore from laying in bed in a pool of your own pee because you can't control your bladder, you will have suffered for three to six months because old bones heals more slowly.

[Dr. Kelly Casperson]

Yep. I have a friend who's like 87 year old grandma fell on the ice in the Midwest and was on hormone replacement therapy and did, didn't break anything falling on the ice.

[Dr. Vonda Wright]

Oh, Kelly. My 84 year old mother has normal bone density because she was on hormones. Then the whole thing happened and then when I got a hold of her, I put her, I sent her to a hormone doctor, we put her back on hormones, she fell off a riser at my daughter's volleyball and I thought for sure she's laying on the ground. Nope. She pops up, she's like, I got.

[Dr. Kelly Casperson]

Yeah, but it's, I mean those are like the, no big deals happen, right? Like the fact that she fell, she got back up.

[Dr. Vonda Wright]

But you know, here's the sad thing, Kelly. We are one fall away from devastation. I have a story. You know, I was in the hospital the other day and one of the ICU nurses was telling me about one of her patients. She's 89, she was community functional, drove her car. In fact, she was the functional one that took care of her 70 year old neighbor that need to go to the doctor. Right. She was the neighborhood driver, she fell, broke several ribs, broke her hip and her heart was so bad that they can't clear her. So her son, who's 70 something himself, puts her in hospice care just to manage her pain. We are one fall away from devastation if our bones are that weak.

[Dr. Kelly Casperson]

Yeah, prevention asks a lot. It asks for you to think about your future self and it's hard to do. Can you give us, before we wrap up, give us insights on the 26 year old with the low bone density. What are risks for that?

[Dr. Vonda Wright]

So let's talk about that. So there are a few main reasons that I'm seeing this. I mean I see this often with you come in with a femoral neck stress fracture, how'd that happen? Or just something spurs me. Here's why it happens. Number one, we have been fed the crock of shit that we have to be little and don't get to eat. On top of the fact that now that the generation of children being raised are sedentary. So not only do they want is we're coming out of this thankfully. But not only were we taught to be little, holding up my pinky little, but we became sedentary. So even impacting our bones didn't work. So that's number one. Even those women that were active athletes, we have, we're in the For 52 years we've had Title IX where sports are equalized at the high school and college level for women. Well, we have that, but we're still told we got to be little. So these women live in relative energy deficiency syndrome and don't have periods of for years. I mean, I was that way. I was a dancer. I wouldn't have periods for six months and nobody ever talked to me about it. Now lots of young girls, if that happens, are being put on birth control so to regulate. So then all those women coming up were either told to be small and are sedentary, told to be small and are in energy deficiency. And we're ending up with younger and younger women with osteoporosis. And then insurance companies tell us that you can't get a DEXA scan until you're 65. Well, I'm sorry, when you've lost 10 to 15 to 20% of your bone density in the time surrounding perimenopause to post menopause, what is that? We are telling women just to sit there and die. That's what the message is. If we don't get in front of this, we become frail old women and we know how that turns out.

[Dr. Kelly Casperson]

Yeah, that's my question for. Because, you know, I get the 50 year old. And she's like, should I, shouldn't I, should I, shouldn't I? I'm like, what do you want to be doing when you're 74? What's life look like? And that. I believe that question helps people be like, okay, I want to keep this going. And what are you going to have to do to keep it going? I think it's incredibly optimistic that we call the ages 40 to 60 midlife. Like, what an incredible branding. This is only halfway through, but it's amazing. But it's like, we have to do things to age healthy and challenge the thought that frailty is inevitable. Because you see the people who. Frailty is not inevitable. And you're like, I want to be those people.

[Dr. Vonda Wright]

I've never believed that aging is an inevitable decline from vitality to frailty. I've never believed that. And I've spent a career trying to dispel that myth.

[Dr. Kelly Casperson]

Keep getting louder. You're getting loud. You got Instagram with a million followers.

[Dr. Vonda Wright]

You know what that shows, Kelly? It shows one of two things, or maybe both. I've got the gift of gab. Oh, three things. I'm a gift of gab. I'm a good teacher, and the need is so tremendous.

[Dr. Kelly Casperson]

Yes. And the book coming out, 2025, tell us.

[Dr. Vonda Wright]

Yes. So I'm writing it now. It's called Unbreakable. How to go Strong, Live Long and Age with Power.

[Dr. Kelly Casperson]

I love it. I'll put your Instagram links down below. Thank you for joining us and thank you for publishing this paper. Open access so people can print it out, highlight the crap out of it, and bring it into their doctors.

[Dr. Vonda Wright]

Thank you.

[Dr. Kelly Casperson]

Awesome. Nice to talk to you. Bye.

[Podcast Host Intro/Outro (Dr. Kelly Casperson)]

Thank you for listening to this week's episode of you Are Not Broken. If you want to dig deeper with me, sign up for my adult Sex Education masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the adult Sex Education Masterclass for free, join my monthly membership for more in depth, exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment, and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the masterclass for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor. In this format and all of my platforms and guests, including on this podcast, are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.