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. Guest links: * Jocelyn Ross Wittstein, MD (Duke Health) https://www.dukehealth.org/find-doctors-physicians/jocelyn-ross-wittstein-md * Jocelyn Wittstein, MD (Instagram) https://www.instagram.com/jocelyn_wittstein_md/ * Duke Female Athlete Program https://www.dukehealth.org/treatments/female-athlete-program * Milken Institute Women’s Health Initiative https://milkeninstitute.org/health/public-health/womens-health Books * “The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD https://www.amazon.com/Complete-Bone-Joint-Health-Plan/dp/1682689417 For full show notes, please visit: https://bit.ly/unPAUSEDDrJocelynWittsteinPart2 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 Never miss an episode—sign up for The ’Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The ’Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.