Ask Dr. Vonda Wright: How Menopause Affects Your Muscles, Bones & Joints

You know her, you love her (and we do, too!), so we had to have Dr. Vonda Wright as one of the experts in our Ask the Expert webinar series. 

About Dr. Wright: At 40, double-boarded orthopedic sports surgeon Dr. Vonda Wright was in the best shape of her life. At 48, she thought perimenopause might be killing her. Thankfully, she has learned how to master midlife and menopause and now spends her time educating the 51 percent of the world born with ovaries (and the people who love them) on how to make the rest of our life the best of our life at the intersection of aging and midlife, menopause and mobility.

Dr. Wright has served as the inaugural medical director and chief of service in several large health systems and is an internationally recognized authority on active aging and mobility, caring for active people, athletes, and executive performers of all ages and skill levels. 

In addition to her surgical practice, Dr. Wright is the founder of Ajles.Life, a membership community, and Women’s Health Conversations, a nonprofit. She’s written five books and is a media content expert who regularly appears on national TV shows and in print and digital media outlets. She also hosts her own podcast called HOT for your HEALTH.

She talked with our community manager, Rachel Hughes, about how to keep your bones, muscles, and joints healthy as you age. She shared an incredible wealth of information, all delivered with her signature blend of expertise and humor, and we are sharing some highlights with you here on our blog. For the whole interview, go to our YouTube–it’s one you won’t want to miss!

This blog post covers some portions of the interview and has been edited for brevity and clarity. As always, this is for educational purposes only and should not be used as personal medical advice.

Rachel Hughes: Thanks so much for being here! We’ll get right into it. You talk about the musculoskeletal syndrome of menopause. Can you please explain what the syndrome is and how it impacts women?

Dr. Vonda Wright: So I see patients on Mondays, Tuesdays, and Thursdays, and every clinic, as I'm scaling down my list, I'll see a 46-year-old woman coming in with shoulder pain. And before I even go in the room, I know that there is a high likelihood that when I get into the room she's going to say, “I didn't do anything. I don't know what happened, but this pain is worse than childbirth. Can you please help me with the fact that my shoulder doesn't move?” She’ll try to raise her arm over her head and she can’t. She has frozen shoulder. There are estrogen receptors all over your body. So, as with all tissues, musculoskeletal tissues, which include muscles, tendons, ligaments, bones, cartilage, and fat, respond to estrogen. When you lose estrogen, you have symptoms. This can include total body pain, which is called arthralgia and was one of my main symptoms of perimenopause. There’s frozen shoulder, loss of bone density, and loss of muscle mass. There’s the rapid progression of arthritis. Did you know that before age 50, men have a higher instance of arthritis, but at 50 women have a rapid progression such that for 30 years it's been described as the arthritis of menopause? Very few people do! We also have a pandemic of low back pain, and a redistribution of fat from the periphery to our bellies. And listen: Fat is not just something that is inconveniently hanging off of places we would rather it didn’t. Fat is a noxious metabolic organ that produces cytokines that can kill us. So it behooves us to get our body composition under control. Rachel Hughes: Thank you, Dr. Wright. Wow. So, what are some of the steps women can take to preserve or improve their bone health? 

Dr. Vonda Wright: Well, first, let's answer this question: Why do we want to preserve our bones? Why is that important? Here's why it's important. Bone is not just structural. Bone is an endocrine organ secreting amazing proteins that go to all different parts of our bodies and tell them what to do. There is a cytokine released by the osteoblasts, the building part of bone, called osteocalcin. One of the things it does is goes to your brain. Part of it goes to the pancreas and muscle to help regulate glucose metabolism. If you're a man or care about a man, it also goes to the testicles and makes testosterone. So, bone is an amazing endocrine organ. Start talking about that with your friends. Bone is also structural. There’s a lot of emphasis right now on building muscle, and thank God. But the fact of the matter is, without bones, muscle is just a quivering mass of tissue. With bones, you can move. Bones are also the body’s storehouse of minerals for every chemical reaction you need in the body. So it is no wonder that the body is amazingly created to have bone from the top of our heads to the bottom of our pinky toe.

The first step to taking care of your bones is knowing about your bones. Stop ignoring your bones. Notice your bones. Now, how do we take care of them? We have to keep them from breaking. When a woman falls and breaks her hip (and 70 percent of hip fractures are in women), 50 percent of the time, she will not return to pre-fall function. Between 22 and 30 percent of the time, she will die in that first year. So, we don’t want to break a hip for those reasons. Plus, it’s painful.  So, we’re going to make an estrogen replacement decision. I believe that every woman is a sentient being with the ability to exercise her agency and make choices. Taking estrogen as a way to save your bones and save your life in midlife is a choice, but I want you to make that decision based on science and not from fear, right? So, that’s the first choice you need to make. Replacing your estrogen has been found to prevent loss of bone density up to 50 percent and to prevent fractures 50 to 60 percent. It's a big deal. And as the world outside this webinar is debating the relative merits of estrogen for the brain and the heart, there is no doubt here. There is no debate here. Estrogen, estradiol, is FDA-approved for the prevention of bone loss in midlife women. Done. So, if I can save 50 percent of the world from a fracture by encouraging you to make your estrogen decision, that’s the soapbox I’m going to stand on. 

Now, what can you do from a lifestyle perspective? People ask me, what’s the best exercise for building bones? It’s bashing your bones. It’s jumping. We need to start a jumping practice. 10 minutes three times a week, or 20 jumps a day. Run up the stairs. Play hopscotch. Jump rope. Do jumping jacks. Our bones respond to the strategic stress we put on them. If you’re already in pain, you can’t do that. But, we can trust NASA, right? NASA builds bones in their astronauts by having them jump on a trampoline when they first return from space. So, you could always use a rebounder in that case. 

The next thing we must do for almost every reason under the sun is we must build muscle mass. We need as much muscle mass as we can for a variety of reasons, including to build better bones. And, finally, we must feed our bones. We need a high-protein diet. Fifty percent of bone is protein. We need enough Vitamin D and Vitamin K2. We need 500 milligrams of magnesium a day. Rachel Hughes: Thank you. I am going to turn to questions from our feed. “I have osteoporosis. How much weight-bearing exercise, and at what intensity do I need to do it, to protect my bones?” 

Dr. Vonda Wright: When we are lifting to build muscle, to build power, to build longevity, it must be heavy. You can lift weights with osteopenia. In fact, you must lift weights with osteopenia. You can even lift weights with osteoporosis. You just have to be careful and do it in a progressive way. Now, what is heavy? It’s different for every woman. Heavy means, for major compound lifts, what you can lift four times, for four sets. We are not talking about pressing a light weight 30 times. We are going to press a heavy weight four times. And, what does it mean? It means that after you press it four times, you could probably do one more, but after that, it’s going to be dangerous. That’s what I mean by heavy. Four reps, four sets. Rachel Hughes:

Just to put a cap on the relationship between mobility and longevity, can you unpack for us quickly what role maintaining joint and bone health plays in longevity? 

Dr. Vonda Wright: If you don't move, you die.

Rachel Hughes: There it is. 

Dr. Vonda Wright: I once had an assistant, bless her heart, who had gotten into an awful pattern. My office was on the seventh floor, and she would park on the seventh floor of the garage, walk a few hundred yards to her desk, and sit down. And I once had asked her to help me by going and getting something from another part of the hospital. And she says, “Doctor, I don't walk.” And I don't think she was being sassy. I think she was being truthful. What happened is that her health progressively declined and declined because the most movement she did any day was walking a hundred yards from the garage to her desk seat where she sat at least eight hours with me, helping me with my work every day. And she died a very proportionately young woman from sedentary death syndrome, which is the 33 chronic diseases that are directly affected by the amount of mobility or walking or moving you do, all the things we've talked about. And it's everything that you know of. Heart disease, stroke, hypertension, Alzheimer's disease, cancer–33 chronic diseases make up this little nomenclature: sedentary death syndrome. So that's why I so glibly said, don't move, or if you don't move, you'll die. It's because there's no question.

Rachel Hughes: Thank you so much. What if someone is overwhelmed by starting or maintaining a fitness routine? You’ve told us about bone bashing, lifting. Is there a framework you lay out for patients with regard to how much movement, what kind of movement, how often? What does it look like? Dr. Vonda Wright: I think it can sound overwhelming. Once you start a few of these things and layer them on, it becomes a lifestyle that's not overwhelming at all. But I think if you're really stepping off the couch for the first time ever, maybe, or the first time since we're thinking about once upon a time, it's okay. Our bodies are designed to move. All of our strongest muscles are below our belly buttons. And so it's nature's most natural course to move all the time. What's unnatural is not moving. The number one thing you can do if you’re just starting out is commit to going for a walk after your biggest meal of the day. If all you can muster is 10 minutes, that’s fine. What you’re going to do is shove all that glucose out of your blood and into your muscles in 10 minutes. Do it for seven days. After your biggest meal, go for a walk. It’s going to clear your brain, it’s going to shift your metabolism. After seven days, you are really going to feel like you have accomplished something, and you're not going to want to break the streak. Rachel Hughes:

Thank you. I'm seeing several questions about plantar fasciitis. Could you share more about it? What can be done about it? 

Dr. Vonda Wright: Absolutely. The plantar fascia is that tough band on the underside of your foot that goes from your heel to your toes. Lots of people get plantar fasciitis, which is inflammation of the plantar fascia. It shows up in midlife because of fluctuations in estrogen.

The first thing to do is get your mechanics straight. Spend some time stretching and foam rolling. But, because it’s involved with estrogen fluctuations, it’s not a simple thing to fix, and one thing alone isn’t going to do it. Rachel Hughes: Thank you. I'm seeing several questions about severe low back pain and hip pain, and questions about MHT versus mechanical stretching. What can we do?

Dr. Vonda Wright: So, everything I have laid out thus far will help those things. Can they be associated with loss of estrogen? Yes. Can it be associated with the fact that you've lost muscle and you're not doing anything about it? Yes. Can it be associated with your vertebrae becoming compressed because you're losing bone? Yes. So listen, I am unashamedly at this point challenging people to pivot from a victim mentality. Lots of people think, “This is the worst part of life. Life was so great when I was 25 years old. 25 was easy.” But, there were a lot of problems then, too. For me, I had no money. I still had decades of education to go. It wasn’t so great. But we worship it. It’s ridiculous. I'm encouraging everybody in midlife to pivot their mindset and invest in yourself in the way that can truly make this the life you envision. We have so much more to live for, but it takes a little bit of work.

Rachel Hughes: Can we talk about nutrition supplements? Do those things play a role? How should we be looking at nutrition?

Dr. Vonda Wright: Our bodies are wondrously made, and they work together so well, but there are changes over time and nutrition in the microbiome is one of them.Our microbiome, due to all the influences, what we've eaten in the first 40 years, due to pesticides, due to changes in the age of our GI system, our microbiome changes and has different needs. So, from a very basic standpoint, I prescribe anti-inflammatory nutrition.  The principal tenant is we must stop eating simple, refined sugar. Sugar will bake us from the inside out. It makes us highly inflamed. Simple, refined sugar includes simple carbs like white bread, white pasta, white rice. And people always ask me, okay, okay, okay, I can give up adding white sugar. What about agave or honey or fruit juice? Well, where do you think simple white sugar comes from? Beets and sugar cane, they're vegetables, right? So agave and honey are the same sugar source. It's just in a different form. I am not against carbs, but we must take our carbs as fiber. Our gut microbiome needs fiber–30 grams. So high fiber, high protein, one gram of protein per ideal pound. Not what you weigh, but what you would ideally want to weigh. And maybe you do weigh what you ideally want to weigh. But that’s the amount.

From a supplement standpoint, I would rather you get what you need from whole foods. But, we already talked about vitamin D with K2 for absorption, magnesium, and Omega-3s are great for brain health if you can tolerate the fishiness of it all. 

Rachel Hughes: Thank you. Somebody commented here,  “Is it possible to clone Vonda? One for every community? Please? 

Dr. Vonda Wright: Isn't that sweet? Well, you know what? I am on Instagram every single day! 

And you should definitely follow her @drvondawright. For more of this great conversation, head over to our YouTube! And, to learn about upcoming events, follow us everywhere @myalloy.