Join Liz Franzel and Dr. Jocelyn Wittstein, an esteemed orthopedic surgeon from Duke University, as they discuss the essential elements of bone and joint health featured in the new book, “Bone and Joint Health Plan.” Co-authored with a registered dietitian, this episode delves into the combination of expert orthopedic insights and nutritional wisdom, offering a holistic guide to maintaining bone strength and joint integrity. Discover why hormone therapy, dietary choices, and simple home exercises play a vital role in the lives of individuals, especially women over 50, facing osteoporosis and arthritis.
This is Liz Franzel with Crawford Media Group, and today our guest is Dr. Jocelyn Wittstein, a board-certified orthopedic surgeon and associate professor of orthopedic surgery at Duke University School of Medicine. We’ll be talking about our new book co-authored by a registered dietitian titled Bone and Joint Health Plan. Welcome to our program, Dr. Wittstein. Thanks for having me. Dr. Wittstein, could you tell us a little bit about your background and why you decided to write this book?
SPEAKER 01 :
Sure, I’d be happy to. I am a full-time orthopedic surgeon. I specialize in sports medicine. I work at Duke University Medical Center where I train residents and fellows and also do collaborative research with some of our basic scientists, including research on the intersection of women’s health and musculoskeletal health and also arthritis and knees. And one of the reasons I wanted to write this book and wrote it with my lifelong friend, Sydney Naskorski, who’s a registered dietitian, is that we wanted to provide a complete guide to bone and joint health that really addresses both of these things, not bone health alone or joint health alone. We just wanted to… provide people with a resource that will give them all the tools they need in terms of dietary changes and exercise changes to optimize their bone and joint health, and allow them to approach any doctor’s visit that they may need in an educated position so that they can really you know, make the most of their of their health care interactions.
SPEAKER 02 :
So you specialize in sports medicine. I was wondering, do you teach them the principles in your book? Or did you write this book because of your work in sports medicine and obviously your work as a surgeon and in all the situations you see?
SPEAKER 01 :
Well, interestingly, there’s not a lot of education in nutrition in medical school, believe it or not. But I studied nutritional science as an undergraduate at Cornell University, so it’s always been something that I’ve incorporated in my practice and my discussions with my patients. But we really wanted to bring together my expertise as an orthopedic surgeon treating these conditions and Sydney’s expertise as a registered dietician So we can give a really, you know, holistic, complete approach to readers.
SPEAKER 02 :
I was flipping through your book. It’s very interesting and has so much information in there. And one thing that kind of stood out is you say that one in four adults has some form of arthritis and osteoporosis-related fractures and that it affects one in two women over 50 years.
SPEAKER 01 :
Well, women are particularly at risk for arthritis and osteoporosis because of hormonal changes that occur at menopause, which is on average at the age of 52. So when women get that withdrawal of estrogen, they lose the bone building effects of estrogen and they lose the anti-inflammatory effects of estrogen. So it makes them strikingly more at risk for arthritis based on the increased inflammation in their joints. and osteoporosis because there is more bone resorption happening and less bone building happening. So they’re losing their bone density at a faster rate after 50, more like 2% per year as opposed to 1% per year prior to the age of 50.
SPEAKER 02 :
Well, that doesn’t sound fun.
SPEAKER 01 :
No. But it’s addressable. Yeah.
SPEAKER 02 :
Well, you know, you hear there’s such controversy around hormonal replacement therapy. And I didn’t get in that in depth into the book as far as is that something that you recommend? You know, there’s pros and cons.
SPEAKER 01 :
Of course. And that’s certainly an individual decision to make with your health care, you know, with your provider. But If we look at the evidence behind benefits of hormone therapy for menopausal women, they are tremendous in terms of preventing osteoporosis, preventing hip fractures, helping with maintaining lean body mass, muscle mass, reducing inflammation, which affects your joints, helping with maintaining a healthy lipid profile, helping with maintaining better blood glucose levels, helping with cognition, helping with heart health. Some of the concerns regarding menopausal hormone therapy were derived from the very earliest versions of the Women’s Health Initiative, which were a bit skewed because they did include women that were more than enough for menopause in the initial trials. Some of the concerns regarding safety of menopausal hormone therapy come from the earliest versions of studies put out by the Women’s Health Initiative that were skewed by including women who started hormone therapy over the age of 62. And it is currently recommended that women start hormone therapy within 10 years of menopause because those risks essentially are not seen when you start at that time frame. So when you revisit the data looking at women who were within 10 years of menopause and started hormone therapy, this turned out to be a very safe thing. And additionally, something to think about is the current regimens that we see used for menopausal hormone therapy are not what was used at the early onset of those trials. Initially, the type of estrogen that was used was called Premarin, which really comes from pregnant mare urine. And this wasn’t bioidentical. And current hormone therapy uses estradiol that is often transdermal, really has little to no risk of budding, for instance, that was seen with the oral Premarin.
SPEAKER 02 :
Yeah, that is different from things that we hear. We hear cancer. We hear different issues that surround the whole estrogen, testosterone thing. But in your book, you have a huge section on nutrition. recipes. They look great. Your friend that co authored the book with you. She’s a registered dietitian. And so tell us about some of the nutritional background that can actually, if people, you know, choose not to do the hormone therapy, that maybe they can supplement their diet with nutrition that would help their them have healthy bones.
SPEAKER 01 :
Yeah, food is, of course, and dietary choices are hugely important in the health of your bones and joints. And Sydney is, of course, a registered dietitian, and I studied nutritional science at Cornell University as well prior to going to medical school. So we both love to incorporate this throughout the book. But we talk about anti-inflammatory food choices to help with joint health, but also bone health choices. So for people who, there are many people, you know, who can’t use menopausal hormone therapy because they have some contraindication, like, you know, they have a history of a genetic clotting disorder, for example, or maybe they had an estrogen sensitive, you know, breast tumor or something like that. There are food components that do not act on the, you know, cancer producing estrogen receptors, but act like estrogens called phytoestrogens that can actually be protective against cancer. And those are found in, for instance, soy is one of the most heavily studied phytoestrogens. There are other substances called lignans that are in things like flaxseed and olive oil that can also act weakly as phytoestrogens and have a beneficial effect. They’re both anti-inflammatory and may help some with bone health. So I think there’s a little bit of myth-busting sometimes with the whole aspect of soy. But it’s really been shown to be cancer protective, not cancer promoting. And I think more of the concern with soy is actually the source of your food. You know, I think organic sources are good. But yeah, so we include some of that in there because it’s true. These are individual health decisions, whether or not you are a candidate for or feel comfortable using hormone therapy. And there are components of our food that can help people, too.
SPEAKER 02 :
So in addition to good eating and great diet, that word diet has such a stigma. Let’s just stick with good eating habits. Are you an advocate for vitamins and supplements that would help in this process?
SPEAKER 01 :
It depends. There are supplements, I think, you know, that don’t have good evidence behind them. And there are some that I think are really helpful to people in general. We say, you know, it’s better to get your nutrients from food if you can, but there are some that are kind of hard to get. Like people do struggle to get vitamin D in their diet and people don’t spend that much time in the sun. So, you know, I’m a proponent of 2,000 international units a day of vitamin D, which is a higher dose than you need for your daily value, but that dose has been shown to help people with joint pain. And vitamin D is also necessary for bone health, and it’s well below, you know, level that you should exceed. So, you know, that’s an example of kind of not seeing things as a silo, kind of thinking about bone and joint health, you know, together. So that’s an example, for instance, of something that I think is well supported by data from But on the flip side, there are things that support so much that are kind of popular, like glucosamine chondroitin hasn’t really panned out or been shown to be, you know, that helpful. And it costs people $30 a month. So when my patients ask about that supplement, I say, It’s not going to hurt you to try it. You can certainly try it for a month, but I would encourage you to try a month off of it and then go back on it and do a little test and see if it makes a difference for you. Because I wouldn’t want you to spend the money on that without it being like, you know, very clear that it’s going to help.
SPEAKER 02 :
That makes sense. Also in your book, you have a great section on exercises. And what I loved about that is that you can do them at home.
SPEAKER 01 :
Yeah, we want this to be very accessible to people so they’ll actually do it.
SPEAKER 02 :
Yeah, and they seemed very, I mean, they’re stretching. I stretch every morning myself, and there are some things in there that’s like, oh, I already do that, which is, you know, made me feel good about what I do. Good choices. You know, it’s not easy for people to either pay for a gym or find a good gym near them or even find the time sometimes. So it was really refreshing to see that you have things in your book that is just right in our own home.
SPEAKER 01 :
Yeah, we want it to be accessible, easy for people to adopt. We don’t want it to be too overwhelming. And, you know, there are really things you can do that are not major changes to your, you know, time commitment, for instance, that’ll make a big difference. My favorite example is just adding a little jumping into your week. You know, if you do something like 30 jumps a few days a week on a regular basis, that’s going to benefit your bone density. And that’s so easy to incorporate in your life. You could do 30 jumping jacks while you’re waiting for water to boil.
SPEAKER 02 :
That’s And you know what, too? I know that jumping is really good for the lymphatic system.
SPEAKER 01 :
Jumping is good for lots of things. I mean, it gets your heart rate up. It’s like a little interval exercise. And it doesn’t take long. No. You could do it a few times a day, you know, break it up. If your knees kind of hurt because you’ve got some early arthritis, you could do 10 jumps in the morning, 10 at lunch, 10 at dinner.
SPEAKER 02 :
We’re visiting with Dr. Jocelyn Wittstein. She is a board-certified orthopedic surgeon and associate professor of orthopedic surgery at Duke University School of Medicine. And we’ve been talking about her new book co-authored by a registered dietitian titled Bone and Joint Health Plan. Dr. Wittstein, welcome. Where can our listeners go to find your book and or do you have a place where they can go find more information about their bones?
SPEAKER 01 :
Yeah. So my joint health plan is available. You can purchase it through Amazon or Barnes & Noble or your local bookstores. If you’re looking for just little tidbits that you can maybe watch in 60 seconds or something, I’ve tried it. create some of those on my Instagram page. They’re just sort of fun little bite-sized pieces of information. But of course, if you want the whole shebang, we’ve tried to put every little detail in this book for you.
SPEAKER 02 :
Well, Dr. Wittstein, it’s been a pleasure talking with you. I encourage all of our listeners to get the Bone and Joint Health Plan book so you can start your journey to great bone health. Thanks for joining us today.
