A Closer Look at Women’s Unique Bone and Joint Health Needs

You can’t “tough it out” forever, especially when your joints and bones are trying to tell you something. We talk honestly about why women often wait longer to get pain, stiffness, and mobility changes checked out and how that delay can mean more progressed arthritis, more limitation, and a tougher recovery if surgery becomes necessary.

We dig into the real drivers behind women’s bone and joint health, including hormones and the menopause transition. Estrogen helps protect bone density, so when levels fall, osteoporosis risk rises, sometimes without obvious symptoms until a fragility fracture happens. We also clear up misconceptions, like the idea that osteoporosis only affects women, and we explain what to ask about screening, including DEXA scans, vitamin D, calcium, and earlier testing for people with risk factors such as prior fractures, smoking history, chemotherapy, or long-term steroid use.

We also get practical about prevention and day-to-day action. Strength training and muscle mass support joint stability, improve balance, and help protect both bones and joints, and we address fears about “bulking up” along with the nuance of weight-bearing exercise when osteoarthritis pain is in the picture. Finally, we share concrete ways to advocate for yourself when symptoms are dismissed: ask to see your X-rays, ask why a treatment is recommended, and get a second opinion when you need one. If you found this helpful, subscribe, share it with a friend who keeps putting herself last, and leave a review with the question you want us to tackle next.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit:  https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St. 
Pittsburgh, PA, 15213 
412-683-7272  

To learn more about The Wellness Center for Bone and Joint Health visit:  https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601 
Pittsburgh, PA, 15213 
412-641-8594  

Transcript

Welcome And Why Women Differ

SPEAKER_00 0:04

Welcome to the Joint Effort Podcast, where mobility meets reality, and your future self says thank you. Your host, Dr. Noel DeJoy Guthrie of the Ponent Joint Center of the Game Women's. And Tiffany Occupy. You're in the right place. Every day, help break it down and build you back up. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_01 0:54

Women experience bone and joint conditions differently, and understanding those differences can lead to earlier intervention, better outcomes, and more personalized care. Welcome everyone. I'm Julie Schwenzer, co-host and producer, back with Dr. Noelle DeJoya Guthrie and Tiffany Belkafine. Ladies, it's so great to be back with you.

SPEAKER_02 1:14

Yes, thank you.

SPEAKER_01 1:16

So we're um really interested in this one about the unique factors that women should be aware

Myths And Delayed Care Risks

SPEAKER_01 1:22

of. So if we could kick it off with this question, how does bone and joint health affect women differently?

SPEAKER_02 1:28

I think one thing that's important to point out is how it really affects them differently and how they think it affects them differently. Um, sometimes people are told things throughout their life that may not actually be true when you get to speak to a medical professional. So sometimes there are myths and things that need to be dispelled. Um, one of the biggest ones, you know, people think only women get osteoporosis. Not true, but women are more likely to get it. And that is definitely a really good thing for us to talk about together. So a lot of the things that women face comes down to the way that our bodies are built and also the way that we experience pain and the way that we present with symptoms. Women tend to wait a little longer to get things checked out than men do. Um, so we may think, oh, that's just a natural part of aging, but we don't always realize it doesn't have to be that way. Do you have insight on that too?

SPEAKER_03 2:19

I I mean, I think we there is literature that shows that women tend to wait longer for initial evaluation. And for that reason, they could be further progressed along the the um progression of arthritis. Um, and also women tend to wait longer to perceive a surgical intervention. So, you know, I think um women tend to care for everyone else around them before they care for themselves. And that's a very, I mean, research has shown that that's that's you know, a proven thing. Um, and then sometimes when you wait longer, you could be stiffer, your surgery might be a little bit harder, your recovery might be a little harder because you're a little bit older. Um, so I think that's one thing we we point out, you know, within our podcast and our practice is that early evaluation is key. You know, when we can, even if you're very um, you know, early in the stage of your arthritis, there's things we can do to to help you um prevent progression. We can't, we can't slow arthritis and help you slow it. Um things we can do conservative management, you know, activity-wise. And it's always I always tell patients, you know, it's can't hurt to come in and get a set of x-rays. That's way, that way we know where you are down the line. Um, so I definitely, I agree definitely for sure. I think between, you know, osteoporosis and osteoarthritis, women definitely are affected differently and disproportionately.

SPEAKER_02 3:37

Um, so and hormones is a big part of that for women too. Um, not that men don't have hormones, they do, but ours are structured a little differently. So the way that our estrogen and other female hormones support and do things for us, we kind of take that for granted until we lose it. And then we don't realize all the things that can happen. And ladies, it's just really important to put your own oxygen mask on first. You got to take care of yourself if you really want to be able to take care of anybody else. You can't pour from an empty cup. You have to be able to make sure that your health is good if you want to help those around you.

SPEAKER_01 4:08

Yeah, you guys have shared wise words because I I've seen it and I agree with you. Like we're always, you know, caregiving for everyone else. So I've found that I don't know if you found this with your patients and even in, you know, personally, but you know, men are less likely maybe to get that checkup, but then the women are like kind of pushing them to, you know, take care of their health, and then you take care of everyone else around you, the younger ones, older ones, same age, and then you're last. And then by that time, something probably already happened.

SPEAKER_02 4:38

Probably every man who comes in comes in with a wife or someone.

SPEAKER_01 4:43

Yes. So great points. And then what about like if we continue with the hormone

Menopause And Osteoporosis Explained

SPEAKER_01 4:49

conversation? What about menopause? What um changes do you see and how does that influence the risk of possibly influence the risk of osteoporosis or joint degeneration?

unknown 4:58

Yeah, go ahead.

SPEAKER_03 5:00

Yeah, so I mean, going through menopause, obviously you lose your estrogen in your body, so you become estrogen deficient. Estrogen actually is a hormone that is um uh prevents or protects your bone, I should say. So it helps with um the building of bone and keeping it strong. So when you lose that protective effect, you're you are at a high risk of developing osteoporosis. So an osteoporosis is weakening of the bone. Um, so you know, we we do a lot of education on, you know, and as Tiffany said, women and men, um, as far as um preventing fragility fractures, because people with osteoporosis, when you fall, you're at an increased risk for having a uh fracture, either, you know, vertebral compression fracture, a hip fracture. Um, those are the two two big ones. So um, you know, as far as hormone replacement therapy, that's a good discussion to have with, you know, OB or I mean GYN um specialties, more so. But I think um orthopedists have um really started to own the bone, we call, because kind of been a a loss. Um you know, no one wants to take responsibility for this, whether it be a rheumatologist, an orthopedic surgeon, your primary care doctor, an endocrinologist, like who do people go for this? I think um, you know, orthopedists are in a central in a really good spot to to take, you know, care for this. And um ask patients if they've had a DEXA scan, ask patients if they've had their vitamin D and calcium levels checked. Uh, we don't necessarily prescribe the you know medications for osteoporosis, which are usually injectables, but we can help refer patients and Tiffany does a lot of help with this as well. I think that's kind of what makes our um relationship very unique, is that I see a lot of patients in clinic with osteoporosis who either don't know they have it or haven't really had their DEXA. And Tiffany's really great with helping them, you know, work through that, connecting them to who they need to be connected to. And um, you know, definitely does have implications surgically too. Um, I have so many patients who say, you know, I just have my DEXA scan and I have, you know, osteopenia or osteoporosis. Can I still have a knee replacement? Can I still have a hip replacement? The answer is definitely yes. You know, we we definitely take that into account when we are talking about surgery and how we proceed with surgery, but but you can for sure still have surgery. You know, I think that's another misconception and you know, or maybe just not a question that no one's ever answered to patients, you know.

SPEAKER_02 7:18

And also even a little bit further than that with the menopausal confirmation and and the conversation around that. Unfortunately, what happens is we don't think about our bones until we're menopausal. So a lot of people aren't thinking about them as early as we would love them to. And when Dr. Guthrie was talking about, you know, our hormones and and how that all starts to shift and change with time. Unfortunately, our bones are at their strongest when we're in our 30s. So if we're waiting until we're 60 or 65 to get a test done that no one has talked to us about before, that's 30 years of not knowing what's happening inside our bodies. So we're trying to help people understand that we want this awareness to be there a little sooner so that they can do things to prevent those problems later.

Early Tests And Warning Signs

SPEAKER_01 8:00

And do you recommend that uh women that we look at any early warning signs or anything that we should pay attention to or any tests that we should do at a certain age?

SPEAKER_02 8:09

So definitely a DEXA scan for bone health is always a good idea. Um, there are a lot of circumstances that people can get a DEXA scan even sooner than they may realize. So if they've had a fracture before, they can get a DEXA scan sooner. If they've been a smoker, if they've had chemotherapy, if they've been on long-term steroid medications or other medications, lots of people can get them done sooner than they even realize. That's really important for them to know. Um, and also, I think it's also worthwhile to notice if you start to lose height or you start to, you know, develop a hunch or something like that. Those are things that we have been taught are normal, but they're not. Those are not signs of good health. Um, those are not just signs of, oh, I'm 80, of course I'm a little shorter than I was. We shouldn't actually be shorter. Um, so if if people are noticing that in, you know, their 40s or 50s, even like, wow, I used to be five, four and now I'm only five, three, that's a concern. That's something that we want to watch out for for sure. Um, and certainly if they're falling down, we want to know why they're falling down because that definitely is going to be a risk for them too.

Strength Training And Joint Stability

SPEAKER_01 9:14

And what about um different activity levels and muscle mass? Does that um play a role like in joint stability? How much are muscles? Should we be paying attention to that?

SPEAKER_03 9:24

Yeah, no, I mean, that's why we always talk about prehab before any type of joint replacement surgery. Um, we want to get your muscles um as strong as they can because your muscles obviously support your joints. Think about how big your quadriceps and hamstring muscles are that support your knee and your calf muscles and your hip and then your back and all your perispinal muscles. It's it's really key, and particularly, you know, discussing how women are different. So, you know, women's, you know, hips related to their knees are very different configured than men. Um, also because of our hormonal differences, we're at increased risk for ligamentous tears. So there's been a lot of research done how what female athletes have higher risk for ACL tears. Um, so there's a lot of prevention that you can do as a young female athlete to prevent that. Um, and then moving towards, you know, pre and post-rehab from knee replacement, there's different exercises that um we can do as far as how your quads are different. So they fire differently in women from men, and they're kind of um or not a they're, you know, the um it's called your cue angle. So from your hips to your knees are just different. So we actually our physical therapists here do have, you know, female specific exercises that they do pre and post um total knee replacement. Um, I think that's it's been a great addition to our program, it acknowledging that and then being able to do something about it. Um so it I mean, muscle mass gives a lot of stability and very important to your joints.

SPEAKER_02 10:49

And I think it's also important for women, especially if they haven't been told yet, that a lot of times they have the misconception that strength training is going to make them bulk up. And it's really important for them to realize that strength training is actually putting good stress on those bones and joints and is actually helping them stay strong and, you know, avoid problems down the road.

SPEAKER_03 11:10

Yeah, I mean, I think everyone sees the weighted vest fad going on with um walking. I think we've I've had a few patients ask me, like, oh, should I be doing this? Is this really effective? I think the biggest thing is doing weight-bearing exercise exercises to strengthen your bones. And then at the same time, there's a very balance because if you do have osteoarthritis, you know, things like, you know, consistent running, um, a lot of high impact stuff can actually hurt your knees and and joints, and meaning hurt as in cause pain. Um, so I don't think the weighted vest is necessary, you know, by all means. It it can't hurt you. I think, you know, in women who are in their 30s to 40s, adding a little bit of extra body weight can help build muscle mass and help with that, you know, loaded, repetitious loading exercises. Um, but but I think it's a really good point.

SPEAKER_01 12:00

Um, the last question for you both, because you're in a very special position of being healthcare providers and experts as well as

Weighted Vests And Safe Impact

SPEAKER_01 12:07

women. So, how do you suggest that um women advocate for themselves when they feel like their symptoms are being dismissed or minimized um by other providers?

SPEAKER_02 12:18

Well, number one is I think we need to realize that our body is telling us something for a reason. And we need to realize we're we're we can't minimize that ourselves. Um, it has to start with us. You know, if something hurts, you need to know why it's hurting, you need to know what happened. Um, there are a lot of things we can try to work out on our own, like, okay, this hurts. Maybe I'll take some Advil, put some heat on it, see what happens. But then it's the follow-up after that. You have to make sure that you're actually not ignoring something to make it get

Self Advocacy And Second Opinions

SPEAKER_02 12:48

worse. Um, you know, it's it's never a bad idea to get something evaluated and see what's happening. Because if you don't ask, you don't know.

SPEAKER_03 12:55

And I think if you, you know, if you go to a provider who's not giving you answers or or explanations to what you want, then just go see someone else. I encourage that. Like even in my practice, I say if you're not happy with, you know, the care or the answers or the treatment progress, you know, there's many other physicians who are willing to provide second opinions. I think it's good to get more information, good to get other opinions. Um, so I think, you know, that's that's always an option.

SPEAKER_02 13:21

Um Yes, and they should always feel comfortable to ask questions. Um, so if people are going to an appointment and they're told, do this, do this, do this, and I don't get to ask why or why not, I think that's a a factor, you know, that we need to watch out for. You need to be able to ask your own questions because these are big decisions that people are making about their health. So we want to make sure that they understand exactly what all is involved in the whole process and really involve those patients in their care.

SPEAKER_03 13:43

That's really important. Even as simple as seeing your own x-rays. I've had so many patients who say, This is the first time I've ever seen my x-rays, or someone's explained them. And you know, we're an orthopedic office. That's what we use. So that's really important to be able to, you know, understand it, see what's going on, you know, understand why someone's recommending the treatment process or surgery. So um definitely being an advocate for yourself is very important.

SPEAKER_01 14:08

Okay. Well, thank you both so much. I wish we had more time, um, especially in a topic like this. We appreciate you guys.

SPEAKER_00 14:19

That's today's dose of strength, balance, and better movement from the Joint Effort

How To Book Care

SPEAKER_00 14:24

Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272. Or visit PGHBJC.com. Or if you are looking for lifestyle changes that are not searched, contact Tiffany Belgifine. Call 412-641-8594, or visit bone at jointhelp.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.