Orthopedic surgeon Dr. Vonda Wright joins Stacy to break down what's actually happening to your bones during perimenopause and menopause — and what to do about it. They cover DEXA scans, the autoimmune-bone connection, and why osteoporosis doesn't mean you have to stop lifting.
Hello Menopause
Guest: Dr. Vonda Wright, MD — double board-certified orthopedic sports surgeon; coined the term “Musculoskeletal Syndrome of Menopause”
STACY LONDON: Dr. Wright, I am so excited that you're here for so many reasons. I talk a lot about the fact that I stopped going to the gym for what I call more “vanity” reasons. After menopause, bone strength became a real concern for me once I understood what our hormones actually do. I'd love for you to break that down for us — because I think people don't understand the difference between going to the gym because you want to look good in a dress, and going to the gym because you want to walk and be strong when you're 85. There was a real perception shift for me. I used to blow off the gym all the time; now I feel a real responsibility to my health to go. Can you talk about why strength training — and caring about our bones — matters so much at this stage of life?
DR. VONDA WRIGHT: Feeling amazing today and being able to do what you want, when you want, for the rest of your life — that's a huge motivator. But I'll tell you a secret: you can have both. Do you know what muscle is, Stacy? It's nature's Spanx.
STACY LONDON: That is literally the best definition of a muscle I've ever heard in my life.
DR. VONDA WRIGHT: It shouldn't be our primary motivator — I always tell my patients, this isn't about your little black dress. That's icing, that's bonus. The real reason is exactly what you said. And here's what surprises me: even my smartest, savviest patients don't have basic terms like osteopenia and osteoporosis in their vocabulary. Those are just measures of the density — the amount of mineral — in your bone. We build bone throughout our youth until about age 30, and that's influenced by what we eat, our activity level, our genetics, our illnesses. I'll tell you the truth — in my orthopedic clinic, I get DEXA scans on everybody, and I have 24-year-olds with osteopenia and osteoporosis. This isn't just a postmenopausal issue. It affects our younger sisters and our daughters too.
What happens as we approach 40 — I call 35 to 45 the “critical decade” — is that we have few enough eggs left in our ovaries that our hormones start to decline, whether we feel it or not. By around 45 on average is when perimenopause begins, and that's when we start seeing all the things your guests have been talking about. But the silent part of that is your bones. You don't hear your bones. In your world, probably the only time you've thought about bones is looking at someone's gorgeous cheekbones, or how a bracelet sits on a delicate wrist.
STACY LONDON: Yes!
DR. VONDA WRIGHT: But bones are structural. They hold us up — without bones, muscle is just a heaping pile of metabolic tissue that doesn't go anywhere. Bones give us our stature, our posture. They're also home to all of our immune cells, they make our blood cells, they house our minerals, and they're a metabolic communicator — bone actually produces hormones itself.
STACY LONDON: I'll be honest — I thought bones were basically like wood. I knew they were structural, but I didn't know anything about what bone actually does or produces. When you see younger people with osteoporosis, that can come from nutrition, genetics, any number of things, right? My mom has osteoporosis, and I have degenerative psoriatic arthritis in my spine and hips — I have some pretty severe autoimmune disease. Is there a connection between autoimmune conditions and bone health? I've never heard anyone talk about that.
DR. VONDA WRIGHT: The data on that is emerging, but what we know is that chronic inflammatory states — whether from autoimmune disease or from what we impose on ourselves through diet, stress, and lifestyle — affect bone, because bone is very responsive to inflammation. Here's something else that might surprise your listeners: we don't get one set of bones for a lifetime. We replace our bones every ten years. They're dynamically building and breaking down our whole lives, which means we don't get to pay attention to bone health just once — we have to pay attention for life. I'm so glad you got your DEXA scan.
For anyone listening: if your mother is shrinking, if you've shrunk, if you have autoimmune disease, if you've been on steroids long-term for something like asthma, if you've ever smoked, if your habits include more than a couple glasses of wine a night, or if you were never much of an exerciser — those are all risk factors for bone density issues. We measure that with a DEXA scan. You just lie there — it's painless.
STACY LONDON: I was like, this is the easiest test I've ever taken. You can't get an answer wrong. You just have to lie there.
DR. VONDA WRIGHT: And it gives you a set of numbers. We interpret those on a bell curve — like college, but hopefully less terrible. The top of the curve, zero, represents the bone density of a healthy 30-year-old. Any positive number — great, your bones are strong. Any number between zero and negative one — one standard deviation from the mean — is defined as osteopenia, meaning your bones are becoming weak. A number of negative 2.5 or below — 2.5 standard deviations — is the definition of osteoporosis. But having that number doesn't mean there's nothing you can do about it, and it definitely doesn't mean you're going to break a bone. There are a lot of factors involved in a fracture — for one, most people have to actually fall.
So when we approach bone health, I think everyone's workout — and I'll describe a “bone workout” for you — needs to include balance. That can be as simple as standing on one leg while you brush your teeth. It doesn't have to be complicated — just get on one leg and move around a little to retrain your balance.
Second, we need to load our bones. If you're able to, I like people to jump rope — even just twenty jumps a day in your office — because bone builds in response to biomechanical force. That force gets translated by the bone into biochemical signals that say, “she's using this bone, let's build better bone for her.” Hormones matter, nutrition is critical — bone is a high-protein organ. We can't starve it.
Beyond jumping, what about the workout itself? Muscle is all the rage right now, and we do need to build muscle. I'll say something a little obnoxious: put down the “mamby-pamby” pink weights you've been told to lift thirty times, and learn to progressively overload — lift heavier.
STACY LONDON: Should I be doing impact training if I have osteoporosis in my spine or anywhere else in my body? Does impact matter the same way, or is it more dangerous?
DR. VONDA WRIGHT: It still matters, but you can approach it differently. NASA, for example, uses mini trampoline rebounders to reintroduce impact to astronauts returning from space — it delivers force without the same pounding. For my patients who have osteoporosis in their spine, or frank compression fractures — where a vertebra that's normally rectangular collapses into a wedge shape — I'm more careful with anything involving axial loading, meaning even how slowly we progress with something like a squat bar. You still can do it. You just have to be mindful.
STACY LONDON: Both my strength trainer and my Pilates coach have told me the same thing: you don't stop because you have osteoporosis — you adjust.
DR. VONDA WRIGHT: Exactly — and that's backed by science, Stacy. There's a study called the LIFTMOR trial that really answered this question: can women with known osteoporosis continue lifting, and lifting heavy? In that trial, it was heavy lifting — five reps, five sets, sometimes supervised — and the women got through the protocol safely because they were careful and adjusted. It answered the question for the field: yes, women with osteoporosis can lift. You just have to be mindful.
The second thing I tell every patient: make your hormone-replacement decision. My stance is that we're all capable of having agency over our own decisions — but you can't make that decision based on fear. You have to make it based on facts, which takes some education, whether you seek that out yourself or find a clinician who actually understands menopause. Then I write out an action plan: how to lift, how to jump — I call it “base training” — how to walk, including rapid walking and sprinting. Because Stacy, this is a time for action.
STACY LONDON: That's actually the whole point of this podcast — to walk away with action items. Honestly, just from what you told me, I feel like I have sixteen things I can go do right now. And that matters, because it's one thing for people to hear this information — then they have to know what to do with it. You can't just stop at education; you have to know how to implement it.
DR. VONDA WRIGHT: That's exactly where I see my place in the menopause conversation. There are so many people — including you — doing incredible work raising awareness and providing education. What I've tried to bring to the table is the concept of the musculoskeletal syndrome of menopause. That's my contribution. But my stance is: now that you're literate on this, what are you going to do about it? It's one thing to swim around in “oh my God, this feels terrible.” It's another to take action — and you're always going to feel bad until you do. That's my role: I'm the “what's next.” Here's how you eat. Here's how you move. Here's how you lift. Because as a musculoskeletal doctor, I can tell you this has a huge impact on your life. Heart disease is the number one killer of women, and we talk a lot about breast cancer, but seventy percent of all hip fractures happen in women — and your bones are silent about it until they're not.
STACY LONDON: Dr. Wright, I can't thank you enough. This has been such an eye-opening conversation. I don't think people know enough about this, and everything you've laid out today are genuine action items — recomposition, taking action, all of it. For people who are still confused about the perimenopausal and postmenopausal experience, you've given us a real map. And getting this information to younger people matters so much — the idea that the next generation won't have to go through this kind of catch-up education, that it'll just be baked into what they know about their own health from the start — that's beautiful. And that's partly because of the work you're doing, Dr. Wright. Thank you so much for your time. I may call you again — about jumping rope.
DR. VONDA WRIGHT: Please, call me anytime. Thank you, Stacy.
Transcript lightly edited for clarity and readability.
