更年期、冻结肩与关节疼痛的警钟——乔塞琳·维特斯坦医生谈（第一部分）

没错。

Exactly.

有时候你并不需要一套全新的衣服。

Sometimes you don't need a whole new outfit.

你只需要一个恰到好处的点睛之笔。

You just need the right finishing touch.

而对我来说，那就是Jenny Bird。

And for me, that's Jenny Bird.

你有没有过这样的时刻：照镜子时心想，好吧。

You know that moment when you look in the mirror and you think, okay.

这样挺好的。

This works.

但当你戴上一件珠宝后，突然就觉得，对了。

But then you add one piece of jewelry, and suddenly it's like, yes.

就是它了。

There it is.

这就是Jenny Bird的魅力。

That's the Jenny Bird effect.

说实话，我所有的Jenny Bird饰品都能完美搭配，所以穿衣变得毫不费力。

It honestly feels like all my Jenny Bird pieces work together, so getting dressed is effortless.

我可以随意混搭，根本不用思考，却依然显得整体得体。

I can mix and match without thinking about it and still feel completely put together.

这些饰品轻盈易戴，能让你轻松展现精致感，而无需花很长时间搭配。

The pieces are lightweight and easy to wear, perfect for looking polished without spending forever accessorizing.

每一件都经过精心设计，能瞬间让整体造型提升，但又不会显得过度装饰。

Everything is designed to pull together instantly in a way that feels elevated but not overdone.

而且说实话，每次我戴上它，都会有人问这是哪里买的。

And honestly, every time I wear it, someone asks where it's from.

每次都是这样。

Every single time.

从标志性的耳环到手镯和臂环，真正适合每一种风格。

From their iconic hoops to their bracelets and bangles, there's truly something for every style.

他们刚刚推出了一款全新的高级珠宝系列，风格现代、优雅且独具特色。

And they just launched a new fine jewelry collection that feels modern, elevated, and really special.

如果你一直在考虑提升日常造型，那么现在就是最好的时机。

If you've been thinking about elevating your everyday look, this is your sign.

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You can get 20% off your first order with Jennie Byrd by visiting jennie-bird.com and using the code unpaused at checkout.

我曾经以为化妆就是层层叠加、步骤繁多、耗时长久，厚重又假面，可最终还是不像我。

I used to think makeup meant more, more layers, more steps, more time, heavy, cakey, and somehow it still never looked like me.

关键是，尤其是随着年龄增长，皮肤也在变化，我不想遮盖我的脸。

And here's the thing, especially as our skin changes with age, I don't wanna cover my face.

我想呵护它。

I wanna support it.

我希望我的皮肤看起来健康、水润，真正属于我自己的样子。

I want my skin to look healthy, hydrated, and like it actually belongs to me.

这正是我如此喜爱 Jones Road Beauty 的原因。

And that's exactly why I love Jones Road Beauty.

他们的奇迹润唇膏是一款让人一用就懂的产品。

Their Miracle Balm is one of those products that just makes sense.

它能提升你的肌肤状态，而不是掩盖它。

It enhances your skin instead of masking it.

你无需叠加任何产品，就能获得清新、健康、比原本更好的光泽感。

You get that fresh, healthy, your skin but better glow without piling anything on.

我用它当腮红，涂在脸颊上，有时甚至直接用在嘴唇上。

I use it as blush, a little more than my cheeks, and sometimes even on my lips.

一款产品，多种用途，搞定。

One product, multiple uses, done.

我真正欣赏的是，Jones Road 专注于使用对皮肤友好的成分，打造纯净且高效的产品配方。

What I really appreciate is that Jones Road focuses on clean, high performing formulas made with skin loving ingredients.

没有厚重感，没有堵塞感，只有真正适合你肌肤的彩妆。

Nothing heavy, nothing cloggy, just makeup that works for your skin.

他们还有像‘Just Enough’调色保湿霜这样的经典产品，提供轻盈均匀的遮盖力，同时让真实的肌肤纹理自然透出。

They also have staples like their Just Enough tinted moisturizer, which gives a lightweight, even coverage and lets your real skin show through.

这是与你的皮肤协同工作，而非对抗的彩妆。

This is makeup that works with your skin, not against it.

现代彩妆，纯净、精准且多功能，让日常护理轻松无负担。

Modern day makeup that's clean, strategic and multifunctional for effortless routines.

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For a limited time, our listeners are getting a free cool gloss on their first purchase when they use the code unpaused at checkout.

只需前往 jonesroadbeauty.com，并在结账时使用代码 unpaused。

Just head to jonesroadbeauty.com and use the code unpaused at checkout.

购买后，他们会询问你是从哪里了解到他们的。

After your purchase, they'll ask you where you heard about them.

请支持我们的节目，并告诉他们你是从我们的节目得知的。

Please support our show and tell them our show sent you.

我怀孕时摔断了脚。

I broke my foot when I was pregnant.

怀孕25周时，踩到路缘绊倒了，第五跖骨骨折了。

Twenty five weeks tripped on a curb, you know, had a fifth metatarsal fracture.

他们把一位怀孕的女性送进了急诊室，脚骨折了。

They brought in a pregnant woman, you know, into the ER with a broken foot.

整个骨科团队都来了，而我就像个外星人一样，格格不入。

And like the entire orthopedic team came in, and like, I was a space, like, know, I was an alien.

他们根本不知道该怎么做，生怕伤到宝宝。

They didn't know what they were so scared to hurt the baby.

我说，你们给我打个石膏就行了。

I'm like, you can put a cast on me.

你们该怎么做就怎么做。

Like, you can do what

你该怎么做就怎么做。

you need to do.

好的。

Yeah.

我突然意识到，我从来没见过这些医生。

You know, I just realized I'd never met any of these people.

我很少见到他们，我们两个专科之间几乎没有任何互动，除非那位怀孕的住院医生带着骨折的脚来就诊。

I rarely saw them, that we had just there was no interaction between our two specialties other than when the one pregnant resident comes in with a broken foot.

我的意思是，我想回到骨科疾病中的性别差异问题上。

I mean, I wanna get back to orthopedic conditions with sex disparities.

是的。

Yeah.

对。

Yeah.

但我得告诉你，我与女性健康以及我所做的一切工作的联系，源于我母亲一生中最喜欢的医生——安福德。

But I will tell you, the gateway to my connection to women's health and all this work that I do came from the fact that my mom's favorite doctor over the course of her entire life, my mom's gone now, but was Anford.

所以，二十多年来，她总是说：我就是喜欢安·福特。

And so for, like, twenty years, she'd be like, I just love Ann Ford.

安·福特是最好的医生。

Ann Ford is the best doctor.

她是她的女性健康医生。

She's her women's health doctor.

她总是说，天啊，她真的太棒了。

She was like she's like she oh my gosh.

我妈妈对她赞不绝口。

She just my mom raved by her.

有一天，我在休息室里，幸运的是，我的办公室就在杜克女性健康中心正对面的同一层楼。

So one day, I'm in the break room, and thank goodness, my office is directly on the same floor across the hall from Duke Women's Health.

我在休息室里看到一位女士，胸前挂着名牌，上面写着‘安·福特’。

I'm And in the break room, and I see this woman with a badge on, and it says, Anne Ford.

于是我问：‘您是安·福特吗？’

And I said, you're Anne Ford?

是的。

Yeah.

我至少十五年来一直听人提起您。

I have heard about you for at least fifteen years.

我们聊了起来，从那一刻起，我们就一直合作至今。

And, you know, we started talking, and ever since that moment, we have worked together.

太棒了。

That's awesome.

但因为她对我妈妈意义重大。

But because she meant so much to my mom.

是的。

Yeah.

不，这是个很棒的故事。

No, that's a great story.

我经常想知道，整个冻结肩的故事是怎么回事

I often wondered how the whole frozen shoulder story we'll get

到那一步的。

to that.

我们会深入探讨

We'll dig into

那件事以后再说。

that later.

我们回头聊聊，嗯。

Let's talk about go back Mhmm.

说到那些诊断结果

To the admissions that

对。

Right.

所以我认为下一个最明显的状况，就是你偶尔会看到的一些小问题，比如桡骨茎突狭窄性腱鞘炎，这在新手妈妈身上常见，也发生在围绝经期女性身上。

So then I think the next most obvious condition I mean, are little ones you see here and there like dequeuer venous tenosynovitis, which happens to like new moms, but also like perimenopausal women.

真的很多。

So much.

真的很多。

So much.

足底筋膜炎，你看到的更多。

Plantar fasciitis, you see more of.

但对我来说最明显的就是冻结肩，就像我们之前聊过的。

But the one that's really, really obvious to me is frozen shoulder, like we talked about.

这是一种主要影响女性的疾病。

It's just a condition that mostly strikes women.

真正患上冻结肩的男性通常是糖尿病患者，而且往往是血糖控制不佳的糖尿病患者，这属于另一种炎症状态。

And really, the only men who get frozen shoulder are men with diabetes and usually poorly controlled diabetes, so another inflammatory state.

因此，冻结肩在几十年前被描述为特发性，这是一个委婉的说法，意思是‘我们不知道病因是什么’。

So frozen shoulder is a condition that for many decades was described as idiopathic, which is a fancy word for we don't know what causes this.

我讨厌‘特发性’这个词。

I hate the word idiopathic.

因为这等于说你是个傻瓜。

Because you're an idiot.

是的。

Yeah.

但你想想，一种几乎只影响女性、极少影响男性的疾病，而且几乎只发生在40到60岁之间的女性身上，怎么可能说是特发性的呢？

But you know, something cannot be idiopathic that almost entirely affects women, but not men, and almost entirely affects women between the age of 40 and 60.

这正是典型的发病年龄段。

That's the typical time frame.

但冻结肩的表现是，如果你听到这个术语——粘连性关节囊炎，它通常是一种非创伤性或仅有轻微创伤的情况，你并没有遭受严重损伤，但肩膀会变得非常疼痛，随后变得极其僵硬。

But what present children is, and it's also called adhesive capsulitis, if you see that term, But it's typically a nontraumatic or sometimes minimally traumatic situation where you didn't have a big injury, but your shoulder becomes very painful and then subsequently very stiff.

这是一个过程，肩关节的内衬——你可能会听到‘关节囊’或‘滑膜’这样的术语——想象一下，围绕你肩部球窝关节的整个内层会发炎、增厚并纤维化。

It's a process where the lining of the shoulder joint, you may hear the term capsule or synovium, think of just sort of the lining around the whole ball and socket joint of your shoulder becomes inflamed and thick and fibrotic.

我的朋友乔安娜·范，她在女性运动医学小组的论坛里，多年来对此有非常清晰的描述，包括对冻结肩组织的病理生理机制进行研究。

And our phases one of my friends, Johanna Fan, who is in the forum with me in the Women's Sports Medicine Group, has described this very well over the years, including looking at the actual pathophysiology in the absellar tissue.

但在炎症阶段，肩膀会变得非常非常疼，比如在活动范围的末端时疼痛，中间范围还好，但一到末端就疼得要命，导致肌肉保护性紧张。

But there is an inflammatory phase where the shoulder becomes very, very painful, like pain at end range of motion, just like okay with the mid range, we get the end range, and ow, super painful, leads to guarding.

然后进入冻结期，疼痛减轻了，但肩膀变得极其僵硬，女性可能出现极端的活动受限。

Then a frozen phase where it becomes not so painful, but just really stiff with women can have extreme lack of motion.

我的一些女性患者甚至无法将手臂向外侧旋转，或者完全抬不起来，我真不知道她们是怎么

I mean, I've had women come in who cannot rotate their arm out to the side or lift it up at all, and I just don't know how they

做到的——她们连梳头都做不到，穿内衣困难，甚至无法在合影时把手搭在朋友肩上。

could So they be can't brush their hair, they can't put their bra on, they can't put their arms behind their girlfriends in a picture.

哦，是的。

Oh, yeah.

常见的情况包括：无法刮对侧腋下，无法把衬衫塞进裤子里，或者扣上胸衣。

Common things are I can't shave under my opposite armpit, cannot tuck in a shirt or fasten a bra.

是的。

Yeah.

洗头发之类的，这些都是很常见的。

Washing your hair, you know, things like that, all very common.

然后进入解冻期，可能需要一到两年时间。

And then there's a thawing phase, which could take one to two years.

如果女性患有糖尿病，那就是最糟糕的情况。

And if a woman has diabetes, that is the worst case scenario.

患有糖尿病的女性，冻结肩的病程可能会非常漫长。

Women with diabetes can have a really prolonged course of frozen shoulder.

但我真的认为这与激素有关。

But, you know, I really believe this is hormonally related.

这种情况主要发生在40到60岁之间的女性身上。

This happens mostly to women between the age of 40 and 60.

滑膜中——也就是肩关节内衬——存在大量雌激素受体。

There are a lot of estrogen receptors in the synovium or, again, lining of the shoulder joint.

雌激素已被证明可以抑制肩关节内衬中的成纤维细胞，这些细胞会导致关节囊增厚和僵硬。

And estrogen has been shown to inhibit cells called fibroblasts in the lining of the shoulder joint, so these cells that can thicken and stiffen the capsule.

我想你们知道，我们曾在NAMS——现在叫更年期学会——上展示了这项研究。

I think you're aware we presented the study on this at NAMS or now the Menopause Society.

这个

The

更年期学会。

Menopause Society.

所以我想让每个人都明白，女性一直以来都患有这种疾病。

So I want everybody to understand, women have been having this condition forever.

她和她的团队，也就是合著者们，是首批提出这种病可能与更年期有关的人，因为这种病通常发生在40到60岁的女性身上。

And she and her team, you know, the co authors, were the first people to even suggest that this may have something to do with menopause since it usually happens in women between the ages of 40 and 60.

但最初大家并不接受这个观点，对吧？

And it didn't go over well at first, right?

是什么让你想到这一点的？

What made you think of this?

是什么让你停顿了一下？

What made you wait a minute?

所以我在一个网络中工作，这是一个封闭的网络——不，不是完全封闭的网络，但所有全科医生的笔记和资料都在里面。

So I work in a network where I can it's a closed network not a closed network, but the primary care doctors, all the notes, everything are in there.

我可以了解我的患者的情况。

I can see what's going on with my patients.

我可以发现他们因为睡眠障碍、夜间盗汗、潮热、血脂升高、焦虑以及其他与围绝经期和绝经相关的症状而看医生。

And I can see that they're seeing their doctor for sleep disruption, night sweats, hot flashes, lipids creeping up, things like that, anxiety, you know, all these other symptoms associated with perimenopause and menopause.

我也开始向我的患者提问。

And I also started asking my patients.

第一个线索是，我有这么多乳腺癌女性患者也出现了这种情况。

So, you know, the first clue was like, I have all these women with breast cancer who have this.

然后我开始想，我主要看到的都是女性患者。

Then I started thinking, well, I mostly see this in women.

然后，你知道，这个年龄段的人，雌激素是一种抗炎激素。

And then, you know, it's in this age group, and estrogen is an anti inflammatory hormone.

我渐渐开始把这些线索拼凑起来，然后发现她们提出的其他各种症状其实都关联在一起。

I sort of started just putting these pieces together and then these other, know, complaints that they're having all kind of together.

真正让我走上这条研究道路的，是芳香化酶抑制剂的影响。

And I just I think the thing that first set me down the pack path was the the effect of aromatase inhibitors.

嗯。

Mhmm.

后来我和安聊了这件事，我觉得这一定是更年期的症状。

And and I ended up talking to Anne about this, and I was, this has to be a symptom of menopause.

这其实发生在新冠疫情期间。

So this was, like, actually during COVID.

我花了成百上千个小时，日复一日地手动审查了数千份病历。

I spent hours and hours and hours, days and days and days manually doing chart reviews of, like, thousands of charts.

我只是想说，这一点很重要，我想让我们的听众明白：要证明这种关联性需要付出大量工作，因为全世界都会告诉你这不可能。

I just, yeah, this is the important part I want our listeners to understand is that the work that goes into getting the scientific proof that this could be correlated because the whole world is gonna tell you no.

是的

Yeah.

你知道的？

You know?

作为第一个建立这种关联的人。

As being the first person to make this correlation.

正如你所知，美国女性中使用更年期激素治疗的比例不到百分之五，因为我接触的都是走在前沿的女性健康医生。

As you know, use of menopausal hormone therapy is less than five percent in Now women in The United in our population, because I work with women's health doctors who are Ahead of the curve.

我认为他们对这些事情掌握得更好。

I would say on top of things.

并不是说其他人没掌握好，只是他们的比例可能更高一些。

Not to say other people aren't on top of things, just they're, I think, have a higher percentage.

我觉得大约是百分之八或九。

I think it's about eight or nine percent.

在学术界，我们通常看到

Typically in academics, we see

就是这样。

that.

对。

Right.

但即便如此，如果你只有百分之八到九的人使用激素疗法，其余的人都不使用，而你研究的是数千名女性，要获得统计上所需的样本量还是很困难的。

But even so, if you only have eight or nine percent of people on hormone therapy and the rest are not, and you have, you know, several thousand women that you're looking at, it's hard to get the numbers you need statistically.

所以我们需要对此进行更多研究。

So we need to do more research on this.

在我们的研究中，我们最终发现，使用包含雌二醇的绝经期激素疗法（系统性使用，而非局部使用）的女性，患上冻结肩的风险比未使用者低一半。

And what we ended up finding in our study was that women who used menopausal hormone therapy that included estradiol, systemic, not just local, had half the risk of developing frozen shoulder as compared to those who didn't.

然而，我们的结果接近统计显著性，但并未达到。

However, we approached statistical significance, didn't reach it.

另外，当你看我们的置信区间时，它们并没有重叠。

And then our, you know, the other thing is we, when you look at our confidence intervals, they didn't overlap.

所以，如果我们能有更多患者，我想我们就能达到显著性了。

So, if we could have just had some more patients, I think we would get there.

我的意思是，接受激素治疗组的冻结肩病例数量实在太少了。

And I mean, just the number of cases of frozen shoulder in the hormone therapy group were so small.

但同样，我们需要更大的样本量。

But again, we need larger numbers.

所以我做了一个事后功效分析，我知道我们需要多少样本，但我无法回头再收集更多数据了，因为这项研究只能使用我们HMO内部的患者。

So I did a post hoc power analysis, you know, and I know how many we need, but I can't go back and get more because this was it had to be I used patients that were in an enclosed system, meaning they were within our HMO.

所以没有数据外流。

So they're not leakage.

我没有遗漏任何数据。

I'm not missing data.

但我正在进行一项前瞻性研究。

But I have ongoing pro Perspective.

我正在与我们的女性健康团队开展前瞻性研究。

Perspective work that I do with our women's health group.

我们正在将人们纳入一个名为‘肌肉骨骼症状与更年期登记库’的项目中。

We enroll people in something called our musculoskeletal symptoms and menopause registry.

我们每隔几个月就会对他们进行调查，跟踪他们开始或不开始激素治疗的时间。

We survey survey them every few months, you know, follow them with timing of onset of hormone therapy or not.

所以我们正在前瞻性地进行这项研究。

So we're doing that prospectively.

我还有一项大规模的横断面研究即将发表，我与冯达·赖特合作完成了这项研究的分发工作，她能与我们合作真是太好了。

And I have a very large cross sectional study that we'll be coming out with that I actually collaborated with Vonda Wright on in terms of distributing, and that was great that she was able to collaborate with us.

我们的样本量非常大，这项研究即将发布。

And we have huge numbers, and, we'll be coming out with that.

我还不想透露具体结果，但它确实证实了我们的猜测。

And I don't wanna say what it shows yet, but it does confirm our suspicions.

这篇论文已经提交了。

I have that in submission.

所以我认为这一点正变得越来越明显，越来越多的人开始认识到这一点。

And so I think it's becoming more and more obvious, and people are recognizing this more and more.

当那篇论文在更年期学会上发表时，我在社交媒体上讨论了它，那是我见过的最受欢迎的视频之一。

When that paper was presented at the Menopause Society, I talked about it on social media, and it was one of the most viral videos that I've ever had.

我记得这件事。

I remember that.

有非常多的人联系了我。

And so many people reached out to me.

他们问我：‘你就是她提到的那位医生吗？’

They're like, Are you the doctor she's talking about?

因为你们是杜克大学的医生。

Because you're like doctors at Duke University.

我当时想，我想我就是。

And I was like, I think I am.

我想说的是，我经常在女性健康领域思考这个问题。

I do wanna say, there are I think about this all the time in women's health.

如果你仔细研究旧的数据，会发现一些零散的线索。

If you look hard at older data, there are pieces here or there.

这些线索是存在的。

There are clues.

这些线索只是没有被整合起来，因为它们被孤立在不同的领域里。

Are clues that just haven't been brought together because they're, you know, siloed.

这里有线索。

There are clues.

有一些线索可以解释，为什么女性患关节炎的比例远高于男性。

There are clues as to why, you know, women have more arthritis than men, a lot more.

这些线索零零散散地存在。

And they're here and there.

有些在骨科文献里，有些在女性健康文献里。

Some of it's in the orthopedic literature, you know, some of it's in women's health literature.

但如果这些线索不被系统地整合在一起，它们就无法发挥应有的作用。

But when you if they're not all brought together, they just don't work as well.

你有没有在骨科期刊上发表过这些数据？

Have you published in orthopedic journals any of this data?

没有，我尝试过，但没发表过关于冻结肩的数据。

No, not the frozen shoulder data I've tried.

我还写过一篇关于围手术期激素治疗和口服避孕药管理的文章。

I've also tried I wrote a piece on managing, you know, hormone therapy and oral contraceptives perioperatively.

我把它投给了很多骨科期刊，甚至已经获得撰写相关社论的预先批准。

And I sent it to so many orthopedic journals, even got preapproval to write editorials on this.

你知道吗？

You know?

是的，这已经获准了。

Yes, this is approved.

投稿吧。

Submit it.

投稿给《JAMA外科》以及其他所有地方。

Submit it to JAMA Surgery, all these places.

但他们收到后审阅时却说：哦，这不符合你的风格？

And then they would get it and review it and be like, oh, this isn't you know?

开玩笑的。

No, just kidding.

我们不会发表这个。

We're not gonna publish this.

或者我不确定我们的读者是否对这个感兴趣。

Or I don't know if this is of interest to our readers.

而且，你知道，而且

And, you know, and

这占了人口的百分之五十一。

It's like fifty one percent of the population.

所以我最终在一本关于女性健康的期刊上发表了，毕竟这是个小众领域。

So I eventually published it in a Like, women's health is niche.

是的。

Yeah.

这到底是怎么回事？

What on earth?

所以，比如那篇论文，我最终发表在了由哈佛的田中美穗担任主编的《女性运动医学杂志》上，为人们提供关于如何在骨科手术中管理外源性雌二醇的指导。

So that paper, for instance, I eventually published in a journal that Miho Tanaka, who's at Harvard, is the lead editor of, which is Journal of Women's Sports Medicine, to give people guidance about how you manage exogenous estradiol perioperatively in orthopedic surgery.

你知道，口服雌二醇有一些增加的风险。

You know, oral estradiol has some increased risk.

经皮贴剂则少得多，几乎可以忽略不计。

Transdermal, much less, little to none.

阴道给药，完全没有风险。

Vaginal, zero.

你知道，手术前后不需要继续使用。

You know, you don't have to hold that around the time of surgery.

但这挺有意思的。

But it's just interesting.

有时候，那些影响如此广泛、如此重要的事情，就是很难达到我想要的推广程度。

Like, sometimes these things that are so significant and affect so many people are just it's just hard to get it to where I want to get it.

关于冻结肩的问题。

Oh, regards to frozen shoulder.

这非常有意思。

This is very interesting.

在一些容易患冻结肩的文化中，比如哪些？

In some cultures that are highly prone to frozen shoulder Such as?

亚洲文化。

Asian cultures.

好的。

Okay.

比如，某些亚洲文化有自己的术语来描述冻结肩，翻译过来就是‘五十肩’。

Like, there are certain Asian cultures that have their own term for frozen shoulder, which translates to fifty year shoulder.

这绝非偶然。

Like, that is also not a coincidence.

他们的术语是‘五十肩’，有些女性甚至完全预期自己会在五十岁左右患上这种病。

Like, their term is fifty year shoulder, and some women just full on expect to get 50 or shoulder.

哦，是的，我妈妈就得了五十肩。

Oh, yeah, my mom got 50 or shoulder.

所以，如果你仔细听人们说的话，这并不是随机的。

So again, if you listen to people, this is not random.

所以我想分享这个小故事，因为它对我而言确实有意义。

So I wanted to share that anecdote because that's actually meaningful to me.

如果你仔细听不同文化群体中的术语，他们会告诉我们，当女性到了50岁，这种问题就会发生。

If you just listen to terminology within various cultural groups, they're telling us this is something that happens to women when they're 50.

是的。

Yeah.

尤其是。

Especially.

既然我们在谈冻结肩，我是妇科医生，完全没有骨科训练。

Since we're talking about frozen shoulder, I am a gynecologist, have zero training in orthopedics.

但因为这是社交媒体上非常热门的话题，而且我总是被问到，我们该如何避免它？

But because it's such a popular theme on social media and, you know, I'm always asked, how do we avoid it?

如果我得了这个病，我该怎么办？

What can I do if I develop it?

你知道，有没有办法预防？

You know, is there prevention?

那我们该如何治疗呢？

And then how do we take care of it?

你该怎么做？

What do you do?

是的。

Yeah.

所以治疗冻结肩最重要的一点是，如果你觉得自己正在发展这种症状。

So one of the most important keys to treating frozen shoulder is if you think you're developing it.

你并没有经历明显的外伤，或者只有轻微的不适，但突然出现了严重的肩部疼痛，并开始注意到活动范围在减少，哪怕只是轻微的减少。

So you didn't have a traumatic event really or something very mild, and then you have this new onset severe shoulder pain, and you start to notice you're losing range of motion, even just a little bit.

比如，当你低头看时，试着将手臂向两侧旋转，如果发现哪怕只有10度的差异，那就不正常了。

Like, if you look down and you try to rotate your arms out to the side and you see even just a 10 degree difference, that's not normal.

通常情况下，你的活动范围应该是正常的。

Normally, you're gonna have normal range of motion.

是的。

Yeah.

我经常告诉人们，尤其是正在接受冻结肩治疗的人：随时自我检查一下。

I tell people this all the time, especially when they're in treatment for frozen shoulder, like, Just check yourself.

确保我们在恢复之后，不要再失去活动能力。

Make sure you're not losing it after we gain it.

但要尽早去看医生。

But go see someone early.

理想情况下，我认为应该去看骨科医生。

This is not Ideally, I think an orthopedic surgeon.

你也可以找一位初级保健运动医学医生，他们可以给你做肩关节腔注射，也就是注入关节盂的注射。

Or you could see, like, a primary care sports medicine doctor, someone who will give you a glenohumeral joint injection, an injection into the bone socket joint.

你的目标是尽快对抗或逆转关节内衬的炎症。

You're basically trying to combat or reverse as soon as possible the inflammation of the lining of the joint.

我认为，冻结肩是骨科领域最适合作为类固醇注射适应症的疾病，因为它不是治标不治本。

And frozen shoulder is the best indication for use of a steroid injection, I think, in all of orthopedics because it is not a Band Aid.

它更像是治愈。

It's like a cure.

会不会太晚了？

Is it ever too late?

所以如果你已经进入病程三到四个月，并且已经开始丧失活动能力，注射的效果就会减弱。

So if you're three or four months into the process and you've already started to lose motion, there is less efficacy of the injection.

我仍然会给患者注射，因为他们仍然在疼痛。

I'll still give it to people because they're still in pain.

只是效果没那么好了。

It just doesn't work as well.

如果我在症状出现后的三个月内发现患者并给他们注射，通常能恢复他们的活动能力，消除疼痛，其中一半的人我再也不会见到他们了。

If I catch someone within three months of onset of the symptoms and I give them an injection, it'll often restore their motion, make the pain go away, and half of those people, I never see them again.

好的。

Okay.

如果他们回来，会因为太开心而拥抱我。

And they hug me when they come back, if they come back because they're so happy.

有多少比例的人会患上对侧（另一侧）？

What percentage will get the contralateral the opposite

我不清楚这方面的准确统计数据。

I don't know an accurate statistic on that.

根据我自己的患者群体的观察，我觉得大约有百分之二十吧。

I would say anecdotally in my own patient population, you know, maybe like twenty percent.

好的。

Okay.

有些人需要第二次注射。

So some people need a second injection.

我们的目标是控制炎症，缩短炎症期的病程，帮助他们减少僵硬程度，或缩短冻结期，以便之后能够恢复活动。

The idea is you keep the inflammation at bay, you're shortening the course of the inflammatory phase, trying to get them to not freeze up so much or shorten the course of the of the frozen phase that they can then thaw.

那物理治疗呢？

What about, physical therapy?

你可以在教科书和我们的考试中看到标准答案是让患者接受物理治疗。

You will read in textbooks and our, like, examinations the correct answer is send people to physical therapy.

但物理治疗师和我会告诉你，如果在炎症期高峰期送患者去做物理治疗，是不会有效的。

But physical therapists and I will tell you, if I send you to physical therapy in the throes of the inflammatory phase, it is not going to help.

所以，如果你正处于非常疼痛的阶段，我让你去接受物理治疗，或者你的全科医生让你去接受物理治疗，通常物理治疗师会发现你患有冻结肩，然后说：‘我现在帮不了你’，并建议你打一针。

So if you're in that very painful phase and I send you to physical therapy or your primary care doctor, whoever send you to physical therapy, oftentimes the physical therapist is gonna recognize you have frozen shoulder and be like, I can't help you right now, and send you for an injection.

因为如果你在关节活动末端感到疼痛，而有人试图帮你活动关节，让你自己动，但每次到活动末端你都会喊：‘哎哟，哎哟，哎哟’。

Because if you have pain in end range of motion and someone is trying to help you move it and let you move it, and at the end of each end range, you're like, Ow, ow, ow.

到治疗结束时，肩膀反而更发炎了，你会更加紧张和保护它。

By the end of the session, it's inflamed, and you guard more.

这实际上是在加重病情。

It's kind of exacerbating.

好的。

Okay.

所以，如果你正在接受冻结肩的物理治疗，但情况反而变得更糟，这并不是因为你的治疗师做错了什么。

So if you're in physical therapy for frozen shoulder, but it's making you worse, not better, it's not that your therapist is doing something wrong.

这只是因为这种疾病的本质就是这样。

It's just that's the nature of the condition.

我认为，现在还不是合适的阶段。

It's not the right phase, I think.

你在物理治疗中获得的效果会打折扣。

You don't get as much out of physical therapy.

所以早期进行注射是有帮助的。

So doing the injection early is helpful.

一旦我们帮你度过疼痛期，我通常会在六周后让患者回来复查，如果我能活动他们的肩膀，且在活动范围的末端不再感到疼痛，只是还有些受限，那时我们再进行物理治疗，效果就会更好。

Once we get you out of the painful phase, and I will bring people back usually six weeks later and check them, if I can rotate them and at the end of the arc of motion, they're not painful, they're just still a little limited, then we do physical therapy, and it's more helpful then.

然后，很少有人需要为此接受手术。

And then rarely people need surgery for this.

我的意思是，我不会为很多这类患者做手术，因为这是一种自限性疾病，患者最终都会好转。

I mean, I don't operate on many of these because it is a self limited course, and people do get better.

大多数人不需要我们所说的粘连松解或手法操作，但有些人确实需要。

Most people don't need what we call lysis of adhesions or manipulation, but some people do.

但你知道，我认为肯定不到百分之十的人需要。

But, you know, I think certainly less than ten percent of people.

所以我认为在正确的时间或阶段进行物理治疗很重要，这样才不会加重病情。

So I think using physical therapy at the right time or phase is important so we don't exacerbate things.

另外，每当我遇到患有冻结肩的女性时，我都会详细询问她们的围绝经期或绝经期病史。

And then the other thing I always do, whenever I have a woman with a frozen shoulder, I always take basically a perimenopausal or menopausal history.

我总会问她们：你有潮热吗？

I always ask them, Are you having hot flashes?

你有夜间盗汗吗？

Are you having night sweats?

你知道的，就是你最近还有什么其他症状？

You know, like, What else is going on with you?

我经常把她们转诊到女性健康科，每天在我的骨科诊所里，大约有三到五名女性被转诊，因为她们同时伴有这些症状。

And I make a lot of referrals to women's health, probably three to five per day in my orthopedic clinic to women's health because they're having these concomitant symptoms.

我有没有证据证明开始使用系统性雌二醇能逆转肩部问题，或者防止另一侧也出现同样情况？

And do I have proof that initiating, you know, systemic estradiol reverses or makes your shoulder better or makes you not get on the other side?

没有，但我正在研究这个问题。

No, but I'm studying that.

但在我看来，这有道理吗？

But does it make sense to me that it would?

我觉得这很合理，而且她们的其他症状也需要治疗。

It does make sense to me that it would, and they need their other symptoms treated anyway.

你目前的数据表明激素替代疗法可能具有预防作用。

And your data so far suggests that HRT could be preventative.

这个说法正确吗？

Is that a correct statement?

是的，我们不断积累的数据表明确实如此。

Yeah, our evolving data that I Yeah.

我不希望以错误的方式表达出来。

I don't want to, like, I gotta get it out there in the right way.

但没错，这正是我所观察到的。

But yes, that's what I'm seeing.

我想以正确的方式来做这件事，以便获得认可、审查和推广。

I I wanna do this the right way to get it accepted and reviewed and everything.

但没错，这确实是我的看法。

But, yeah, that's that is my feeling.

好的。

Okay.

荷尔蒙的影响不止于你的感受。

Hormones affect more than how you feel.

它们也会影响你的皮肤。

They affect your skin too.

随着中年时期雌激素水平下降，你的皮肤可能会失去胶原蛋白、水分和弹性。

As estrogen drops in midlife, your skin can lose collagen, hydration, and elasticity.

这就是Alloy Health的用武之地。

That's where Alloy Health comes in.

Alloy让基于证据的更年期护理变得触手可及，帮助女性连接更年期专家。

Alloy makes evidence based menopause care accessible, connecting women with menopause experts.

现在，他们正通过M4系列重新定义护肤，该系列含有雌三醇——一种仅作用于皮肤的雌激素形式。

And now they're redefining skincare with M4, their line made with estriol, a form of estrogen that only works on the skin.

最初推出的是M4面霜处方版，现在Alloy又推出了两款突破性产品：M4面部精华处方版和M4眼霜处方版。

It started with the M4 Face Cream Rx, and now Alloys added two game changers, the M4 Face Serum Rx and the M4 Eye Cream RX.

开始使用非常简单。

Getting started is easy.

前往 myalloy.com。

Head to myalloy.com.

就是 M Y A L L O Y 点 com。

That's M Y A L L O Y dot com.

回答几个简单的问题，持证医生将审核您的信息。

Answer a few quick questions, and a licensed physician will review your info.

使用代码 MCH20。

Use code MCH20.

输入 MCH20，首次订购立减 20 美元。

That's MCH20 for $20 off your first order.

您的个性化护肤产品将直接配送到家。

Your personalized skin care ships right to your door.

无需预约，无需排队取药。

No appointments, no pharmacy lines.

因为你的皮肤在变化，你的护肤流程也该随之调整。

Because your skin's changing and your routine should too.

访问 myalloy.com 并使用代码 MCH 20。

Visit myalloy.com and use code MCH 20.

就是 MCH 二零。

That's MCH two zero.

新年常常带来巨大的压力，让人觉得必须彻底改变一切。

The new year often brings a lot of pressure to do everything differently.

更健康的习惯、更清洁的生活、巨大的改变。

Healthier routines, cleaner living, big changes.

但事实是，有意义的健康改善通常来自小而持续的选择，而非彻底颠覆。

But the truth is meaningful health improvements usually come from small, consistent choices, not overhauls.

无毒生活不必令人不知所措。

Nontoxic living does not have to be overwhelming.

简单的替换积累起来就会有成效。

Simple swaps add up.

而一个经常被忽视却能产生重大影响的领域，是每天使用的清洁产品。

And one area that is often overlooked yet makes significant impact is the cleaning products used every single day.

许多人认为，刺激眼睛流泪的强烈气味意味着产品更有效。

Many people assume that a strong eye watering smell means a product is effective.

但实际上，这种反应往往是一个警示信号。

In reality, that kind of reaction is often a red flag.

它可能表明家中存在不必要的化学物质暴露。

It can indicate unnecessary chemical exposure in the home.

这就是像Branch Basics这样的品牌脱颖而出的原因。

That's why brands like Branch Basics stand out.

Branch Basics由三位女性在她们自身的健康旅程中创立，致力于生产对人体安全、以植物和矿物为基础的清洁产品，并获得MADE SAFE认证。

Founded by three women on their own health journeys, Branch Basics creates a human safe plant and mineral based cleaning products that are MADE SAFE certified.

他们的高端入门套装旨在简化清洁流程。

Their premium starter kit is designed to simplify cleaning.

一种浓缩配方可以稀释后用于家中的各个角落。

One concentrated formula can be diluted for use throughout the home.

好消息是。

And here's the good news.

Branch Basics 现在已在 Target 所有门店、target.com、Amazon 以及 branchbasics.com 全面上市。

Branch Basics is now available everywhere you shop at Target, target.com, Amazon, and of course, branchbasics.com.

告别有害化学物质，从未如此方便。

Tossing the toxins has never been more convenient.

凡购买高级入门套装的用户，可在 branchbasics.com 使用我们的优惠码 UNPAUSED 享受 15% 折扣。

And for anyone grabbing the premium starter kit, you can get 15% off at branchbasics.com with our code UNPAUSED.

在 branchbasics.com 购买高级入门套装时，请使用优惠码 UNPAUSED 享受 15% 折扣。

Just use the code UNPAUSED for 15% off the premium starter kit at branchbasics.com.

购买后，当他们询问您是从哪里了解到他们的产品时，请务必提到我们的节目。

After you purchase, when they ask where you heard about them, please be sure to mention our show.

冻结肩是更年期肌肉骨骼综合征的一部分，这是一个新术语。

So frozen shoulder is part of the musculoskeletal syndrome of menopause, which is a new term.

大家是否都张开双臂欣然接受这个说法呢？

Is everyone like arms open wide accepting this term?

这个术语在某些组织中是否遭到抵制？

Is it are you or is the terminology receiving pushback in certain organizations?

我的意思是，人们会质疑，更年期关节炎是不是只是因为年龄增长而出现的关节炎？

I mean, I think people question, is menopause arthritis just do you just have arthritis because you're aging?

有很多事情我们都可以归因于单纯的衰老、关节炎的进展以及骨密度的流失。

There are a lot of things that we can attribute to just aging, progression of arthritis, loss of bone density.

但这些情况在女性50岁左右时，会以不同于以往的方式加速发生。

But some of these things accelerate in a different way at age 50 in women versus

我们特别关注的是那些卵巢早衰人群中的这些异常表现。

And what we see as the premature What really stands out to us is some of these conditions in the people with premature ovarian failure.

你看到他们的新陈代谢健康状况迅速恶化，而且

You see this rapid, you know, in their metabolic health and

或是手术性绝经。

their Or surgical menopause.

是的。

Yeah.

或者手术性绝经。

Or surgical menopause.

对。

Right.

这又让我想到了芳香化酶抑制剂。

Which is, again, like takes me back to the aromatase inhibitor.

或者AI基因突变。

Or the AI mutation.

你知道的。

You know?

就像，是的，这些人经历了最极端的版本。

It's like, yes, these people have the most exaggerated version.

手术性绝经就像是卵巢切除大鼠研究的人类版本。

Surgical menopause is the human equivalent of the studies on the Oophorectomized Rats.

大鼠。

Rat.

我绝不是在把我的可爱女患者和老鼠相提并论。

Not I'm in no way comparing my lovely female patients to rats.

但我们没有动物的围绝经期模型。

But we don't have a perimenopause model in animals.

根本没有围绝经期模型。

There's no perimenopause model.

他们要么直接切除卵巢，使动物进入手术绝经状态，然后进行实验；要么就根本没有过渡阶段的模型，因为不存在这种状态。

They either take out the ovaries and they're surgically menopausal, and then they do the experiments, or we don't have, there's no transition Yeah, states there's in the

没有小鼠的围绝经期模型。

not a mouse perimenopause model.

他们正在尝试，但这很

They're trying, but it's

太复杂了。

so complicated.

是的。

Yeah.

更年期对肌肉骨骼系统的影响是多方面的，有些表现得更为隐匿。

The, you know, musculoskeletal effects of menopause are multiple, and some are more silent than others.

因此，骨密度流失加速、关节炎症增加以及关节炎风险上升。

So, you know, more accelerated loss of bone density, increased joint inflammation, and risk of arthritis.

50岁的女性患关节炎的概率比男性高出35%，而这种差异要到80岁才趋于平衡。

Women 50 are thirty five percent more likely to have arthritis than men, and that difference doesn't equilibrate until age 80.

真的吗？

Really?

所以，这是关节的非均衡老化。

So that is a disparate aging of joints.

而这并不仅仅是正常的老化。

And so that's just not normal aging.

嗯，我想对于女性来说，这确实是正常的老化过程，因为女性通常都会经历更年期。

Well, I guess it is normal aging for women because women do normally go through menopause.

但我认为这很可能是可以干预的，就像骨质疏松症一样。

But I'm saying it is probably a modifiable thing, right, as is osteoporosis.

我们都知道。

We know that.

而且，ACRTA已获得FDA批准

Mean, we're And ACRTA is FDA approved

用于预防骨质疏松症。

for the prevention of osteoporosis.

再回到小鼠和人类的情况，我们谈论的是肌肉质量和肌肉质量的维持。

And then getting back to the mouse versus human situation, you know, we talk about muscle mass and maintenance of muscle mass.

随着年龄增长，男性和女性都会失去肌肉质量。

As we age, both men and women do lose muscle mass.

有一些研究表明，50岁以后男性和女性的肌肉质量流失速率并无差异。

Now, are some studies that show that men and women don't have different rates of muscle mass loss over 50.

最近一项系统性综述考察了包含雌二醇的激素疗法，这项荟萃分析显示，它实际上对帮助女性维持肌肉质量没有明显效果。

There was a recent systematic review that looked at hormone therapy that included estradiol and showed in this meta analysis that it didn't actually make a difference in terms of helping women maintain muscle mass.

另一方面，一些研究使用的是较旧的肌肉减少症评估方法。

On the other hand, some of these studies use older forms and older ways of assessing for sarcopenia.

还有一些新研究刚刚发表，我最近读到一项来自泰国的研究，显示雌二醇激素疗法对肌肉质量有积极影响。

And then there are some new studies coming out that I want I read one recently out of Thailand where there was a positive effect of of hormone therapy with estradiol on on muscle mass.

有一项非常有趣的芬兰研究，他们长期追踪了一组同卵双胞胎。

There's a very interesting Finnish study where they followed these sets of monozygotic twins, like, for years and years and years.

这是一项小规模研究，但他们追踪了15对双胞胎，其中一位女性接受了激素治疗，另一位没有。

And it's a small study, but they had these 15 twins sets where one woman was on hormone therapy and one wasn't.

天哪。

Oh my gosh.

他们追踪了她们多年，结果显示——当然，这是一项小规模研究，但样本非常独特，你怎么能获得这样的群体？

And they've followed them for years, and they show that they're And again, this is a small study, but so niche, and how would you get this group?

因为斯堪的纳维亚国家的研究做得非常好。

Because they have such good studies in Scandinavian countries.

他们发现激素疗法对维持肌肉质量有积极影响。

And they show a positive effect of hormone therapy on maintenance of muscle mass.

所以我认为这一领域正在不断发展。

So I think that is evolving.

我认为就肌肉质量这个方面而言，我希望能看到更多研究，也许我只是没找到，因为我读了很多研究，但我也有一份完整的临床和手术安排。

And I think in terms of the whole muscle mass aspect of thing, I would like to see more research on and it's possible I just haven't found it because I read a lot of research, but I also have a full clinical and surgical schedule.

我可能会漏掉一些内容，但你别感到惊讶。

I could I could miss something, but I don't Don't be shocked.

我们的听众太多了。

We have so many listeners.

一定会有人为你深入研究，然后你会收到一封邮件。

Someone is gonna do a deep dive for you, and you're gonna get an email.

我非常希望如此。

I would love this.

我想要，但我还没看到。

I I want I haven't seen

或者有些研究人员会听到这个。

Or some researchers gonna be listening to this

如果有人正在做研究，并且有关于激素治疗与否对肌肉耐力或疲劳影响的数据，我不知道这方面的数据。

and be like, if someone is doing research and has data on more like muscular endurance or fatigue with or without hormone therapy, I don't know the data on that.

很好，关于这一点。

Wonder And about that.

我会思考这个问题，因为在运动医学中，我们有时会想到这一点，关于经期黄体期ACL风险可能增加的一个假设是，此时雌激素水平较低，肌肉更容易疲劳。

And I think about that because we think about it in sports medicine sometimes in terms of And that's one of the hypotheses about maybe potentially having increased ACL risk during luteal phase is their more muscular fatigue at a lower estrogen state.

我们知道雌激素与肌肉中的葡萄糖利用和代谢有关。

We know that estrogen relates to glucose utilization and metabolism in muscle.

因此，我认为这可能会对疲劳产生一定影响。

So it would make sense to me that there could be some effect on fatigue.

但无论如何，我们确实可能对肌肉产生一些影响。

But any case, so we have potential effects on muscle.

这些想法部分源于我们对切除卵巢的小鼠研究，发现它们的卫星肌细胞减少，肌肉质量下降。

Some of that thought process comes from what we know about oophorectarized mice having less satellite muscle cells, loss of muscle mass.

正如你所说，我们实际上并没有真正模拟围绝经期或绝经期的小鼠模型。

Now, like you said, we don't really have a perimenopause or menopause model necessarily with mice.

这更类似于手术性绝经。

It's more like an equivalent of surgical menopause.

有一些数据表明，接受手术绝经的女性可能比自然绝经的女性更容易出现肌肉减少症，这一点我们之前也讨论过。

And there is some data that suggests that women with surgical menopause maybe are more at risk for sarcopenia as compared to just regular And we've talked about it

之前在播客里提到过，但对于新听众来说，肌肉减少症是指肌肉质量流失到影响身体功能的程度。

previously on the podcast, but sarcopenia, for new listeners, is the loss of muscle mass to the point where you lose function.

所以如果你要解释一下什么是肌肉减少症的话。

So if you want to explain what sarcopenia is.

是的，显然更极端的情况是，你变得非常虚弱，甚至衰弱。

Yeah, obviously a more extreme version is you're having so much weakness that you- You're frail.

你变得衰弱。

You're frail.

比如，女性的握力低于17公斤左右。

I mean, like grip strength less than 17 kilograms or something like that for women.

但总体而言，显然从肌肉量充足到肌肉无力是一个连续谱，不过有一些数据显示，手术绝经会使人比

But in general, obviously everything is on a continuum from a large amount of muscle mass to less weakness, but there's some data suggest that surgical menopause would put people more at risk for having some loss of muscle mass than

自然绝经的人更容易出现肌肉质量流失。

Than someone who had natural menopause.

是的。

Yeah.

或者更容易出现影响力量和肌肉功能的调查结果，表明手术绝经比自然绝经更易导致肌肉减少症。

Or more at risk for, like, completing a survey that indicates your strength and muscle function being more at risk for sarcopenia than natural menopause.

所以我认为我们需要更多关于基础科学研究的信息，这些在小鼠模型中是有道理的。

So I think we need more information about there are basic science things that make sense in mice models.

我认为随着未来对现代医学应用的进一步了解，我们会更清楚肌肉质量究竟会发生怎样的变化。

I think maybe we'll learn more going forward about actual you know, what actually happens to muscle mass with some of the more, you know, modern day utilizations.

但这些都属于

But those are kind

一些组成部分。

of the components.

所以你说肌肉骨骼健康可能是女性健康中最被忽视的方面。

So you've said that musculoskeletal health might be the most overlooked dimension of women's health.

你为什么这么说？是的。

Why do you say Yeah.

出于多个原因。

For multiple reasons.

雌激素撤除对终身影响最大的之一就是骨质疏松症，这主要影响女性，且是一种无声的疾病。

So one of the largest impacts lifelong of estrogen withdrawal is osteoporosis, which largely affects women and is a silent condition.

因此，直到晚年出现髋部骨折或椎体压缩性骨折时，才容易被忽视。

So it's easy to overlook it until so late in life that you have a hip fracture or, you know, a vertebral compression fracture.

那时，你会去看谁呢？

And then who are you seeing at that point?

通常是位男性外科医生。

Usually a male surgeon.

到了那时，你知道，比如在我工作的机构，我们在髋部骨折或椎体骨折后会把患者转诊到脆性骨折门诊。

And at that point, you know, yes, you know, for instance, where I work, we have a fracture, a fragility clinic that we send people to after a hip fracture, vertebral fracture.

但许多患者从未接受过骨密度检测，也从未接受过唑来膦酸输注之类的治疗。

And many of these people haven't been tested for the bone density or haven't ever had a zalendernate infusion or something like that.

我们正在引导他们走上这条道路，但已经太晚了。

And we're getting them down that path, but it's so late.

因此，我认为这里出现了一种奇怪的现象：女性显然通过女性健康提供者接受着终身的医疗保健。

And so I think there's this weird thing that happens where women are obviously receiving life a lot of lifelong health care through their women's health providers.

有一种沉默的疾病，而预防骨质疏松症长期以来一直是绝经期激素治疗获得FDA批准的适应症，用于保护骨密度。

There's a silent disease, which, you know, prevention of osteoporosis is and has been for a long time an FDA approved indication of menopausal hormone therapy for protecting your bone density.

但雌激素水平下降、骨吸收超过骨形成的最终结果，就是向骨质疏松和骨折的进展。

But the end result of declining estrogen levels and more bone resorption than bone building is this progression to osteoporosis than fracture.

最终的结果发生得太晚了，以至于在终点看到这些人的医生，当初并没有参与这个过程的起始阶段。

The end result is so far down the line that the people seeing at the end of the line were not there at the beginning of the process.

因此，这又是一种孤立的医疗模式。

And so again, it's this siloed approach.

我参与了我们医院的骨折脆弱性委员会，正在极力推动让我们的桡骨远端骨折患者——也就是手腕骨折患者——进入脆弱性门诊。这种骨折在女性50至60岁之间首次达到高峰。

And I'm on our, you know, fracture fragility committee, and I'm pushing really hard to get our distal radius fractures, you know, your wrist bone fractures, which peak for the first time in women between the age of 50 and 60, I want that group to go to the fragility clinic.

摔倒并摔断手腕的积极一面是，这其中有好有坏。

The silver lining of if you fall and break your wrist I mean, there's good and bad things to this.

如果你是一位50岁的女性，以同样的跌倒方式摔断了手腕，根据你参考的研究，你最终发生髋部骨折的风险比从未发生过桡骨远端骨折的女性高出近50%甚至两倍。

If you're a 50 old woman and you fall, same level fall and break your wrist, depending on the study you read, you have a nearly fifty percent or maybe two hundred percent greater risk of eventually breaking your hip as compared to a woman who never had a distal radius fracture.

但这一群体的人，如果你曾发生过远端桡骨骨折，正是我想要关注的对象，因为如果我能让你进入脆性骨折门诊，并在65岁前进行DEXA检查，确诊为骨量减少，并以骨健康作为主要考量来决定是否采用激素治疗，而你又恰好处于可以安全开始治疗的窗口期。

But this group of people, if you had a distal radius fracture, you are the group I want to focus on because if I get you to a fragility fracture clinic and I get you a DEXA before the age of 65 and you're diagnosed with osteopenia and you make your hormone therapy decision about potentially bone health as the driving factor may be, and you're in the window where you can safely start.

你正处于干预的黄金窗口期，因为这些情况主要发生在50多岁的女性身上。

You're in the window of opportunity because, again, these are happening in women in their 50s.

这会促使你思考，好吧，我不希望发生髋部骨折。

This would inform you, and you may say, Okay, I don't want to have a hip fracture.

我有更高的髋部骨折风险。

I am at increased risk for a hip fracture.

也许你只是骨量减少，而不是骨质疏松。

Maybe you have osteopenia, not osteoporosis.

我们知道，包含雌二醇的激素治疗能随着时间推移增加你的骨密度，显著降低骨折风险。

And we know that hormone therapy that includes estradiol will increase your bone density over time and protect you against fractures, you know, quite significantly.

因此，我认为我们需要将思维模式转向更早期的预防。

So I think we need to shift our thought process towards, obviously, earlier prevention.

但在我的领域里

But in my world

我们尽量为每个人做骨密度检测。

We try to get a bone density on everybody.

是的。

Yeah.

在我的世界里，我认为我们需要关注这些腕部骨折，因为至少我们还没有走得那么远。

In my world, I think we need to focus, like capture these wrist fractures because at least we're not so far down the line.

骨骼健康是无声的。

So bone health is silent.

其他一些问题就没那么隐蔽了。

Some of the other things are less silent.

女性还可以做些什么来预防骨质疏松？

What else can a woman do to prevent osteoporosis?

很多生活方式就是这样

Many lifestyle That's how

我找到你了。

I found you.

是的。

Yeah.

是的。

Yeah.

是的。

Yeah.

是的。

Yeah.

许多生活方式的选择有助于保护你的骨密度。

Many lifestyle choices will help you protect your bone density.

正如你所知，很多人并不适合激素疗法。

And so many people, as you know, are not candidates for hormone therapy.

因此，仅靠激素疗法可能远远不够，或者肯定不是保护骨骼的唯一方法。

So hormone therapy alone will not be really enough probably, or certainly isn't the only way to protect your bones.

所以有很多数据。

So lots of data.

而且，你多次提到过力量训练。

And, you know, you've talked about a lot of times about strength training.

每个人都听过这句话：你必须举重。

And everyone hears the saying, You have to lift heavy.

我想说的是，作为一名骨科医生，我见过很多人，并不是每个人都能举重，但这没关系。

And I do want to say, because I'm an orthopedic surgeon and I see people not everyone can lift heavy, and that's okay.

但有证据表明，高强度的力量训练比中等和低强度训练更能增加骨密度，不过中等和低强度训练仍然有好处。

But there is evidence that heavier strength training, higher intensity does increase your bone density more than moderate and lower intensity, but there's still benefit to moderate and lower intensity.

是的。

Yeah.

这两种方式都能帮助你增加骨密度。

They both they both will can can help you increase bone density.

当然，大家都知道的经典研究——LIFmore研究，是一项非常出色的研究，它针对绝经后女性，其中一些人骨量减少，一些人患有骨质疏松，她们进行了深蹲、硬拉、过头推举和引体向上跳跃，并在八个月内逐步提高强度，结果腰椎骨密度增加了3%，髋部也显著提升。

And, course, the classic trial that everyone knows, which is an amazing trial, the LIFmore trial, you know, a great trial that used women who were menopausal with some of them osteopenic, some them osteoporotic, and they did back squats, dead lifts, overhead presses, and jumping chin ups, and they kind of ramped them up to high intensity over eight months, and they gained 3% in their lumbar spine and also significant gains in their hips.

力量训练非常有效。

Strength training is very effective.

但对于那些无法进行高强度训练的人，比如85%单次最大重量的举重，别放弃，别觉得自己做不到就算了。

But for people who cannot do that high intensity, you know, 85% single rep max type lifting, like, don't give up and just be like, I can't do that.

中等和低强度训练确实也有益处。

There's definitely benefit to moderate and low intensity.

所以我只是想强调这一点。

So I just wanna say that.

是的。

Yeah.

跳跃或冲击性运动也是提高髋部骨密度的好方法。

Jumping or impact, you know, is also a great way to improve your hip bone density.

大多数负重力量训练动作对腰椎的影响比对髋部的影响更大。

The most of the, like, load bearing strength training exercises will have a larger effect on your lumbar spine than the hip region.

所以这是你的背部？

So that's your back?

对。

Yeah.

你的背部。

Your back.

力量训练对髋部区域仍然有一定益处，但跳跃和冲击这类机械负荷，也就是所谓的机械转导过程，会在骨骼中引发生化反应并刺激骨形成，这对围绝经期女性的效果比绝经期女性更显著，但绝经期女性依然能从中获益。

There is still some benefit with strength training to your to your hip region, to your hips, but there is a specific effect with jumping and impact this mechanical load or this process called mechanotransduction, which basically creates like a biochemical reaction in your bones and and stimulates bone formation, is more effective in perimenopausal women than menopausal women, but there's still benefit for menopausal women.

一项研究显示，在为期六个月的干预中，每周进行几天跳跃训练，每次约30次跳跃，绝经期女性的髋部骨密度提高了约1%。

So one study showed over a six month period that included jumping a few days a week, maybe 30 jumps each time, that there was about a one percent improvement in hip bone density in menopausal women.

但如果你查看围绝经期女性的类似研究，可能会发现通过这些干预措施，髋部区域的骨密度增长可达2%——有研究比较了每天10次和20次跳跃，另一项研究则采用每天50次跳跃。

But if you look at similar studies of perimenopausal women, you may see gains of 2% in the hip region with these interventions that could be One study compared 10 versus 20 jumps a day, another did 50 jumps a day.

这项针对围绝经期女性的研究实际上显示，髋部区域的骨密度增加了约3%。

And that study in perimenopausal women actually showed an increase of like 3% in the hip region.

因此，冲击训练非常有效。

So impact is very effective.

我们从儿童参与有冲击性运动的研究中也得知，他们能积累更多的骨量。

And we know that from studies of children participating in exercise with impact, they accumulate more bone mass.

冲击训练效果很好。

Impact is great.

现在有些人无法进行冲击性运动，因为我是骨科医生。

Now there are people who cannot do impact because, again, I'm a orthopedic surgeon.

我有太多这样的病人，说：这太好了。

I have so many patients like, That's great.

我真想这么做。

I would love to do that.

我收到大量人的留言，说：这太荒谬了。

And I get tons of messages from people, That's ridiculous.

我做不到。

I can't do that.

你知道吗？

You know?

我说：很抱歉。

And I'm like, I'm sorry.

我只是想分享跳跃能带来的好处，但还有很多替代方案。

I'm just trying to share information about what jumping can do, but there are lots of modifications.

如果你有严重的膝关节关节炎，每次跳跃后膝盖都会肿胀，那么跳跃对你来说不是一个好的选择。

And so if you have terrible knee arthritis and every time you jump, your knee swells, that is not going to be a good option for you.

你可以做脚跟下落运动。

You can do heel drops.

你可以在反弹器上跳跃，这种跳跃对身体的冲击比地面跳跃要小。

You can do jumping on a rebounder, which doesn't do as much as land based jumping.

你可以在泳池里跳跃。

You can do jumping in a pool.

当然，这种跳跃的冲击力不如地面跳跃大，但比久坐不动要好。

Again, not as much as land based jumping, but better than sedentary.

所以，冲击力是一个很宽泛的类别。

And so impact, that's a broad category.

那振动平板呢？

What about vibratory plates?

是的。

Yes.