8 Things We Learned About Joint Pain, Bone Health, and Aging Strong

Highlights from YVO's Built to Last webinar with Dr. Riteesha Reddy, MD, of Canyon Ranch Austin

Dr. Riteesha Reddy grew up in central Texas, but spent summers at her grandparents' farm in India. Here, food, movement, and connection were woven into everyday life. If she got thirsty in the fields, she chopped down a coconut, and when her grandmother asked what she wanted for dinner, they walked out and picked it together.

After years of being in academic medicine, she realized that way of living was the missing piece in how she'd been trained to care for patients. Being able to diagnose and prescribe was one thing, but she wanted to provide patients with the common sense, whole-life approach she grew up with. To round out her rheumatology training, she added an integrative medicine fellowship, lifestyle medicine board certification, and a menopause certification.

Today, Dr. Reddy is a board-certified rheumatologist and lifestyle medicine physician at Canyon Ranch Austin, with training from Brown University and the University of Chicago. For the latest webinar in our Built to Last series, YVO co-founder Marie Berry sat down with her to dig into the questions our community sent in about joint pain, bone density, and what it takes to stay strong and mobile for decades.

You can watch the full replay on YouTube. Our community sent in more questions than we could fit, so here are the eight biggest ones, answered.

1. Is Joint Pain Just Part of Aging?

One of the first questions asked by the community was whether joint pain is just something to expect with aging. Dr. Reddy explained that aging is just one part of the bigger picture.

Over time, your body does become a bit less resilient, but hormones play a huge role, especially for women. In the years around perimenopause and menopause, estrogen "kind of leaves the room," as Dr. Reddy put it, and those changing hormones increase joint pain and affect how well you move.

How much you move your body (and how you do it) also makes a big difference. Dr. Reddy hears "I used to run" or "I used to ski" from patients all the time, but even small drops in your activity levels take away some of the mechanical stimulus your bones and muscles depend on.

Muscle power and quick movement also start to decline as we lose our fast twitch muscle fibers a little faster than the rest as we age. "It has to become intentional to protect your body and to stay mobile and not in pain," she said.

2. Can Muscle Protect Your Joints and Bones?

If you think of a skeleton, Dr. Reddy pointed out, it can't move or go anywhere without muscle and soft tissue, which is why the two systems are trained together.

Some of her patients have "bone on bone" arthritis on their X-rays yet feel no pain at all, because they've built the muscle strength and flexibility that protect those joints. She has also seen the reverse, where the X-rays look completely normal but the person is in pain anyway since the strength isn't there to support their skeleton.

Muscle does decline with age if you don't work to keep it, which is called sarcopenia, Dr. Reddy explained. How much muscle you can build typically peaks between age 20 and 35, and research suggests your power and strength start slipping first, as early as your 30s, well before you'd notice any muscle loss. From age 50 onward, adults who don't train lose around 0.5-1% of their muscle mass per year, and strength drops two to four times faster than the muscle itself.

Dr. Reddy stressed that regular training is crucial even just to maintain what you already have, let alone build more. Research shows building more muscle and strength is realistic at any age, even in your 70s and beyond, so don't be afraid to start.

3. What Are the Best Exercises for Bone Health in Menopause?

Dr. Reddy gave us a great list of the best exercises for bone health during perimenopause and menopause:

• Resistance training at least twice a week, using progressive loading (gradually increasing the weight your muscles and bones work against over time)
• Jump training, since bone needs the mechanical stimulus that comes from impact
• Sprint intervals and zone 2 cardio (an easy pace where you can still hold a conversation) for your cardiovascular health

Previously, older guidelines mostly told women with osteoporosis to stick to walking, but Dr. Reddy says a groundbreaking trial (LIFTMOR) showed women with low bone density who lifted heavy weights safely with supervision did not have more fractures. This changed how doctors think about osteoporosis and exercise, she said, showing it's safe to lift heavy and made resistance training the main feature of bone care.

As Marie said in the webinar, our community walks always incorporate jumping with a goal of boosting bone health, which Dr. Reddy was glad to hear.

4. Is a Weighted Vest Safe If You Have Arthritis?

Dr. Reddy describes osteoarthritis as the wear and tear kind of arthritis. Over time, cartilage gets thinner, and the bone around a hard-working joint can respond with small areas of overgrowth called osteophytes, which she compares to a callus forming where there's been too much friction.

Walking, including walking with a weighted vest, is typically safe with arthritis, according to Dr. Reddy, but anyone with spinal arthritis should be cautious. Loading weight down through the spine can strain the small joints in your back and set off a flare, so check with your doctor before adding a vest if arthritis affects your spine.

She gave a rule for judging whether you've done too much because your joints and bones don't always tell you in the moment if you've overdone it. "They tell you a day later, a day or two later," she explained, so if you feel stiff, sore, or achy the day after an activity, go easier the next time.

Dr. Reddy also uses weighted vests with patients who have inflammatory conditions like rheumatoid arthritis, where the immune system attacks the joints. Once treatment has calmed their symptoms and they're ready to exercise again, a vest gives them a way to get more out of walking and build their strength back up.

One attendee asked how much extra bone benefit a 16 lb vest gives you over a 12 lb one, and Dr. Reddy pointed out that while she isn't aware of any studies comparing the two, a heavier vest likely adds bone-building stimulus when you're doing jump training. During regular walking the biggest difference will be a harder cardiovascular workout as you go heavier.

She recommends starting at about 5% of your body weight, which lines up with our own guidance to begin around 5% and build toward 10% over time. The Warrior Vest has modular 2.5 lb pouches that make it easy to just add a bit more weight at a time as you get stronger.

5. Are Pilates and Resistance Bands Enough for Your Bones?

One community question was whether bands and Pilates work as well as weight training for bone health. Dr. Reddy said mat Pilates has a gap, because since you spend most of the class lying down, the weight bearing bones, like your low back and hips, don't get the mechanical load they need to adapt. Bone building responds to load plus the rate of strain, force, and impact, so exercising while lying down isn't going to cut it.

The same likely goes for the jumpboard on a Pilates reformer, which can be fantastic for cardio, and maybe even muscle, but might not be quite enough on its own for bone health. She does like rebounders as a gentle introduction to jump training, especially for her arthritis patients, with one condition. Use a balance bar, because rule number one is don't fall and hurt yourself.

However, Dr. Reddy does stress the most important thing about any exercise is that you enjoy it enough to stay consistent. If you're going hard being "a warrior for a day," as she put it, then spending the rest of the week sore, that won't likely be as effective as a Pilates class or band routine you do consistently multiple times a week.

So keep the Pilates you love, and surround it with weight-bearing work like weighted walking and strength training so your hips and spine get loaded, too.

6. How Do You Know If You're Getting Enough Calcium?

One of the trickiest things about bone loss is that you can't feel it happening, and Dr. Reddy explained why even bloodwork won't tip you off. Your body is very good at keeping the calcium level in your blood steady, so if you're not absorbing enough from food, it'll just pull calcium out of your bones to make up the difference. Your blood test will look normal even though your bone density is declining, and the only way to know for sure is to get a DEXA scan (an imaging test that measures bone density).

Vitamin D is worth watching for the same reason, since it works hand in hand with calcium and deficiency is common now that most of us are careful in the sun. It isn't always included in a standard annual physical, so Dr. Reddy suggests asking for the test.

7. When Should You Get a DEXA Scan?

The official guidelines start screening healthy women at age 65, repeated every two years. Dr. Reddy screens earlier for patients with risk factors like rheumatoid arthritis or a history of steroid medications.

She also believes there's a big gap in that schedule because bone mass peaks around age 30 and starts declining after that, speeding up sharply around the menopause transition, with the steepest losses beginning about a year before your final menstrual period and continuing for one to two years after it. Since the average woman reaches menopause around age 50 or 51, waiting until 65 could be much later than it should be for many women.

Dr. Reddy likes to check closer to age 50, give or take a few years depending on symptoms like disrupted sleep or irregular cycles, then every two years after that, or after one year if you've made a change worth measuring. Insurance doesn't always cover an early scan, but she considers it absolutely worth paying for.

Every Warrior Vest comes with a free DEXA scan through BodySpec, so you can get that early baseline without waiting on a referral.

8. What Does It Mean to Build a Body That Lasts?

Marie closed by asking what it means to build a body, and a life, that's built to last. Dr. Reddy said for her, it's "being able to maintain your independence and, with that, the joy that comes in being functional." So, things like getting down on the ground to play with your grandchildren, going on a bike ride with your kids, traveling and lifting your own suitcase at the airport, and having the presence of mind to be able to connect with loved ones in ways that feel fulfilling.

Joy is a word that comes up in our community all the time, so her answer felt right at home here. Watch the full conversation with Dr. Reddy for the questions we couldn't fit, including her take on collagen supplements.

Carry power!

About the Author

Rachel MacPherson, CSCS, CPT

Rachel is a certified strength and conditioning specialist with over a decade of experience, and a pre- and postnatal exercise specialist. She specializes in helping women build strength and confidence through evidence based training.

Disclaimer: This article is for educational purposes. Always consult a healthcare professional before starting a new exercise routine.