增强力量，延年益寿：与Vonda Wright博士共探更年期长寿蓝图

它们一直在互相交流。

They're all talking together all the time.

这就是为什么我们可以通过肌肉活动来增强骨骼。

So that's why we can build better bone through the through the action of muscle.

是的。

Yeah.

肌肉骨骼系统总是协同工作。

That musculoskeletal unit always works together.

没错。

Exactly.

强壮的肌肉通常意味着更强壮的骨骼。

Strong muscles usually mean stronger bones.

更好的骨骼。

Better bones.

嗯。

Mhmm.

好的。

Okay.

我们刚才讨论了骨密度峰值。

So we talked about peak bone density.

那么什么是低骨密度呢？

What is low bone density?

对。

Yeah.

测量骨矿化和骨密度最常见的方法是通过一种叫双能X线吸收测定法（DEXA扫描）的检测。

So the most common way to measure bone mineralization, bone density is through this test called a DEXA scan.

它利用X射线来检测我们的骨量。

It uses X-ray to tell us about our how much bone we have.

钟形曲线的顶端，即零点位置，代表的是健康30岁女性的平均骨密度值。

So the top of the bell curve, the zero point, the average is the bone density of a healthy 30 year old woman.

当你做DEXA扫描时，任何正数结果都非常理想。

When you get your DEXA scan, any positive number is fantastic.

这意味着你的骨密度高于健康的30岁女性。

That means you have bone density more than a healthy 30 year old.

但当数值降至负一时，我们开始称之为骨质减少，意味着骨骼开始变弱。

But at minus one, we start calling that bone osteopenic, which means it's getting weak.

如果继续流失骨量，T值降至负2.5，即比平均值低两个半标准差。

If we continue to lose bone and our T scores declines to minus 2.5, which is two and a half, two and a half standard deviations below average.

这就是骨质疏松症。

So that's osteoporosis.

约每两名女性中就有一人会患上骨质疏松症。

One in about two women will get osteoporosis.

概率大约是40%到50%。

It's about forty to fifty percent.

如果患病，你有50%的骨折风险。

And if you do, you have a fifty percent chance of fracturing.

因此这会显著提高你的骨折风险。

So it it makes your fracture risk much, much higher.

直到骨折前你甚至都不会在意这个问题。

And you wouldn't even care about that until you fracture.

然后这就会成为你全家唯一关心的事。

And then it's all anybody in your family can think about.

当然也是你唯一思考的事情。

Definitely all you're thinking about.

你什么时候会安排做骨密度检查？

When do you order a Dexa?

或者说你建议所有人什么时候做骨密度检查。

Or when do you recommend Dexa on everybody.

同理。

Same.

我认为就像我们40岁开始做乳腺X光检查一样，40岁也应该做骨密度筛查。

I think just like we get our mammograms at forty, I think we should have our screening test by forty.

我们应该有个基线数据。

We should have a baseline.

我们想办法解决吧。

Let's just figure it out.

不管是REMS还是DEXA，选一个做就行。

Whether it's REMS, whether it's DEXA, just find one.

其实我们应该35岁就做，那时体内还有少量雌激素循环。

In fact, we should probably do it at 35 when we have a little bit of estrogen still circulating.

看看你的基准值是多少。

See what your baseline.

如果

And if

你的数值已经偏低，那就必须重视起来，因为这时你可能还在分泌一些雌激素。

you're already low, then you really gotta get after it because you're still probably producing some estrogen.

给我们讲讲骨质随时间流失的过程吧。

Walk us through bone loss over time.

具体是什么机制？

Like, what is the process?

什么是骨骼

What is bone

的作用？

do?

对吧？

Right?

所以如果我们在30岁前建立峰值骨密度，之后会稳定一段时间。

So we're building peak bone density if we're building peak bone density to 30, and then we stabilize for a while.

好的。

K.

然后和男性一样，我们开始以每年1%的速度缓慢稳定地流失骨密度。

And then just like men, we start to lose bone density about 1% per year in a slow steady decline.

而男性会持续这种状态。

And men just continue like that.

男性也会得骨质疏松症。

Men get osteoporosis.

这个国家有两百万男性患有骨质疏松症，但他们的骨质流失是缓慢而稳定的。

Two million men in this country have osteoporosis, but they have this slow steady decline.

没有人注意到。

Nobody notices.

对于处于围绝经期的女性来说，当雌激素离我们而去（就像我喜欢说的那样永不回头），我们开始以每年23%的速度快速流失骨密度，因此在围绝经期到绝经期结束前后的五到七年里，我们可能流失15%到20%的骨密度，而我们大多数人对此毫不知情。

For women in perimenopause, when estrogen walks out the door, as I like to say, and never looks back, that girlfriend of ours, we start to rapidly lose bone density between 23% a year, such that in the five to seven years surrounding the end of perimenopause to menopause, we can lose 15 to 20% of our bone density, and most of us never know it.

完全不知道。

Have no idea.

毫无察觉。

No idea.

令人震惊的是，即使是做对所有预防措施的女性，也会因为雌激素的流失而降低骨密度。

It's a shock when people even women who are doing all the right things will lose bone density because of the loss of estrogen.

这就是实际情况。

So that's what happens.

因此在骨骼方面，男性和女性的衰老过程并不相同。

So men and women do not age the same when it comes to bones.

我们刚才谈到了雌激素的作用。

Now what role we talked about estrogen.

另外两种来自卵巢的激素，孕酮和睾酮，在这过程中有影响吗？

Does the other two hormones involved, you know, coming from the ovaries, progesterone and testosterone, have any play in this?

是的。

Yeah.

睾酮的作用比孕酮更大。

Testosterone has a bigger role than progesterone.

我的意思是，实际上这些问题还需要研究。

I mean and the reality is these things need to be worked out.

我们并非掌握所有答案。

We don't we don't know all the answers.

比如，孕酮是如何影响骨密度的？

Like, how does progesterone affect it?

我们该如何使用有些人晚上服用的补充孕酮？

How can we use the supplemental progesterone that some of us take at night?

但由于研究还不够充分。

But because not enough research has been done.

我们知道睾酮对男性和女性的骨密度都有重要影响，但作用不及雌激素。

And we know testosterone plays a a big role in bone density in both men and women, but not as big as estrogen does.

雌激素确实如此。

Estrogen does.

什么是肌肉减少症？

What is sarcopenia?

是的。

Yes.

肌肉减少症直译就是肌肉量低下。

So sarcopenia translated means a low muscle.

好。

K.

Sarco指肌肉，penia表示减少，就像骨质疏松症（osteopenia）一样，肌肉减少症（sarcopenia）。

Loss sarco mean muscle, penia less like osteopenia, sarcopenia.

但这不仅仅关乎你肌肉的总重量。

But it is not just about your total pounds of muscle.

这是一个功能性定义。

It is a functional definition.

实际上你希望肌肉占比达到45%或更多，但这取决于功能性。

You wanna be 45% muscle or more actually, but it's functional.

意思是，你能完成坐立动作吗？

Meaning, can you sit to stand?

你的步行速度有多快？

How fast can you walk?

因为肌肉减少症的概念与功能有关。

Because the concept of sarcopenia has to do with function.

我们是否有足够的肌肉量来维持正常功能？

Do we have enough muscle mass to function?

我们是否具备足够的肌肉力量，能够从地面起身或快速行走以确保安全？

Do we have enough, strength in the muscle we have to get up off the floor or to walk fast enough to be safe?

这不是跑步，但也不像我们看到的某些人随着年龄增长而变得行动迟缓那样。

It's not running, but it's not the slow crawl we see some people do as they age.

什么是肩周炎？

What is frozen shoulder?

更年期最明显的肌肉骨骼症状之一与我们的肩膀有关。

One of the most audible musculoskeletal symptoms of menopause has to do with our shoulders.

这并不是说你的肩膀突然对你不好了。

And it's not because suddenly your shoulder is bad for you.

雌激素流失了。

Estrogen walks away.

我们全身都会出现高度炎症反应。

We become highly inflamed everywhere.

肩膀部位特别容易受到影响。

The shoulder is very susceptible.

所以肩膀内部的情况，你从外部通过皮肤和肌肉就能观察到。

So the shoulder on the inside, you see it on the outside with skin and then muscle.

而在那里面，有一层叫做关节囊的结构。

And then inside of that, there's this layer called the capsule.

关节囊会发炎到这种程度——你一夜醒来肩膀就疼得要命。

The capsule will become so inflamed that overnight you wake up and your shoulder is killing you.

而你并没有撞到门。

And you didn't bump into the door.

什么都没发生。

Nothing happened.

你会想，我不知道发生了什么。

You're like, I don't know what happened.

所以像大多数女性一样，你试图等待它自愈。

So like most women, you try to wait it out.

你会想，我能挺过去。

You're like, I got this.

我已经受了一点苦。

I've suffered a little.

因此女性通常在短时间内来找我时，她们的手臂已经无法活动了。

And so women come to me in a relatively short amount of time, and their arms will no longer move.

她们痛苦不堪，手臂抬不起来，更别说扣上胸罩了。

They're excruciating, and they can't get their arm up, and they certainly can't hook their bra.

我几年前分享过你关于冰冻肩的视频，当时简直病毒式传播。

I shared one of your videos on frozen shoulder years ago now, and it was absolutely viral.

评论区成千上万的女性留言，天啊。

The comments in the thousands and thousands of women, oh my god.

从来没人说过这些。

No one's ever said this.

我简直不敢相信我经历过这个。

I can't I've had this.

我注意到一个典型现象是女性连拍集体照时都很困难——你知道我们最爱拍集体照了。

And one of the hallmarks I see is that women struggle to put their you know, we always love to take our group photos.

哦，对。

Oh, right.

哦，她们无法环抱手臂

Oh, can't put their arms around

她们每个人都无法环抱手臂

They each can't put their arms around.

你怎么知道自己可能患上了肩周炎？

How would you know maybe if you had frozen shoulder?

比如有人坐在家里听着

Like if someone is like sitting at home listening Are to

你是否处于围绝经期，肩膀突然开始无缘无故地疼痛？

you in your perimenopausal years, Did your shoulders start hurting out of nowhere?

就像，没有明显的外伤

Like, didn't hit there was no obvious injury.

你是否突然无法向后伸手或向侧面伸展？

Can you suddenly not reach behind your back or reach out to the side?

这两个动作会最先受限，突然间你就无法从背后扣上胸罩了

Those are the two motions that go first, and suddenly you can't put your bra on from the back.

你得从前面绕过去。

You gotta scoot it around in the front.

这些都是线索。

Those are clues.

这种情况也会发生在糖尿病未受控制的患者身上。

This also happens in people with uncontrolled diabetes.

所以如果你没有糖尿病，那这症状是从哪来的？

So if you don't have diabetes, like, where is this coming from?

不过关键点在这里。

Here's the thing, though.

医学术语叫做粘连性关节囊炎。

The medical term is called adhesive capsulitis.

我们认识这种病症已有数百年历史。

We have known about this for centuries.

事实上，有些论文结论中描述它常发生在中年女性身上，却没人进一步追问：为什么不能是（其他原因）？

In fact, it's sometimes described in the conclusions of papers tends to happen in middle middle aged women with nobody then taking the next step to say, well, why can't it be?

这很常见，愿上帝保佑他们。

What's a common so bless their hearts.

我必须说说我那些亲爱的骨科同行们。

I have to say about my orthopedic peers whom I love.

确实如此。

I do.

但他们中大多数人，94%的人天生就没有卵巢。

But most of them, ninety four percent of them were born without the benefit of ovaries.

所以他们永远不会知道自己没经历过的事情。

So they're never gonna know what they don't experience.

确实。

True.

他们只知道女性到了中年就会出现肩膀问题，然后需要两年时间才能恢复。

All they know is that women show up in midlife, their shoulders don't work, and then it's gonna take two years to defrost.

天啊。

Oh my gosh.

哦，天哪。

Oh my gosh.

凉爽的天气已经到来，节日季也近在眼前。

Cooler weather is here, and the holiday season is right around the corner.

没有什么比既舒适又时尚的叠穿更棒的了。

And there's nothing better than layers that feel as good as they look.

如果你想寻找一个购买毛衣、外套和日常奢华基本款的好地方，Quince就是最佳选择。

If you're looking for a great place to find sweaters, outerwear, and everyday essentials that truly feel luxurious, Quince is the place.

在找礼物吗？

Looking for a gift?

Quince应有尽有。

Quince has it all.

50美元的蒙古羊绒毛衣。

$50 Mongolian cashmere sweaters.

没错。

Yep.

我刚买了几件不同中性色的。

I just purchased a few in different neutral colors.

他们还提供时尚牛仔、真丝上衣和能瞬间提升整体造型的半身裙。

They also carry stylish denim, silk tops, and skirts that instantly elevate any outfit.

还有专为这个季节设计的羽绒外套。

And down outerwear built for the season.

说实话，连他们的行李箱都在我的心愿单榜首。

Honestly, even their luggage is at the top of my list.

Quince直接与符合道德标准的高品质工厂合作，省去中间商环节，价格比同类品牌低约50%。

By working directly with ethical, high quality factories, Quince cuts out the middleman and offers prices about 50% lower than similar brands.

就我个人而言，他们的蒙古羊绒茶饮已成为我录制播客、演讲活动和朋友聚会的必备品。

Personally, their Mongolian cashmere teas have become my go to staple for recording podcasts, speaking engagements, and relaxing with friends.

昨晚我就穿了一件去晚餐，真的。

I wore one to dinner last night, literally.

穿上Quince精心打造的叠穿单品，感受舒适、精致持久的节日氛围。

Step into the holiday season with layers made to feel good, look polished, and last from Quince.

无论是送礼还是自用都再合适不过。

Perfect for gifting or keeping for yourself.

访问 quince.com/unpaused 可享免运费及365天无忧退货服务。

Go to quince.com/unpaused for free shipping on your order and three sixty five day returns.

现在加拿大地区也可购买。

Now available in Canada too.

请记住网址 quince.com/unpaused 获取免运费和365天退货权益。

That's quince.comunpaused to get free shipping and three sixty five day returns.

你们听我谈论过更年期护理缺口的问题——女性的症状常常被忽视或得不到治疗。

You've heard me talk about the care gap in menopause how women's symptoms are often dismissed or left untreated.

我在诊所里经常遇到这种情况。

I see it all the time in my practice.

许多女性苦苦寻求答案却不知该向谁求助，往往得不到所需的支持。

There are many women struggling for answers, unsure where to turn, and too often not getting the support they need.

这就是为什么我要向大家推荐MediHealth。

That's why I'm so excited to tell you about MediHealth.

MediHealth是一家专注于中年女性的远程医疗诊所，由值得信赖的医疗领导和临床医生团队领导。

MediHealth is a telehealth clinic focused exclusively on women in midlife, led by trusted medical leaders and clinicians.

该团队致力于提供基于证据的全人护理。

The team is committed to evidence based whole person care.

他们也是唯一一家由主要保险公司承保的全国性女性健康远程诊所，使专业护理变得可及且负担得起。

They're also the only national women's health teleclinic covered by major insurance, making expert care accessible and affordable.

当你与Midi合作时，你会获得一个个性化计划，可能包括激素治疗、营养指导、体重管理和生活方式支持。

When you work with Midi, you get a personalized plan that can include hormone therapy, nutrition guidance, weight management, and lifestyle support.

这种护理不仅旨在帮助你今天感觉更好，还能为未来保护你的心脏、骨骼和大脑健康。

It's care designed not just to help you feel better today, but to protect your heart, bone, and brain health for the future.

这是一个如此激动人心的时刻。

This is such an exciting moment.

更年期护理终于发展成了它应有的样子：可及且以女性真实需求为中心。

Menopause care is finally evolving into what it should be: accessible and centered on women's real needs.

看到Middie取得的进展令人鼓舞，它帮助女性真正感受到被倾听和支持。

It's inspiring to see the progress Middie is making, helping women feel truly heard and supported.

你值得拥有既满足当下需求又能守护长期健康的医疗服务。

You deserve care that supports you now and protects your long term health.

访问joinmidi.com预约Midi医生，为未来岁月开启最佳状态。

Visit joinmidi.com to meet with a Midi clinician and start feeling your best for the years ahead.

你曾写过一篇改变我人生的论文《肌肉骨骼与综合征》，对此我无比期待，因为正如你可能知道的，在医学院期间我只学过一小时更年期课程。

So you wrote a paper that changed my life called the Musculoskeletal And Syndrome of I was so excited for this because I, as you probably in medical school, got one hour of menopause.

哦，我甚至都不记得了。

Oh, I don't even remember.

也许吧。

Maybe.

而在我的妇产科住院医师生涯中——那是四年每周超百小时的工作——我们只安排了六次关于更年期的讲座，四年总共六小时。

And then in my OBGYN residency, which was four years of hundred plus hour weeks, I had six scheduled lectures on menopause, six hours in four years.

当时只教了潮热、血管舒缩症状这些内容。

And I was taught hot flashes, vasomotor symptom.

还教了些阴道干涩、萎缩相关的知识。

I was taught some vaginal dryness, atrophy.

我学到的是骨骼会开始退化，作为女性真是倒霉。

I was taught the bones would begin to deteriorate and sucks to be a woman for that.

而且我们对此无能为力，直到她被诊断出骨质疏松症，然后我们才会给她各种药物。

And there's not much we can do about it, you know, until she's diagnosed with osteoporosis, then we give her all these meds.

我从未学过雌激素的作用，以及雌激素流失对肌肉骨骼系统的影响。

I was never taught estrogen's effects, the loss of estrogen's effects on the musculoskeletal systems.

请为我们的听众解释一下什么是更年期肌肉骨骼综合征。

For our listeners, walk us through what the musculoskeletal syndrome of menopause is.

更年期肌肉骨骼综合征，大约70%到80%的女性都会受到影响。

The musculoskeletal syndrome of menopause, which affects about seventy to eighty percent of all women.

想象一下所有有潮热症状的女性，同等数量的人会有其中一种症状。

So think of all the women with hot flashes, Equal numbers have one of these.

对吧？

Right?

每一块肌肉骨骼组织——肌肉、肌腱、韧带、骨骼、软骨（即膝关节末端比冰面还光滑的衬层）都会受到影响。

Every musculoskeletal tissue, muscle, tendon, ligament, bone, cartilage, which is the smoother than ice lining of the end of the knee.

脂肪也是一种肌肉骨骼组织。

Fat is a musculoskeletal tissue.

我们体内有干细胞。

We have stem cells.

我们背部的椎间盘等所有类似组织，都携带着雌激素α和β受体。

The discs in our back, all of those, which are cousins, have estrogen alpha and beta receptors on them.

所以我总是把手举成小篮子状，因为雌激素正好可以嵌进去，然后所有好事就会发生。

So I always hold up my hand like a little basket because estrogen fits in there and then all the good things happen.

这些组织中缺乏雌激素会表现为全身疼痛。

Lack of estrogen in these tissues manifest as total body pain.

这被称为关节痛。

It's called arthralgia.

我认为我们把所有女性都草率归类为纤维肌痛，实际上这是未经治疗的更年期肌肉骨骼综合征关节痛。

I think we throw every woman under the bus and call her fibromyalgia when actually it's untreated arthralgia of the musculoskeletal syndrome of menopause.

所以就是全身疼痛。

So total body pain.

我曾经历过这种情况。

I had this.

我是个运动员。

I'm an athlete.

这让我丧失了行动能力。

It was disabling.

我的意思是，虽然还没严重到无法工作，但我连起床都很困难。

I mean, not so much that I couldn't work, but I had trouble getting out of bed.

首先是双侧肩周炎，都是炎症引起的。

Number one, frozen shoulder, both due to inflammation.

我们还有肌腱炎。

We have tendonitis.

网球肘怎么样？

How about Tennis elbow.

网球肘、高尔夫球肘、跟腱炎、髌腱炎。

Tennis elbow, golfer's elbow, Achilles tendon, patellar tendon.

你所有的肌腱都会无缘无故地疼。

All your tendons hurt for no reason.

你的脚底会疼。

On the bottom of your foot, it hurts.

你的足底筋膜会疼。

Your plantar fascia hurts.

女性

Women

50岁后会出现软骨流失导致的关节炎快速恶化。

have a rapid increase of arthritis, which is loss of cartilage after 50.

50岁前，男性患关节炎更多。

Before 50, men have more arthritis.

50岁后，女性会迅速患上关节炎。

After 50, women rapidly develop arthritis.

我在诊所里经常看到这种情况。

I see this all the time in my clinic.

这是因为，雌激素α和β受体对维持软骨至关重要。

It's because, again, estrogen alpha and beta receptors are critical for maintaining cartilage.

基质软骨就是基质。

Matrix cartilage is a matrix.

没有它，软骨就会瓦解。

And without it, it just crumbles.

我们的软骨会磨损，且不可再生。

And we wear down our cartilage, which is irreplaceable.

我们一生只有一套软骨。

We get one set for a lifetime.

所有这些问题的根源都相同——雌激素下降。

All of these things happen for the same reason, estrogen decline.

你经常提到作为骨科医生，第一次在急诊室见到女性患者时她们ERY_ERR_EMPTY_RESPONSE

You often talk about meeting women for the first time in the emergency room when they're shattered, broken, fractured as an orthopedic surgeon, where should they have met you first?

最年轻的重大骨折患者，改变人生的骨折，不是脚踝，不是手腕。

The youngest big fracture, life changing fracture, not an ankle, not a wrist.

那位女士57岁。

The woman was 57.

我在书中写过她，是在急诊室遇见她的。

I write about her in my book, and I met her in the emergency room.

而我本可能在健身房就认识她。

And I had probably met her in the gym.

我们去的是同一家健身房，因为她正在践行自己认知范围内所有可能的健康方式。

We went to the same gym because she was doing everything she thought she could possibly do.

因为——你知道她的动机是什么吗？她不愿像母亲那样衰老——虚弱且超重。

She was because you know why her motivation was she was not gonna age like her mother who was frail and overweight.

所以她正在执行自己从'谷歌医生'那里获取的所有建议。

And so she was doing everything she thought Doctor.

她进行力量训练，但同时却在挨饿，因为她仍坚信自己只能保持这样的体型，明白吗？

Google would want her to do.

（注：最后一句保留口语化反问语气）

She was lifting, but she was starving because she still believed that she could only be this big, right?

所以如果我们打算这么拼命锻炼，就得同样拼命地补充营养。

So if we're gonna work that hard, we need to feed ourselves that hard.

但我的做法——你提到的是当我在急诊室或病房遇到女性患者时，她因髋部骨折而入院，这是她生平第一次考虑自己的骨骼问题，被迫面对，因为骨折的疼痛令人难以忍受。

But what I do, what you're referring to is when I meet women in the emergency room or on the floor because she has a hip fracture, it's the first time she's ever thought about her bones and she's forced to because fractures are excruciating.

最终，这些你以为沉默的骨头开始尖叫，疼得你知道医院里那些铺着塑料床单的病床有多滑吗？

Finally, these bones that you think are silent are screaming, so painful that you know in hospitals how the beds are kind of slick because they're in their plastic bed?

病人会滑到床尾，需要被拉回原位，但他们不让你碰，因为实在太疼了。

And people slide down to the end of the bed, and they need to be pulled up in bed, but they won't let you touch them because it's too painful.

剧痛难忍。

So much pain.

他们承受着巨大的痛苦。

They're in so much pain.

但现实是——我现在已经敢于大声说出这些话了。

But here's the reality, and I've gotten not afraid to say these things out loud.

你知道当我走到病床边时，她已经失禁了。

You know that when I go to the bedside, she has been incontinent.

她通常躺在那里并非因为护理不当，而是因为她长期失禁。

And she's usually laying there not because of bad nursing care, but because she's a constant incontinence.

因为她已经失去了膀胱控制能力，而我们对她的盆底肌或膀胱脱垂问题却未采取任何措施。

Because she's just lost her bladder control, and we've done nothing about her pelvic floor or her prolapsed bladder.

通常当我试图为她进行手术前评估时——我们会进行特定流程的实验室检测——发现她患有尿路感染。

And often when I'm trying to clear her for surgery, which we go through a certain procedure, do lab tests, she has a UTI.

事实上，她可能正是因为长期尿路感染导致头晕而跌倒，我们知道这种情况确实存在。

In fact, maybe she got dizzy and fell down because of her chronic UTIs, which we know is a thing.

现在医院里的流程是：内科医生会来评估她的心脏状况。

Then what happens now in the hospital is the medical doctor will come and clear her heart.

手术本身修复髋部只需约45分钟，但心脏必须足够健康才能承受。

For surgery, it takes about forty five minutes to fix a hip, but the heart has to be healthy enough.

但很多女性从未接受过雌激素治疗，比例只有4%到5%，对吧？

But many women have not been treated with estrogen, only four or five percent, right?

所以她们可能患有自己都不知晓的微血管心脏病，这使得心脏评估难以通过。

So they have microvascular heart disease that they may not even know about, and it's difficult to clear their hearts.

最终意味着，让她们的心脏达到

Then finally Meaning, clear their hearts for

手术标准。

surgeries.

为了

To

让心脏做好准备

prime their hearts

进行手术。

for surgery.

确保她们能够

That they're not they're gonna survive the surgery.

承受麻醉。

Gonna survive anesthesia.

感谢你的澄清。

Thank you for clarifying that.

因为手术和麻醉本身就是一种压力。

Because it's a stress to undergo surgery and anesthesia.

就像跑一场比赛一样。

It's like running a race.

你肯定不希望有人在手术台上心脏病发作。

You don't want somebody to have a heart attack on the table.

但另一方面，玛丽·克莱尔，要么是事件的压力，要么是他们已经患有早期阿尔茨海默症。

But the other thing, Mary Claire, is that either the stress of the incident or they've already got early Alzheimer's.

他们...他们并不清醒。

They're they're not they're not cogent.

他们的大脑无法像他们期望的那样正常运作。

Their brains are not functioning the way they would want them to.

说实话，我们本可以在女性35岁时就介入预防所有这些问题的。

So we've got all these things that, frankly, my friend, we could have prevented had we gotten a hold of women when they were 35.

所以妈妈现在88岁了。

So mama is 88.

是的。

Yes.

她这辈子从未做过骨密度扫描，也从来没有任何人跟她谈论过她的骨骼健康。

And she has never had a bone density scan in her life, and no one ever, ever, ever, ever talked to her about her bones.

她的母亲躺在床上，大小便失禁，患有严重痴呆，不仅髋部骨折，还断了肋骨、肩膀和手臂，多次跌倒，最后大概有三到五年时间都躺在床上，出现幻觉、失禁、大喊大叫，

Her mother laid in a bed, incontinent with severe dementia and had broken, not a hip, but broke ribs, broke shoulder, arm, you know, multiple falls and spent probably the last good three to five years in a bed hallucinating, incontinent, yelling out, you

这不是她想要的生活状态。

know Not how she wanted to be.

她绝不会希望

She would've never

从来没有人告诉过妈妈可以采取什么措施来预防这种情况。

No one ever talked to her about what mama could do to prevent this.

甚至连我也没有。

Not even me.

现在我试着用阴道雌激素来帮助她。

Now I tried to help her with vaginal estrogen.

我母亲从我小时候起就一直有失禁的问题。

My mother's had struggles with incontinence since I was a child.

妈妈现在患有阿尔茨海默病。

Mama is now has Alzheimer's.

是的。

Yes.

她住在养老院，在新年夜摔倒，当时她正在寻找六年前去世的父亲，产生幻觉以为听到了他的声音，摔倒后髋部粉碎性骨折，被送去做了心脏检查后，挺过了手术。

Is in a facilitated And living on New Year's night fell looking for my father who passed away six years ago, hallucinated, thought she heard his voice, fell, shattered her hip, got taken to the passed clearance for heart, survived the surgery.

术后八个月，她现在才刚开始用助行器走路。

It is eight months post op, and she is just now walking with a walker.

从那以后，她一直坐着轮椅四处移动。

She has been rolling around in a wheelchair, scooting herself around since that.

我们终于请到了一位优秀的物理治疗师，真的...哇。

And we finally got the right physical therapist in to really Wow.

让她站起来并激发她的动力。

Get her up and get her motivated.

却没人关心这些女性

And no one is talking to these women Nobody.

没人告诉她们这些本可以避免

About prevention, about this doesn't have to happen.

她正重蹈我祖母的覆辙

She's exactly walking the path my grandmother did.

而我决不允许

And I am refusing I know.

这种事

For this.

我要为女儿们改写家族命运

I'm changing the legacy for my daughters.

是的，你正在这么做

Yes, you are.

你绝不会让悲剧重演

There is no way you'll let that happen.

是啊。

So Yeah.

我们要谈谈

We're gonna talk

关于我们要如何，你知道的，我们能为此做些什么。

about how we're gonna how how you know, what we can do about that.

炎症在其中扮演了什么角色？

What part does inflammation play in all this?

很高兴你问到这个问题。

I'm so glad you asked that.

因为这不仅仅是单一因素。

Because it's not just one thing.

不仅仅是更年期的问题。

It's not just menopause.

也不仅仅是钙摄入量的问题。

It's not just calcium intake.

这本书的第二章专门探讨衰老背后的科学原理，因为我不希望人们误解为只要再参加一个锻炼计划或尝试另一种饮食方案——这些完全不是我们讨论的重点。

The second chapter of the whole book is all about the science behind aging because I just don't want people to walk away thinking, just get on another exercise program or another diet that is so not what you and I are talking about.

我们讨论的内容之一就是'炎性衰老'这个概念。

One of the things we talk about is this concept of inflamaging.

嗯。

Mhmm.

这是指你体内永不停歇的慢性炎症过程。

It is chronic inflammatory processes in your body that never stop.

现在让我们明确一点：

Now let's clarify.

炎症是身体的正常生理过程。

Inflammation is a normal bodily process.

当你扭伤脚踝时，它会发热发红肿胀——这是保护性反应，因为你的身体正在紧急调集资源到伤处。

When you twist your ankle and it gets hot and red and it swells up protective because your body is rushing to the scene.

它正在释放生长因子。

It is dumping growth factor.

它会产生炎症性细胞因子，用于治愈和清理混乱，让你能恢复正常生活。

It is creating inflammatory cytokines, to heal and to clean up the mess so that you can return to life.

当我们无法关闭炎症过程时，可能是因为长期处于压力状态，这会提高我们的皮质醇水平，进而增加这些我们通常会产生的炎症性细胞因子。

When we do not turn off our inflammatory processes, either because we're chronically stressed, which increases our cortisol levels, which and increases all these inflammatory cytokines that we just normally produce.

它们从未得到处理。

They never get taken care of.

我们进入了一种‘炎症衰老’状态，这是所有慢性疾病的诱因之一，无论是心脏病、糖尿病、肌肉减少症还是骨密度问题，因为骨骼和肌肉都对炎症性细胞因子极度敏感。

We enter a state of inflamaging, which is one of the motivators for all of our chronic disease, whether it's your heart disease, whether it's your diabetes, whether it's your sarcopenia and your bone density, because both bone and muscle are critically sensitive to inflammatory cytokines.

当这些细胞因子持续存在时，它们会加剧骨质流失，因为它们让破骨细胞（吞噬骨质的细胞）占据优势。

When they are present all the time, they can increase loss of bone because they give osteoclasts, the bone eating cells, the advantage.

因此，高度炎症意味着更多骨质流失。

So high inflammation, more loss of bone.

肌肉量也是如此。

The same for muscle mass.

高水平的炎症性细胞因子会让我们变得更虚弱，使肌肉损伤恢复得更慢，这方面已有大量深入研究其机制的学术成果。

High levels of these inflammatory cytokines make us weaker, make us recover from muscle injury slower, such that there are lots of studies that go way deep into the mechanisms of this.

但我们知道，在一些针对女性的研究中，当测量血液中这些物质的水平时，可以将其与肌肉质量和恢复能力的显著下降相关联。

But we know that in some studies in women that when they measure these levels in the blood, they can correlate it to, significant decreases in muscle mass and recovery.

因此这不仅仅是理论上的。

So this is not just theoretical.

我们知道这种情况会发生。

We know this happens.

那么为什么我们会如此发炎呢？

And so why do we become so inflamed?

因为雌激素是一种强效抗炎物质。

Because estrogen is a potent anti inflammatory.

我记得看过关于血液炎症标志物的数据，感谢一些研究人员追踪了这些标志物

I remember reading the data on blood inflammatory markers and some researchers, thank God, who were tracking them across

在

the

整个生命周期中的变化，特别是女性，发现平均在45岁左右会出现这种急剧上升。

lifespan, specifically in women and seeing this dramatic uptick somewhere around forty five on average.

而其他一些研究人员则提出，我在想这是否与更年期有关。

And some other researchers said, I wonder if this is menopause.

他们开始研究动物实验，随后转向人体研究，发现仅因雌激素减少和孕酮变化导致的更年期本身，就会使身体进入促炎状态。

And they started looking at animal studies and then then human studies and just how menopause itself, just from the loss of estrogen changes in progesterone, you know, becomes a pro inflammatory state.

这个发现让我震惊不已。

I was floored by that.

完全正确。

Exactly right.

当女性说'哦，我没经历更年期'时。

When women say, oh, I didn't have menopause.

我没有盗汗、脑雾这些症状。

I didn't have night sweats, brain fog.

我感觉没什么不适。

I didn't feel bad.

或者你知道吗？

Or you know what?

我只是稍微有点感觉。

I just had it a little.

或者说我已经完全结束了。

Or I'm done with all that.

哦，我已经结束了。

Oh, I'm done.

嗯，好吧。

Well, okay.

这正说明我们需要持续教育女性，告诉她们可能感觉不到，但它确实在发生。

That just comes from the fact that we need to educate women continually to say that you may not feel it, but it's happening.

它正在发生。

It's happening.

它确实在发生。

It is happening.

是啊。

Yeah.

雌激素的流失将伴随你整个余生，影响全身各个系统。

Loss of estrogen will follow you in every whole system for the rest of your life.

没错。

That's right.

好的。

Okay.

跟我聊聊维生素D

Talk to me about vitamin D

嗯。

Mhmm.

还有钙。

And calcium.

我们在社交媒体上经常听到这些。

We hear a lot about that on social media.

是的。

Yeah.

这是我被教导过的事情之一

And this of one the things I was taught

在住院医师培训期间。

in residency.

所以，你知道，我们经常谈论这些关于增强骨密度的事情，但我们忘记了维生素D对大脑健康、免疫功能和肠道吸收至关重要。

So, you know, we talk a lot about about those things in terms of building bone density, but we forget that vitamin D is critical for brain health and immune function and gut absorption.

钙补充剂，而且

Calcium supplements, and

如果我错了请纠正，从未被证明能降低骨质疏松性骨折的风险。

correct me if I'm wrong, have never been shown to decrease the risk of osteoporotic fracture.

我们需要从食物中获取它。

We need it from our food.

积累1800毫克并不困难。

It's not hard to accumulate eighteen hundred milligrams.

1200毫克肯定不难。

Definitely not hard for twelve hundred.

因为一杯酸奶含有约300毫克的钙。

Because a cup of yogurt has about three hundred milligrams of calcium.

带骨鲑鱼。

Salmon with bones in it.

沙丁鱼，但你知道，谁想吃那些呢？

Sardines, but, you know, who wants to eat those?

但李子和小白菜，选择太多了，我更希望人们尝试从食物中获取钙。

But prunes and bok choy, there's just so many choices that, I'd rather people try to get it from their food.

我给病人的建议是，这些富含钙的食物同时也富含许多其他对身体有益的成分。

The way I counsel my patients is these foods that are rich in calcium are also rich in so many other things that are wonderful for you.

非常健康。

Great health.

所以从食物中获取总是更好。

So it's always better from food.

早些时候我们谈到，50岁后每两位女性中就有一位可能遭遇骨质疏松性骨折。

So earlier, we talked about that one in two women, after the age of 50 can expect to have an osteoporotic fracture.

要知道，这就是我们的现实。

And, you know, that's our reality.

但在我的诊所里，我会建议做骨密度扫描。

However, in my clinic, I am recommending DEXA scan.

所以让我们去检查一下你的骨密度吧。

So let's go get your bone density checked.

通常保险公司要到65岁或存在严重风险因素时才会报销这项检查。

Often insurance won't pay for it until the age of 65 or if she has some severe risk factor.

但即便如此，我觉得那时已经太迟了。

But even in that setting, I feel like that is too late.

当我的患者被诊断出骨密度低时，他们感到非常沮丧。

When my patients are diagnosed with low bone density, they are devastated.

是啊。

Yeah.

他们简直不敢相信。

They cannot believe it.

你在诊所里是如何给这些患者提供建议的？

How do you counsel those patients in your clinic?

他们感到

They feel

失望、羞愧、害怕。

disappointed, ashamed, frightened.

但我们不会让谈话就此结束。

And then we don't just leave the conversation there.

我认为单纯的DEXA扫描数值毫无意义，除非你给患者或女性制定一个计划。

I think a DEXA scan number alone is useless until unless you give a patient or a woman a plan.

因此我们会讨论所有已知有助于改善骨骼的方法，我们知道通过这些方法可以稳定甚至增强骨骼质量。

And so we go through all the things we know that will help build better bone, and we know that we can stabilize or build better bone.

有哪些

What are

具体方法呢？

those things?

每位女性都是有感知的生命体，有权做出自己的激素决策，但我坚持这必须基于事实而非恐惧。

Every woman is a sentient being and gets to make her hormone decision, but I insist that she makes it based on facts, not fear.

因此我每天都会推荐——好吧，我推荐你的书。

And so every day I recommend, well, I recommend your book.

所以我告诉她们：如果你想了解关于激素安全性的全球数据，就去读《雌激素很重要》。

So I say if you want all the world's data on the safety of your hormones, you're going to read Estrogen Matters.

如果你想了解自己即将经历的变化，就去读《新更年期》。

If you want to know what's about to happen to you, you read The New Menopause.

如果你想知道这个年龄段的性爱能有多美好，就去读《你并未残缺》。

If you know how good sex can be at this age, you read You Are Not Broken.

当然，现在我还会推荐《坚不可摧计划》作为你的方案。

And then of course, I recommend now here's your plan unbreakable.

但我会向她们解释：你必须自主决定激素治疗，因为——这时我会讲解雌激素对骨骼的作用。

But as I explain to them, I say, you must make your hormone decision because and then I explain the role of estrogen on bone.

如果我们不这样做，未来要扭转局面将会更加困难。

It's gonna be harder to get in front of this if we don't.

但如果你不愿意，那我们还能做什么呢？

But if you don't want to, well, what else are we going to do?

我们要学习举重。

We are going to learn to lift heavy weights.

我们要放下那些娘娘腔的五磅哑铃——那种让你做到力竭的30次重复训练，然后花六到九个月时间逐步适应硬拉用的六角杠铃。

We are going to put down the mamby pamby five pound weights that we lift 30 times to failure, and we are going to take the six or nine months to work up to lifting the hex bar that you lift when you deadlift.

对吧？

Right?

因为只有大重量训练才能对骨骼施加最大的牵引力。

To lift heavy because it is that which is going to exert the most pulling force against your bone.

我们要像疯子一样蹦跳。

We're gonna jump around like a crazy person.

我希望人们每天跳20次，不是轻飘飘地直上直下落地。

I want people to jump 20 jumps a day, not just straight up and down, not landing lightly.

我要你重重砸向地面，因为我们需要产生四倍体重的冲击力。

I want you to thud on the floor because we need to generate four times body weight.

你能做到这一点。

You can do that.

步行产生约1.2倍体重的冲击力。

Walking generates about 1.2 times body weight.

跑步会产生两到三倍的冲击力。

Running two to three times.

但我们需要落地时的重击声，这需要从大约八英寸的高度跳下。

But we want a thud on the floor, and that takes jumping from a height of about eight inches.

如果你的膝盖疼得受不了，NASA会使用反弹器或小型蹦床。

If you cannot do that because your knees hurt too much, well, NASA uses rebounders or little trampolines.

我们不能以此为借口。

We can't use it as an excuse.

我们只能尽力而为，因为举重、跳跃、雌激素的增减，加上高蛋白营养，都能帮助你稳定和重建骨骼。

We just have to do the best we can because lifting, jumping, plus or minus estrogen, plus nutrition high in protein can help you stabilize and rebuild bone.

在这些因素中，最有力的数据来自雌激素和举重。

And so of those things, the best data is from estrogen and lifting.

女性经常问我，尤其是在网上，但我要么害怕，要么已经患有骨质疏松症。

Women always ask me, especially online, but I'm either I'm afraid or I have osteoporosis.

我无法进行负重训练。

I can't lift.

我见过很多这种情况。

I see a lot.

每当我发布关于力量训练的内容时，评论区总是充斥着各种担忧：但如果我已经骨质疏松了呢？会不会骨折？

Anytime I post about lifting exercises, the comments are always full with, but what if, but what if, you know, I have osteoporosis already, am I gonna fracture?

我有椎间盘突出，有关节炎。

I have a herniated disc, I have arthritis.

你知道，很多女性本身就患有各种疾病，这让锻炼变得更加困难。

You know, a lot of women are already dealing with conditions that are gonna make these things harder.

但讽刺的是，来自新西兰的Beck医生进行了一项名为'举重更多'的大型研究。

But you know the irony is so so, doctor Beck, who's from New Zealand, I believe, did a big study called the Lift More.

在专业指导下，我们必须学会进行大重量训练。

And under supervision, we must be taught to lift heavy.

我们不想受伤。

We don't wanna get hurt.

在她的方案中，你要做到力竭，每组5次重复，共5组。

In her protocol, you're lifting to failure in five reps times five sets.

这很吃力。

That is heavy.

结果没人骨折，大家都增肌了。嗯哼。

And nobody broke and everybody built Mm-mm.

没有受伤。

No injuries.

所以，是的，这

And so, yes, it

是可以做到的。

can be done.

而且他们全都有骨质疏松症。

And they all had osteoporosis.

哦，参与研究的条件是骨质疏松症。

Oh, entry to the study was osteoporosis.

你刚才说的讽刺之处在于，人们认为患有关节炎就不能举重，或者因为关节炎就不能跳跃。

What the irony about what you just said is people think that they can't lift because they have arthritis or they can't jump because they have arthritis.

当我遇到因关节炎来找我的人时，我不会一开始就采取医疗干预措施。

When I get someone coming to me for arthritis, I don't start with the medical interventions.

我会先说：我们要让你强壮如牛，因为你的臀部、核心和髋部力量将成为缓冲器，减轻体重对膝盖的冲击——毕竟日常活动会给关节施加7到9倍体重的压力。

I start with, We are gonna make you strong as a bull because your butt, core, and hip strength will act as shock absorbers against the impact of your weight on your knees because regular activity exerts, you know, seven to nine times body weight on your joints.

所以如果我们不想让关节互相撞击，就必须增强肌肉力量。

So if we don't want them to pound together, we have to build better muscle.

对吧？

Right?

当我说我们要先让你变强壮，再开始医疗干预时，人们总是非常震惊。

People are so shocked when I say that we're gonna make you strong first before we start doing all the medical stuff.

但这种可能是他们在常规医生那里没听过的方案——因为你说得对，我们总把问题割裂看待。

But that's an approach that maybe they haven't heard at their standard doctors because you're right, we silo things.

但现实是，如果我们想要治疗整个人，这个人必须变得强壮。

But the reality is if we want to treat the whole person, that person needs to be strong.

你能谈谈目前已开发用于治疗骨质疏松症的一些药物吗？以及何时会开始使用这些药物？

Can you talk about some of the pharmaceuticals that have been developed to treat osteoporosis and when would you begin those?

药物分为几大类。

So there's several categories.

最常见的是人们熟悉的双膦酸盐类药物，比如福善美。

Most common one that people are familiar with are the bisphosphonates, Fosamax.

现在还有一类新的单克隆抗体药物，它能作用于破骨细胞上的受体并阻断其功能。

And then now there's a new category of monoclonal antibodies that work on there's a receptor on the osteoclast that it blocks.

当女性确诊骨质疏松症（即T值达到-2.5时），我们会提供这些药物治疗。

Those medications are offered to women when they have the diagnosis of osteoporosis, which is a T score of minus 2.5.

但你知道吗？几乎每个来找我的女性患者都会说：'我得了骨质疏松'。

But do you know nearly to a woman that I see, they've all said to me, I have osteoporosis.

医生想让我服用双膦酸盐来挽救骨骼，但因为副作用，我并不想用。

My doctor wanted to put me on a bisphosphonate to rescue my bones, and I don't want it because of the side effects.

是的。

Yeah.

嗯，这可以理解，因为其中一些副作用听起来确实很可怕。

Well, that's understandable because some of them are very terrifying sounding.

但现实是这样的，玛丽·克莱尔。

But here's the reality, Mary Claire.

我们刚才在讨论我治疗的那些女性患者和你母亲的情况。

We were talking about the women I treat and your own mama.

如果发生髋部骨折，70%的髋部骨折患者都是女性。

If you get a hip fracture, seventy percent of all hip fractures are in women.

其中30%的患者会在骨折后第一年内死亡。

Thirty percent of the time you die in the first year from that moment.

即使接受了手术。

Even after surgery.

即使接受了手术。

Even after surgery.

并发症包括尿路感染、久坐不动、褥疮、痴呆、行动不便等，卧床一周以上就会流失9%的肌肉量。

From the complications, whether it's a UTI, sedentary living, bedsores, dementia, not being mobile, you lose 9% of your muscle mass laying in bed for a week or more.

这些因素在原本就虚弱的群体中会不断累积。

These things add up in already frail people.

对吧？

Right?

百分之三十的概率，你会倒下。

Thirty percent, you hit the floor.

那些幸存者中，50%的人将永远无法回家，因为他们行动不便。

Those people who survive, fifty percent will never get to go back home because they're they can't get around.

明白吗？

Right?

要独立生活，你必须具备从椅子上起身和完成日常活动的能力。

To live independently, you must be able to get up and down from a chair and do ADLs.

这就是为什么我们要重视骨折问题。

This is why we care about fracture.

确实如此。

Absolutely.

除非后果严重，否则没人会在意，

No one would care unless the devastating,

这些后果。

outcomes of it.

所以大多数女性没有意识到的是，目前大多数女性并未被提供任何骨质疏松筛查。

So what most women don't realize is most women are not offered any screening for osteoporosis currently.

她们就这样被忽略了。

They just kind of get skipped.

而大多数人是在

And most people are diagnosed with their osteoporosis at the

你可以无需处方购买DEXA扫描。

You time of can buy a DEXA scan without a prescription.

你可以谷歌搜索'附近的DEXA扫描'。

You can Google DEXA scan near me.

如果你不想做DEXA扫描，现在有一种使用超声波的新技术叫REM扫描仪。

If you don't want a DEXA scan, there's a new technology using ultrasound called a REM scanner.

对吧？

Right?

它在美国不如英国或澳大利亚那么普遍，但正在逐渐普及。

It's not as common in The United States as it is in The UK or Australia, but it's coming.

它使用超声波而非X光来评估骨质，因为是否骨折更多取决于骨质质量而非矿物质含量。

And it uses ultrasound, not even X rays, to tell you bone quality because whether or not you fracture has more to do with the quality of your bone than how much mineral you have in it.

人们还不了解的是，每当你迈步时，比如这是你的股骨——大腿骨，它会有轻微弯曲。

Because what people don't know about bones either is that every time you take a step, if this is your femur, your leg bone, your thigh bone, it bends a little.

会有轻微弯曲。

It bends a little.

你的身体感知到这一点后，会在弯曲最明显的位置构建最坚固的骨骼。

And your body, knowing that, perceiving that, will build the strongest bone where you have the most bending.

所以这种超声波预测技术能告诉你骨质质量。

So the ultrasound type predictor will tell you the quality of your bone.

但听好了，这些东西都是可以买到的。

But either one of these things, listen, can be purchased.

所以如果你的医生不愿意做，你可以自己攒下星巴克的钱来买。

So if you've got a clinician who just won't do it, then you can buy it yourself by saving up your Starbucks money.

所以去做吧，就因为我们俩都建议你这么做。

So do it just because we both told you to do it.

但如果这还不够说服你，想想这些事。

But if that's not enough for you, think about these things.

你母亲在变矮吗？

Is your mother shrinking?

是啊。

Yeah.

我母亲已经缩水了很多。

My mother has shrunk so much.

她以前和我一样高，现在大概只有这么高了。

She used to be my height, and now she's about down here.

对吧？

Right?

我现在都能俯视她的头顶了。

I can look over her head.

为什么人会变矮？

Why are they shrinking?

因为我们脊柱的椎体，脊髓被骨质的铠甲保护着，这些椎体就像积木一样层层堆叠。

Because the vertebral bodies in our spine, our spinal cord is surrounded by an armor of bone, and they are like blocks, literally blocks.

它们一个叠一个地堆叠起来。

They sit one on top of each other.

随着骨质流失，椎体会塌陷收缩，所以我们身高会变矮。

And as we lose bone, they collapse and shrink, so we lose height.

那你母亲身高变矮了吗？

So is your mother shrinking?

你自己身高变矮了吗？

Are you shrinking?

你年轻时抽烟是因为觉得很酷吗？

Did you smoke when you were young because it was so cool?

吸烟和尼古丁对骨骼有毒害。

Smoking and nicotine is bone poison.

或者你小时候是否患过哮喘之类的疾病，需要长期服用大量类固醇？

Or did you have an illness when you were little like asthma where you had to take a lot of steroids chronically?

或者你有自身免疫性疾病吗？

Or do you have an autoimmune disease?

坦白说，所有这些因素以及更多情况都是骨质疏松的风险因素。

All of these things, and many more frankly, are risk factors for osteoporosis.

玛丽·克莱尔，或者这种情况如何？

Or how about this, Mary Claire?

如果你像我一样会怎样？

What if you're like me?

你是一名年轻运动员却从未有过月经。

You're a young athlete and you never had periods.

月经。

Periods.

或者也许你有月经，但你是个运动员且从未好好进食。

Or maybe you had periods, but you were an athlete and never fed yourself.

所有这些因素都可能让你面临骨质疏松的风险。

So all of these things could make you at risk for osteoporosis.

如果你发现自己有以上任何情况，就去做个扫描检查吧。

And if you're identifying with any of these things, go get yourself a scan.

那么女性应该从什么时候开始考虑主动保护骨骼健康？

So when should women begin to think about being proactive or just begin to be proactive about protecting their bones?

比如说

How about

在我们的生育年龄期间？

during our fertility periods?

我开始谈论这个话题时，必须非常注意措辞。

I start talking about this, and I have to be very careful with the way I phrase this.