Have done lots of research into the different medication options (biophosphonates, Forteo, Prolia), but endocrinologist didnâ€™t think they were appropriate given my age and lack of any other known underlying issue. From my own research, I understand there are big drawbacks to each at my age, but hoping to get a good professional perspective from a metabolic bone specialist Iâ€™m seeing in July. My bone health has clearly gotten much worse over the last year (vertebral compression fracture was completely non-traumatic), so I understand I need to be very proactive and that might mean medication.
Trying to stay positive and proactive throughout this ordeal and appreciate that there are far more worse things affecting people, but Iâ€™ve been an extremely active person my entire life so very frustrated and want to at least get back to pain free daily activities. Including a bunch of additional info below, and really appreciate any thoughts or suggestions!
Timeline of symptoms:
- Ran up to 90 miles per week throughout college (ran 1500m and 5000m at NCAA D1 level, so this included lots of fast/intense running, strength training, etc.) without any bone issues (but plenty of soft tissue injuries, nothing unusual for that level of running though)
- After college, started to have bone stress injuries running substantially less (40 â€“ 50 miles per week), including 1 x tibia stress reaction and 3 x femoral shaft stress reaction (all diagnosed via MRI) â€“ these are not uncommon running injuries, so doctors werenâ€™t overly concerned, and all healed fine - looking back, I think these were early signs of declining BMD
- Stopped running completely in March 2018 to let other injuries heal and take a breather from the grind of competitive running
- Started feeling stress fracture-like pain in May 2018 after a short hike, MRI showed bone stress injury to tibia, so DEXA scan was ordered, which showed osteopenia (scores of -1.9 and -2.4 for femur and spine, respectively)
- Was referred to endocrinologist and labs (blood, urine, 24 hour urine) all came back fine (full metabolic panel, calcium:creatinine ratio (24 hour urine), PTH (parathyroid hormone), magnesium, phosphorus, CMP, tissue translgutaminase, and endomysial AB)
- Tibia pain resolved and was completely pain free from July 2018 to September 2018; started to have occasional pain October 2018 to January 2019
- Pain worsened in February 2019 and MRI showed tibia injury was still there
- As I was having pain walking, have been on crutches for majority of time since March - have been trying to ween off, but it's been a long process
- Perhaps most concerning, I started having bad back pain a few weeks ago. Just received MRI results that confirmed a compression fracture in lumbar vertebrae - waiting to get more detail and will be getting referral to a spine specialist. Fortunately, the pain has started to get a bit better.
- I'm 6'2 and ~170 lbs - have always been very thin (in college was even lighter), and I understand that is associated with lower BMD
- Taking Cal/Mag/D, Multi, Boron (helps with calcium absorption), and Cissus Quadrangularis (plant-based supplement that promotes bone health â€“ figured it couldnâ€™t hurt) daily
- Diet is good â€“ plenty of fat, protein, fruits/veggies (no dietary issues noted in labs)
- Limiting alcohol (2-3 drinks per week)
- Have been seeing a physical therapist for the last couple months, mainly to try to understand pain patterns (have been on/off crutches so no strengthening yet)
- Found out I was mildly lactose intolerant in late high school and didnâ€™t have dairy from 18 â€“ 25 before reintroducing dairy w/o any notable issues. Bone issues seem to coincide with reintroduction of dairy into diet, but doctors havenâ€™t thought that an issue from labs, so maybe just coincidental.
- Traveling to see a metabolic bone specialist in July that has experience treating young people with low bone density