Bone Density Test: beginnings of Osteopenia

Triathlon Forum
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I was diagnosed with a femoral neck stress fracture at the end of June. I recently had a bone density test. The unofficial results are that I have the beginnings of osteopenia which is the precursor to osteoporosis. The tech who did my DXA scan said I fit the typical profile for this low bone density condition: white female, mid 40s, thin. (I don’t think I’m overly thin, my BMI was a 19 when I got my DXA scan)

Has anyone else had experience reversing low bone density and doing triathlons/marathons? I did get my blood work back and it was all excellent. Iron and calcium levels were very good. Vit D was in the normal range but on the lower side (40.3 where normal range is 30-100). Besides upping my Vit D and continuing with calcium/magnesium supplents, and adding more lower body strength work, any other suggestions?

I still plan on signing up for the Mont Tremblant 70.3 and 140.6 for 2016, but it is daunting knowing I have the beginnings of osteopenia. Anyone else in my boat?

Thanks,
Joyce

2

So my story is a bit similar as I was also diagnosed with a femoral neck stress fracture at the end of June. The difference is that I had my osteopenia diagnosed in 2012 (age 36) after fracturing my wrist three times (long story). Since the osteopenia diagnosis, I have done 1 100 mile race, a 6-day stage race, several 50M and 50Ks, 1 IM, several HIMs and the Triple T. Until this June, I have had no other stress fractures or other chronic injuries. Was the osteopenia a factor in the stress fracture? Possibly/likely, But so were many other things - training volume, intensity, age, bad luck. None of my doctors feel that the osteopenia should require me to stop racing/training. I just try to be smart about it, eat well and take my supplements. I have a new scan schedule soon so I will be able to see if I have any significant decrease in values since my last scan.

If you want more info on the cause of the osteopenia, you could ask for a referral to an endocrinologist. I did a full workup and we found out/confirmed some hormonal imbalance issues and some indications that some food sensitivities were contributing to my inability to properly absorb some nutrients including calcium.

Good luck with your training!

3

My recent bone tests showed low bone density, but it was also a reflection of body weight. Like you I’m early 40’s and BMI 17. In one year I “lost” 5% of bone mass but also 10 lbs of weight. I was told that yes bones may have thinned (I had fractures) but that my thin body and weight loss made the test results read lower. So they couldn’t say if the 5% was really thinning bones or thinning me. Also told thin people get lower readings, and it’s not necessarily always bone changes. So you’re “condition” might include being thin? However like me since you are getting fractures, it’s not just body weight it’s the bones changing.

My vitamin D was low, I’m taking supplements. We’re still working out why I was vitamin D deficient, we’re thinking it’s my gut dysfunction and poor absorption. I’m still doing long course training, just have to be careful and it could take 1-2 years before I’m back towards normal.

Hope this helps

4

You might also add Vitamin K2 which supposedly helps bone incorporate calcium into bone rather than the arteries.

I’ve read somewhere where doing max effort standing jumps each day may help bone strength and remodeling.

Consider adding more D than the amount generally included in the combination Calcium D supplements.

And get a followup DEXA. What was your T score?

5

I did get my blood work back and it was all excellent. Iron and calcium levels were very good. Vit D was in the normal range but on the lower side (40.3 where normal range is 30-100). Besides upping my Vit D and continuing with calcium/magnesium supplents, and adding more lower body strength work, any other suggestions?
Ask for an NTX study. Chances are it will come back normal, but it’s worth a try. It’s a urine sample and they check Ca excretion.

Has anyone else had experience reversing low bone density and doing triathlons/marathons?

Yup. I suffered from anorexia from 2000-2005. I was diagnosed with osteoporosis in my spine and osteopoenia in my hips in early 2005 (I was 18). Fairly common “side effect” of anorexia. After a couple of years of being at the low end of a healthy weight I went to low normal hips, spine on the border of osteopoenia/osteoporosis. It has been about 6 years since my last DEXA scan so I can’t tell you what they are now.

I had a rash of stress fractures from 2005 - 2009 and another in 2012 (fibula, metatarsals on two or three separate occasions, also possibly one in my hip - I had hip tendonitis and it was hard to tell from the images whether there was a fracture or not, but given the pain I suspect it was at the very least a stress reaction). While the low bone density probably contributed to it, I think the main problem was that I just tried to run too many miles. For a good stretch of my anorexia I ran about 13 miles a day every day, and never had any injuries or bone issues. It was very puzzling to go from that, to running 50 mpw - about half of what I’d done - and get so hurt. The explanation from someone smarter than myself was that my bones needed some time to adjust to the 20 pounds I had to gain. I’ve been running 50 miles a week for the past several years with no issues. Also, while I should lift, I don’t … it’s not like I can point to a bunch of exercises with weights I’ve been doing for years that “magically” changed things for me.

I think that one reason I am able to run so much is that with the exception of racing and the very occasional run on a track, I do all of my miles on a treadmill. You can substitute some other soft surface here if you want to be outside - a grass field, or trail, or whatever - but pavement is hard stuff, and when I got fractures, I was running on pavement most of the time. I would rather run 50 mpw on the treadmill than 30 miles outside, I guess.

In addition to the lower body strength conditioning you mentioned, I’d do upper body stuff and stuff to strengthen your lower back and shoulders… hips and spine. I think they do hip and spine because they’re likely spots to fracture, or because you can end up with that dowager’s hump, but I was also told that if hip and spine are low, other bones likely are as well - so from a long term health perspective it’s good to strengthen everything.

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  1. make sure you do enough resistance training.

  2. make sure your diet is good

  3. contact a health professional, not slow twitch. i may have my doctorate in a health care field (well, i actually do) but my advice is you seek someone in person.

bests,

john

7

Thank you for the replies and sharing your stories! Good to know there are some triathletes out there still training with low bone density!

8

  1. make sure you do enough resistance training.

  2. make sure your diet is good

  3. contact a health professional, not slow twitch. i may have my doctorate in a health care field (well, i actually do) but my advice is you seek someone in person.

bests,

john

John, I am consulting with health professionals and will ask my primary care giver for further referrals. I only posted on Slow twitch to hear about other athletes’ stories and learn if they had found success in treating their low bone density.

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65 year old 6’0, 168 lb male here. I was diagnosed with osteopenia in April. I was proscribed 600mg calcium with vitamins and Fosimax daily. I started the calcium right away but held off on the Fosimax until after American Zofingen in he middle of May. With recovery from AZ and jet lag from a trip to Hawaii, I wasn’t sure but I never had power in my legs. First race on Fosimax in middle of June, I was 3 minutes slower than the year before and had nothing f.or the run. Stopped taking Fosimax, kept taking the calcium and quit all diet sodas. I’m going to have the doctor monitor my bone density and see how it goes. If it gets bad enough then I will stop running and racing and go on an anti-osteoporosis drug. Until I have to I will stay off of it and enjoy myself.

10

I’m a 25yo pro triathlete and I was diagnosed with osteopenia last fall. My sports doc wasn’t too surprised given that my hormonal profile was pretty crappy in the past due to some combination of overtraining, under-eating and other factors. For reference, at my lightest in 2012, I was under 140 lbs at 6’ tall (BMI ~19) and I’m now about 20 lbs heavier.

I learned that low bone density in men can be one of the many insidious effects of low testosterone. Bone density responds slowly and, in my case, is likely a legacy of years of low T. My doctor is optimistic that retesting later this year will show improvement. The good news is that I haven’t had any fractures and I’ve continued to train and race at a high level.

General advice (not necessarily targeted at the OP):
-train appropriately (I sucked at this so I eventually hired a coach)
-eat well/enough (I found it helpful to consult a sports nutritionist/dietitian and also track energy intake/expenditure for a while.)
-monitor your blood work, especially hormonal profile (I get a few blood tests per year.)
-consider resistance training (I do weights and plyometrics most of the year.)

11

49 yr old male. In 2013 I had two stress responses - left side femoral neck and right side femoral shaft during training for IMC. No fractures though, even though the white areas on the MRI were big and very white. Then later the same year I turned my ankle running and fractured my 5th MT. That led to a dexa scan of my lower spine (the stress reaction itself leads to bone changes what mess with the dexa reading, so I understand). I came out with a T score at -2.5, which is on the borderline of porosis and penia.

I was devastated. I imagined I’d be the person walking downstairs petrified of falling over, having to use a stick, blah blah blah.

Well, that all turned out to be a crock of crap! First, the specialist I saw was massively reasssuring: his view is that the WHO index presents a black and white picture whereas this is much more a greyscale; my MT break was just bad luck (which I happened to agree with) and the stress responses were down to upping mileage too quickly. I’ve heard since from a couple of physios that cyclists and rowers most often produce stress injuries from running - big engines plus poor technique/low levels of running conditioning are a recipe for beating their lower limbs to a pulp simply because they have the cv fitness and determination to go far longer than is good for them. Tick - that’s me.

Since then I’ve done a couple of HIMs, a couple of Olys and am lining up an IM next year. Working on my running technique has help a lot, and being a bit more sensible about building volume likewise.

I’ve completely forgotten about it, to be honest. It’s only when I see posts like this that I remember my history. I’m much happier treating it that way.

12

Yep, dx with osteopenia (via dexa scan) in my late 40’s. Thin, tall, female, family history. Worked on diet -sort of - and was monitored by my primary care doc. Then I had multiple upper extremity fractures in a 6 month time span. All fall/crash related but i would have walked away uninjured 10 years earlier. Dexa showed spine had progressed to osteoporosis so I started on a bisphosphonate - Fosamax. I take the weekly dosage form. After 12 months I’ve had significant improvement in my spine t score. I’m not currently doing long distance training so my weight is up ~10lbs although my bmi is still in the low normal range. Also seeing an endocrinologist and wish I’d pushed for a referral sooner. Osteoporosis is life altering. Take it seriously. Good luck.

13

Jump rope a couple of times a week, It’s fun and there have been some studies showing good results.

14

Cody/Greg66 - I’m so glad you are both still able to train and race. That gives me hope!

Sneaker - so sorry your bone density progressed to osteoporoisis. I am going to get a referral to an endocrinologist for further testing. I hope you can find some answers and reverse your bone density.

Re: jumping rope, it’s not a bad idea. It reminds me of all the running drills I used to do from my first running coach. When I’m better I may incorporate those back into my training: skipping, straight leg kicks, high knees, carioca, hopping on one leg, running backwards, butt kicks, etc…Meb suffered a pelvic stress fracture and now does lots of running form drills like those. Might be helpful to bone health.

15

62 yr old female. Hit the 2.5 which is the dividing “line” for osteoporsis vs penia. Been doing triathlons, lifting weights etc for 30 yrs with 18 IM. I’ve never been thin very low bmi or lost my period (which would have been nice). Just always have a healthy muscular weight. They never seemed too concerned when I was …penia for several years. Just said to increase Calcium & add Vitamin D. Both of which I did already. I had been using calcium citrate products which worked better for me.
Then at 2.5 now great concern & suggestion to see a specialist & go on medication neither of which I’ve done yet.
Though this Feb had my little finger broken with bone chipped & ligaments blow out which was more serious by an innocuous slap in the pool by another swimmer. Then 5 days later broke my foot which was recovering 5 months after tearing the peroneal tendons. I was wondering if this was the “start”. But the scan was done after literally lying around for 5 month due to the foot injury where even swimming was uncomfortable

After researching the medications I’m very hesitant to use any of them. They all seem to me to be like a super glue hardening or plasticizing the bone so they then become more brittle & succeptible to breakage. Might check out the save our bones web site which has some useful information.

I have decided to use a vegetable based calcium source along with strontium which has been scientifically shown to increase calcium absorption & boost the numbers. I’m finally active again finally and which alone should hopefully improve things. Then after a yr I’m going to go for another scan.
Barb

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62 yr old female. Hit the 2.5 which is the dividing “line” for osteoporsis vs penia. Been doing triathlons, lifting weights etc for 30 yrs with 18 IM. I’ve never been thin very low bmi or lost my period (which would have been nice). Just always have a healthy muscular weight. They never seemed too concerned when I was …penia for several years. Just said to increase Calcium & add Vitamin D. Both of which I did already. I had been using calcium citrate products which worked better for me.
Then at 2.5 now great concern & suggestion to see a specialist & go on medication neither of which I’ve done yet.
Though this Feb had my little finger broken with bone chipped & ligaments blow out which was more serious by an innocuous slap in the pool by another swimmer. Then 5 days later broke my foot which was recovering 5 months after tearing the peroneal tendons. I was wondering if this was the “start”. But the scan was done after literally lying around for 5 month due to the foot injury where even swimming was uncomfortable

After researching the medications I’m very hesitant to use any of them. They all seem to me to be like a super glue hardening or plasticizing the bone so they then become more brittle & succeptible to breakage. Might check out the save our bones web site which has some useful information.

I have decided to use a vegetable based calcium source along with strontium which has been scientifically shown to increase calcium absorption & boost the numbers. I’m finally active again finally and which alone should hopefully improve things. Then after a yr I’m going to go for another scan.
Barb

Hi Barb, thank you for your post and I’m sorry you are also dealing with low bone density and injuries. It’s very frustrating! Are you taking Algaecal supplements? I just ordered the package with both the calcium and the strontium and it will arrive next Wed. It sounds like it has helped reverse low bone density for many people. I was looking at the Save our bones website yesterday. She claims to have reversed her own osteoporosis so it’s worth looking into! I do think getting more tests like a **Parathyroid Hormone Test (PTH) and ** **Calcium-Phosphate Urine Test **might be good to rule out other issues that could be causing low bone density. Getting to the root cause is my quest at the moment. I’m still waiting to hear back from my primary care giver about a specialist but I still don’t have my official numbers from the DEXA scan yet.

I’m also not planning on taking any medications either. There are too many side effects and unknowns.

17

I was looking at the Save our bones website yesterday. She claims to have reversed her own osteoporosis so it’s worth looking into! I do think getting more tests like a **Parathyroid Hormone Test (PTH) and ****Calcium-Phosphate Urine Test **might be good to rule out other issues that could be causing low bone density.

The Ca-Phosphate urine test is the same as the NTX study I mentioned, I think.

The meds do seem to be showing long term side effects, which is unfortunate.

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Yea I am using the algaecal. I didn’t mention it directly as didn’t want to sound like a fake person posting a recommendation. There is another vegetable based calcium supplement mentioned in the Save Our bones website but I decided on this after seeing evidence that stromtium can help restore as opposed to just a manitenace program.
The Save our bones website has some simple exercises that they send out in an e-mail weekend challenge.
Best of luck.
Barb

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The Ca-Phosphate urine test is the same as the NTX study I mentioned, I think.

The meds do seem to be showing long term side effects, which is unfortunate.

I’m so sorry to learn you are experiencing the side effects. I do believe in the body’s ability to heal so don’t give up.

20

Yea I am using the algaecal. I didn’t mention it directly as didn’t want to sound like a fake person posting a recommendation. There is another vegetable based calcium supplement mentioned in the Save Our bones website but I decided on this after seeing evidence that stromtium can help restore as opposed to just a manitenace program.
The Save our bones website has some simple exercises that they send out in an e-mail weekend challenge.
Best of luck.
Barb

Oh good, glad you are also using the Algaecal as well. I hope we both see results on our next bone scans. The strontium sounds promising. BoneBlast is another calcium supplement from algae sources. It sounds good too but Algaecal has more proven results. I’ll have to sign up and check out the exercises on Save our bones.

My primary care provider just ordered me both tests I mentioned above. One is more blood work. The other is peeing in a big container for 24 hours and getting it to the lab. Fun fun! But I feel I’m on the right track for solving my own bone density mystery :slight_smile: Depending on the test results I’ll either see an endocrinologist or a rheumatoid specialist. Maybe this is overkill for the beginnings of osteopenia but I want to nip it in the bud early. Ironman training is no joke! Need to be fully functional in order to make it to the starting line healthy and in one piece for 2016!