Dr. Coggan, I just broke my ankle is a somewhat stupid XC ski crash (aren’t they all).
Anwyay, the break is in the fibula, just above the ankle joint. As far as breaks, it is clean and my Orthopedic Surgeon is treating it was air cast and as much weight bearing as possible, encouraging me to walk on it without cast if I can tolerate the pain. I do a lot of weight bearing exercise (run, XC ski), but with all the cycling I also do, is the there a risk of reduced bone density. My wife says that she suspects so, given my break, but the crash was pretty severe in that my right ski was stuck in the snow under my left when I fell over and had no room to budge.
Is there something I should do to check if my bone density is reduce. I’m 43, so not immune from this esprecially from all the years of closing calcium through daily sweat. I have been taking a calcium supplement for 6 months now, but that is only quite recent. Never did for 42.5 years. First bone break since 1986.
Dual X-ray absorptiometry (DXA) is the method by which bone mineral density is usually measured. Having a scan performed entails a slight exposure to radiation, but that (and the cost…not much here in the US, but may be different in Canada) may be worth it if only for the peace of mind. My suggestion would be to discuss the issue with your orthopedic surgeon and see what he/she has to say.
Since you do run on a very consistent basis and have for years, you are much less likely to be at risk for having low bone density. I may be wrong about Dr. Coogan but, I believe he is primarily a cyclist so he doesn’t get the weight bearing activity (running) that helps to maintain bone density. Unless you have a hereditary propensity for lower bone density you are probably alright.
Although x-rays are not a completely diagnostic test for lower bone density, when they looked at the x-rays of your fracture they probably would have noticed if you were osteopenic or osteoporotic. The only definite way to know though, would be to get a bone density test done.
Dr. Coggan, I just broke my ankle is a somewhat stupid XC ski crash (aren’t they all).
Anwyay, the break is in the fibula, just above the ankle joint. As far as breaks, it is clean and my Orthopedic Surgeon is treating it was air cast and as much weight bearing as possible, encouraging me to walk on it without cast if I can tolerate the pain. I do a lot of weight bearing exercise (run, XC ski), but with all the cycling I also do, is the there a risk of reduced bone density. My wife says that she suspects so, given my break, but the crash was pretty severe in that my right ski was stuck in the snow under my left when I fell over and had no room to budge.
Is there something I should do to check if my bone density is reduce. I’m 43, so not immune from this esprecially from all the years of closing calcium through daily sweat. I have been taking a calcium supplement for 6 months now, but that is only quite recent. Never did for 42.5 years. First bone break since 1986.
Dev
Dev,
Sorry to hear about your fracture. Stay with the PC’ing and, I suspect, that when you are allowed to run again you will find you have lost almost nothing. will be interesting to see. This should repair pretty fast.
With all the running you do the risk of reduced bone density in you is almost zero. If you did have reduced bone density I would take that more as an indication of something else going on causing calcium loss than from bike riding. If you had a loss of bone density and it was concluded it was from bike riding I think the only conclusion would be that bike riding somehow actively reduces bone density as opposed to causing it by reducing loads on the bone. That would be worthy of a case report and some active scientific study by someone to confirm the finding and to find the mechanism.
I’m not Dr. Coggan, but I can reply with some amount of knowledge of recently-diagnosed osteoporosis.
If your orthopod wasn’t concerned with the mechanism of injury being inordinate for the injury sustained, I might not worry too much about it, assuming of course you talked through it in detail with him/her. If you are still concerned that the mechanism was insufficient to produce a break in a normal bone, then I might request that your ortho write you a prescription for a DXA scan just to be on the safe side. If you do have bone density issues, I’d certainly want to know about it, but given your history of weight-bearing exercises, I wouldn’t worry too much about the recent cycling-related studies that attribute decreased bone density to riding your bike (only).
For slightly more info on my specific background in this, see the end of this thread if you haven’t already:
Thanks Mike and Andrew. I will ask my orthopedic surgeon when I see him next. He is also a 10:xx Ironman guy and avid XC skier, so he knows where I/we are coming from.
I may be wrong about Dr. Coogan but, I believe he is primarily a cyclist
Correct. I also had two parents (of recent English descent) who smoked heavily, grew up where it was rather cloudy, and at least flirted with what now might be diagnosed as anorexia athletica when I was in my mid-teens. IOW, I suspect that having a low peak BMD is as much, if not more, a part of my problem as my lifestyle (especially since, averaged over the last ~30 y, I’d estimate that I’ve spent at least 20% of my time running and lifting weights, in addition to/instead of cycling).
…If you are still concerned that the mechanism was insufficient to produce a break in a normal bone…
Oh yeah,…the mechanism was certainly sufficient to break a healthy bone in my opinion. I just wanted to make sure that if there is any bone density issues that I get them now. I don’t recall any of my grandparents of parents having bone density issues, but they were life long walkers and never road bikes to the extent we do.
Frank. I am allowed to ride indoors right now. Right now I am just on the regular cranks and will incorporate PC riding next week for sure. For the moment, just getting back slowly working through the soft tissue damage as all the ankle area was sprained and my achilles was swollen to 4x its size. The cycling has actually helped and swelling is near zero, although achilles is still 1.5 times its size, but at least not blue like last week! Since I lent my trainer out, I only have rollers and wanted to be comfortable riding again before throwing PC’s on rollers. I will also need to use the shin more actively on the upstroke and the tendons on the front of the ankle are still beat up, so they need assist from the downstroke quad to get the broken foot over the top.
…If you are still concerned that the mechanism was insufficient to produce a break in a normal bone…
Oh yeah,…the mechanism was certainly sufficient to break a healthy bone in my opinion. I just wanted to make sure that if there is any bone density issues that I get them now. I don’t recall any of my grandparents of parents having bone density issues, but they were life long walkers and never road bikes to the extent we do.
Frank. I am allowed to ride indoors right now. Right now I am just on the regular cranks and will incorporate PC riding next week for sure. For the moment, just getting back slowly working through the soft tissue damage as all the ankle area was sprained and my achilles was swollen to 4x its size. The cycling has actually helped and swelling is near zero, although achilles is still 1.5 times its size, but at least not blue like last week! Since I lent my trainer out, I only have rollers and wanted to be comfortable riding again before throwing PC’s on rollers. I will also need to use the shin more actively on the upstroke and the tendons on the front of the ankle are still beat up, so they need assist from the downstroke quad to get the broken foot over the top.
That is fine. Get on them when you can. If you can maintain your training time cycling with PowerCranks during this rehab I would predict that when you are allowed to run that you will find almost zero reduction in running performance when you get back to serious running. Like I said, it will be interesting to see what happens. Good luck and fast recovery.
Dev, that is a common place for fracture and would not alert me to decreased bone density. You are at low risk (male, non smoker, normal weight…). Fibula is a pretty small bone - in fact we often see fractures closer to the knee with severe ankle sprains
good luck with your recovery - hope it does not affect your season too much