Here is a question for the Dr’s in the group. I have suffered a second stress fracture in my right foot in 10 months. I had a the first one in the calcaneous and now have one in the metatarsal of the same foot. This is the first time I have suffred stress fractures in over 35 years of running. My Dr wants me to get a DEXA test to be sure there are no imbalances causing this injury to reappear. This injury appeared over three weeks ago and I am now pain free so I will wait another 3-4 weeks before running.
I eat a realitively decent diet but am concerned of larger issue.
As a multi sfx’er myself, I’d recommend the DEXA. I didn’t get one for about 12 years. Had I gotten one a long time ago, maybe I would have not gone through all the crap that I’m dealing with now.
If it does turn out that your bone density is low, you will want to know why. Age 35 is when you first stop adding bone density and you begin to start losing, so whatever you are now, it’s only going to go down (or maintain). There are a lot of reasons why someone may have low bone density, and it’s worth looking into for the sake of your long-term well-being.
I am out of running due to a “6 X 6 mm osteochondral erosion with adjacent fibrovascular stress reaction in the posterolateral aspect of the TALUS, adjacent to the subtalar joint.” I think this means I have a bone bruise on the top of my foot/ankle. My Podiatrist has me in a boot thingy for a month. I don’t know when I will be able to run again.
I would be careful about believing its a stress fracture. I thought I had one and it turned out to be that my foot muscles were inflamed. I stayed off of it a week and took some Etodolac. It worked great I began to rebuild my miles slowly. I ran over 30 miles this past weekend.
A DEXA scan measures bone density. You’ll be given a sheet with T and Z scores on it. You do not find out what your actual bone density is, but rather a statistical interpretation that compares you to people of your own age, as well as a “perfect” healthy person’s bone mass. Based on the deviation from the mean you’re either diagnosed as normal, or having osteopoenia (a little bone loss) or osteoporosis (a lot of bone loss).
It’s like getting an x ray. Not painful at all, you just have to lie still.
They’re usually repeated once a year; they take awhile to show changes but it’s the most accurate way to measure changes in bone mineral density.
Apparently they are a very accurate way to measure body composition (body fat %) too though I’ve never had that done with any of mine.
other things to look at —
-are you running the same mileage as usual? a big jump in mileage is the quickest way to get hurt.
-are you running on a different surface than usual? Pavement and concrete are the worst. Track, treadmill, good. Sand, grass, best. I got a stress reaction five weeks ago from running on pavement when I’ve been used to trails and soft surfaces… not kidding.
-worn out shoes?
-change in gait for some reason? (maybe that is the imbalance thing)
You said you eat relatively decently… make sure you’re getting enough calcium. 1500mg a day and no more than 500 mg at a time.
Sorry to hear about the fractures and sending (((((hugs))))) your way… I’ve had a bunch and they SUCK.
love
tc
This is what I was thinking because I was pain free and even ran for 10 minutes pain free yesterday after 1 month off. The Dr wants me to wait 3 -4 more weeks.It’s frustrating to have run 100 mike weeks and have run a sub 2:30 marathon in my 30’s and never have problems and now run 20-30 miles per week and get 2 stress fractures granted I am 52 but still I cross train to get away from the high running mileage and only run 4 days per week. What can be done for low bone density?
Already started the November Challenge in October it helps me forget that Clearwater is out for this year. Spending 5 days a week inthe pool. Setting a goal of15,000-20,000 per week for the next two months with 4 days of cycling thrown in. I live in a warm climate so I am still swimming and riding outdoors.
First, get an accurate diagnosis! Most good musculoskeletal radiologists rarely miss one on MRI. Bone scans are very sensitive, but tend to give some false positives.
A DEXA scan is an OK idea, but it would be unusual for a 52 yo male runner to have any osteopenia/porosis (but certainly possible). Most likely from a biomechanical issue that you need to figure out now. If for some reason the DEXA is low, there are many newer medications to help stop bone loss (like the common bisphosphated, Fosamax, Actonel, Boniva, etc.). If low, you get to have some blood drawn for LOTS of other tests (thyroid, parathyroid, Calcium/phosphate levels, etc.)
RRoof,
The question is could a few variables fall in to this mix. We have moved to Florida just over 2 years ago and obviously the humidity can be brutal at times. I am running on pavement but really running probably less mileage than I ever have due to less time because of work so that is what confuses me. Could conditions figure into an imbalance.
a word of caution on the bone density meds - my orthopedic who did my hip is considered on of the top orthos in the country and is very much on top of research, etc. he advised me away from fosamax, boniva, etc. saying that new research shows they actually cause bones to become more brittle over time.
i agree with whomever said to get a definitive diagnosis… i should have said that before. docs like to call everything a sfx…
Sure! That is exactly your problem! You moved to Florida at age 50 which is MUCH too young! You are likely developing osteoporosis by default since there are likely more people with osteopenia/porosis in Florida than anyplace else in the U.S.
All joking aside - I don’t know of any relationship between heat/humidity and osteopenia. Obviously, lots of running on roads is certainly linked though. Did you really have 100 mile weeks before? If so, a 60 mile week (big for me and most people) might seem like “less mileage”, but PLENTY enough to develop a stress fx for sure. I always have to ask what kind of weekly mileage a patient/runner is doing before even beginning any other history/exam as this tells me a lot.
a word of caution on the bone density meds - my orthopedic who did my hip is considered on of the top orthos in the country and is very much on top of research, etc. he advised me away from fosamax, boniva, etc. saying that new research shows they actually cause bones to become more brittle over time.
i agree with whomever said to get a definitive diagnosis… i should have said that before. docs like to call everything a sfx…
That is NOT true. Also, how is one considered one of the top orthos in the country? At any rate, if he is a good surgeon, he isn’t doing much research.
I happen to refer lots to Dr. Nelson Watts since he is in my neck 'o the woods and he IS considered the foremost expert in the U.S. regarding osteoporosis with over 250 papers/abstracts and books regarding this and LOADS of current research/clinical trials.
Dr. Watts is certified by the American Board of Internal Medicine and in the subspecialty of Endocrinology and Metabolism. He currently serves as Chair of the FDA’s Advisory Committee for Endocrine and Metabolic Drugs, is an Associate Editor of the Journal of Clinical Densitometry and the on editorial board of Osteoporosis International. He is Past President of the American College of Endocrinology, Past President of the International Society of Clinical Densitometry, and active in numerous professional societies. He has published more than 50 books and book chapters and more than 250 abstracts and articles in such journals as the New England Journal of Medicine and the Journal of the American Medical Association .
The high mileage of 100 miles per week was over in almost 25 years before I go into triathlons. The last 10-15 years the mileage very rarely went above 40 miles. I was obviously younger with much faster times this is what makes the low mileage of 20-30 miles per week so frustrating. The weird thing with this latest injury is that I was injury free after my last run before the injury appeared and did not run for over 2 days and all of a sudden developed pain as I was headed to a meeting at work. I had no morning pain on the morning the injury appeared as well as the day before. This is what makes the stress fracture claim all the more confusing.