I scored a double feature at the doctor's office today. My wrist was so sore this morning I could not brush my teeth, dress myself or turn doorknobs. I'm a righty and I landed hard on my right arm when I back flipped on black ice yesterday. So for about the third time in a month (leg, bone scan, and now wrist), I was on an X-ray table again. I joked with SteveG at work that I need a punch card, so I get every fifth X-ray free. Salem Radiology certainly knows me now.
I have to wait for the radiologists to look at my wrist images, but the tech let me peek, and to our eyes, there were no obvious fractures. A fractured scaphoid would have been a disaster, as those require 12 weeks cast time and usually a screw. My son is mid-way through a scaphoid fracture recovery. No fun at all.
So what was the double feature? The bone density results were in. I kind of already knew what to expect, as the X-ray tech shared what the machine was indicating last week. My bone density is low. The first chart below shows my measured results. Ideally, I should be in the middle of the blue zone for 48 years old. The blue band is the normal range. Note it kinks downward with age, as after a certain age, we all loose bone density.
The next chart draws conclusions from the measurement. My spine and right hip are moderately low density, and this places me at moderate fracture risk. My left hip has low bone mineral density, and this places me at high fracture risk. In fact, my left hip is getting pretty close to the osteoporosis threshold. My condition is medically called osteopenia, which is basically pre-osteoporosis. Some people, mainly those from alternative medicine disciplines call osteopenia a disease that was invented to sell drugs. Others claim it is nothing more than low side of normal. But still, there's no getting around that my BMD is about 20% below average for my age.
My doctor said I was a most interesting individual. I had a pretty big difference between my left and right hips. He pondered why this would be. I had a ready answer. I spent a big chunk of the summer zero weight bearing on my left leg. Thus that hip atrophied while my right hip held its ground.
The doctor said there were two ways to go about dealing with this - drugs or physical activity. I have no interest in taking BMD enhancement drugs. Some very scary things have surfaced with those recently, some horrific side effects. I have to work more weight bearing activity into my weekly routine. He did not recommend running, although from what I read, it is one of the surest ways to stave off bone loss. Not sure what my plan will be yet. It is ironic that I went out for a hike Sunday for the purpose of getting more weight bearing activity, and that very thing sent me to the doctor the next day. Just can't win. The doctor recommends simply walking. Wonder how much I have to do to make a difference? I have a year before a follow up scan to check progress.
So could low BMD in my hips and spine have been linked my ankle fracture in May? Maybe weakly. I bet having little lateral stability in my ankles had more to do with it, since I do so little weight bearing work. In 2008, a study was published by the University of Missouri comparing BMD of cyclists and runners. The cyclists were 7x more likely to have osteopenia than the runners! This included subjects in their 20's. There's a saying out there in the elite ranks that you should rest when not riding, sit if you don't have to stand, and lie down if you don't have to sit. This rules out any kind of impact or weight bearing on the skeleton. I do ski in the fall and winter, but this is very low impact. Studies have shown that high intensity resistance training can also maintain bone density. There's a nice summary of Bone Health in Cyclists here. I not only need to curb the loss, I really need get my BMD back into the normal range. The risk of my activities is compounded by low BMD. Crashing in a road race entails increased risk. Mishaps happen all the time riding off-road. Even XC skiing sees its share of fractures in races.
There are other factors too, the doctor didn't discuss. There's some evidence out there that high intake of processed carbs and animal protein can result in bone mineral loss. I eat lots of both. Additionally, high coffee consumption has been shown to interfere with calcium absorption. I've always been a big dairy products eater, so I doubt I was ever deficient in calcium in my life. I do think I could have been vitamin D deficient in winter months though. The doctor advised me to take a D supplement, which I have been since my fracture. Calcium cannot be absorbed unless vitamin D levels are adequate. So do I have the will power to shun Starbucks? I drink three cups per day, essentially grande sized, and very strong. This might be equivalent to six regular cups of fast food chain or Dunkin Donuts coffee per day.
So one can focus on cycling, podium masters road races, even win a hillclimb championship series, but still be in pretty pathetic shape overall. It is cruel that what can be so kind to your joints and help you achieve incredible cardiovascular fitness, can also leave you woefully out of shape in many other ways. I've started addressing some of the core deficiencies, now it's time to take the next step (literally) to address BMD deficiencies.