Monday, December 13, 2010

Cycling is bad for your health

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.

14 comments:

Michael Scott Long said...

It was hinted in the linked pdf presentation that standing while pedaling in high resistance might build bone density. Is that true? For some reason I love riding up hills in the highest resistance I can manage without falling over, as long as it's less than around 2000 ft climbing; otherwise my legs give out prematurely. I've gotten, by my judgment, strong that way. If it builds bone density, I have a ready retort to people who pick on me for this kind of riding. And, I hope your wrist heals up soon.

CB2 said...

I have a theory that riding a rigid singlespeed mountain bike offers more in the way for skeletal fitness.

Hill Junkie said...

I suspect both you guys might be on to something. I don't suppose either of you have ever been tested? I rarely have issues with my knees. Maybe I should gear my SS up a notch and hit the Cape more often this winter. Historically, I've been a spinner, not a masher.

My 68 year old mother just informed me that my BMD is lower than hers.

PatrickCT said...

Doug: You probably know this - if you decide to run, trails/grass are more forgiving as is running with a forefoot strike - & ease into it very slowly...

CB2 said...

I've never been tested.
Fractures are pretty rare in my family though. Other than my very minor fracture this year (the injury was more to the tendons), I think the only other fracture my family has seen is a bone in my Mother's foot 30 years ago.
I'm surprised about your vitamin D deficiency, sounds like your diet would be fairly rich with it.

rick is! said...

this is exactly why I initially started running a few days a week. thankfully I haven't broken anything in years (since before I really began to ride) but it still makes me nervous.

Alex said...

I think it was an article in men's health or something, a couple years ago, that had some suggested plyometric activities for cyclists. The author of the article had done some research, but he recognized that most cyclists don't like to run, and apparently, jumping was just as good. It might be worth looking into. Of course, it might also build too much muscle, and then you wouldn't win hillclimbs anymore...

Peter Minde said...

Doug,

As you noted, skiing/roller skiing is low impact; however these are still weight-bearing activities. Think about incorporating more roller skiing into your schedule during the summer. I agree with PatrickCT, trail running is a lot easier on the body than pavement, and ease into it. Good luck and let us know how you're doing.

Peter

Anonymous said...

It's tough to beat free weight squats as a weight bearing exercise. Putting a weighted barbell on your shoulders stresses your spine, pelvis, hips and legs. It can help your power on the bike and while skiing. You'd have to start out slow since your quads, glutes and adductors will need to get used to it. You can do them with one or two other exercises and make a little interval workout from it.

Paul said...

So, how do you convince your physician that you need a bone density test?

Hill Junkie said...

A sure way to to convince your PCP to order a bone density scan is to suffer frequent fractures. Else your insurance company might bulk. I suffered a serious "freak" fracture and have lost nearly an inch of stature in the last 10 years. These were enough for the doc to order up the test. Good thing. Better to know now than after I suffer a hip fracture.

TJ said...

Sorry, but your recent injury related posts have me thinking about playing video games more often...need some motivation this week, gimme something epic please!!!

Anonymous said...

Is running really all that bad? I would argue if you have only an hour and the weather stinks it is tough to beat.

Of course we all prefer to ride but occasional running can be enjoyable and beats the hell out of my indoor trainer in terms of a cardio workout.

Hill Junkie said...

I could dig trail running. I could reach all kinds of places I cannot on a mountain bike. Scenery moving by outside beats any kind of indoor workout regardless of weather in my opinion.

I had one minor foray into running a few years ago, but went into it way too hard with no idea of technique and immediately developed knee bursitis. I sense a restart is in the works.