Bone Health - Male Osteoporosis and Running, 29 Years Old

Hi formerosteo -

Thanks for your detailed reply - this is very helpful. Did your insurance require you to try other forms of treatment before pursuing Forteo? Needless to say, with two FAI repairs already under my belt for the year, my insurance company basically already hates me haha...

Well, I ran quite a bit in college and for a couple years after (2007 - 2013), stopped for a few years and was just starting up last summer again when the hip injury became an issue. But yes, I have run moderate mileage (60-80 mpw) before for extended periods without bone injuries. I do wonder if bone density has deteriorated significantly over the past several years, but I guess there's no way to truly know. But yes, I also was doing moderately heavy (for me) lifting between 2012 and 2016. With the most recent labral repair only being done 4 weeks ago, I'm probably a few months away from getting back into any heavy lifting, unfortunately. But I will definitely ask my PT/surgeon when that is again an option.

Eat more yogurt.

No, they didn't require other forms of treatment. Some doctors may suggest bisphosphonates (Actonel, Boniva, Fosamax), but those are HIGHLY contraindicated for runners as they can make your bones more brittle. Make sure you check all your other levels (Vitamin D, iron, etc), as those can all play a role as well.

Me again - now 31 and worried. After 1.5 years of the ultra-conservative approach on this (basically dietary, vitamin D / calcium supplementation), my original hip surgeon order another Dexa. Spine t-score now is at -3.7. I don't have the full work-up in front of me yet but I'm told the scores in the hips only indicate mild osteopenia, however the spine score is obviously really bad... The doc basically messaged me to set up an appointment (july 10) and said that we will start treating this more aggressively now. Vitamin D score is now 48, which is the best that has ever been.

My question is - should I flat out ask to pursue something like Forteo? Would that be too forward? Maybe it's likely they will want to start there anyhow. I think getting my insurance to cover it is going to be difficult. Not sure if it's likely that we will first have to pursue bisphosphonates - I know it was previously mentioned in this thread that it's not a good idea given that I am a runner.

Last questions - for anyone that has taken Forteo - how much did the injections suck? It's hard to picture having to inject myself daily... Did you have any side effects?

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I think it is always worth asking. The doc might have a good reason for not recommending a treatment.

See a different doctor for an opinion of why your body is in the state it's in.

Sleep more.

Eat more.

Run less

Do some strength training (not sure how heavy you should go given your bone issues, maybe just bodyweight)

Might take a couple of years to get better. The key is not to expend more energy than you are taking in, that means managing your total load whilst prioritizing recovering. This isn't something you can half-bake, would definitely err on the side of caution.

Definitely ask. I was able to get my insurance to cover Forteo because my Z-scores were low enough. Miracle drug - didn't get a single stress fracture when I was on it and helped increase my bone density a bit. Unfortunately, you can only be on it for two years max.

If you don't mind me asking, what is your sex, approx age and insurance company? I know there are different rules for men vs. women seeking this treatment for Aetna...

Male 39 here , got diagnosed with osteopenia at 37 because my orthopedic surgeon put me in a dexa scan, because my tibia surgery fracture was healing to slow. My doc did the bloodwork found my Vit D level at 27 was way to low ,he said the key to this isnt a boatload of calcium, but take Vit D, Vit K, Calcium and go to the gym and lift, oh and eat healthy , good tot youre T levels to , its not 1 thing its a combination of things, and i still run 40 mpw , the only thing he said be carefull with lifting heavy above youre head youre spin could compress. Good Luck.

additional question for "hmmm yeah" - what were your t / z scores? thank you

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I am a bit older than you. I just turned 42. I was diagnosed with osteoporosis, but only affecting the trabecular bone, after a weird pelvic stress fracture in 2019. Have also been treated for hypothyroidism for several years. My TSH scores were extremely low in 2019 and, when the osteoporosis was diagnosed, my endocrinologist took away my T3 medication as a precaution. The link between my treatment for hypothyroidism and the osteoporosis is not clear although I struggle to believe that the hypothyroidism is totally coincidental. Anyway, I do not know about the treatment that you have mentioned. All I can tell you that I have been treated with a medication/supplement called Strontium and it has helped me a lot. To give you an idea - in 2020 the stress fracture is totally healed and, before catching Covid 10 days ago (which has forced me to take it easy, even though my symptoms are mild), I ran 42, 40, 42.5 and 45km on four Saturdays in a row in late May/June (training for a backyard ultra which I now can't do because of the Covid) without any problems. My most recent MRI (in May) shows excellent healing and zero edema.

During my recovery, I made a concerted effort not to go into an energy deficit for long periods of time, supplemented with calcium (because I am also not a big dairy fan) and kept my vitamin D levels above 50. That, combined with the Strontium (and also being conservative on the thyroid treatment) seems to have done the trick. I was also obviously very conservative reintroducing running - and even now I rotate with cycling on a trainer because I am reluctant to go too huge on running mileage. Everyone is different, but I would at least raise the possibility of using Strontium with your docs.

maybe stop with the strontium now then?

If your vitamin D is 48, I'd get that up as a first step.

I also believe it's unlikely to be dietary if you only restricted milk and nothing else, so please don't blame yourself for that.

I hope you are working with your doctors to find an effective solution.

If you haven't already, consider getting a decent water filter - one that leaves essential minerals in, but takes out the rest of the shiit.

I recommend this one:

https://www.amazon.co.uk/Epic-Microorganisms-Pesticides-Industrial-Pollutants/dp/B01FRRN9YY

I am interested that you say that because my doctor has suggested that I keep taking it for a while. Do you have reason to believe that it is harmful?