Late 20s Male - Osteoporosis Causing Tibial Stress Reactions from Walking

Did they check your thyroid levels? Hyperthyroidism can cause osteoporosis and stress fractures.

Also did you make any changes to your running post collegic? Having no problems with stress fractures in college suggests but having a lot of them now suggests that you may be doing some differently that is conbuting to your bone injuries. Are you training differently? Running on different surfaces then you were in college? Running in different shoes?

Your story is similar to what I went through. After a lot of testing I found out that I had celiac disease. I was largely asymptotic but had intestinal damage that led to impaired nutrient absorption. They can use a blood test to initially screen for it. Do not go on a gluten free diet before being tested as it will interferes with the test.

Thank you for the responses -- really appreciate it.

No major differences to my training or shoes from college beyond lower mileage, which shouldn't be problematic.

I was screened for celiac's in both blood and 24 urine tests - both came back fine. No thyroid issues identified via labs with endocrinologist either.

Mango - would be great to hear more about your experience as it sounds similar (beyond the celiac's).

I suspect that low bone density in relatively young male distance runners is more common than most people -- and, indeed, most endocrinologists -- realize. And I think that's a significant problem. T-scores of -2.5 to -2.8 in a 29-year-old male are disconcerting, whatever the cause, and I doubt that merely tinkering with diet and weight-bearing exercise is going to resolve things.

A few quick questions (I have a flight to catch) -- What is your height/weight history? Where do you live, and are you in a position to travel outside your local area for testing, diagnosis, and treatment? Have you had thorough screening to rule out thyroid disorders?

I would seek out someone -- likely, but not necessarily, an endrocrinologist -- with extensive experience in treating relatively young males (ideally, males with a history of competitive distance-running) with very low bone density. And I would not be so quick to rule out medication. (In fact, I would be more inclined to rule out a medical professional who refuses to consider medication for a 29-year-old male with very low bone density.)

(I just saw your response to someone else's question about possible thyroid issues.)

I stopped growing at 6'2 around ~18. At that point, I was about 135 lbs (recognize that's very light). By end of college, weighed ~155 lbs. Stayed around 155 until I stopped running last May, and now about ~170.

Just checked and had calcium:creatinine ratio (24 hour urine), PTH (parathyroid hormone), magnesium, phosphorus, CMP, tissue translgutaminase, and endomysial AB all tested by endocrinologist - all came back fine. This set of tests was described to me as being fairly thorough, but let me know if anything appears to be have been missed.

I previously had full metabolic panel ordered by sports doc to check calcium, vit D, etc., which was all fine.

I live in DC and am able to travel for testing, diagnosis, and treatment. I would definitely welcome any recommendations for docs w/ experience treating young males with low bone density. I'm currently trying to see someone in the endocrinology department at Georgetown for a second set of eyes (also trying Johns Hopkins, but having a hard time getting through...)

Helpful comment on the medication. I wouldn't say anybody has refused to consider medication, but medication has been positioned to me as more of a last resort.

Avocado's Number - I see on another thread (

https://www.letsrun.com/forum/flat_read.php?thread=8463903

) that you ultimately went to the Mayo Clinic, where you finally figured things out. What was the process for getting an appointment there?

I've been told Johns Hopkins has the best endocrinology department in my area, but I've had no luck getting in there, so have to imagine it's even harder getting into a world-leading institution like the Mayo Clinic...

BadBones wrote:

Avocado's Number - I see on another thread (

https://www.letsrun.com/forum/flat_read.php?thread=8463903

) that you ultimately went to the Mayo Clinic, where you finally figured things out. What was the process for getting an appointment there?

I've been told Johns Hopkins has the best endocrinology department in my area, but I've had no luck getting in there, so have to imagine it's even harder getting into a world-leading institution like the Mayo Clinic...

Just saw your latest posts.

To get an appointment at the Mayo Clinic (the original one in Rochester, Minnesota), I filled out an application, setting forth my relevant medical history and issues. It was surprisingly easy. (I think it was only one page long, with no referrals and probably no attachments required.) At some point, I received a letter accepting me as a patient. I was scheduled to spend a week at the Clinic for tests and appointments, during which I stayed at the hotel across the street. Because the issues in my case implicated quite a number of possible problems in various areas, my initial appointment was with an internist who went through my whole medical history and set up appointments and tests over the next few days. It is an extremely efficient operation. (As a totally unexpected "bonus," a suspicious mass in my bladder was spotted during a scan of my kidneys. Turned out it was cancerous. But it was surgically removed at the Clinic just two or three days after it was first spotted, and there's been no recurrence in the years since.)

The Mayo Clinic is an incredible place. But before I went there, I was also fortunate to find a professor emeritus at the University of Colorado, Dr. Paul Miller, one of the country's foremost experts in the treatment of osteoporosis, who has dealt with many cases for low bone density in athletes. He has been my main treating physician throughout this process.

If you're so inclined, I'd love to hear how things go. My sense is that low bone density among male distance runners is very much underreported.

Thank you! This is incredibly helpful.

I'm going to look into seeing Dr. Miller and the Mayo Clinic and will follow up here to let you know how it goes.

Are you a heavy drinker? Maybe I'm way off the mark with you but I have to ask seeing as alcohol can be a heavy calcium blocker.

If your taking a Calcium Supplement-STOP. If your taking D3 that's over 800IU STOP.

I don't mean to come across as an order of absolute but your Dairy intake could be covering your needs but when combining with Can and VitD supplement your creating an environment for bone mineral loss. The labs are always a range and don't allow accuracy because of no comparison to what you were at during healthy years.

When you are taking dairy, vitD, Ca your setting up for a copper, zinc, and Magnesium Deficiency. You'll have to Google it but there was a recent study about women with lower Calcium But high Magnesium not having Osteoporosis. This protocol would definitely not hurt: 1.) Absorbable Multi like Men's Garden of Life, this will make sure your getting proper ratios of Copper, Zinc.

2.) Magnesium Glycinate 400mg this is the best Gut friendly form. 3.) Boron 3mg/2xday. This trace mineral is the driver for all the minerals, zinc, mg, Ca to go into the Bone and mineralize.

To really be proactive I would limit my food Calcium to 400mg Again theres another article out there about Americans unbalanced Ca to Mg ratio.

*I use this supplement regimen with success. I have had tibial (both) Sfx, toothaches, tendonitis. During the Sfx I upped the Mg to 600. Calcium is good and necessary but it gets incomplete at best at worst without the mentioned co factors you'll have stress reactions, high blood Ca, list goes on

Dude, you’ve got a mild case of osteogenesis imperfecta. Go see a geneticist and then a better endocrinologist.

Alcohol use has come up in discussion with my doctor and endocrinologist - I've always been a social drinker, but not to the point that any doctors thought was problematic. Just to be sure though, I've cut down drastically the last several months (

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Alcohol use has come up in discussion with my doctor and endocrinologist - I've always been a social drinker, but not to the point that any doctors thought was problematic. Just to be sure though, I've cut down drastically the last several months (

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Alcohol use has come up in discussion with my doctor and endocrinologist - I've always been a social drinker, but not to the point that any doctors thought was problematic. Just to be sure though, I've cut down drastically the last several months.

Really interesting suggestions on supplementation. Magnesium and Boron sound like good ideas that can't hurt, and I'm going to do some more research into problems with excess calcium / vit d as that runs counter to the conventional wisdom (though appreciate that conventional wisdom isn't always right).

One thing I haven't mentioned: I found I was mildly lactose-intolerant in late high school and cut dairy out completely from ~18 through ~25. I slowly reintroduced dairy a few years ago after I found it wasn't giving me problems, which is around when the bone problems started. Doctors haven't thought that was a problem, but I wonder...

I've come across Osteogenesis Imperfecta, but think my medical history rules that out as it is usually early onset (before puberty).

Really appreciate everyone's input here. I've done a ton of research already, but this is all super helpful. Trying to stay optimistic and not let this become my new normal.

As an update here for those interested:

Pain in tibia has continued, so ended up going back to my Sports Doc about a month ago, who suggested ~4 weeks non weight-bearing. Also started Orthofix ultrasound bone stimulator (3 hours/day), and revamped my supplement routine to include good multi-vitamin including copper and zinc (went with the Garden of Life recommendation above), boron, Cal/Mag/Vit D, and Cissus Quadrangularis (a few on here have suggested for bone health and read some interesting studies showing it can help - figured it wouldn't hurt). Have continued to keep diet good otherwise and limit alcohol. Using ice cup 2x/day to help w/ pain.

Doctor also prescribed a bone scan to get another look at things, and interestingly, that just came back totally fine (no abnormal uptake in either tibia). For reference, MRI last May showed "minimal periosteal edema along anteromedial aspect of cortex of tibial shaft" but symptoms improved over ~6 weeks w/o crutches, and MRI in March showed "endosteal bone marrow edema in mid to distal tibia compatible with stress reaction. No discrete fracture or periosteal reaction."

I'm starting to transition off crutches, but unfortunately still get an aching/swelling feeling in my tibia on a fairly regular basis, which is puzzling given Bone Scan results. Trying to figure out if I should push through the pain or stay off of my leg until symptoms go away completely. Seeing my doctor late next week and hoping to get to a few days of no crutches before then so we can see how that goes and discuss. I know the non-weight bearing isn't going to help increase my bone density in my tibia, but also don't want the tibia pain to get worse, so feel like I'm in a tough spot there.

Also made an appointment with Dr Paul Miller in July (appreciate the recommendation!) , so hoping to get a perspective on a longer term approach for the bone density issue, as most of my treatment now is focused on getting my tibia pain resolved.

Any thoughts on why the pain has continued despite the bone scan being fine? I know phantom pain is common for stress fractures, but this is non-weight bearing pain and feels similar to the pain I had with the initial injury.

Really appreciate everyone's input here. Would love to get back to running one day, but for now just want to get back to day-to-day activities pain free.

Bump + update:

Had follow-up w/ my Sports Doc last week. While Bone Scan was completely negative, he wants me to take my time returning to weight bearing since I'm still having some symptoms, so going to transition off crutches over next two weeks. Fortunately, leg is starting to feel a bit better, so I'm optimistic.

Still need to figure out underlying bone density issue, so looking forward to meeting with Dr. Miller in July. Will post an update after that for anyone that's interested.

Just read back through this thread - I feel for you. I'm female, but have dealt with similar bone density issues (I do have a history of disordered eating though).

A few things I can offer:

- by bone scan, do you mean CT? If so, that makes sense - CT scans won't show stress reactions or edema, just fractures. MRIs are the gold standard for edema (I learned this the hard way after several negative CT scans)

- I spent two years on Forteo - GREATLY improved by bone density scores. And I was fracture-free for the two years on it. Unfortunately, after I came off of it, the fractures started again. And it's only FDA approved for two years, which is frustrating. But if your insurance covers it, I'd look into it.

Best of luck - keep us updated.

Thanks for the response, roughhand, and sorry you've had to deal with this as well.

A bone scan is different from a CT scan (

https://www.mayoclinic.org/tests-procedures/bone-scan/about/pac-20393136

). You're injected with a radioactive tracer and have imaging done a few hours later to see how your bones uptake the tracer. My understanding is that it's more sensitive to bone injuries than MRI, but less specific. My understanding from my doctor is that any clinically significant amount of edema should show up in the bone scan. Fortunately, my symptoms in my tibia seem to be resolving (albeit slowly) as I transition off crutches so it may be a moot point.

I'd love to hear more about your experience with Forteo if you're willing to share. What was your age and fracture history when you started? Did insurance cover it? Any side effects? Were you able to travel with it? Now that you've stopped, are you going on other medication (e.g., biophosphonates or denosumab)?

Thanks!