joevella

hate to ask for advice, but here goes..
my physiotherapist tells me I have to give up cycling ( my doctor didn't say that however.. )
I told her I wouldn't and she isn't happy.

I'm 46 with acutely severe osteoporosis above the waist and moderately severe below the waist.
( "I don't have the bone structure of a 75 year old man" to hear my doctor tell it..)
This is recently diagnosed, by bone scan - but still have the endochrinologist to see.
I do exclusively time trialling, and a bit of riding with the fam on my cross bike.
The physio thinks the time trialling posture is going to shatter my lower spine.
what would you do? I'm hoping that weight bearing excercise and appropriate supplements will allow me to rebuild my upper body at least to let me continue cycling and maybe get me off fosamax, or is that a dream?

1centaur

Can't tell you about positioning, but research strontium and choose calcium citrate over other forms. Recently did the Google thing on osteo re: Fosamax et al and it was not encouraging - Strontium looks better but the person for whom I researched got hives from it. No reference to that is on the Web.

edbikebabe

Ever read Fat Cyclist? www.fatcyclist.com His friend Kenny has osteoporosis & still rides road & mountain. Maybe you could email him to get some first-hand info....

jrobe

You undoubtedly will need long term medical Rx. Biphosphonates (ie. Fosamax) are generally the treatment of choice but your own MD should decide this.

You also should probably consider a more balanced exercise regimen with some days of weight bearing exercise and maybe some weight lifting work. Exclusive cycling (esp in time trial positioning) is probably not in your best interest but you shouldn't have to give it up entirely. You might actually time trial better with a more balanced workout regimen.

For what it is worth, I am an Internal Medicine MD.

joevella

Yeah - I'm on fosamax with some side effects, and some other drug to alleviate those, a bit anyhow.. That's why I suggested the physio clinic to my MD, to get started on some bone building excercise. I definitely am not adverse to a balanced excercise regime - I'll work like a turk if It'll get me off the fosamax.

jrobe

If you are having gastrointestinal side effects from Fosamax (most common side effect), there are alternative biphosphonate treatments. Ask your doctor about Boniva which can be taken orally once a month (but still with some risk of GI side effects) or as an every 3 months IV injection (no GI side effects as it bypasses the stomach). There are also some people using Zometa as a once a year IV injection. I frequently switch people to IV Boniva if they can't tolerate oral Fosamax.

Getting off drugs is not likely though - your real goal is to avoid future problems with osteoporosis.

R900

In addition to any Rx, CROSS TRAIN.

Bontrager

I remember from a cancer CME they were advocating in addition to bisphosphonates high doses of calcium and vitamin d.

joevella

Thank you - I will ask about that.

neusaab

Joe, great advice across the board, except perhaps the strontium bit. As an internist as well, I completely agree with jrobe. From your description it is unlikely you'll get off the Fosamax or its equivalent any time soon. However, one of the questions being answered right now is just how long you need to take the drugs--a finite period of xx years, or a liftetime? The trend appears to be toward the former; film at 11.

I disagree with the idea that you must quit cycling. The tt position is indeed stressful, especially to your lumbar spine, but it won't guarantee you fracture a vertebra. It would probably increase the risk overall, though. How much? I'm not aware that anyone has studied that particular problem.

All that said, I think you should consider spending more time, relatively, riding more upright, with a traditional road geometry, or better yet, a little higher than that on a "plush bike." You should be able to get your competitive juices flowing in races other than tt's, I hope. And clearly you would benefit from mixing in some weight-bearing exercise like walking, hiking/hill climbing etc. Remember too that cycling does involve some weightbearing, especially if you are a nut job like me, love to climb, and spend a lot of time standing.

Good luck.

CharlieWoo

Does a TT position really put that much stress on a spine?

michaelmc

I think that translates to an Rx for a new Specialized Roubaix!

joevella

The funny thing is that I hike with my 4 year old on my back ( even up and down cliff faces ) - have done with each of my 4 kids till they got too big, that will be next summer for this guy.
I do a lot of training on my bianchi cross bike with eggbeater pedals and the baby seat over the back wheel and my 4 year old. He brings his radio, some toys and keeps me company. Tugs on my shirt, pats my back, talks about the stuff he sees, and we are in a very hilly area that many cyclists come to for training - only thing is that I always climb from seated ( it's a TT thing ). I go on long walks with my wife.. I suppose I just don't understand why the excercise I have been doing hasn't been enough to keep ahead of the bone building - but I suppose Lactose intolerance doesn't help...
in any case, thanks for the props guys.

neusaab

Joe, you must have some other risk factor or predisposition to develop osteoporosis. It will be good to follow up with the endocrinologist.

It sounds like you are doing some good cross training with weight-bearing exercises. It will be important to increase the relative proportion of those exercises.

joevella

Will do. I see the endo on oct 30 - too far in the future for my liking, but there you go.

Nachoman

Or maybe just increase the intensity of the weight bearing exercises.