Forums >Health and Nutrition>Bone density and running
I have recently been prescribed Fosomax for osteopena. I am worried about the side effects it might have on running. I am a marathoner and have an intensive plan of races for the coming year and don't want to mess with my limited successes as a 65-year-old runner. Does anyone have any experience with this drug (or other treatments for osteopena? I was under the belief that running was great for bone density!
Thanks for your help!
SMART Approach
Short term risk is minimal but do your research on longer term risks. It may increase your bone density but will it reduce your fracture risk???In my opinion if diagnosed with only osteopenia, I would not recommend being on a bisphosphonate. This is what I recommend.
* Continue wt bearing exercise like running.
* Add more wt bearing exercise i.e. full body wt training.
* Be nutitionally sound sound. More than likely you need to supplement with certain nutrients that can be a challenge to achieve optimal levels via diet.
* Vitamin D3 at least 5000 iu per day and/or getting your blood level above 40 or preferrably 50.
* Magnesium at least 300 mg per day.
* Vitamin K2 (MK-7) 200 mcg per day. This nutrient is so crucial if you have osteopenia/osteoporosis and if you consume extra Vitamin D. It helps shuttle calcium to the bone where it benefits you.
* Protein. Get enough of it. So important for bone strength
* Calcium. If you eat dairy, yogurt, milk, cheese etc. daily, You don't need to add calcium. Rarely are Americans low on calcium. I think is recommended too much. Our bodies are full of it. Asian culture with low calcium inntake have very low incidence of osteoporosis but have high K2 in their diets because they eat a lot of fermented soy. You need to utilize calcium and other nutrient efficiently.
Do your research and then discuss with your physician and of course monitor your bone density. Good luck.
Run Coach. Recovery Coach. Founder of SMART Approach Training, Coaching & Recovery
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I have a lot of experience with this. I would not take that category of medication. The president of our local running club actually had the spontaneous femur fracture (just from stepping off of a curb) that is one of the possible risks of bisphosphonates. I took a bisphosphonate for awhile and it prevented the healing of a small fracture in my knee from a skiing fall. There are just too many risks and the jury is really out on the true benefits of the medication.
If you have really severe osteoporosis, Forteo is an option (not a great one, because it is a daily small injection and can be expensive) that I believe has fewer risks.
If you can delay taking meds, I would do so. Doctors are way too quick to slap patients on the bisphosphonates. I felt achy for awhile, too, on those meds.
Right now I am taking nothing. I did the 2 years of Forteo (broken up into 2 stints) which is the max and then tried another med that was a twice a year shot, but I didn't like how I felt after the first shot so I quit. My doctor was fine with taking a break and seeing what new meds are developed.
Out there running since dinosaurs roamed the earth
runktrun
I'll echo the above comments. From what I understand, the bisphosphonates slow down bone resorption, when osteoclasts break down old bone, but do not actively aid in bone building by osteoblasts...so bone density may remain "ok," but you're full of old bone cells. Tchuck can probably elaborate. I'm not familiar with Forteo, but sounds like it is potentially a better option.
Were you prescribed Fosomax because of a history of fractures (bone stress injuries/stress fractures) in conjunction with low T score? If you don't have a history of fractures, I would be super cautious about introducing medication.
Tchuck's suggestions are solid.
Not running for my health, but in spite of it.
Pace Prophet
I am in the same boat (though younger than you) and interested, too. I had two stress fractures 6 years apart, and a DEXA scan after each, showing a lot of bone loss in the intervening time - also my blood markers of bone formation/destruction were worrisome, and I just hit menopause. I'm seeing an expert in osteopenia and osteoporosis, and he suggested biphosphonates for me partly because of my age (54) - there are other types of medication that might be better for you, or possibly none at all if you're not having fractures.
He did say that it was a good thing I was a runner, because that probably limited my bone loss!
The nutrition information is good. D3 is the thing that was stressed to me as being most important.
justrundan
Many cases of osteopenia don't require treatment with prescription medications. There is an algorithm to determine fracture risk
FRAX, fracture risk assessment tool. https://www.nof.org/patients/diagnosis-information/risk-assessment-frax/
If that was not done, it should be before considering bisphosphonate therapy.
The atypical femur fracture risk is typically in those on the medication for >5 years. They are often stopped at that point and bone density and markers of bone turnover monitored.
Dan
^^ I know they say the risk is "typically" after 5 years of use, but just my personal anecdotal experience shows otherwise. Unless you are about to break a wrist from leaning too hard to get out of a chair, I would stay away from the bisphosphonates.
I am sure that personal anecdotal evidence seems compelling to the person whose experience it is, but population risk studies show a small risk of atypical femoral fracture, increasing with long-term usage, which is why monitoring and drug holiday periods are important. A quick google found a New England Journal of Medicine study citing 11 cases per 10,000 person-years of use. Which is a lot compared to the general incidence of atypical femoral fracture (AFF), which is estimated to be about 0.1 that rate at maximum and possibly less, but still, a small chance, especially with short-term usage. There also seems to be a correlation (from a 2015 study) with age and incidence of AFF, having to do with the deformation of the femur with age. In another study, usage for 2 years or less resulted in under 2 cases per 100,000 person-years, but usage for 8-10 years in 113 cases per 100,000 person-years. In yet another study, risk reduced 70% for each year after stopping biphosphonates.
Relative reduction in fracture risk for hip, vertebrae, and wrist ranges from 26%-90% as cited in several studies on the package insert information. For some of my own personal anecdotal evidence - I was given a 35% chance of fracture risk over 10 years. My vertebrae are what's showing the worst bone loss, which may be related to scoliosis and a herniated disk a few years ago. So I'd just as soon improve my chances of not breaking my back, and use biphosphonates for a measured and hopefully short period of time, before ether going on a drug holiday or changing to a different approach. YMMV.
I think these tools are a bit too broad for a running population. I started running in order to prevent bone loss due to early menopause caused by chemotherapy. My risk is still low, though, even though my femoral head T-score is -2.8. I maintain that being active and strong in order to prevent falls is as or more important than meds.
Suffering Benefiting from mature onset exercise addiction and low aerobic endorphin release threshold. Hoping there is no cure.