Marathon Training With Osteoporosis

Audio Transcript

Coach Haughey: Hi everybody. Today, we have a great question from Bobby Lynn.

Bobby Lynn: Hi, my name is Bobby Lynn and I live in Orlando, Florida, which of course is historically flat.

I’ve been a runner for about three and a half years and was doing extremely well,placing in my age category just about every race and having a great time with training.

Last fall, I developed a bone bruise after doing a running camp with my son’s team in the mountains of North Carolina and then came back to flat.

I probably didn’t take it easy enough and developed that bone bruise, spent about five months recuperating from that, slowly started running again and developed a second stress fracture in the other leg, and subsequently learned that I have osteoporosis.

I’m only 50. I eat very healthy, and like I said, I’ve been running for a couple years now and prior to that, I was always doing weight-lifting so I felt like my bones should have been strong enough.

My biggest question is I am running to train for my first marathon, and based on my half marathon times of 1:55, the last three, I should be able to qualify for Boston with my first marathon, which is a big goal for me.

With this latest development, does that mean that I shouldn’t or can’t really train for a distance that far, or can I run that far, just not at a pace to qualify for Boston?

I’ve been trying to do all kinds of research on osteoporosis and distances and training, and there’s very little that I have found. Any help on this subject would be greatly appreciated. Thank you.

Coach Haughey: First off, I just want to say I’m so sorry to hear about your condition, Bobby Lynn. I’m sorry you’ve been dealing with all these injuries; I know how frustrating that can be but I will say you’re certainly not alone.

A lot of people end up figuring out they have osteoporosis, either when they get a bone density scan done, which I’ll talk about in a few minutes here, or when worst case scenario, they wind up with a stress fracture like yourself.

Osteoporosis isn’t something you can feel coming on, unfortunately, but it does afflict a lot of people.

According to the National Osteoporosis Foundation, 55% of men and women over the age of 50, in the US, have low bone mass.

Clearly, this puts them at a greater risk for stress fractures and there are so many different factors that go into osteoporosis, whether it be genetics, or for women, their menstrual cycle.

There are so many different factors that I’ll touch on in a few minutes here. But again this can happen to absolutely anyone.

I think as runners, we feel like we’re almost immune to osteoporosis because like you said, we do a lot of weight-bearing exercise. Running, in and of itself,is a weight-bearing exercise and we live these really healthy lifestyles.

We eat well, sleep well, and do all the little things that we think are going to set us up nicely for our later years, but unfortunately again, there are just so many different factors that go into osteoporosis and bone density, that doing these things alone just isn’t going to guarantee that you’re not going to get osteoporosis.

Unfortunately some physicians believe that those who have a highly athletic lifestyle, like we do, might actually be at greater risk for osteoporosis.

This is an area of study that is developing. Osteoporosis among endurance athletes has not been studied extensively thus far, but it continues to develop and right now it seems that there are these two camps of thought that are almost diametrically opposed.

You’ve got the people that think that this athletic lifestyle, where you’re incorporating all these weight-bearing exercises, that’s really going to set you up nicely and help prevent osteoporosis, and then you have this other party that believe these are the things that actually contribute to your risk for osteoporosis.

It’s like what can you do? It seems there’s no winning here but again, I think both camps would agree that there are just so many different factors that go into your risk for osteoporosis, and I think that at the end of the day, we runners are doing ourselves a favor by incorporating all these weight-bearing exercises, and helping to strengthen our skeletal systems.

One anecdote that I want to include here, that demonstrates how this can happen to absolutely anyone, is a story about Bill Rogers.

If you’re not familiar with Bill Rogers, he is a former American record holder in the marathon. He’s also a four-time winner of the Boston Marathon, so he’s a very accomplished runner.

I had the pleasure of hearing him speak at a camp last summer, and during his talk, he shared with us a little bit about his experience with osteoporosis, which he was diagnosed with at the age of 55 or 56.

This is clearly a very accomplished runner we’re talking about here. He has continued running to this day,and has remained very fit.

Apparently, Bill, at the age of 56, was out for a run one day, and he felt a crack in his leg and it turned out that he had broken his tibia.

Bill ended up going in and getting a bone density scan done, determined that he had osteoporosis. He had very low bone density for his age and he was put in a cast, couldn’t run for six weeks and at the end of that six weeks, it turned out that his fracture had only barely healed.

It had made very little progress and so at this point his physician insisted that he start doing weight-bearing exercises again.

This is the interesting part to me that I think serves as evidence that weight-bearing exercise is good for those with osteoporosis.

It helps to strengthen the skeletal system and in this instance, facilitated recovery for Bill. He was able to heal much more quickly when he started to incorporate exercise back into his regimens. That’s the interesting part there.

I will say it obviously he wasn’t just throwing exercise back and alone. He was doing all sorts of rehab and his physician prescribed some form of bisphosphonate that is used to treat osteoporosis in men and post-menopausal osteoporosis.

According to Bill, this medication has helped him tremendously. It’s helped to strengthen his bones and starve off any future stress fracture.

I had the pleasure of running with Bill last summer, and he was moving at a pretty solid [clip 00:08:42] so I think the medication has definitely done its job.

I don’t want to talk too much about medication because quite frankly, I’m not a medical professional.

This is something that you’ll have to address with your doctor, but I will say there are a ton of medications specifically designed for women that help to mimic oestrogen, which is essential to building and maintaining bone mass.

These medications don’t have the same risks associated with hormone replacement therapy.

Women, as you’re probably aware, are more prone to osteoporosis and this has a lot to do with their oestrogen levels throughout their lifetime.

Again, oestrogen is essential to both building and maintaining bone mass throughout a woman’s life.

This is where a lot of things come into play here, because there are a lot of causes for oestrogen deficiency in a woman’s lifespan.

For instance, women who might have had infrequent menstrual cycles as a teenager or as a young adult,will naturally be at a greater risk for developing osteoporosis later on in their lives.

The same is true for women going through pre-menopause or even perimenopause, which can be anywhere between two to ten years before menopause.

During these stages, oestrogen levels naturally begin to decrease slightly and worst case scenario, a woman might end up with oestrogen deficiency.

This is where, as a result, your bone mass can begin to diminish slightly. Studies have shown that women between the ages of 35 to 50, this is typically that perimenopausal stage,will actually experience a 7 to 16% loss of bone mass.

This is where it becomes paramount, first and foremost, to get tons of calcium in your diet, even take a calcium supplement, and also of course, do some weight-bearing exercise.

These are both going to help minimize any sort of bone loss that you might experience during these stages, in your life, as a woman.

Bobby Lynn, it sounds like you’ve got these both covered fairly well. Unfortunately, I think chances are you might just be genetically predisposed to osteoporosis. This is where I think it’s really lucky that you have been incorporating weight-bearing exercises.

You’ve been running for the past three and a half years now, so this is really going to help. Just strengthen your skeletal system. It also sounds like you practise a very good diet, so you’re probably getting quite a bit of calcium in your diet naturally.

If you’re not taking a supplement already, I would definitely recommend you do that, and it’s advised that women take anywhere between a 1,000 to 1,500 milligrams of calcium daily, especially if you’re not taking hormones.

This is something I would want you to talk to your doctor about, and I think it’s important for women to monitor your levels, especially your calcium and oestrogen, but also your vitamin D because vitamin D is also essential to your skeletal system.

It helps to absorb and maintain calcium so that’s another vital one to keep track of.

It’s also important for women and men over the age of 50 to have a bone density test done. This is a type of x-ray, called a DXA, and this is the most accurate method for measuring your bone mineral density.

After getting this test done and getting your results back, Bobby Lynn, your doctor will be able to tell you if your bone mineral density is adequate enough to endure this stress of marathon training.

This is something that’s really important to you so consult your doctor about it and make sure that your doctor is aware of your goals, your aspirations of qualifying for the Boston Marathon, and I’m sure your doctor will be able to work with you on that.

I think the level at which you’re able to train might depend on that result.

There are a lot of things you can do within marathon training to still get the same benefits, and the same work in but not put quite as much impact on your body.

For instance, I think it’s quite fortunate that you live in a very flat area down in Orlando, so you’re not going to have the added stress to your skeletal system that comes with going up and down hills.

I will say it’s going to be really important for you to try and stick to soft surfaces. I know this might be hard depending on where you live. Most of us tend to gravitate towards concrete, and that’s a little easier for us to run on, but for you, it’s going to serve you well to stick to the grass as much as you can.

Stick to hard-packed dirt areas as much as you can, because this decreases the impact you put on your body and decreases your chances of getting a stress fracture.

There are a ton of successful athletes that are very injury-prone so what they’ll do is incorporate some alternative training methods or even just focus on sticking to soft surfaces.

For instance, I have a friend that is a very accomplished athlete. He runs for Nike and he’s broken four in the mile and he’s run on several US teams but this guy is very prone to stress fractures.

He keeps most of his runs to this 400 metre grass field, and I’m not kidding when I say this, he will do 16- milers on this grass field, which sounds like pure agony.

If you can find a good golf course or something of that nature to ensure that you are staying mostly on soft surfaces, that’s going to serve you well in the long run.

One more thing I’ll say is that another alternative training method would be to incorporate some cross training into your marathon build-up.

For marathon training, it’s really important you emphasize the long run and your marathon-specific workouts.

For the easy days in between, you can take out some mileage and replace it with some cross training.

For instance, awkward jogging or swimming are great alternatives to running, that still provide a really good aerobic workout but remove the impact of running.

There are tons of other cross training methods. For instance, you can get on the elliptical which works different muscular systems but it still produces a good cardio workout.

I would also say it’s important for you, Bobby Lynn, as well as women in general, to incorporate a weight-lifting regiment as well.

This doesn’t have to be anything too strenuous, but just something that’s going to help strengthen bones and muscles that aren’t strengthened through running alone.

What this is going to do is first and foremost help minimize bone density loss, and also equip your body with the strength it needs to do the mileage and intensity you want to do in your marathon build-up.

Thanks so much again for you question Bobby Lynn. I really hope I helped you out today.

Again, I would recommend you consult with your doctor, get a bone density test done and then from there, I think it will be perfectly fine for you to train at the intensity you want.

Realize that while you still want to emphasize your workout days and your long run days, you can play around with some cross training on the recovery days in between.

You can also replace some runs with maybe, jumping on the pool or getting on the elliptical, which will both help you build your aerobic capacity the same way an easy run would, but it will take away some impact and reduce your chances of getting injured.

I hope that helps you out Bobby Lynn. Your half marathon time is extremely impressive.

1:55 is certainly nothing to sneeze at, so I hope you end up making it to Boston and that you can remain healthy with some help from your doctor, as well as some of the tips I provided today.

If you haven’t already, please also consider heading on over to iTunes or your favorite podcast directory and subscribing or leaving us a review. This helps us reach more runners like you. Thank you so much and I hope you have a great run today.

Finally, sometimes, it can be nice to take in your surroundings and be left to your own thoughts on a long, quiet run. Sometimes it can be pure agony. I started running with music about a year ago and while it helps me get out the door and made solo runs more enjoyable, even music can get old especially when you’re exhausting your playlist every third run.

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