# Bone Density Drugs Anyone?



## venus1 (Aug 4, 2006)

Boniva anyone? How may of you take a preventative osteoporosis treatment? My GYN doc wants me to start. Instructions say you must stand for 1/2 hour after to avoid reflux damage to the esophagus. Gees, is this like drinking Drano or what?


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## LadyDi (Apr 17, 2005)

Not on 'em, at least not yet. You're right to research this issue before beginning such a regimen. Those meds can be *very* hard on the system. What good are strong bones if you lose your esophagus? Genetics, diet, age and lifestyle play major roles in the later-life development of osteoporosis. We can't control certain factors, like our gender (obviously), but we can take charge of our diets and our lifestyles. Women like you, who partake of regular load-bearing & spine-jarring workouts, have higher bone densities than the average sedentary gal. Have you pointed this out to your doctor?

My major vice is Diet Coke. Oh man, I've tried to kick that habit so many times and I KNOW it's bad for my bones.


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## connie (Mar 16, 2004)

Is this recommendation based on a bone density test or just a random "you're a woman so you need it" thing? Sounds pretty insane to take something like that unless you're really having problems.


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## brg (Sep 7, 2004)

*luckily i have dense bones...*

I do have friends that are very active (rock climbers/bikers) in their mid-to-late 30s and have Osteopenia - but I don't recall them mentioning getting on any drugs as of yet - just doing weight bearing exercises and taking calcium .

I did a bone density test and my density was healthy for a woman 20 years younger (i'll be 46 this year)

i think it was because I grew up on a farm, we had milk cows so that's were we got our milk. kinda gross now that i think about it. And *why* do cows have to be milked @6am - i never understood that!


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## Homegirl (Jul 28, 2006)

My doc put me on a mega dose of Vit D because I was pretty close to defecient according to blood test. Supposedly it helps your body to absorb calcium and alot of people are defecient. I am 34.


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## Merdoff (Jul 1, 2005)

Lady Di is correct that weight bearing exercies are usually highly recommended for retaining bone density, however, if I recall Venus used to competively body build. Alot of women in that industry keep their body fat levels in a very low range, sometimes in the single digits for extended periods of time which wreaks havoc with your estrogen levels, which can significantly decrease bone density. 

Venus, I would really research on that drug before even thinking of taking it, those side effects sound frightening. There must be better alternatives.


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## The Squeaky Wheel (Dec 30, 2003)

Venus,
Complicated question you ask. Allow me to clarify a few points:

Boniva belongs to a class of medications called bisphosphonates which includes Fosamax & Actonel, among others. These medicine "may" cause esophogeal problems but they are uncommon due to infrequent dosing. When Fosamax & Actonel were first released they were dosed daily which cased lots of problems. Yes, esophageal problems can occur, but again, they are not common if taken according to direction.
In my experience bisphosphonates are among the most well tolerated medicines but they are not for everyone.

The decision whether or not you should take this medicine is far more complicated. I'd be happy to lend you my free internet advice but I'd need A LOT more info such as:
- age
- age of menopause
- DXA (bone density) score
- any history of fragility fracture?
- weight
- family history of osteoporosis in 1st degree relatives
- smoker?
- drinker?
- ever take corticosteroids, anti-seizure meds or blood thinners
- how much calcium (mostly in the form of dairy or supplements) and Vitamin D are in your diet
- other health problems?
- history or anorexia or irregular menses


As you can see, this isn't a black or white issue.


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## Impy (Jan 6, 2004)

As a physician who used to run an osteoporosis clinic, I'd advise getting a second and careful opinion.

The problem is not the drug itself, as squeaky has pointed out, if you really need it. The problem is starting something with lots of uncertain long term side effects especially in someone young & super active with lots of bone stress / remodeling who may not need it. Long term data is just now starting to come in.

It is important to realize that some women never get "normal" bone density. A doc who is just treating your T score and not looking at the entire picture isn't doing you any favors.

Here's a personal example:
I scanned myself a few years ago at 31 for kicks and was shocked to learn I was osteopenic with a t score of -2 (2 standard deviations below the mean of young healthy women/max bone density). I was too young & healthy to have lost bone, so it's clear that my bones are & always have been thin compared to the mean. What does this actallly mean? I haven't had any fracture so far so I'm not super worried. I know that I can expect to be losing bone now if I follow the pattern of most women, with an acceleration after menopause. So I take my calcium and keep with exercise. If I get rescanned around menopause, and it says -2, I'm going to think I'm doing pretty darn well. If it says -3.5, pass the boniva.

Get a real second opinion, or a compelling explanation from your doc.


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## prozac_boy (Oct 5, 2004)

btw, just want to clarify that you DON"T have to STAND upright for 1/2 hour. Just don't lie down during that time so that gravity can pull the pill pass the oesophagus quickly.


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## The Squeaky Wheel (Dec 30, 2003)

Impy & PB are correct.

Impy, one point of clarification: Use Z-scores, and not T-scores, in premopausal women and men under the age of 65.


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## Impy (Jan 6, 2004)

The Squeaky Wheel said:


> Impy & PB are correct.
> 
> Impy, one point of clarification: Use Z-scores, and not T-scores, in premopausal women and men under the age of 65.


Z scores ARE the T scores in that population I was referring to (young healthy women) as I am sure you are aware.

I refuse to get into men and dexa scans, since the NOF definition of osteoporosis is based on women's data and the nuances of that complex discussion are just not appropriate for this forum - we will bore people away.


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## The Squeaky Wheel (Dec 30, 2003)

Impy said:


> Z scores ARE the T scores in that population I was referring to (young healthy women) as I am sure you are aware.
> 
> I refuse to get into men and dexa scans, since the NOF definition of osteoporosis is based on women's data and the nuances of that complex discussion are just not appropriate for this forum - we will bore people away.


Statement #1: not necesarily. Depends on the age of the woman. The NHANES database used 25-30 year old white women. I've seen 40 year old pre-menopausals where T does not equal Z. Unfortunately I'm seeing way too many women in this population who are taking aromatase inhibitors as adjunctive treatment for Breast CA. But I digress......

Statement #2: Agreed. But NOF is only one reference among several and BMD disease in the >65 year old male population is underrecognized & undertreated. Expect to hear a lot more about this population in the near future from ASBMR, ISCD & others.

But in general, I agree with you and now we're talking minutae - which is where the excitement lays for boneheads like us :thumbsup:


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## pixy (Nov 8, 2005)

My husband who is a serious mountain biker, has been on fossamax for 1.5 years. He does the once a week formula, sits and watches TV for an hour after, and has never had any side effects yet. I too am uneasy about him taking the drug. I hear there is some strange side effects with dental surgery also. According to his doctor, there is more to diagnosing osteopenia than reading one score. Analyzing the scores from different parts of the body separately, history and lifestyle were all taken into account.

Unfortunately, it took my husband breaking many bones including his hip, to find out that there was something wrong with his bone density. Currently he has quit drinking, eats tons of leafy greens, takes calcium and is trying to continue riding as much as he can before he faces a hip replacement.

I too would recommend a second opinion. As a mountain biker, this is a seriuos issue, as we all take falls out on the trail now and then. 

Ellen


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## The Squeaky Wheel (Dec 30, 2003)

Pixy,
Glad to hear hubby is on the right track.
2 out of 3 men have a secondary disease causing their osteoporosis (that stat is 1 out of 3 for women). Please be sure to discuss a secondar osteoporosis eval with his physician. It would be a shame for him to be on Fosamax when something under the surface is driving his bone density loss.


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## Crockpot2001 (Nov 2, 2004)

The Squeaky Wheel said:


> Pixy,
> Glad to hear hubby is on the right track.
> 2 out of 3 men have a secondary disease causing their osteoporosis (that stat is 1 out of 3 for women). Please be sure to discuss a secondar osteoporosis eval with his physician. It would be a shame for him to be on Fosamax when something under the surface is driving his bone density loss.


This has been some very interesting dialogue. For both my personal and professional interest (I am a dietetic intern) what would be some primary factors outside of caffeine, sodium, protein, and renal insufficiancy that would contribute to low bone density. 
I am male with osteopenia as indicated by a full DEXA but it is restricted to my extremities such as my arms and legs. My spine is built like a tank.

Regards,
Crockpot


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## The Squeaky Wheel (Dec 30, 2003)

Crockpot2001 said:


> This has been some very interesting dialogue. For both my personal and professional interest (I am a dietetic intern) what would be some primary factors outside of caffeine, sodium, protein, and renal insufficiancy that would contribute to low bone density.
> I am male with osteopenia as indicated by a full DEXA but it is restricted to my extremities such as my arms and legs. My spine is built like a tank.


The #1 cause is Vitamin D deficiency which is almost epidemic in the US.
#2 is calcium deficiency.

From a dietary perspective, aside from the calcium & Vitamin D, you pretty much nailed it. High intake of carbonated beverages, due to the phosphate load, seems to also be a contributing factor but we really haven't been able to define how much phosphate, or caffeine for that matter, is "too much." I generally use the 2-3 servings general rule of thumb for both caffeine & carbonated beverages.

The list of diseases contributing to bone mineral density loss is vast. For your interest, Gluten Enteropathy (celiac sprue) and post-gastrectomy (weight loss surgery) malabsoprtion are very common culprits. Our weight loss surgeon vigorously checks Vitamin D levels regularly. Other diseases include testosterone deficiency (obviously male only but very common), various inflammatory rheumatic diseases, malignancies, renal & hepatobiliary diseases, endocrine diseases (diabetes, hyperthyroidism, cushings, etc), hereditary disorders of collagen & bone, among others. The list goes on & on and is really beyond the scope of MTBR.


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## The Squeaky Wheel (Dec 30, 2003)

PS. I really should hang out more in the Ladies Forum. This place is rocking !

:thumbsup:


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## connie (Mar 16, 2004)

The Squeaky Wheel said:


> The #1 cause is Vitamin D deficiency which is almost epidemic in the US.
> #2 is calcium deficiency.


So is the Vitamin D deficiency problem in the US basically stemming from a lack of getting outside enough (exposure to sunlight)? I mean, since natural sources of Vitamin D are what - fatty fish, eggs, and shiitake mushrooms... Though I personally eat them a lot, I can't imagine the human body was designed to need to eat those specific things or especially fortified foods. Seems like it was more designed to get some sunlight and create it on its own.


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## The Squeaky Wheel (Dec 30, 2003)

connie said:


> So is the Vitamin D deficiency problem in the US basically stemming from a lack of getting outside enough (exposure to sunlight)? I mean, since natural sources of Vitamin D are what - fatty fish, eggs, and shiitake mushrooms... Though I personally eat them a lot, I can't imagine the human body was designed to need to eat those specific things or especially fortified foods. Seems like it was more designed to get some sunlight and create it on its own.


In a nutshell...yes.

No sunlight = Vitamin D deficiency......but less skin cancer


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## Impy (Jan 6, 2004)

The Squeaky Wheel said:


> Statement #1: not necesarily. Depends on the age of the woman. The NHANES database used 25-30 year old white women. I've seen 40 year old pre-menopausals where T does not equal Z.


My example was one healthy 31 year old woman in my example , if you read carefully.


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## deanna (Jan 15, 2004)

Impy said:


> Here's a personal example:
> I scanned myself a few years ago at 31 for kicks and was shocked to learn I was osteopenic with a t score of -2 (2 standard deviations below the mean of young healthy women/max bone density). I was too young & healthy to have lost bone, so it's clear that my bones are & always have been thin compared to the mean. What does this actallly mean? I haven't had any fracture so far so I'm not super worried. I know that I can expect to be losing bone now if I follow the pattern of most women, with an acceleration after menopause. So I take my calcium and keep with exercise. If I get rescanned around menopause, and it says -2, I'm going to think I'm doing pretty darn well. If it says -3.5, pass the boniva.


This has all been quite interesting! Due to my frame size, I'm technically in a "higher risk" group than others... A few years ago my employer was paying for bone density scans for anyone who wanted, I figured since it was free... why not? If it's low, it's best I know to perhaps take steps to prevent it from getting worse.

Anyway, I scored a +1.6. Highest density out of everyone tested that day. So I guess I'm doing ok via genetics (no history of osteoporosis in any of my relatives), and consuming calcium + vitamin D in the foods I eat as well as supplements. Being an active person who regularly does "weight bearing exercise" could be helping too. Also explains why it takes me so long to learn things at times... thick skull!


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## formica (Jul 4, 2004)

...while we are on the topic, what are some recommended kinds of calcium supplements? I do not eat a lot of dairy. I've gotten so confused over which kind of what to take that I end up taking nothing.

formica


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## The Squeaky Wheel (Dec 30, 2003)

formica said:


> ...while we are on the topic, what are some recommended kinds of calcium supplements? I do not eat a lot of dairy. I've gotten so confused over which kind of what to take that I end up taking nothing.


Good question. There are tons of preparations out there each touting why theirs is the "best."

The truth of the matter is that, in general, it doesn't matter.

Calcium citrate is preferable for people with gastric problems because it is better absorbed under certain situations which I won't get into.

I don't recommend "shellfish" or "oyster" calciums as there have been reports of high lead levels due to polluted waters.

For premenopausal women, shoot for 1,000-1,200 mg of calcium daily. One cannot absorb more than 500mg at a time so take in divided doses WITH food to maximize absorption. Your average dairy serving has 250-300mg of calcium so you can do the math and figure out what you need. For postmenopausal women the goal calcium intake is 1,500mg daily.

I recommend 1,000 IU of Vit D daily, preferably in the form of D3 (cholecalciferol) as opposed to D2 (ergocalciferol). Unfortunately the US RDA for Vitamin D is low at 400 IU for adults and I see lots of Vitamin D deficiency at that intake. Overdosing on Vit D is a very minor concern and rarely, if ever, occurs at daily intakes less than 10-20,000 IU daily.

See here on Vitamin D for more info: http://ods.od.nih.gov/factsheets/vitamind.asp

In general, I'll recommend OsCal wit D, one tab three times daily with meals and then have the person take an additional 400-1,000 IU of Vitamin D as the situation merits.


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## Jewell of D(enial) (Apr 25, 2005)

The Squeaky Wheel said:


> Good question. There are tons of preparations out there each touting why theirs is the "best."
> 
> The truth of the matter is that, in general, it doesn't matter.
> 
> ...


Alot of good info here. Thanks Squeeker. I have low bone density (at least in my spine)as my dexa tells me so. I'm under 30, fit, active and do quite a bit of weight training. So of corse I was frustrated. I'm not doing anything much different since I had the dexa, just taking random calcium supps, which probably isn't doing all that much good (since I'm not taking it consistantly, timely, with food, twice a day, with vit D, etc...). Thanks for the above recomendations. I'll have to give it some thought. 
p.s. I'm also IDDM with a history of eating disorder/s so maybe that plays a part as well?
Julee


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## The Squeaky Wheel (Dec 30, 2003)

Jewell of D(enial) said:


> Alot of good info here. Thanks Squeeker. I have low bone density (at least in my spine)as my dexa tells me so. I'm under 30, fit, active and do quite a bit of weight training. So of corse I was frustrated. I'm not doing anything much different since I had the dexa, just taking random calcium supps, which probably isn't doing all that much good (since I'm not taking it consistantly, timely, with food, twice a day, with vit D, etc...). Thanks for the above recomendations. I'll have to give it some thought.
> p.s. I'm also IDDM with a history of eating disorder/s so maybe that plays a part as well?
> Julee


Julee,

In short, Yes. Your IDDM has likely contributed to decreased bone mass. The reasons for this are complicated but there is good evidence that insulin deficiency may induce osteoporosis in IDDM. This is usually not clinically relevant in a young woman but the bone loss in diabetics might become clinically important with advanced age and superimposed menopause associated bone loss. This relationship does not reliably hold up in NIDDM.

Your best bet is to load up on calcium & Vitamin D now. Your bones will never again be as strong as they are today. That's a sobering thought, but true. Follow the calcium & Vit D guildelines I've detailed above & let me know if you have ????

It would also help if you'd avoid pile-driving your body headfirst into rock thus resulting in unstable vertebral fractures. In my experience that practice has not been associated with good long term musculoskeletal health.


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## IttyBittyBetty (Aug 11, 2005)

*Bicycling as an "Impact Exercise"*

I have read that bicycling is not considered to be a good impact exercise and as such does not help build or maintain bone density. I recall reading an article about the prevalence of low bone density in cyclists, but can't remember where I read it. What I gleaned from this news was that my riding needs to be augmented with running and/or weight training. All that biking is great for the heart and the muscles but not necessisarily for the bones. I'd be curious to hear what the professionals have to say about that.


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## connie (Mar 16, 2004)

The Squeaky Wheel said:


> In a nutshell...yes.
> 
> No sunlight = Vitamin D deficiency......but less skin cancer


Ironically, I just read something that says they're finding a correlation between cancer and vitamin D deficiency. SO... I guess that means exposure to the sun both prevents and causes cancer. SWEET!

Though in reality, I think that just means everything in moderation. Get a little sun, without burning yourself, on a regular basis, and you're better off than sitting on the sofa all day. Duh.


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## The Squeaky Wheel (Dec 30, 2003)

connie said:


> Ironically, I just read something that says they're finding a correlation between cancer and vitamin D deficiency. SO... I guess that means exposure to the sun both prevents and causes cancer. SWEET!
> 
> Though in reality, I think that just means everything in moderation. Get a little sun, without burning yourself, on a regular basis, and you're better off than sitting on the sofa all day. Duh.


Correct !
1000 IU daily Vitamin D intake has been linked to decreaesd rates of colon, breast & ovarian cancer.

Synopsis here

All one needs is 20-30 minutes of sunlight daily to be Vitamin D replete. I know I don't get that much on an average basis during the winter and I ski or bike several days per week but the other days are spent indoors.


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## The Squeaky Wheel (Dec 30, 2003)

IttyBittyBetty said:


> I have read that bicycling is not considered to be a good impact exercise and as such does not help build or maintain bone density. I recall reading an article about the prevalence of low bone density in cyclists, but can't remember where I read it. What I gleaned from this news was that my riding needs to be augmented with running and/or weight training. All that biking is great for the heart and the muscles but not necessisarily for the bones. I'd be curious to hear what the professionals have to say about that.


I recall an article from JBMR (Journal of Bone & Mineral Research) a few years back that made this conclusion. As I recall, the study size was very small and the authors noted that the results should be interpreted with caution. As memory serves me, it involved 20 year olds participating in a cycling club from Utah. I'm not aware of any studies in MTBers. If interested, I'll try & get the citation from PubMed. Lemme know.

Personally, I'm not buying it. While cycling may not stress the spine, forceful pedaling certainly loads the things which contribute to bone remodeling ( a good thing).


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## chuky (Apr 3, 2005)

We discussed this article some months ago, here:

http://forums.mtbr.com/showthread.php?t=206105

Gist was this, if you don't want to click over. No one ever did have a link to the article mentioned below, it would still be interesting to find:

1. there has been some re-evaluation of mtb-ing and its value as far as bone density goes. An excercise physiologist friend cited a new study that shows that mtbing is far more effective than previously thought and far more effecive than road riding. The theory is that those times when you are out of the saddle, standing on the pedals and using your joints as shock absorbtion, that this is a form of "impact" exercise. Is anyone here familiar with this study? It would be interesting to know the details, and I would be curious - is a hardtail better for this than, say, an FS bike? Seems like it would be.

2. Everything I have read about exercise to promote bone density is very specific - it isn't just load-bearing exercise that promotes bone health, it has to be load bearing exercise that involves "impact". Load bearing exercises with gradual increases in resistance do not have the same bone-strengthening effects - this may rule out singlespeeding as being any more effective than other types of mtb-ing.


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## The Squeaky Wheel (Dec 30, 2003)

chuky said:


> We discussed this article some months ago, here:
> 
> http://forums.mtbr.com/showthread.php?t=206105
> 
> ...


Let's get geeky 

These are great questions but do not have clear cut answers. The studies thus far have not been of the highest quality and so it's tough to draw definite conclusions.

I did a bit of research this A.M. and came up with a few articles to illustrate this point. I'll briefly summarize a few for you.
BMD=Bone Mineral Density
DXA= Dual X-Ray Absorptiometry (the test commonly used to measure BMD):

The U of Utah in 2002 published the only study I could find (Journal BONE) involving mountain biking and BMD. 
They compared the BMD of 16 male XC MTBers, 14 male roadies and 15 controls (weekend warriors and X-box playing couch potatos). The cyclists had trained an average of 11 hours per week for 8 +/- 4 years. The MTBers were younger and weighed less than road cyclists and controls. BMD at all sites was comparable among the three groups (p > 0.05). *When adjusted for body weight and controlled for age, BMD was significantly higher at all sites in the mountain cyclists compared with the road cyclists and controls.* In conclusion, endurance road cycling does not appear to be any more beneficial to bone health than recreational activity in apparently healthy men of normal bone mass. *Higher BMD in the mountain cyclists suggests that mountain cycling may provide a positive bone stimulus that is not inherent to road cycling.*

San Diego State U conducted a study in 2000 to determine the effect of sport-specific training and calcium intake on bone mineral density (BMD) in 30 women including 12 master cyclists, 9 runners and 9 non-athletes for control. Patients were assessed at baseline and 18 months for calcium intake, current exercise activity, and BMD of the lumbar spine and hip (DXA). BMD of the femur was maintained in cyclists and runners but declined in controls . *BMD of the lumbar spine was maintained in runners but declined in cyclists.* No significant interaction effect of sport and dietary calcium intake was noted for BMD at any site.

The same folks from SDSU published another study in 2003, this time using male cyclists. 
The purpose of this study was to determine total and regional bone mineral density (BMD) in highly competitive young adult and master male cyclists. Three groups of men were studied: older cyclists (average 50 years); young adult cyclists (average 32 years); and 24 non-athletes matched by age and body weight to the master cyclists. All of the master cyclists had been training and racing for a minimum of 10 years and engaging in little to no weight-bearing exercise. The younger cyclists also engaged in little weight-bearing exercise and had been training and racing for 10+ years. Age-matched controls were normally active. *BMD (measured by DXA) of the spine and hip was significantly lower in the master cyclists compared to both age-matched controls and young adult cyclists. Total body BMD was lower in the master cyclists compared to the young-adults Furthermore, four (15%) of the master cyclists, but none of the men in the other groups, had T-scores (spine and/or hip) lower than -2.5. *

*They concluded that master cyclists with a long history of training exclusively in cycling have low BMD compared to their age-matched peers. Although highly trained and physically fit, these athletes may be at high risk for developing osteoporosis with advancing age.*

Another study from the UK compared male runners, cyclists & controls and CONDLUDED: Running is associated with increased bone density, particularly in the leg, whereas cycling is associated with a mild decrease in bone density in the spine. In athletes who do both, running exerts a stronger influence than cycling.

None of these studies are what I would deem to be of "high quality," yet I think we can draw some conclusions:
1. Cycling seems to help femur/hip BMD but may adversely affect spinal BMD
2. Being a couch potato is no good
and finally...
*3. It's clearly obvious that MTBing is a far superior sport than road cycling.*


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## connie (Mar 16, 2004)

chuky said:


> ... I would be curious - is a hardtail better for this than, say, an FS bike? Seems like it would be.
> 
> 2. Everything I have read about exercise to promote bone density is very specific - it isn't just load-bearing exercise that promotes bone health, it has to be load bearing exercise that involves "impact". Load bearing exercises with gradual increases in resistance do not have the same bone-strengthening effects - this may rule out singlespeeding as being any more effective than other types of mtb-ing.


Seems to me that even if you're on a very squishy bike, if you're using it to ride more uneven trails, jump, etc., it might be about the same as riding a HT on a smoother trail, or more slowly?


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## Lucky (Jan 12, 2004)

*On Boniva, my story*



venus1 said:


> Boniva anyone? How may of you take a preventative osteoporosis treatment? My GYN doc wants me to start. Instructions say you must stand for 1/2 hour after to avoid reflux damage to the esophagus. Gees, is this like drinking Drano or what?


After a number of clues, including 10-12 broken ribs, I asked my doc for a bone density test (DEXA). I was 42, heathy, grew up drinking milk, exercised regularly, never had an eating disorder, never drank heavily, never took drugs, never lost my cycle and hadn't hit menopause. In other words, I was one of the last people you'd expect to have osteoporosis. I could hear the surprise in his voice when he told me. He didn't give me the numbers, and I was too dumbfounded to ask, but I was able to get a glimpse of the report later, and it appears that my hips are actually ok, but the spine numbers were pretty bad. It was actually consistent with having cycled intensely for 24 years. My legs were well muscled, but my upper body made me look like an anorexic.

So, after I dug myself out of a deep depression, I started scouring the web for any info I could find from reputable sources. Things I gleaned from the web, in no particular order, that might be useful to you:

1. Fosamax and Actonel require you to remain upright for 30 minutes. Boniva requires 60 minutes (for the 1/month dose). This is to prevent refux of the caustic drug into the esophagus, where it can cause irritation or ulcers. This is the only serious documented side effect and supposedly easily avoided by following the instructions.

2. There really isn't any good data on the use of osteoporosis medications on premenopausal women without other underlying ailments (prolonged steroid use, chemotherapy, genetic bone disorders, etc). Without a history of low impact fractures (like my several of my broken ribs), it may not be justified. Personally, unless diagnosed with osteoporosis, I would not take the meds before menopause. I'd get a 2nd opinion on using it as a preventative treatment. If it ain't broke, don't fix it. If you haven't hit menopause, try to build bone in other ways, like lifting weights.

3. The actual measureable bone density increases are very small - a couple % per year is good. However, the risk of fracture decreases by a lot 50-75%, depending on which study you read, after 6 months to a year on meds. So, if your doc wants to jack up your density numbers, it's not really going to happen. If you are experiencing low-impact fractures, you should see improvement. Apparently, the meds increase the quality of the bone in ways not measured in a DEXA.

4. In osteoporosis, the actual bone matrix is lost, so the pores in the bone are larger. It is hard to restore the matrix, which is probably why the bone density numbers do not increase dramatically. The remaining strucure is improved, but there is no increase in the structure. There are good SEMs of osteoporitic bone vs. normal on most of the osteoporosis web sites.
Links:
http://www.clevelandclinicmeded.com...crinology/osteoporosis/osteoporosis.htm#ref32
http://courses.washington.edu/bonephys/

I hope this is helpful to you. I started out taking Actonel 2.5 years ago, but had to switch to Boniva because my insurer dropped Actonel from their formulary. I do like only taking it once a month, but I read a few things that made me think that Actonel may actually be the better drug with better documented improvements in fractures, especially of the upper body - my main concern. I have had no side effects so far. I do mtbike with a chest protector now, though. Broken ribs hurt. A lot.

Good luck!
Kathy


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## Lucky (Jan 12, 2004)

Merdoff said:


> Venus, I would really research on that drug before even thinking of taking it, those side effects sound frightening. There must be better alternatives.


I agree Venus should do her homework, but the side effects are pretty easy to avoid if you follow the instructions. All that is needed is to prevent reflux of the drug into the esophagus, and being vertical, standing or sitting is effective for most people (not those with serious reflux problems). I've been taking Actonel and then Boniva for 2.5 years with no issues. If she really has osteoporosis, the biphosphonate family of drugs, including Boniva, are the gold standard in treatment.

Kathy


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## The Squeaky Wheel (Dec 30, 2003)

stripes said:


> As long as Fo doesn't follow you in, I don't think that'll be a problem


Shhhhhhh..........let's not speak of He Who Shall Not Be Named around here :nono:


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## shark.legacy (6 mo ago)

What do you think about this device https://marodyne.ca/?


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## TeeCee (Jan 7, 2021)

The Squeaky Wheel said:


> It would also help if you'd avoid pile-driving your body headfirst into rock thus resulting in unstable vertebral fractures. In my experience that practice has not been associated with good long term musculoskeletal health.


I did this a few years back: 6 fractures, two vertebrae unstable. So lucky! Healed better than before, removing a nerve pinch that had bothered me for twenty years. Kind of like a free chiropractic manipulation!
But since then, recently, I have had a low trauma tibia fracture so will be seeking a density scan...


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## Cleared2land (Aug 31, 2012)

shark.legacy said:


> What do you think about this device https://marodyne.ca/?


No supporting information to this?
I'm not clicking on that.


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