THE CLINIC: A Shin That Won’t Heal Could Mean MBD

Thu, 6 June 2013 - 2:23 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I’ve had four stress fractures in three years, all to my right tibia. I’m now 40, and I’ve been competing in road races for six years. I also train with weights once a week and do the occasional triathlon. 

I’ve tried running on a rubberized track, treadmill, and trails. I take Fosamax for osteoporosis prevention; I also take hydro-calcium supplements and isoflavones. I’ve tried orthotics. I went six weeks without impact exercise and had pain immediately while trying to run on grass. I weigh 110 pounds and bone scans revealed some thinning, but in my back only. I’m not sure what else to try. I’ve seen an orthopedic surgeon, a sports medicine doctor, two chiropractors, a physical therapist, and a podiatrist.

Karen Moore

Georgetown, MA

 

ANSWER:

Despite your lengthy and ongoing troubles, it sounds like you are still in the diagnostic phase, which of course precedes effective treatment. Until you’ve got a complete and accurate diagnosis, it’s impossible to find a solution to your problem. I think you may have a metabolic bone disease (MBD). I had a similar patient two months ago who ended up having an endocrine problem that is currently being treated successfully. I would see an endocrinologist with interest in metabolic bone abnormalities. You may need one of several tests that determine how your body processes bone matrix information. Do also get a pituitary and thyroid work up. University hospitals are a good place to find this type of work up.

Robert C. Erickson, MD

Canton, OH

 

ANSWER:

Competitive athletes with heavy training schedules sometimes need to evaluate whether they have irregular menstrual cycles. This type of irregularity affects progesterone-estrogen levels, which has a significant impact on bone mass. I too recommend seeing an endocrinologist for a work up. As an orthopedic surgeon and runner of 35 years, I can anecdotally provide that usually when I see this problem there is something else going on behind it, and it is often endocrine related. You are doing everything right; seeing a number of physicians, addressing any biomechanical issues with orthotics, and trying to crosstrain on easier surfaces are all recommendations I would make. It’s time to look for underlying metabolic issues.

Raymond F. Lower, DO

Leesburg, VA

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