Osteoporosis and Cycling

This post is about me (Coach Ric), but this could be about you, whatever your age (it happens with younger as well as older people) and either gender. Osteoporosis, is a decrease in bone mineral density, that causes the bones to weaken and means that impacts (falling over in older people, or crashing in cyclists) can result in more fractures compared to if you didn’t have osteoporosis. Osteopenia, is the less severe version of osteoporosis. Bone mineral density is ascertained via a DEXA scan with osteopenia resulting in a “T Score” of -1 to -2.5, and osteoporosis being -2.6 and below. Score may differ in different countries and T Scores are a measure of standard deviation from the norm.

Evidence has suggested that a combination or individually, osteoporosis may occur in cyclists, due to their being very low forces involved, underfuelling, and heavy sweat rates. However, other factors can play into osteoporosis — genetics and other medical conditions.

Background: I started bike racing in 1984 (and haven’t missed a year since!). Prior to starting cycle racing i was extremely ill and spent ~13 months in hospital and around 2 years in a wheelchair with Juvenile Rheumatoid Arthritis. I was told I would be able to walk again, and had other related issues with my eye health. JRA can also cause osteoporosis.

Back in the mid 1990s, I remember falling down the stairs (i was late for a race and slipped in my socks!) and hurting myself badly. X Rays showed that I’d fractured my ribs (they hurt badly when you laugh, sneeze, cough or breathe hard!), and this was the start of multiple fractures. At a similar time I also started recording my power output and I now believe I have the largest data collection on a single person who is still racing (this is important).

Fast forward through a few more crashes, and I fractured more ribs. Then in 2016 at my favourite race circuit I was bought down in a crash that resulted in me fracturing my scapula, a couple of ribs and some fingers. It was great fun. Actually, it was miserable and I needed some quite strong painkillers.

Due to my JRA I had never done any other sports since starting cycling (other than a brief 4 weeks of weight training when I was 14). My joints would severely hurt if I ran or jumped etc. Then as I attempted to get to a decent level of cycling I ended up underfuelling as I attempted to become as light as possible.

These all contributed to my osteoporosis, which was clinically diagnosed 3 years ago, when I asked my GP for a DEXA scan. My T-Score was -2.7.

Even before my results came back I knew I had it and so I set about starting some weight training to increase the forces acting on my skeleton along with increased Vitamin D intake to see if I could ‘rebuild’ my bones.

I knew that weight training would have a positive effect on my bone health, and so, I wanted to build this into my weekly training schedule. Having not done weights for a long time (I must have done a 6 week block when I was 14 and nothing since) I knew, that while I needed to lift heavy I must start by lifting light and higher reps. This would allow me time to build up correct movement patterns, gently strengthen my muscles, and connective tissues, and start to get used to the additional workload.

At first, many of the exercises felt strange and difficult to complete. I recall trying to do box jumps early on, and not being able to lift both legs together (such that one leg would be in front of the other and I’d feel like I was a galloping horse!). Eventually, it started to come together. One day I was in the gym and one of the rehab PTs saw me and reckoned I’d improved significantly (strength wise) and that I should be able to go from a dumbbell goblet squat to a barbell back squat. He quickly pushed me to squat 40kg (it’s amazing what a bit of coaching can do!). From there I’ve been gradually upping the weight. I think the first year I reached a max squat of 60kg and now I’m at 77kg!

I targeted a variety of joints and movements, these included bilateral and unilateral exercises. Upper and lower body exercises, and included, squats, leg press, plyometrics, bench press, rowing, etc. At first I’d have quite severe DOMS (delayed onset muscle soreness) and would make me struggle on the bike for a day or two, but over time this has subsided and doesn’t affect me as much as it once did.

Once my results came back, my GP wanted me to take Vitamin D, calcium, and a variety of medication - Bisphosphonates. However, after consulting with an endocrinologist she thought I could prevent further decreases in my BMD with the strength training.

The first year I did the weight training, I ended up stopping/going very ad-hoc to the gym once the race season was underway. Reviewing this at the end of the race season, I decided that the following year I’d make a more concerted effort to continue with the gym through the race season. That year I did 30 road races (May to September) and managed to go at least once a week (and ride my bike every day). At the conclusion of that season I went back to 2 to 3 times per week at the gym and then during the winter had my follow up 2 year DEXA scan to see how my bone density had improved. When the results came back every one was very happy as my osteoporosis had now reversed from -2.7 to -1.6. I’m told that this is good, and accordingly have gone from 2 year DEXA follow ups to 5 year DEXA follow ups. I’m hoping that my bone density continues to improve.

While having improved bone density is extremely important for old age, I really wanted to know how - if at all - the weight training had improved (or worsened) my cycling fitness. At the start of this article I mentioned that I’ve had the luxury of knowing my power output over a very long period of time. Although I started racing at 14 (prior to commercial power meters being invented) my best race seasons (in terms of category rankings were in the 1990s) which approximately coincides with my power data. I looked at my data from my 20s and compared it to now. I’m the same weight as then (after careful weight management which I mention in other blogs), however at 55 years my 5-sec sprint power is ~150 W higher than my previous best in my 20’s. My 5-min power is around 5 W higher, and my FTP is currently 10 W higher. My 60-secs power is about 20 W lower than in my 20’s but I personally find this one the hardest effort to test (as I’m pretty rubbish at 60-secs max efforts and they really hurt!).

All in, I’m extremely happy that I’ve improved my bone density. I haven’t (and don’t want to) test high impact collision forces (!) since my last spill in 2016, and I’m extremely happy that I’m able to maintain/improve my fitness level from my 20’s as an oldie!

If you're ready to take control of your bone health and cycling performance like I did, consider joining our Strength Training Coaching programme. For just £90/month, you'll receive personalised coaching to help you improve your bone density and overall fitness, whether you're a cyclist or simply want to build stronger, healthier bones.

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