Bone Density in Female Runners

James A. McHale, D.C.
Director, Atlantic Regional Osteoporosis Specialists, P.C.
Director, Clinical Advisory Board, The Institute of Weight Management and Health

Email: mrmack2@yahoo.com

Peer Reviewed by:

Philip Pappas, PhD.
Richard Purse, D.O.
Jeffery Turner, D.C.

192 Female runners were tested and surveyed to evaluate running as a form of weight bearing exercise, and how it relates to osteoporosis.

The age group of the participants started at age 15; and ended with a 63 year old woman who currently runs 30 miles per week, and uses a soymilk and calcium supplement for bone health.

Testing was performed using the Norland Apollo® portable bone densitomer. This specialized D.E.X.A. (Dual Emission X-ray Absorptiometry) is a safe, simple, painless, procedure which uses the heel bone to determine bone mineral density (B.M.D.). The heel is used because of several factors:

1. The heel (calcaneus) has an extremely similar bone mineral density pattern to the hip (92%)
2. Access to the heel is relatively easy, and the test takes only 15 seconds
3. The testing site has a high degree of precision and accuracy
4. Heel testing makes it possible to trend and manage ongoing bone building programs (weight training/weight bearing exercises, walking, running, calcium intake/absorption)

In my experience of performing over 5,000 D.E.X.A. tests, I have seen improvements in bone density in as little as six months.

What is osteoporosis?

Osteoporosis is essentially a disorder where either too much bone is being lost (osteoclastic activity exceeds osteoblastic activity), or too little bone is being formed.

How is do we measure it?

Bone Mass Measurement assesses bone density, which helps determine the existence of

A. Normal, strong bone
B. Early stage bone loss (osteopenia)
C. Osteoporotic condition (thin, weakened bone tissue)

D.E.X.A. scanner generates a "T" score, which compares the patient’s bone mass to that of young patients of the same gender and ethnic background.

T-score values are as follows:

A. Zero to –1 are essentially normal, with an associated low risk of fracture.
B. –1.1 to –2.4 indicates early stage bone loss; this condition is referred to as osteopenia,
with an associated medium risk of fracture.
C. Scores –2.5 and below are considered to be true osteoporosis, and the risk of fracture is high.

Fracture risk potential is assessed using World Health Organization criteria.

How serious is the problem of osteoporosis in America?

In 1998, The United States Congress passed the Bone Mass Measurement Act. The act mandates that bone density testing is reimbursable from Medicare Carriers. This law states:

"In general, bone mass measurements…are considered to be the most valuable objective indicator of the risk of fracture and/or osteoporosis."

Office of the Federal Register 19 June, 1998 Department of Health and Human Services (H.C.F.A.)

The osteoporosis statistics, according to The National Osteoporosis Foundation:

  • Half of American women over age 50 suffer from osteoporosis, affecting 25 million Americans.
  • More than 1.5 million osteoporosis related fractures occur annually.
  • More than 300,000 hip fractures are related to osteoporosis.
  • Half of all women will suffer from an osteoporosis fracture.
  • Hip fracture is the most serious consequence of osteoporosis: (Up to 50% of all hip fracture patients do not walk again) (Up to 25% of all hip fracture patients die within one year)
  • There is a greater risk of developing osteoporosis than of developing breast, uterine, endometrial, and ovarian cancer combined.
  • Women comprise about 80% of all osteoporosis sufferers
  • Cost to American health care system: $13 Billion Annually

Bone Density Study Data:

  • 192 total Female Runner Study Participants were grouped according to ages
  • 15-50 and 51-75, as well as training distances (Miles Run Per Week).
  • 3-8 miles per week
  • 9-25 miles per week
  • 26-40 miles per week
  • 41-70 miles per week


Survey questions addressed calcium supplementation regimens, and knee-ankle-foot injuries/conditions.

Group A

Consisted of 13 females aged 15-50 who ran between 3 and 8 miles per week:

  • All 13 tested within normal limits for bone density.
  • Only 3 of 13 (23%) took a calcium supplement daily.
  • 2 participants used a tablet form of calcium supplement, 1 used an antacid source.
  • 9 of 13 (69%) reported either knee pain (7) or arch pain (2).

Group B

Consisted of 4 females ages 52-74 who ran between 3 and 8 miles per week:

  • 3 out of 4 (75%) were found to be in the range of osteopenia, with an average T-Score of –1.36.
  • 1 subject tested +1.1, well above normal.
  • 3 of 4 reported regular calcium use (75%), with 2 of 3 using the tablet form. (1 person could not remember the form of calcium she used)
  • 2 of 4 (50%) reported knee pain.
  • 1 of 4 (25%) reported fallen arches.

Group C

Was the largest group studied, with 116 participants ages 20-50 who averaged 9-25 miles per week.

  • 111 of 116 (95.7%) were in the normal/low risk for fracture range. (T-Scores in the 0 to –1 range)
  • 5 of 116 (4.3%) were in the medium risk for fracture range. (T-score average –1.39)
  • None of the subjects were found to be high risk for osteoporosis fracture.
  • 40 of 116 (34%) reported regular calcium use.
  • 76 of 116 (66%) reported no calcium supplementation program.
  • 16 of the 40 calcium users consumed tablets (40%)
  • 6 of the 40 (15%) used calcium chews
  • 18 of the 40 (45%) weren’t sure which type they took.
  • 58 of 116 (50%) of this group reported some sort of injury or condition:
The most common was knee pain-reported by 34 of 58 (59%),followed by Heel pain (21%)

Ankle pain (16%)
Plantar Fascitis (12%)
Arch pain (9.6%)

Group D

Consisted of 9 ladies between the ages of 51 and 57, with an average age of 54, logging 9-25 miles per week.

  • 5 of 9 (56%) were found to have T-scores that placed them in the osteopenic range-medium risk for fracture. (average T-score = -1.49)
  • 4 results were within the normal range.
  • 5 of 9 (56%) reported a calcium supplementation program, with 3 of 5 (60%) utilizing tablet forms of calcium. Two subjects were unsure about the brand or type of calcium they were consuming.
  • Injury distribution in this group was quite clear; 5 of 9 (56%) had no complaints.
  • 2 of 9 (22%) reported knee pain, followed by heel pain and heel spur (11%) each.

Group E

Consisted of 4 test subjects with ages between 51 and 63; average age=56. Their mileage range was 25-40 per week.

  • 3 of the 4 (75%) had T-scores at or above the normal range.
  • 1 of 4 (25%) had a T-score in the osteopenic range. (-1.3)
  • 3 of 4 reported adhering to a calcium supplementation program; one used tablets, one used liquid calcium sources, and one was unsure.
  • Injury distribution was split; 2 had complaints, 2 did not.
  • Injury complaints were: (1) arthritis (1) Plantar Fascitis

Group F

Consisted of 36 females, age 20-50. Their mileage range was 26-40 per week.

  • 35 of 36 (97%) had T-score results at or above normal range.
  • 1 of 36 (3%) had a T-score result which reflected very early stage osteopenia (-1.2)
  • Calcium supplement users were split almost evenly: 17 took some form of calcium, 18 took none. (one person did not respond to the question)
  • 6 of 17 (36%) utilized the tablet form of calcium.
  • 6 of 17 (36%) utilized chewable calcium. (All respondents reported the same brand of chewable calcium which they utilized)
  • 2 of 17 (11%) relied on some form of antacid as their calcium source.
  • 3 of 17 (18%) could not recall the type or form of calcium they consumed.
  • 20 of 36 (56%) reported one or several running injuries or complaints.
  • 9 of 36 (25%) reported knee pain.
  • 5 of 36 (14%) reported ankle pain
  • 4 of 36 (11%) reported plantar fascitis.
  • Heel pain and arch pain had 3 each (8%)
  • Hamstring and Achilles pain rounded out the group with one complaint each (3%).

Group G

Consisted of 8 women, between the ages of 20 and 44 (average age=35 years), who logged 41-70 miles per week.

(Average of 49 miles per week)

  • 8 of 8 (100%) produced T-scores in the normal to higher than normal range.
  • 7 of 8 (88%) combined average T-score was +1.39.
  • 1 of 8 (12%) scored -0.2
  • 7 of 8 (88%) of this group did not take calcium.
  • 1 of 8 (12%) used a generic tablet form of calcium.
  • 5 of 8 (63 %) reported no complaints of knee, or foot-ankle injuries or pain.
  • 3 of the 8 members (38%) of this group reported one or several running injuries.
  • 2 of 8 (25%) reported knee pain.
  • 2 of 8 (25%) reported heel pain.
  • 2 of 8 (25%) reported plantar facitis.
  • 1 of 8 (12%) reported fallen arches.

Group H

Consisted of two females ages 15 and 18, who averaged 30 miles per week.

  • T-score data for both participants was above normal. (Average T-score = +1.2)
  • Both consumed chewable calcium on a daily basis.
  • There were no injuries or complaints reported within this group.

Discussion:

A vast majority of study participants, 177 of 192 (92%) tested at or above the normal bone mineral density values. 15 of 192 (8%) tested in the range of osteopenia—early stage bone loss and thinning.

9 of the 15 (60%) osteopenia results were in the 51-63 age group.

6 of the 15 (40%) osteopenia results were in the 15-50 age group.

Only 74 of 192 (39%) participants reported taking calcium on a regular basis; 30 used the tablet form, and 14 used the chewable form (all reported using the same brand).

The balance of participants could not recall which type they took, or left this section blank.

Overall, 99 of 172 (52%) of the female runners in this study reported some sort of injury or running related condition.

Knee pain was the most common complaint reported, 56 of 192 (29%).

Study participants were 3.6 times more likely to suffer from knee pain than to suffer from osteopenia or osteoporosis.

Clearly running may be beneficial in the battle against osteoporosis. It may improve balance and coordination, decreasing the likelihood of falling.

Increased muscle, tendon, and ligament tone may provide stability to the hip as a result of running; possibly decreasing the risk of hip fracture if a fall does occur. Additional testing needs to be done on a much larger scale. Information on mineral use (calcium, magnesium, chromium, boron etc) and their impact on other body systems besides the bones needs to be made more available to female runners. Injury prevention and treatment guidelines need to be implemented.

Supplementation information directed at reversing pain (methyl sulfonyl methane MSM) and degeneration of joint tissue/cartilage (Glucosamine Sulfate) needs to be shared with female runners, age 20-74.

Questions or Comments? mrmack2@yahoo.com