"I'm a 28 year old male who has run since the age of 11. I'm extremely bowlegged, and have had a history of stress fractures to the tibia (predominantly left leg) since the age of 19. At 22, I was diagnosed as osteopenic, and prescribed fosamax. I was taking fosamax for ~2.5 years before stopping (health insurance no longer covered it). Thankfully I stopped when I did, as I was referred to your blog due to the discussions of fossy jaw etc from last July.
For the last 4-5 years my running has been inconsistent at best, primarily due to pain in the upper quad/hip flexor area. The symptoms are always the same; it starts out once my training reached a certain level as a sensation of tightness, and after a few days it became extremely difficult to put weight on the left leg. Rest usually cleared up all the symptoms, but once my training reached a certain level (~45 miles per week) it was never long before the symptoms returned. While I generally didn't seek medical help, I just assumed that the pain was bone-related due to the osteopenia.
After a prolonged absence (~1.5 years) from running, I resolved to run a marathon this past year. In an attempt to try to avoid the same problems I made certain adjustments to my training, the main ones being only running on flat (and soft as often as possible) surfaces and weight training on the upper and lower body in an attempt to increase bone density. Surprisingly training went exceptionally well (I was averaging 65 miles a week for ~ 12 weeks without any problems) until 2 weeks prior to the marathon. I received extensive physio therapy and was told that my gluteal muscles were underdeveloped and causing the quads/groin/adductors to do additional work which was contributing to the pain in my quad. I attempted to run the marathon, but was forced to stop ~12 miles in. After sitting down for a few mins after stopping. I was unable to put any weight on the left leg at all without excruciating pain, which did not abate for 4-5 days.
I underwent an MRI which did not show a stress fracture (also had a DEXA scan which showed the bone density in the hips and lower spine are perfectly normal), but rather an issue with the bone marrow in the femur (apologies for the long winded background, here is the crux of my question). Rather than the typical yellow fatty marrow found in the long bones like the femur, the MRI showed high levels of red marrow, with evidence of trauma to the haemopoietic stem cells (likely due to this and the previous injuries).
I am awaiting an appointment with a haemotologist, but my initial appointment was with an orthopaedic specialist, who wasn't able to shed much light on this issue for me.
My question (finally!) is are you aware of any reason why this might be occurring, and is it reasonable to assume that this is the source of my discomfort and why? I have recently begun light training again after a ~10 week layoff and already I am starting to feel some discomfort in the quad area (at ~20 miles per week) despite having spent the downtime working on building up my gluteal strength/other core areas.
As like most people who write to your blog, I'm pretty frustrated with my situation, so any help you can possibly shed on this would be massively appreciated." (Name withheld and further correspondence not published - Gary)
First of all, I warn you that what I am about to explain may come across as rather depressing. I am upbeat about your prospects for a full recovery because you are young and have not been on Fosamax for too long.
I have written more than 20 articles about bisphosphonates over the last few years (Fosamax being one of these) (Go here to read them). I am of the opinion that this class of drug will go down in history as one of the most scandalous events of modern history. The following is my opinion - not necessarily fact - but opinion that is based on study and the experiences of readers and clients.
There is no place for this drug in an athlete's programme, or any young person for that matter. The only valid use would appear to be in the case of bone cancer. If there is a problem with biomechanics and stress fractures, then the underlying causes need to be identified and addressed: Such as nutrition, vitamin D deficiency, footwear, running technique and training programme structure. The advice at the end of this article will assist anybody struggling with stress fracture. If the legs are seriously bowed for whatever the cause, then marathon running may not be the best recreational choice. Legs are valuable tools that will faithfully serve a person for 100 years; but not if abused from an early age - this includes hammering them with nasty drugs.
Each year we see new side effects from the use of bisphosphonates. There are currently in excess of 900 lawsuits pending in the US for Fosamax alone. These drugs are prescribed for osteoporosis. Rather than preventing bone fractures they are suspected to cause bone death and consequent fractures. They are implicated in serious muscle, joint and bone pain, cardiac problems, kidney problems and damage to the digestive tract.
Despite the warnings and growing evidence of harm and uselessness for any health benefit, doctors worldwide continue to prescribe these drugs with scant regard for the health of their trusting patients. Here in New Zealand the drug is promoted by media celebrities direct to consumer advertising on prime time television.
The half life of these drugs may be as long as 10 years.
If you suspect that you have suffered harm from taking a bisphosphonate drug such as Fosamax, then I recommend that you consult a lawyer and tell the prescribing doctor that you are doing so.
As your first point of contact, I recommend Tom Lamb Law which specialises in these kinds of cases. I respect Tom Lamb's judgement and integrity. He should be able to help with some initial advice as to your legal rights/case or who you might be best to contact in your area.
How a bisphosphonate works
Bisphoshonates are similar to phosphate laundry detergents that wreaked environmental havoc a few decades ago. They kill living things. Phosphates have an affinity to deposit in living bone where they concentrate, gradually killing off all live bone cells, eventually leaving nothing but dead bone. Among the first cells to die off are the ones that break down old bone (osteoclasts) because they gorge on the poisonous bisphosphonate as they suck up old bone. The cells that lay down healthy new bone (osteoblasts) die off at a slower rate. So, while there is gradual bone death, there is an initial increase in bone density but this peaks after just a few years.
This explains why a bone scan may show an apparent increase in bone density after using a bisphosphonate. Bone density does not confer structural strength unless there is living tissue throughout it. Bone is an amazing biological structure that exceeds anything designed, let alone made by Man. For us to think that we can outdo Nature by soaking a person in laundry detergent is arrogance of the highest order.
As a matter of interest, here is the Wikipedia entry about bisphosphonates. Who wrote this? It comes across as a well laundered attempt to appear authoritative while carefully downplaying the dangers. There isn't any mention about all the law suits going on.
Please refer to the video below which gives an insight into the astonishingly complex and intricate structure of bone. You will appreciate why we should be extremely reluctant to interfere in such a crude an indiscriminate way.
Why the thigh pain and abnormal bone marrow?
When doing repetitive exercise like training for a marathon, the bones are subject to thousands of compressions, flexions and torsions. Microfractures occur within bone. In healthy bone this is a normal event and part of the process of bone remodeling and strengthening. The long thigh bone is particularly affected even when running on flat, soft surfaces. The normal repair mechanisms either do not exist or are extremely compromised in a "laundered" bone. The result is increasing stress fractures within the bone, including bleeding. The runner will feel this as disabling pain and this may explain the red marrow. Complete catastrophic fracture of the thigh bone may occur if this micro damage continues without repair.
Stress fractures can be extremely difficult to detect even in healthy bone. Their presence may only show months later when the tell-tale signs of callousing is detectable by imaging. There may be no callous formation if the bone has reduced capacity for repair.
My advice about what to do in addition to consulting a lawyer
The over-riding strategy is to facilitate bone repair, bone health and to avoid further damage:
- Stop running for several years: Take up another sport, like paddling a kayak or riding a bike.
- Ensure you consume a small amount of protein 3-5 times a day. Whey protein will do this very well, in addition to eggs, meat, fish, beans and so on. Bone needs protein. Make sure you eat lots of fresh fruit and vegetables as well.
- Do not drink any acidic bone dissolving beverages, including most sports drinks.
- Take three ICL Algotene daily. Algotene is used to get toxic substances out of the body. It may help to safely chelate any remaining Fosamax from the bones while providing a rich source of bioavailable minerals and other nutrients to nourish the bones.
- Take three ICL Reparen daily. Reparen was first developed to aid patients undergoing destructive chemotherapy. It will assist bone repair.
- Get your vitamin D levels tested by a doctor then send the results to me for interpretation and advice.
- Arrange for an ICL Hair Tissue Mineral Analysis. Continue the above therapy until the results come through (usually about 3-4 weeks after sending in the hair sample).
As I said, I am upbeat about your recovery. The main thing is to make your recovery your new challenge to replace your marathon goals. Give yourself several years recovery just to be sure. In the meantime, you can always train for another challenge such as coming to New Zealand and paddling the Abel Tasman National Park.
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Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.