Out and back: a runner's race against osteoporosis.

Out and Back A Runner's Race Against Osteoporosis

Any runner will tell you that pain is simply part of the territory. In order to build up stamina, one must be prepared to endure a certain amount of discomfort. Likewise, when training for speed for slogging through those last few miles of a marathon, overcoming pain is part of running's challenge--indeed, its appeal.

So I was not alarmed when, in the winter of 1985, I was more than usually achy. After all, I'd been running for nine years. For six years my regimen included running more than 100 miles a week--15 miles a day, seven days a week. In the past two years, I'd added a weekly evening of speed work at the track.

Over the years I'd run in nine marathons, including five Bostons. Of the remaining four, I'd won three, and set my PR (personal record) in the other. I had just won two half-marathons within a month of each other. So my ankles and back had every right to feel creaky.

But they never seemed to get better. In fact, I could hardly remember when my ankles didn't hurt. I wore high-top aerobic shoes in order to walk without discomfort. My back, too, seemed chronically sore. Still, I continued grinding out my two-hour morning sessions.

And then, in January of 1986, the roof caved in. Or rather, the skeleton caved in. While running wind sprints with my track partner, my lungs gave out. Gasping for air and frustrated at my continuous slump, I began sobbing. I had always been able to run through the pain. Now I couldn't walk. In fact, I could hardly breathe.

Some months earlier I had participated in an osteoporosis research project at Loma Linda University, where I worked at the time. I had always known I was at risk for this bone-weakening disease. For while it strikes postmenopausal women in greatest numbers, amenorrheic athletes are also at risk. Though I was only 34, I had only recently begun to menstruate, after a lapse of nine years. In addition, I seemed to break bones easily. Any fall seemed to land me in the orthopedic office, and usually in a cast. My injuries included a broken shoulder from a bicycle spill; two serious sprains from tripping while running; and a broken wrist, also from a bike accident.

The results of the research profile were not unexpected. Most of my bones were at or below the fracture level. In fact, there was evidence of several tiny rib fractures that had since healed, fractures of which I had been unaware.

With this breakdown on the track, there was a new urgency to these findings. A second, comprehensive series of tests indicated that I had a serious case of osteoporosis. I had the bone density of a woman twice my age. The mean density of my bones was 102 mg/cm3 (milligrams per cubic centimeter), whereas the normal woman at my age should be 175 mg/cm3. The fracture level for inactive women is 100 mg/cm3, and for active women about 130 mg/cm3. The fracture level is based on levels of activity; as a runner, I exposed my thinning bones to the persistent trauma of running.

Dr. David Baylink, head of the Loma Linda Osteoporosis Clinic, gave me the news in no uncertain terms. I had, among other things, three crushed vertebrae in the neck area--a prelude to kyphosis, the "dowager's hump" that deforms so many aging women. That was the probable source of my lung distress on the track that evening. The only possible way to avoid the prospect of disfigurement was the one order I could not bear--I must stop running altogether, or, at the very least, until I was healed.

The cause of osteoporosis in some runners is in dispute. Some studies indicate that high mileage induces amenorrhea, which in turn interferes with the body's ability to absorb calcium. Other studies point to low body fat levels, and still others to estrogen deficiency. At any rate, I was not absorbing calcium, and continuing my draconian habits would only make the problem worse.

For nine years, running had been my chief joy. My day was incomplete without my run. My week was punctuated by my track session or with a long weekend run with a group of friends. My years began and ended with the Boston Marathon. I had been on the cover of Runner's World. I had won or placed in nearly every race I entered. I had no identity apart from running--at least, none that I cared about.

I was devastated. Those who love running as I do know that running is much more than a simple activity that can be taken up or cast aside with careless nonchalance. It is an integral part of our selves. Imagine forbidding a poet to write or a musician to play. The passion does not diminish. Unsatisfied, it is a source of perpetual pain and loss.

I could not compose myself for the rest of the day. I wanted to be brave, but I was terrified. Not only was running my source of recreation and identity; it was my key to weight control. I had a strong, compact body of which I was proud. Body image had dogged me for years, and running was the only healthy way I had to maintain my weight. I feared repeating two brushes I had had with anorexia in my teens and 20s.

Nevertheless, I was determined to stay fit while under Dr. Baylink's care. Along with the high doses of calcium and fluoride prescribed me, I took up bicycling as a nontraumatic, aerobic alternative to running. But while my lungs remained as fit as ever, there was no doubt that two hours of bicycling burned only a fraction of the calories of two hours of running. After two months of bicycling, I had gained nine pounds.

I hit bottom three months after receiving orders to give up running. I was to attend a glamorous awards banquet in Century City, but the designer gown I had bought for the occasion two weeks earlier did not fit. I broke the zipper and had to go to a tailor's shop, where a tailor sewed that expensive, broken dress on to me. It was a grim, humiliating evening.

The next morning I put on my running shoes and gingerly scooted around the neighborhood for a half hour. I told no one because of fear of a scolding, but I felt happy for the first time in months.

Meanwhile, my bone density gradually improved. For the first few months I was given estrogen, high doses of calcium, and fluoride. I hated taking estrogen. Whether the hormone itself or the body changes it induced made me depressed, I don't know. Estrogen is standard treatment for menopausal osteoporotic women, but I had been menstruating regularly for some months. Dr. Baylink acceded to my wish to drop the hormone. When I did, my mood and and weight improved dramatically.

The first six months showed a continuous, though slow, increase in bone. By June of 1986 my bone density had increased to 112 [mg/cm.sup.3]. And the pain went away. By the end of the first year of treatment, my bones were out of danger. In March 1987 my bone density had shot up to 172 [mg/cm.sup.3], very close to the 175 normal range. Dr. Baylink gave his blessing to moderate running, provided I would halt at the first sign of pain. Without the estrogen and with a 35- to 40-mile-per-week running schedule, my weight came back to 120, three pounds over my prebreakdown weight. I could live with that.

In January of 1987, I entered my first race in over a year, a 10K (10-kilometer). In previous races I had always run to win, despite the pain. This time I was running for fun, not time. If I was to be int he back of the pack, I was grateful to be there at all. The old rush of excitement and jitters were still there. I ran a comfortable, easy pace and finished in 45 minutes, about a minute a mile off my old pace. In one of those rare instances of a weak field, that was good enough for first in my age group. A first place in Boston couldn't have meant more.

I continued to take fluoride and calcium for another year, this time with rapid improvement. Today, my bone density is above normal, at 218 [mg/cm.sup.3]. The pain is only a memory. I am running again, but with moderation--an hour in the mornings, and a 5K or 10K every couple months. My times continue to improve. In fact, last November I broke 40 minutes in the 10K, a feat I had never done even in the old days. And I still am a size 4.

Sure, I've had to give up the marathon, because it is simply too debilitating for me. I've had to soften the ferocious focus with which I approached my training. I still get wistful every April, remembering Boston. But that's a cheap price for a healthy body.

Carol Richardson is a free-lance write living in Loma Linda, California. She also serves as a part-time medical librarian at Loma Linda University.