Is Bicycling Bad for Your Bones?

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In 2006, Aaron Smathers, then 29, was a graduate student in the Department of Health and Exercise Science at the University of Oklahoma, gathering data for a study of brittle bones in cyclists. One of his subjects was himself, since he’s been a bike racer for years. A recent scan had revealed that his bones were less dense than usual for a man his age. Not long after those results came in, he crashed during a race, snapping his collarbone. Six weeks later, in his first post-injury race, he was engulfed by a multi-rider pile-up, crashed again, and re-broke his collarbone. Worse, he fractured his hip so badly that the ball of the ball-and-socket joint broke off. “Later I thought, well, this reinforces my study,” he says.

Phys Ed

Is cycling bad for the bones? A number of intriguing studies published in the past 18 months, including Smathers’, have raised that possibility — an issue that has special resonance now, with this weekend’s start of the 2009 Tour de France. Certainly, the toll of broken bones among top-level racers is high. Famously, Lance Armstrong broke his collarbone this year, while Christian Vande Velde, another of America’s premier Tour hopes, fractured six bones, including three in his spine, during a crash at the Giro d’Italia in May.

Of course, slamming into the pavement at 40 miles per hour can be expected to break anyone’s bones. But Smathers’ research suggests that other factors may be at work as well. “If you have low bone mineral mass, you can wind up with a much more serious break from a crash” than if your bones are thicker, he points out.

In his study, the bone density of 32 male, competitive bike riders, most in their late 20s and early 30s, was compared to that of age-matched controls, men who were active but not competitive athletes. Bone scans showed that almost all of the cyclists had significantly less bone density in the spine than the control group. Some of the racers, young men in their 20s, had osteopenia in their spines, a medical condition only one step below full-blown osteoporosis. “To find guys in their twenties with osteopenia was surprising and pretty disturbing,” Smathers says.

Another recent study, this one published last year, had similar results. It followed competitive cyclists over the course of a race season in Colorado. The riders, aged 27 to 44, began with slightly below-average bone density. By the conclusion of the race season, they had lost a significant portion of their total, already-low bone mass in their hips, though not in their spines. At a three-month follow-up exam, however, they showed a small amount of bone recovery in the hips.

Other broader studies suggest that cycling is unique in its impact on skeletal health. Other endurance sports don’t seem to hurt bones in the same way and are typically beneficial. A study published in March, for instance, that compared the bone densities of weight lifters, runners, and cyclists found that the cyclists had lower bone mineral density than the runners or the weight lifters. In another study, triathletes added moderately to their bone mass over the course of a season.

Cycling, unlike running or weight-lifting, causes little impact to skeletons. Bones react to external stresses by strengthening bone. Smathers and other researchers aren’t sure why cyclists have lower bone density. From their studies they have found that body mass is a central factor. In Smathers’ study, the lightest riders had the lowest bone density. In addition, many serious riders burn more calories in a day than they consume, an energy imbalance that is being studied to determine its impact on bone loss. And sweat could play a role. A rider can lose hundreds of milligrams of calcium an hour through sweat. Although the riders in both Smathers’ and the Colorado study were ingesting more than the recommended daily allowance of calcium for their age, they may still have had a deficit of the mineral, which is essential to bone-building. Some researchers theorize that calcium must be taken during exercise to be most effective. A 2004 laboratory study of cyclists who were given either tap water or calcium-enriched water during a 50-minute, stationary-bicycle ride found that the riders drinking the tap water had much higher levels of blood chemicals related to bone loss than did the riders swigging the calcium. Researchers suspect that drinking calcium-enriched waters or sports drinks during long, hot bike rides may help to stave off some bone loss.

Even more encouraging, most recreational cyclists probably don’t need to worry too much about their bones. “The studies to date have looked primarily at racers,” Smathers says. “That’s a very specialized demographic. These guys train for hours at a very high intensity. They sweat a lot. They never go for runs. They don’t usually do much weight-lifting,” to avoid adding bulk. “They’re strange.” He knows. “For competitive riders, I’d recommend spending some time weight-training.” If you do race or train hard and often on a bike, consider a bone scan, he says. “It’s good to know your status.” For himself, his racing career ended with hip surgery and four metal pins in the joint after his second severe crash. “I do miss racing,” he says. On the plus side, his latest bone scan, completed just weeks ago, shows that his bone density, while still low, is increasing.

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It would be interesting to know if the same phenomena is observed in swimmers since they, too, do not have much impact on the skeletal system. Unlike bicycling, however, swimmers avoid the chance for high speed crashes. Never-the-less the same physics/physiology should apply.

Wolf, I’d like to know about that too.

Bone density is not necessarily related to impact on the bones themselves. Rather , it is the muscles that receive the stress when they are lengthened under tension. This in turn pulls on the bones they are attached to reinforcing remodeling of the bones thus maintaing bone density or improving it depending on the intensity of the resistance. Think about why resistance training is good for bones. Every exercise does not place direct forces against the bones. Rather it is the resistance pulling on the muscles. Also keep in mind that any aerobic exercise done to an extreme will result in muscle loss and thereby bone loss. When cycling is performed to an extreme the body will look to unused muscles for a source of energy. This muscle wasting will also negatively affect those bones the muscles are attached to. An Athlete should train the entire body. This is seen in sports like Tennis where both arms are now trained as compared to past training of only the side of the body involved in the hitting. If you have questions check out //www.visionswellness.com for advice and training if you are in nyc

I’m curious if a loss in bone mineral density also applies to mountain bikers? The current research seems to only have studied road racers. Mountain biking is a high impact sport, even with advances in suspension, and so I can’t imagine that this holds true for this style of cycling or, if it is, I have a feeling that it would not be as severe.

Alex Lickerman, M.D. July 1, 2009 · 12:03 pm

I suppose cycling isn’t considered a “weight bearing exercise.” The other issue this article includes but doesn’t explicitly mention is that men, though at less risk for osteoporosis than women, still are at risk. I have many male patients who are actually being treated for it. It really isn’t just a woman’s disease.

//happinessinthisworld.com

I have a theory (not sure where I first heard this) that elite athletes tend to have weaker bones due to to the build-up of lactic acid in the muscles during strenuous exercise. It seems logical to me that acid would eat away at one’s bones, and that casual athletes would not be susceptible to this same phenomenon.

Interesting. I wonder if it might also have something to do with constrained movements and posture. Training for competitive cyclying generally means speanding hours a day quite literally hunched over the handlebars with feet strapped into the pedals. its not what could really be described as a natural or comfortable posture.

Point about swimming is interesting, but just based on observation i don’t think it would hold true. Swimmers generally have much more body mass than bikers. Look at Michael Phelps next to, say, your average Tour de France competitor. Cyclist tend to have very over-developed legs and very under-developed torsos, while swimmers tend to have good muscle mass throught the body. Also, swimmers generally do a decent amount of cross training (dryland workouts).

The title should have been called Competitive Cycling not Bicycling… most people don’t do that damage that the story reported on by riding to work or for pleasure.

Sorry Alexis, but your theory is bunk. Without going into specifics, you have to realize that bone remodeling is a constantly active process with specialized cells working night and day to break down, and rebuild, your bones.

Tim Niles, Minneapolis July 1, 2009 · 12:35 pm

I was an endurance athlete – non-professional – for over a decade. I ran virtually every day for two hours, and when work was nearby I would bike sixty miles (to/from/noon/after), and work with weights. In 1980 a clumsy driver blocked the gutter lane I was riding in and to evade the car I turned sharply right… catching the front wheel in a rain channel… resulting in a hairline fracture of the pelvis, BUT an X-ray photo taken a couple of weeks later showed massive amounts of ‘calcius’ (I believe that was the term for the convergent bone repair material) surrounding the pelvis. It tookm over two months to recover fully (and there were weeks when I didn’t know if I’d ever be able to run smoothly again.) Three years later a 14 year old illegally riding a motor scooter hit me from behind, my left hand caught on the hand set and I broke the left collarbone (worse, the doctor – who evidently did not want to do surgery – didn’t show me the X-rays and lied to me about the extent of the injury (there was a 2+ inch gap at the break points and plenty of muscle tissue in that gap; as an engineer I knew enough when I finally saw the films to know it wouldn’t heal!) For the collarbone there was never any of the ‘calcius’ like for the pelvis. My diet had plenty of non-fat milk in it for both breaks, and because I was running and using the weights extensively, the collarbone had been getting plenty of structural stress… in other words, the calcium in my diet was not just going to the legs. Bicycle accidents are inevitably going to generate a percentage of collarbone breaks; the forces involved and the way that impacts with the pavement transfer to the collarbone virtually guarantee that much. Age also plays a vital role, the more you age the less rapidly and robustly the body responds to bone breaks. Important rule: do not trust doctors about anything, the best ones for athletes are those who are also athletes.

One shouldn’t do anything too much, so is exercise.

Tim Niles, Minneapolis July 1, 2009 · 12:47 pm

By the way, even though my biking era was over long ago, I would strongly advise bicyclists to use weight training because upper body strength is amazingly important when climbing hills. Absolutely do NOT ignore the abs either!!! If there is a belief that building strength in the upper body adds bulk that wears down the legs during cycling… it is false. Strength and bulk are two separate things; you can have significant strength in the upper body without much extra bulk.

Astronauts are subject to bone loss in the absence of gravitational force (more correctly, they are in free-fall) and presumably do some sort of resistance exercises to prevent this. I would agree that similar or greater bone loss should occur in swimmers and should be easy to check. Impact exercises such as running apply stresses to the bones equal to several times body weight and should benefit cyclists. Obesity lowers risk of osteoporosis even though it increases the risk of almost everything else. If these studies indicated a loss of bone in the forearms of cyclists, compared to runners, then something else is going on. What seems logical in medicine often turns out to be wrong because things are much more complex than we think.

Tony, mountain bikers seem to have higher bone density than road cyclists according to a published study in a 2002 issue of Bone magazine.

I read this in a related online article at BikeRadar.com //www.bikeradar.com/fitness/article/health-bad-to-the-bone-21929

This cited article actually includes a bit more helpful advice re: increasing bone density for cyclists. Definitely worth a reading.

– Dario

The Healthy Librarian July 1, 2009 · 12:56 pm

Very interesting collection of studies–particularly for me–because my base exercise is cycling and I have a strong family history for osteoporosis.

Definitely I good lesson for the value of cross-training with weight bearing exercises!

My bone-density, although not ideal, has remained stable, probably thanks to HRT– but when I fell off my bike last year, and slipped on ice, I was happily surprised that no bones broke.

Recently I’ve learned so much about the importance of vitamin D for bone health—and how the amount of vitamin D that we receive as infants has an impact on our bones for life!

Couple that with our religious use of sunscreen!

According to Dr. Michael Holick, one of the foremost authorities on vitamin D, infants who are deficient in vitamin D never attain genetically preprogrammed bone density or height.

And if you think calcium pills & vitamin D are all you need to protect yourself from bone loss, think again!

This is from the JCEM–it really surprised me!

“Diets high in protein (especially animal protein) and cereal grains produce an excess of acid in the body which may increase calcium excretion and weaken bones, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM)”

To read more about this:

Osteoporosis Prevention. A Diet High in Fruits & Vegetables & Low in Animal Protein & Grains

//www.happyhealthylonglife.com/happy_healthy_long_life/2008/12/bone-loss.html

Very interesting,I must say that I’m hate bikes ever since

Wolf, you’re missing two important points from the study, which I see reinforced among competitive cyclists in California. The first is body mass, the second is time on the bike.

From the article:

“From their studies they have found that body mass is a central factor. In Smathers’ study, the lightest riders had the lowest bone density. In addition, many serious riders burn more calories in a day than they consume, an energy imbalance that is being studied to determine its impact on bone loss.”

1) Body Mass: I’ve ridden with men with tiny, tiny waists and hips – their ankles and hips aren’t just tiny because they have four percent body fat. Their ankles and hips are tiny because their bone mass has steadily decreased as they don’t take in enough minerals/calories to compensate for what they lose OVER LONG RIDES.

Not all cyclists get down to such low weights, and that is why you see the difference among lower weight cyclists, as the article states.

Competitive swimmers are not under such pressure to keep their weights low, as gravity plays less of an issue.

Although water dynamics rewards leaner swimmers, for the longer distances, most swimmers do not train for the length of time that cyclists do – and if they do, they are training for something on the level of the Channel swim, and at that point, swimmers are encouraged to gain weight, not keep a very low weight, as you must in competitive cycling.
2) Time on the bike: Unlike swimming and running, cyclists ACTUALLY CAN keep riding for 8, 16 hours, and many cyclists involved in brevets continue riding NON-STOP for three or four days. (Even parallelled by the the distance divisions of an Ironman triathlon – 2.4 miles of swimming, 112 miles of cycling, and 26.2 miles of running.)

During this time, you are losing minerals from bone. The majority of competitive runners simply cannot keep going for such long periods. Even ultramarathoners rest. But cyclists, because there is “so little” impact, can and will keep going.

Really need more concerted data re: cyclists.
need 24 hour urinary calcium (and phosphate and magnesium and potassium) excretion, use urinary markers re: bone status (NTx an dCTx) as well as accuracy re: Calcium intake. Another – need vitamin D levels – that not just “adequate” versus more optimal levels. If using sun screen it is still possible to be deficient.

Need to remember that calcium (and Mg, and Phosphate as well as potassium) are essential to generation of muscular power. Thus, concern re: muscle turnover as well as conservation of calcium.

Additionally, I not that the fractures noted are all clavicle. The clavicle helps to stabilize the shoulder. The shoulder and upper extremities likely have the least stress and so will have the least impetus to maintain bone strength (sort of like astronauts.)

At one time there was concern re: bone strength in nonweight-bearing exercise as swimming versus weight bearing as walking/running. But there continued to be bone strengthening. But recall, swimming necessarily uses the UE and shoulder girdle (esp in world class swimmers) as well as lower extremity large muscles. Cycling does not do so much.

In addition to bone loss, competitive cycling has been show to have a dramatic and negative effect upon fertility.

I wonder if this is related to testosterone. Cycling extended period of time may cause harm or injury to testicles which produce testosterone.

Lower testosterone levels cause lesser bone density.

Poor bikers: just a few years ago, there was all that press about the connection between serious cycling and erectile dysfunction. Now it’s bone density loss.

Were these studies done only on male cyclists? I am curious about competitive female cyclists and bone density.

It makes sense that a hardcore endurance sport such as cycling would have negative effects on bone density since bone density is correlated with testosterone levels, and studies have shown that long cardio workouts are correlated with lower testosterone levels.

//www.barefootconcepts.com

Were the cyclists drug tested to make sure something else wasn’t causing the bone density loss?

Gee we have no problem accepting the fact that a worker existing under coolie conditions – too much work with too little nourishment – will sicken and and possibly die. The human body doesn’t distinguish between sports training and Dickensian overwork!