Diseases, Conditions & Concerns / Question
Published: February 16, 2009

Dear TeenHealthFX,

I am a 17 year old girl, 5 ft 4, and 102 lbs and I am a very serious runner. I recently went to my sports medicine doctor because of really bad shin splints and he became concerned about my bone density. I have not yet gotten my period and he was concerned that I had osteoporosis despite the large quantities of milk I drink. He told me to eat more so that I would get my period. I dont want to have osteoporosis and shin splints/stress fractures but I dont want to eat more either. I do not have an eating disorder and eat a balanced diet when I am hungry. I'm also concerned that forcing myself to gain weight will mess up my running. Do you have any advice?

Signed: Serious Runner With Osteoporosis

Dear Serious Runner With Osteoporosis,

 

Osteoporosis is a serious disease in which bones basically become fragile and can easily break. The bones which most frequently break for people who have osteoporosis are the hip, spine and wrist. Each of these types of breaks is very serious and can lead to other serious problems. So, if your doctor is concerned that you may have osteoporosis, or be at risk for osteoporosis, TeenHealthFX thinks that you need to take this seriously and follow any recommendations he gives you.

 

You mentioned drinking lots of milk, and taking in calcium and vitamin D is very important in preventing osteoporosis. But low estrogen levels and the absence of menstruation can also be risk factors for osteoporosis. Your doctor may see a connection between your hormone levels, your not having gotten your period yet, and your being at risk for osteoporosis.

 

To deal with this, FX suggests the following:

• If your doctor thinks you already have osteoporosis, check with him to see if a bone density test would be good idea to determine the extent of this problem.
• Talk to your doctor about your not having a period, and if there is anything he would want to check regarding your estrogen levels.
• Ask your doctor about other ways in which you can get calcium and vitamin D into your system since you already feel like you drink lots of milk (and see lists below)
• Ask your doctor if he thinks any particular weight-bearing or muscle-strengthening exercises would be good for you to do as these types of exercises can be helpful in preventing osteoporosis.

 

Consider the following foods that are rich in calcium in addition to your milk intake, and speak to your doctor about appropriate quantities:

• Plain, fat-free yogurt
• Part-skim ricotta
• Cheese
• Fruit yogurt
• Orange juice, soy beverage, or rice beverage with added calcium
• Tofu (with calcium sulfate on ingredient list)
• Boiled collards, boiled kale, cooked or fresh broccoli, cooked or fresh bok choy
• Pudding made with milk
• Whole wheat English muffins
• Cottage cheese
• Dry roasted almonds
• Oatmeal with added calcium

Consider the following foods that are rich in vitamin D in addition to your milk intake, and speak to your doctor about appropriate quantities:

• Cod liver oil
• Cooked salmon
• Cooked mackerel
• Tuna fish
• Sardines
• Eggs
• Cooked liver or beef
• Swiss cheese
• Ready-to-eat cereal fortified with 10% of the DV for vitamin D

 

 

To learn more about treating and preventing shin splints, talk to your doctor and read the answer to “How Do I Treat My Shin Splints” under the Aches and Pains section of the Health and Illness category of the website. To learn more about osteoporosis, read the following:

 

What is Osteoporosis?

• Osteoporosis is a disease in which bones become fragile and more likely to break due to low bone mass and structural deterioration of bone tissue. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks.
• These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.
• Any bone can be affected, but there are special concerns for hip and spine fractures. Hip fractures almost always require hospitalization and major surgery, and they can impair a person’s ability to walk unassisted and may cause prolonged or permanent disability. Spinal fractures have serious consequence such as loss of height, severe back pain, and deformity.

 

Preventing Osteoporosis:

• About 85-90% of adult bone mass is acquired by age 18 in years and age 20 in boys. So building strong bones during childhood and adolescence is very important to help prevent osteoporosis later in life.
• There are five steps that can optimize bone health and help prevent osteoporosis:

1)      Get the daily recommended amounts of calcium and vitamin D.

2)      Engage in regular weight-bearing and muscle-strengthening exercise

3)      Avoid smoking and excessive alcohol

4)      Talk to your healthcare provider about bone health

5)      Have a bone density test and take medication when appropriate.

 

Symptoms of Osteoporosis:

• People cannot feel their bones getting weaker. The may not know they have osteoporosis until they break a bone.
• A person with osteoporosis can break a bone from a minor fall, or in serious cases, even from a simple action like sneezing.
• Spinal fractures may initially be felt or seen in the form of severe back pain, loss of height, or various kinds of spinal deformities. Some spinal fractures can even occur with no pain.

 

Risk Factors for Osteoporosis:

• Being female
• Older age
• Family history of osteoporosis or broken bones
• Being small and thin
• Being Caucasian, Asian, Hispanic/Latino
• History of broken bones
• Low sex hormones: Low estrogen in women, menopause, missing periods (amenorrhea); low levels of testosterone and estrogen in men.
• Diet: Low calcium intake, low vitamin D intake, excessive intake of protein, sodium, and caffeine
• An inactive lifestyle
• Smoking
• Alcohol abuse
• Certain medications, such as steroids and some anticonvulsants
• Certain diseases and conditions, including anorexia nervosa and asthma.
• Loss of height (which might indicate a spinal fracture)

 

Diagnosing Osteoporosis:

Bone mineral density (BMD) test using a central DXA (dual energy x-ray absorptiometry). A BMD test performed by a central DXA can:

• Tell if a person has low bone density before a fracture occurs.
• Tell if a person’s bones are losing bone density or staying the same when the test is repeated at intervals of one year or more. 
• Predict the chances that a person will have a fracture in the future.
• Help determine if treatment is needed.

Signed: TeenHealthFX

Compared with other age groups, teens have the lowest rate of seat belt use, and male high school students are more likely than female students to rarely or never wear seat belts. 

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