
Bone health and cycling
Cycling can help across a broad range of areas, including the cardiovascular, muscular, respiratory, and metabolic systems. Although there is a need to complement it with other forms of resistance and weight-bearing exercises to get the full health benefits.
If you have a family history, fall within the risk factors or have been diagnosed with osteopenia or osteoporsis then cycling could be an activity that you need to consider to improve bone health.
Impacts of cycling on your bones
Non resistance based or weight-bearing activities
There have been many studies that investigate the relationship between a non-weight-bearing activity like cycling and the impacts on bone density. While the health benefits of cardiovascular exercise cannot be understated enough, given that the nature of cycling is not weight-bearing, the compression force needed to maintain healthy bones can be compromised.
Cycling has many disciplines ranging from the type of cycling, road, mountain biking, track, BMX, gravel but this is further broken down into specialties within cycling. For example a road cyclist may be more endurance focused while spending the majority time seated versus a sprint cyclist, who has short bursts of explosive energy.
Even the riding style varies within a discipline. Consider a road cyclist who spends their time seated with a high cadence compared to a rider who varies their cadence by alternating between getting out of the saddle and sitting.
Post ride recovery
Many professional and elite cyclist's recovery methods have trickled down to the amateur enthusiast level with many riders undertaking post-race and ride ride ice baths, massages or getting some couch time now which is non-weight-bearing.
How different cycling disciplines or age impacts bone health
Road Cycling
Studies indicate that adult road cyclists, especially at competitive levels, may experience lower bone mineral density (BMD), particularly in regions like the lumbar spine. Spending extended periods in a weight-supported position while cycling, combined with necessary recovery time spent sitting or lying down, might contribute to this effect.
Despite efforts to understand this phenomenon, road cycling alone doesn't seem to confer significant osteogenic benefits.
Mountain Biking
Unlike to road cycling, mountain biking or other types of cycling, especially when combined with weight-bearing activities may not have the same detrimental effect on bone health. Studies are still being undertaken to determine whether recreational mountain biking or variations of cycling with additional sporting activities could potentially mitigate the negative impact on bone mineral density observed in road cyclists.
Triathletes
Triathletes, who engage in cycling along with running and swimming, show mixed effects on bone health. While cycling alone might not provide significant osteogenic benefits, the combination of cycling with weight-bearing activities like running may provide a high impacting activity.
Unfortunately this in itself may lead to other bone related incidents developing such as stress fractures. Further research is needed to understand the full impact of triathlon training on bone health.
Children/Juniors
The limited studies on children and adolescents suggest that cycling during early years may not negatively affect bone health. However, differences in bone mineral density between cyclists and non-cyclists may become more pronounced with age. It's important to consider factors like calcium intake, hormonal profiles, training level, and the type of cycling practice, as they all contribute to bone health outcomes in young cyclists.
Again, this is another area that requires further reaearch and current findings cannot be relied upon without first developing a suffcient base of evidence supporting such findings.
Overall, while cycling provides numerous health benefits, including cardiovascular fitness, it may not be sufficient alone to promote optimal bone health, especially in adult road cyclists. Incorporating weight-bearing activities, resistance training, and plyometric exercises into training routines may help mitigate the potential negative effects of cycling on bone mineral density.
What is Osteopenia and Osteoporosis
Osteopenia
Is a condition characterised by bone mineral density (BMD) that is lower than normal but not low enough to be classified as osteoporosis. It indicates reduced bone density, which may predispose individuals to a higher risk of fractures. Osteopenia is often considered a precursor to osteoporosis.
Osteoporosis
Is a condition where bones become weaker and have greater chance of breaking than normal bones. The chronic condition affects around 1.2 million Australians and leads to over 183,000 fractures each year.
According to Proffesor Professor Itamar Levinger the process of Osteoporosis takes years and is very gradual. It is something that cannot be picked up in 1 - 3 months as the bone loss process is very slow, however it can be accelerated in post menopausal women.
What is a healthy Bone Mineral Density - BMD
A DXA (Dual-Energy X-ray Absorptiometry) scan measures bone density and the results are used to create a T-score, translated into a table that indicates the level of risk for developing Osteopenia or Osteoporosis.
A reading of -1 is normal, between -1 and -2.5 is considered to be osteopenia or ‘low bone density’ range while below -2.5 indicates osteoporosis.
These cut off level guidelines were based on specific populations and groups of people. It may have a different cut off level among a diverse population but this is still undergoing further research to gain a better understanding.
A similar issue is common in other healt guidelines such as BMI where a value of 30 may be considered a risk factor for some diseases, however in some regions such as SE Asia, a value of 27 is indicates risk factors for some diseases.
Proffesor Professor Itamar Levinger elieves that it is worth noting that studies have shown that the majority of fractures are happening in the osteopenia range as many who are diagnosed with osteoporosis are taking the necessary steps to reduce the risk of bone fractures. Early diagnosis is important for help protect bone health and reduce fracture risk.
Risk factors
Personal History |
Medical Conditions |
Medications |
Previous fracture
(from minor bump or fall) |
Coeliac disease |
Certain treatments for
breast cancer |
Family history of osteoporosis (parent / sibling) |
Overactive thyroid
or parathyroid |
Certain treatments for prostate cancer |
Loss of height (3 cm or more)
|
Rheumatoid arthritis |
Glucocorticoids (steroids) |
Smoking / Consumption of
excessive amounts of alcohol
|
Early menopause/
Low testosterone |
Anti-epilepsy treatment |
Inadequate calcium, vitamin D
or lack of exercise
|
Chronic kidney disease or liver disease |
|
Age 70 years and over
|
Diabetes |
|
5 -10% loss of body weight
|
|
|
Low body weight
|
|
|
Being diagnosed - the next steps
When udertaking any exersie regime, be it on or off the bike, it's important to have an individual and tailoired exercise pogram that is supervised by a professional such as an exercise physiologist or physiotherapist.
Having being diagnoised with oseteopena or osteporosis, there is a higher risk of fractures or sustaining further fractures or multiple fractures.
Over 50's
For adults over 50 years any risk factors may lead to a bone density test to determine if bone density is the ‘low’ or ‘osteoporotic range’.
If osteoporosis is diagnosed then it can be managed with treatment, usually a combination of adequate calcium, Vitamin D and exercises to help support bone health.
It is essential for adults who sustain a ‘minimal trauma fracture‘ from a trip or fall to speak to a medical professional and see if they are at risk of havin osteoporosis. Those who are at risk should look at being scanned every 2 - 3 years.
I'm just unlucky
What is often dismissed as an unlucky event could have an underlying cause. In these situations poor bone health needs to be identified and treated to prevent additional fractures.
According to Professor Itamar Levinger if there is an underlining fault, generally an underlining fault is the trigger to precipitate a fracture. It is very rare for someone to fracture then hit and then have a fall. People with a lower Bone Mineral Desity who have a traumatic fall will generally have an increased risk of sustaining the fracture.
How to improve your bone health
Vitamins and Minerals
Calcium Tips
• What’s recommended? 1,000 mg per day for adults, increasing to 1,300 mg per day for women over 50 yrs and men over 70 yrs.
• Calcium content in food varies. Choose higher calcium foods at meal times to help boost calcium intake.
Vitamin D Tips
• Adequate Vitamin D levels help absorb the calcium we eat
• Balance sun protection with limited exposure for Vitamin D for bone health.
Recommend time in the sun is limited and varies depending on location in Australia, skin type and UV index.
If required a supplement may be needed, especially for people at high risk of skin damage where sun protection is most needed year round
Exercise programs outside of cycling
Not all exercise is equal – bones respond to a combination of weight bearing and resistance training, and for older adults balance exercises reduce falls. For people diagnosed with osteoporosis a tailored and supervised program, working with a physiotherapist or exercise physiologist, is recommended.
Regular cycling may benefit from improved lower body, especially leg strength and stability which could lower the risk of falls in day-to-day living, especially benefiting latter in life.
Plyometric training
Plyometric training, characterised by high-intensity, explosive movements with high acceleration, deceleration such as jumping and hopping, can significantly contribute to enhancing bone mineral density (BMD).
These exercises subject bones to rapid and forceful impacts, stimulating bone remodeling processes similar to those induced by resistance training. The repetitive stress placed on bones during plyometric exercises triggers osteogenesis, the formation of new bone tissue, leading to increased bone density and strength.
By incorporating plyometric exercises into a workout routine, individuals can effectively enhance their BMD and overall bone health, thereby reducing the risk of osteoporosis-related fractures and improving physical performance.
While plyometric training improves muscle power, coordination, and balance, which are crucial for reducing the risk of falls and fractures, especially in older adults this type of training is generally not recommended unless under the strict supervision of an exercise physiologist or physiotherpaist. It is usually done after undertaking a thorough assessment inclusing risk factors to oseteopena or osteoporosis.
Resistance training
Resistance training, characterised by load-bearing activities such as weightlifting and resistance band exercises, plays a crucial role in enhancing bone mineral density (BMD) and prersevering bone mass. By subjecting bones to resistance or stress, resistance training stimulates bone remodeling, a process where old bone tissue is broken down and replaced by new bone tissue.
This remodeling response leads to increased bone density, strength, and overall bone health. Additionally, resistance training promotes the formation of osteoblasts, the cells responsible for bone formation, thereby contributing to greater bone mass.
Regular engagement in resistance training also helps to maintain muscle mass and strength, which indirectly benefits bone health by reducing the risk of falls and fractures. Therefore, incorporating resistance training into a comprehensive exercise regimen can be an effective strategy for improving bone mineral density and reducing the risk of osteoporosis-related fractures.
Again when undertaking any physical exercie regime, always first consult a trained medical practioner.
Balance and power exercises
If you happen to trip or slip and are about to fall, your immediate movement needs your muscles to work quickly and apply force to prevent the fall.
Leg strength assists balance, and balance exercises are recommended to prevent falls in older adults that include:
1. Single Leg Stands: Stand on one leg while keeping the other leg lifted slightly off the ground. Hold this position for as long as you can, then switch to the other leg.
2. Balance Board Exercises: Stand on a balance board or wobble board and try to maintain your balance while the board tilts in different directions. You can perform various exercises on the board, such as squats or lunges, to challenge your balance further.
3. Heel-to-Toe Walk: Walk in a straight line by placing the heel of one foot directly in front of the toes of the other foot with each step. This exercise mimics walking on a tightrope and helps improve balance and coordination.
4. Stability Ball Exercises: Perform exercises on a stability ball, such as seated balance exercises or stability ball planks, to challenge your core muscles and improve balance
5. Balance Challenges: Create balance challenges by standing on uneven surfaces like foam pads or pillows, or by closing your eyes while performing balance exercises to further challenge your proprioception and balance control, ie standing on a single leg while your eyes are shut.
Always complement with Strength, resistence, agility and balance
In summary, there is liittle evidence supporting the impacts of bone density and cycling.
As a rule of thumb, it's always better to supplement your cycling whether it's for training, sport, recreation, or transport with other forms exercise and training.
The information presented in this article is for informational purposes only and should not be considered as medical advice. It is not intended to be relied upon nor replace consultation with a qualified healthcare professional.
References
Professor Itamar Levinger, PhD, AEP, FESSA, FASBMR
Associate Director Research and Research Training, Institute for Health and Sport (IHES), Victoria University
Leader: Bone, Muscle and CV Research Group, IHES.
Cycling and bone health: a systematic review - 2012
Explores the impact of cycling on bone mass and metabolism. While cycling is known for cardiovascular benefits, evidence suggests it may not significantly enhance bone mass. Studies reveal lower bone mineral density (BMD) in adult road cyclists, particularly in the lumbar spine, compared to other athletes or controls.
Factors such as training level, type of cycling, and age influence bone health outcomes, with endurance road cycling showing potentially detrimental effects. Hormonal profiles and calcium intake appear normal in cyclists, suggesting the lack of impact during cycling may contribute to low bone mass. Recommendations include incorporating weight-bearing exercises into training programs to mitigate the potential negative effects of cycling on bone health.
Further research is needed to understand bone metabolism changes and identify effective interventions for cyclists at risk of osteopenia or osteoporosis.
Cycling and bone health: a systematic review
Olmedillas, H., González-Agüero, A., Moreno, L.A. et al. Cycling and bone health: a systematic review.BMC Med 10, 168 (2012)
https://doi.org/10.1186/1741-7015-10-168
The population burden of fractures originates in women with osteopenia, not osteoporosis - 2006
The study aimed to assess the contribution of postmenopausal women with modest fracture risk, as indicated by bone mineral density (BMD) measurements, to the overall burden of fragility fractures. Among 616 women aged 60-94 years, the majority had normal or osteopenic BMD, with only 14.5% classified as osteoporotic. However, over 73% of fractures during the 5.6-year follow-up occurred in women without osteoporosis, with 56.5% in those with osteopenia and 16.6% in those with normal BMD. Decreased BMD, advanced age, and prior fracture independently contributed to fracture risk, with each SD decrease in BMD associated with a 65% increase in fracture risk. Notably, women with osteopenia and a prior fracture had comparable or even higher fracture risk than those with osteoporosis alone. These findings emphasize the importance of targeting interventions towards women with osteopenia, alongside those with osteoporosis, to effectively reduce the population burden of fragility fractures.
Pasco, J.A., Seeman, E., Henry, M.J. et al. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17, 1404–1409 (2006). https://doi.org/10.1007/s00198-006-0135-9
Low bone mineral density in highly trained male master cyclists - 2003
The study examines bone mineral density (BMD) in highly competitive male cyclists compared to age-matched controls.
The research involves older cyclists (mean age 51.2 years) with extensive training experience and young adult cyclists (mean age 31.7 years). Results show significantly lower BMD in the spine and total hip among master cyclists compared to both age-matched controls and young adult cyclists, with some master cyclists exhibiting T-scores indicating osteoporosis risk. The study finds that weight-bearing exercise during earlier life stages does not appear to influence BMD.
These findings suggest that despite being highly trained and physically fit, master cyclists with a long history of exclusive cycling training may be at risk for osteoporosis as they age. Further research may be necessary to explore preventive measures for this population.
Nichols JF, Palmer JE, Levy SS. Low bone mineral density in highly trained male master cyclists. Osteoporos Int. 2003 Aug;14(8):644-9. doi: 10.1007/s00198-003-1418-z. Epub 2003 Jul 11. PMID: 12856112.
https://pubmed.ncbi.nlm.nih.gov/12856112
One Season in Professional Cycling Is Enough to Negatively Affect Bone Health - 2023
The study investigates the impact of professional cycling on bone health markers after one season. Using densitometry, bone mineral density (BMD), bone mineral content (BMC), bone area (BA), fat mass (FM), fat-free mass (FFM), T-score, and Z-score were measured in professional cyclists. Results reveal significant decreases in BMD in the legs, trunk, ribs, and pelvis, as well as decreases in BMC in the arms and spine, and BA in the arms and spine after one season of professional cycling. Additionally, a significant decrease in Z-score and a decreasing trend in T-score and total BMD were observed. These findings suggest that even a single season of professional cycling can have a detrimental effect on bone health status.
Martínez-Noguera FJ, Alcaraz PE, Ortolano-Ríos R, Marín-Pagán C. One Season in Professional Cycling Is Enough to Negatively Affect Bone Health. Nutrients. 2023 Aug 18;15(16):3632. doi: 10.3390/nu15163632. PMID: 37630821; PMCID: PMC10458969
https://pubmed.ncbi.nlm.nih.gov/37630821
Bone Health Status, Muscular Strength and Power, and Aerobic and Anaerobic Capacities of Malaysian Male Athletes Involved in Sports with Different Mechanical Loading on Bones - 2022
The study compares bone health status, muscular performance, and aerobic and anaerobic capacities among young male Malaysian athletes participating in sports with different mechanical loading on bones. Forty-four participants were categorized into sedentary control, weightlifting, cycling, or squash groups. Results indicate that all athletes had significantly higher tibial and radial bone speed of sound (SOS) values compared to sedentary individuals. Weightlifting athletes showed superior muscular performance and anaerobic capacity compared to cyclists and squash players, while cyclists exhibited higher aerobic and anaerobic capacities than weightlifters and squash players. These findings suggest that the type of sporting activity influences athletes' bone health and physiological profiles.
Samsudin N, Ooi FK, Chen CK. Bone Health Status, Muscular Strength and Power, and Aerobic and Anaerobic Capacities of Malaysian Male Athletes Involved in Sports with Different Mechanical Loading on Bones. Malays J Med Sci. 2022 Jun;29(3):54-67. doi: 10.21315/mjms2022.29.3.6. Epub 2022 Jun 28. PMID: 35846495; PMCID: PMC9249415.
https://pubmed.ncbi.nlm.nih.gov/35846495