Greenwich, Conn.—February 15, 2012
Thirty-one-year-old Mandy DiMarzo of Old Greenwich has been athletic most of her life. She played soccer in college. These days her favorite activity is running. “It’s my passion, it’s what I love to do,” she says. An accomplished athlete, Mandy has participated in five marathons, placing first in Charlottesville, Va. Last year, she won a half-marathon in Westchester County.
So when she suffered a stress fracture that wasn’t healing and a bone density test found her bones were becoming brittle and weak, she was thrown for a loop.
Most of us consider osteoporosis a disease of older adults, but Dr. Marci Goolsby, a sports medicine specialist in Greenwich, is seeing the warning signs in increasing numbers of young women, especially female athletes like Mandy. Bone density tests are revealing a condition called osteopenia, a precursor to osteoporosis, which causes bones to be brittle, weak and prone to fractures.
“The main problem is an ‘energy deficiency,’ which means they’re not consuming enough calories and nutrients to match the energy spent with exercise,” explains Dr. Goolsby, a non-operative sports medicine doctor at Hospital for Special Surgery Physicians Office in Old Greenwich (HSS.edu/CT). “This often takes a toll on their bones, causing stress fractures and early osteoporosis. In addition to stress fractures, another clue of an energy deficiency is a decrease in frequency or an absence of periods. This constellation of problems is known as the ‘female athlete triad.’"
When the body is in an energy-deficient state for an extended period of time, it can lead to osteoporosis at a very young age. Mandy was referred to Dr. Goolsby after the stress fracture in her thigh bone didn’t heal after a month of rest.
“Dr. Goolsby was very thorough, she didn’t leave a stone unturned, and she was able to tell me why the stress fracture wasn’t healing,” Mandy said. It turned out that running 10 to 12 miles almost every day had taken a toll on her body. “The main thing I learned was the importance of providing fuel for my body with the right nutrients so it could perform.”
That meant an overhaul of Mandy’s diet. “I learned that my diet is my best friend, and basically, I added a lot of dairy - yogurt, milk, cottage cheese. I used to stay away from dairy and load up on carbohydrates. I also started to consume more protein and vegetables.” Mandy also takes a multivitamin, along with calcium and vitamin D, which she had never taken before.
Instead of running up to 12 miles a day, Mandy now engages in more cross training and has added swimming and yoga to her activities.
After making these changes to her diet and exercise routines, she repeated the bone density test, and her bone density was back to normal.
Dr. Goolsby says it’s critical for everyone - not only female athletes - to engage in good habits to protect one’s bones early on and maintain these practices throughout adulthood. Individuals can do a great deal to prevent osteoporosis.
Consuming a diet rich in calcium and vitamin D or taking supplements, if necessary, and engaging in regular physical activity are important for people of all ages. “Even though many people know this, it often takes a conscious effort to put it into practice. Studies show that only a very low percentage of adolescents get enough calcium,” Dr. Goolsby says.
Mandy, who coaches an eighth grade girls soccer team, wants to get the word out about the importance of good nutrition because she sees warning signs of the “female athlete triad” in her 13- and 14-year-old players. She recalls one girl who was sidelined because of repeated stress fractures. “I think there’s a major need for education in the community,” Mandy says. “Some of these young people may be going down a slippery slope. I wouldn’t want them to develop the same problem I did.”
“It’s really important to diagnose and treat the ‘female athlete triad’ early,” Dr. Goolsby says. “Ignoring it can lead to long-term problems, such as recurrent stress fractures and osteoporosis.”
As for Mandy, she says she now has more energy than ever and feels great. “I’m the best version of myself.”
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.