Mary’s broken leg – Part 2

A year ago, I told you the story of Mary, a 27-year-old client of mine who had broken her leg in a low-impact fall and came seeking answers for why her bones were weak. In the 18 months that have passed since her accident, Mary has learned a lot about the underlying health issues that led to her fracture. I think her story has some remarkable lessons to offer.

First, let’s recall that Mary’s vitamin D was low — 24 ng/mL. After our consult, Mary went ahead with a vitamin D supplementation protocol of 50,000 IU per week for 8 weeks to raise her vitamin D levels to the 32 ng/mL minimum needed for bone health. However, she couldn’t get retested as planned because shortly after she started, she was involved in a car accident that injured her back. Her physician told her that he wanted to wait until she was off the anti-inflammatory medications before retesting her, so she simply had to assume that the restorative dose she’d taken had done its job. She did take a maintenance dose of 4000 IU per day in the interim, knowing that Maine winters tend to deplete vitamin D stores. When she was finally able to get re-tested, surprisingly, Mary’s vitamin D level had only increased by 4 ng/mL, from 24 to 28.

Why had her vitamin D level stayed low?

It’s somewhat unusual that “front-loading” vitamin D won’t appreciably raise a person’s blood levels, so I realized that Mary’s problem might be more convoluted than we first thought. My first thought was that she might have an absorption problem — and since she said she had reported no obvious GI symptoms, I thought perhaps she had a “silent” disorder such as celiac disease, or perhaps hidden food allergies (and later testing showed that she indeed has multiple food allergies). But the story got even stranger when she recounted to me what she’d learned because of the car accident.

The car accident had taken place not long after our second consult. Mary was rear-ended, hard, by another car while her car was stopped. While checking her for spinal injuries, her primary care physician had ordered an MRI. This MRI uncovered a surprising fact: Mary has an abnormal thyroid. A normal thyroid gland is shaped like a butterfly, but Mary’s thyroid has only one “wing.” From this, you’d expect that Mary might have hypothyroidism, but as I mentioned in the earlier blog, her doctor had told her that her thyroid tested “normal.” Upon retesting almost a year after the car accident, though, Mary’s free T3 and T4 levels were high, not low — and excess thyroid hormones can be bone-damaging.

But there was still more. Mary asked to have a free cortisol blood test performed — one of the tests I generally recommend for a medical osteoporosis work-up, and particularly appropriate given her high stress levels. (Cortisol, for those who don’t know, is a stress hormone produced in the adrenal glands, and consistently high cortisol can be bone-depleting.) After almost a year of telling Mary it was a waste of time and money, in the end her doctor reluctantly ordered the test — and bet her $5 that it would show nothing of consequence. To his great surprise, it showed that Mary’s cortisol levels were at the high end of normal in the morning, and were significantly elevated above normal levels in the evening. The high cortisol levels help explain Mary’s recent bouts of insomnia, and are consistent with the high-stress life she leads. And it’s possible that they contribute to the weakness in her bones that led her to fracture.

These test results are building a picture of Mary’s bone health in which significant endocrine dysfunction, and possibly autoimmune disease, play a role. Let’s look at the pieces of the puzzle:

• Irregular menstrual cycles / possible sex hormone imbalance

• Vitamin D malabsorption / possible GI tract issue or autoimmune disorder

• Hyperthyroidism / possible thyroid hormone dysfunction

• Hypercortisolism / possible adrenal gland dysfunction

Now, it’s worth noting that even though Mary has all of these issues going on, she feels like a normal, healthy young woman. She has energy, she feels pretty good, and if it weren’t for her broken leg and her car accident, she wouldn’t have discovered these problems until much, much later in life. If there’s a silver lining to both incidents, it’s that she has uncovered these issues sooner rather than later — while she’s still young enough to address them and build strong, healthy bone before her menopause transition.

Mary is continuing to explore the source of her endocrine problems, but for me, her experience underscores some of the points I like to make about bone health:

• A low-trauma fracture is osteoporosis “proof of the pudding” and should inspire a search for causes of bone weakening,

• it’s never too early OR too late to pay attention to your bones,

• bones do not stand alone — they are intimately connected with all our bodies’ other systems, and

• if you strive to have better bones, you will have a better body — whether you’re young or old.