Cycling CME

A unique CME learning experience for Physicians, PA-C's, and other Medical Providers who love to bike

Active CME:  Combining Continuing Medical Education (CME) and Bicycle Touring for the Healthcare Provider

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Cyclists and Bone Health

Cycling and Bone Health

Should we be concerned about spending too much time on the bike saddle? As an avid cyclist and a physician interested in successful aging, I have followed the literature on bone health in cyclists.  Adult bone mineral density is dependent on many factors including genetics, nutrition, weight bearing exercise and other lifestyle factors.  One of the key determinants to bone health as you age is the peak bone mass achieved during adolescent years.  This has led to the description of Osteoporosis as a disease of adolescence, not aging.

Higher impact exercise leads to greater peak bone mass and in general, young athletes have greater bone density than their non-athletic counterparts.  However, there is a concern for younger endurance athletes, including cyclists.  There are several suggested etiologies for lower bone density in endurance athletes: genetics, nutritional errors or energy imbalances, training-related suppression of sex hormones, exertional loss of calcium and lack of sufficient mechanical stressors.

Related to the issue of the male endurance athlete, our Human Performance lab at Colorado Mesa University recently looked at the bone status using Quantitative Ultrasound (QUS) of 50 collegiate athletes from five sports.  There was significant difference in the stiffness index of bone between cycling and all weight bearing sports (soccer, football, cross-country) as noted in the figure below.

Bone Health Graph.png


Figure.  Comparison of stiffness index (SI) values between dominate foot for each sport. There was significant difference (p < 0.01) between all sports and cycling. Error bars indicate standard error. Each group listed in the graph consisted of 10 currently participating collegiate athletes from Colorado Mesa University.

As health care providers or concerned parents, this information leads to several recommendations:

1.     Avoid sports specialization in the young athletes

a.     Including activities with weight bearing and multidirectional movement is key

2.     Optimize nutrition – the Institute of Medicine recommends that adolescent athletes consume 1300 mg of calcium and 600 IU of Vitamin D daily. Achieving this through a balanced and varied diet would be ideal but the supplementation of Vitamin D may need to be considered.

3.     Maintain a positive energy balance to support musculoskeletal health.

4.     Consider screening for impaired bone health.

a.     Risk Factors per Barrack et al (2017):

                                               i.     Low body weight

                                             ii.     History of stress fractures

                                            iii.     High weekly mileage

                                            iv.     Consuming fewer than one serving of calcium containing foods per day

Although the overall effect of exercise is so positive, it is important to consider bone health in the adolescent and collegiate aged athletes in our roles as coaches, parents and health care providers.

Dr. Mike Reeder, Monfort Family Human Performance Lab, Colorado Mesa University


Barrack MT, Fredericson M, Tenforde AS, et al. Evidence of a cumulative effect of risk factors predicting lower bone mass among male adolescent athletes. BJSM 2017 (in press)

Tenforde AS, Nattiv A, Ackerman K, et al. Optimizing bone health in the young male athlete, BJSM, 2016.

Beatty T et al. Bone density in competitive cyclists. Current Sports Medicine Reports, 2010.

Cycling Safely


Spring is in the air…and we are taking full advantage of the great weather we’ve been having here in Western Colorado! Time to hit the road.

With cycling on our minds, we at Cycling CME want to take a moment to recognize the importance of bike safety. To help highlight these sentiments we want to share an interesting article with you. Jenny Holt, a freelance writer for a small LED company, sent this our way and we thought it worthy to pass on. Enjoy the read.


A Little Bulb Designing the Future of Cyclist Safety

Since the 1990s, the number of cyclists on our roads has increased significantly, yet at the same time, the number of cyclist fatalities and injuries has not risen by the same amount. Though there are strong and good campaigns to ensure drivers remain aware of cyclists, and indeed for cyclists to behave themselves too, it is technology which has helped the most.

The key driver, in addition to better-built bikes and robust helmets, has been visibility. In the past, this meant a large incandescent bulb which drained batteries of power and often stopped working merely because the cyclist hit a bump. However, the humble LED has changed that by making lights more affordable, brighter, more stable, and more flexible.

And it is not ending there; people the world over are trying to develop new ways to use LEDs to improve cyclist safety. These include:

  • LED display coats which make cyclists even more visible in the dark, so drivers no longer just see a single light, but see more of an outline of the cyclist.

  • Self-illuminating LED cycle paths, which instead of using overhead lights are embedded in the paths themselves.

  • Projection lights which cast an image of a bike 5-10 meters ahead of the bike, so cars see the projection and know a cyclist is in their blind spot.

This last one could save many lives as drivers turning right as a cyclist goes straight is one of the largest causes of accidents. Take a look at the full article on how LEDs are helping to make cyclists safer.

Jenny Holt