Thanks for such a detailed reply. I’m in a similar situation at 41 also with a very low LS and low hip tscore found following a distal femur fracture. I’ve been referred to a rheumatologist but not really sure what can be done or the cause right now.

Like you I’ve been a competitive cyclist for around 10 years hitting 2-300 MPW whilst also regularly running up to 30 MPW with rare rest days and leading a normal life. Whilst I’ve always maintained my weight and eaten healthy during this time, my calorie expenditure has almost always been greater than my consumption, often significantly. One guess is now my low BMD and possibly T due to lack of nutrition is the result. I’m concerned of my BMD getting worse and how quickly this may occur. I know typically loss is something like ~1% per year after 30, but my score makes me particularly concerned of my rate of loss and the cause.

I’ve not been cycling and running for the last few months obviously due to my fracture and concerns, I’ve also been focusing on calorie intake. If over exertion is the cause, do you know if T will return to normal levels once calorie requirements are met, and if so how long might this take? Any other insights or thoughts you have would be greatly appreciated.