Landis' Medical Condition Often Linked to Steroid Use, By Joy Victory

July 27, 2006

Earlier today, Tour de France winner Floyd Landis was suspended from his cycling team after he tested positive for an unusually high amount of testosterone/epitestosterone in his urine. Both are natural sex hormones that can be made into a synthetic form to boost performance.

The results from a second confirmatory test expected within days will either mean he's stripped of his winner's jersey or that he will be allowed to keep the title.

Landis, who suffers from a debilitating bone condition in his right hip, won the hearts of many Americans as he raced through the rugged hills of France last week, pushing through the pain.

He suffers from osteonecrosis, or avascular necrosis, in his right hip. The condition occurs when a bone or joint loses its blood supply, causing the bone to wear down. Landis said that in his case, the condition was brought about by a previous cycling crash.

That's not unusual. Bone fractures are the biggest risk factor in developing osteonecrosis. However, what is unusual is the positive drug test, which adds a new twist to his story because osteonecrosis is also linked to steroid use, according to the National Osteonecrosis Foundation and other sources.

For reasons still unclear, people who take steroids — including anabolic steroids — appear to have a greater chance of coming down with the condition. Landis has admitted to taking corticosteroids, which, since they are used to treat inflammation and aren't related to performance, are not banned and wouldn't throw off tests for other steroids, doctors say.

All steroid use leading to or exacerbating osteonecrosis is a "well proven cause and effect," said Dr. Mark D. Miller, an orthopedic surgery professor at the University of Virginia, who said that it's possible Landis' condition may have been caused or worsened by anabolic steroid use. Dr. Lewis Maharam, a New York sports medicine specialist, echoed that sentiment, but emphasized that osteonecrosis is just as likely to be caused by an injury.

The problem is there's not a whole lot of research looking into performance-enhancing steroids and the bone condition.

Also, until the second test comes back, it's too early to say for sure what's going on with Landis and the allegations of steroid doping — except for one thing, Maharam said.

The first urine test's positive result is unlikely to be a fluke, because the test only comes back positive when there is a fairly high imbalance between testosterone and epitestosterone.

There is "no way to have that ratio without taking something that was banned," he said.