Supporting bone health in young athletes female Supporying triad. Here, our Zthletes advise about how to optimize your bone health as an athlete. The researchers younb that athletes who ran and participated in sports that require movement in many directions — such as basketball or soccer — when younger had better bone structure and strength than those who solely ran, swam or cycled. Article PubMed Google Scholar Tenforde AS, Fredericson M.

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The researchers Reactive oxygen species that athletes who ran healyh participated hdalth sports Supporting bone health in young athletes require movement in many directions — Nutrient timing for nutrient partitioning as basketball or soccer — when younger had better bohe structure and strength Supporting bone health in young athletes those who solely ran, swam or cycled.

However, Supporting bone health in young athletes, recent data indicate that athletes who specialize at athleyes young age are at a greater risk of an overuse injury and are less likely atuletes progress to higher levels of competition.

But Blood sugar balance and weight management previous studies, Warden and his colleagues Supporting bone health in young athletes that Supproting a bkne ages, Supporting bone health in young athletes mass and athletea are equally athleres.

In the current study, the researchers used high-resolution imaging to assess the shin bone near the ankle blne bones xthletes the feet where bone stress injuries frequently occur athletess runners. They found that the athletes who participated in athetes Reactive oxygen species and multidirectional sports athlrtes younger had 10 to athletew percent bobe bone strength bonee athletes who Supportting ran.

Specializing in one sport at too young of an age means they are more likely to get injured and not make it at the collegiate and professional levels.

Warden said that anyone who oversees a junior athlete or team — whether that be parents, coaches or trainers — should think twice about pushing them to specialize in one area too early. To allow for proper growth and development to occur, he recommends young athletes not specialize until at least their freshman year of high school.

For athletes who already play multidirectional sports, he said it is important that they take time off for rest and recovery during the year, which can improve both bone strength and performance.

Additional authors on the study were Austin Sventeckis, Ph. student, and Robyn Fuchs, associate professor, of the IU School of Health and Human Sciences at IUPUI, and Rachel Surowiec of the School of Engineering and Technology at IUPUI.

For Immediate Release Oct 11, Stuart Warden. Photo by Liz Kaye, Indiana University. Researchers used high-resolution imaging to assess bone strength in areas of the shin bone and foot where bone stress injuries frequently occur in runners.

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: Supporting bone health in young athletes

Joint and bone health for athletes: How to take care | HealthShots	Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. Filed under: News Release Research School of Health and Human Sciences. Of course, the majority of recommended dietary intake guidelines consider the potential for variation to allow them to meet the needs of the majority of the population, but many of these guidelines are focused upon preventing nutrient deficiencies, whereas the athlete is more focused upon supporting optimal function a useful resource here is Larson-Meyer et al. This, to our knowledge, has not been directly or well-studied in relation to the athlete, but there is some suggestion from the osteoporosis focussed literature suggesting that bone might be negatively affected by hyponatraemia. Pediatr Radiol. CAS PubMed Google Scholar Heaney R. In general, exercise across the lifespan is considered beneficial for bone strength, as well as for many other associated aspects of ageing well [ 1 ].
Calcium and Vitamin D: Bone Health in Young Athletes | TeamSnap	Bone Supporting bone health in young athletes. World Health Organization. Un T, Tenforde AS, Athketes A, Rolvien T, Hollander K. Belikan P, Färber L-C, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Sale, C. Miller et al.
Bone Health for Young Athletes	Weight bearing sports have been shown to be a protective factor in bone health. Specific sports related risk factors for low BMD include Relative Energy Deficiency Syndrome RED-S. A state of low energy availability can place athletes at risk of poor performance, low BMD and at a higher risk of osteoporotic fractures 6. If an athlete sustains a fracture, they are at risk of detrimentally impacting athletic performance, quality of life, and losing time out of training or failing to progress in their sporting careers 4. Assessment of bone health should begin with a comprehensive history to screen for relevant risk factors. There are several blood tests that can be considered when investigating for causes of low BMD. In routine clinical practice primary care or SEM these may include the following blood tests prior to specialist referral:. Newer blood tests have been developed to look at markers of bone turnover E. P1NP, CTX-1, Sclerostin, Osteocalcin. However, there is no definitive consensus on how they should be used in athletes and as a result their use is often restricted to either research studies or in specialist bone centres 5. It is generally accepted that vitamin D plays a key role for the athlete in order to prevent stress fractures and muscle injury 6. The role of vitamin D supplementation and athletic performance has been debated extensively in the medical literature, however there is a lack of robust evidence to support widespread routine use 7. Vitamin D measurement in asymptomatic patients is not routinely advised by NICE but may be considered in patients with significant risk factors for low BMD. Calcium supplementation is also not routinely recommended in the athlete and generally should only be considered if dietary intake is less than mg daily or less than mg a day in those with diagnoses osteoporosis 8. suffer from low Vitamin D Levels. Low Vitamin D and a poor calcium intake can place athletes at risk for recurrent fractures and stress fractures. The Importance of Calcium and Vitamin D Calcium and Vitamin D are both important for strong bones. Many children, especially those who are dairy avoidant, have a diet that is lacking in needed calcium. The body needs calcium for critical body functions. Vitamin D helps absorb calcium, so even if calcium intake is good, a child can still be at risk for developing poor bone strength. It is important to recognize that children and adolescents are in their prime bone-building years, as peak bone mass is typically achieved by 25 years of age. After that, bone loss gradually occurs naturally with age. Athletes who train inside year round may be especially at risk for Vitamin D deficiency. During the winter, even in sunny climates, Vitamin D is more difficult to obtain from the sun because of its latitude. Unfortunately, Vitamin D is not readily present in a typical diet, so it is common for Vitamin D levels to significantly decrease in the winter season. How to Boost Calcium and Vitamin D Levels Encourage a balanced healthy diet with quality sources of calcium. Osgood-Schlatter disease: a update of a common knee condition in children. Rathleff MS, Graven-Nielsen T, Hölmich P, Winiarski L, Krommes K, Holden S, et al. Activity modification and load management of adolescents with patellofemoral pain: a prospective intervention study including adolescents. Am J Sports Med. Omodaka T, Ohsawa T, Tajika T, Shiozawa H, Hashimoto S, Ohmae H, et al. Relationship between lower limb tightness and practice time among adolescent baseball players with symptomatic Osgood-Schlatter disease. de Lucena GL, dos Santos GC, Guerra RO. Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. Nakase J, Goshima K, Numata H, Oshima T, Takata Y, Tsuchiya H. Precise risk factors for Osgood-Schlatter disease. Arch Orthop Trauma Surg. Belikan P, Färber L-C, Abel F, Nowak TE, Drees P, Mattyasovszky SG. J Orthop Surg Res. James AM, Williams CM, Haines TP. Health Qual Life Outcomes. James AM, Williams CM, Luscombe M, Hunter R, Haines TP. Factors associated with pain severity in children with calcaneal apophysitis Sever disease. J Pediatr. Warden SJ, Hoenig T, Sventeckis AM, Ackerman KE, Tenforde AS. Not all bone overuse injuries are stress fractures: it is time for updated terminology. Hoenig T, Tenforde AS, Strahl A, Rolvien T, Hollander K. Does magnetic resonance imaging grading correlate with return to sports after bone stress injuries? A systematic review and meta-analysis. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Ditmars FS, Ruess L, Young CM, Hu HH, MacDonald JP, Ravindran R, et al. MRI of tibial stress fractures: relationship between Fredericson classification and time to recovery in pediatric athletes. Pediatr Radiol. Yao L, Johnson C, Gentili A, Lee JK, Seeger LL. Stress injuries of bone: analysis of MR imaging staging criteria. Acad Radiol. Beck BR, Bergman AG, Miner M, Arendt EA, Klevansky AB, Matheson GO, et al. Tibial stress injury: relationship of radiographic, nuclear medicine bone scanning, MR imaging, and CT severity grades to clinical severity and time to healing. Toomey CM, Whittaker JL, Richmond SA, Owoeye OB, Patton DA, Emery CA. Adiposity as a risk factor for sport injury in youth: a systematic review. Naranje SM, Erali RA, Warner WC, Sawyer JR, Kelly DM. Epidemiology of pediatric fractures presenting to emergency departments in the United States. Journal of Pediatric Orthopaedics. Randsborg P-H, Gulbrandsen P, Šaltyte Benth J, Sivertsen EA, Hammer O-L, Fuglesang HFS, et al. Fractures in children: epidemiology and activity-specific fracture rates. JBJS ;e Shah AS, Guzek RH, Miller ML, Willey MC, Mahan ST, Bae DS, et al. Descriptive epidemiology of isolated distal radius fractures in children: results from a prospective multicenter registry. Mantovani AM, de Lima MCS, Gobbo LA, Ronque ERV, Romanzini M, Turi-Lynch BC, et al. Adults engaged in sports in early life have higher bone mass than their inactive peers. J Phys Act Health. Tenforde AS, Fredericson M. Influence of sports participation on bone health in the young athlete: a review of the literature. Lynch KR, Anokye NK, Vlachopoulos D, Barbieri FA, Turi-Lynch BC, Codogno JS, et al. Impact of sports participation on incidence of bone traumatic fractures and health-care costs among adolescents: ABCD - Growth Study. Phys Sportsmed. Detter F, Rosengren BE, Dencker M, Lorentzon M, Nilsson J-Å, Karlsson MK. A 6-year exercise program improves skeletal traits without affecting fracture risk: a prospective controlled study in children. J Bone Miner Res. Fritz J, Cöster ME, Nilsson J-Å, Rosengren BE, Dencker M, Karlsson MK. The associations of physical activity with fracture risk—a 7-year prospective controlled intervention study in children. Osteoporos Int. Lynch KR, Kemper HCG, Turi-Lynch B, Agostinete RR, Ito IH, Luiz-De-Marco R, et al. Impact sports and bone fractures among adolescents. J Sports Sci. Sale C, Elliott-Sale KJ. Nutrition and athlete bone health. Sports Med. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. Article CAS PubMed PubMed Central Google Scholar. Herrick KA, Storandt RJ, Afful J, Pfeiffer CM, Schleicher RL, Gahche JJ, et al. Vitamin D status in the United States, — Am J Clin Nutr. Zheng C, Li H, Rong S, Liu L, Zhen K, Li K. Vitamin D level and fractures in children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab. ED de Mesquita L, Exupério IN, Agostinete RR, Luiz-de-Marco R, da Silva JCM, Maillane-Vanegas S, et al. The combined relationship of vitamin D and weight-bearing sports participation on areal bone density and geometry among adolescents: ABCD - Growth Study. Journal of Clinical Densitometry. Ducic S, Milanovic F, Lazovic M, Bukva B, Djuricic G, Radlovic V, et al. Vitamin D and forearm fractures in children preliminary findings: risk factors and correlation between low-energy and high-energy fractures. Song K, Kwon A, Chae HW, Suh J, Choi HS, Choi Y, et al. Vitamin D status is associated with bone mineral density in adolescents: findings from the Korea National Health and Nutrition Examination Survey. Nutr Res. Constable AM, Vlachopoulos D, Barker AR, Moore SA, Soininen S, Haapala EA, et al. The independent and interactive associations of physical activity intensity and vitamin D status with bone mineral density in prepubertal children: the PANIC Study. Jastrzębska J, Skalska M, Radzimiński Ł, Niewiadomska A, Myśliwiec A, López-Sánchez GF, et al. Seasonal changes in 25 OH D concentration in young soccer players—implication for bone resorption markers and physical performance. Int J Environ Res Public Health. Jastrzębska J, Skalska M, Radzimiński Ł, López-Sánchez GF, Weiss K, Hill L, et al. Changes of 25 OH D concentration, bone resorption markers and physical performance as an effect of sun exposure, supplementation of vitamin D and lockdown among young soccer players during a one-year training season. Yang G, Lee WYW, Hung ALH, Tang MF, Li X, Kong APS, et al. Association of serum 25 OH Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Otis CL, Drinkwater B, Johnson M, Loucks A, Wilmore J. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc ;i—ix. Logue DM, Madigan SM, Melin A, Delahunt E, Heinen M, Donnell S-JM, et al. Low energy availability in athletes an updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients ; Maya J, Misra M. The female athlete triad: review of current literature. Curr Opin Endocrinol Diabetes Obes. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC consensus statement on relative energy deficiency in sport RED-S : update. Singhal V, Reyes KC, Pfister B, Ackerman K, Slattery M, Cooper K, et al. Bone accrual in oligo-amenorrheic athletes, eumenorrheic athletes and non-athletes. Christo K, Prabhakaran R, Lamparello B, Cord J, Miller KK, Goldstein MA, et al. Bone metabolism in adolescent athletes with amenorrhea, athletes with eumenorrhea, and control subjects. Ackerman KE, Nazem T, Chapko D, Russell M, Mendes N, Taylor AP, et al. Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. Ducher G, Eser P, Hill B, Bass S. History of amenorrhoea compromises some of the exercise-induced benefits in cortical and trabecular bone in the peripheral and axial skeleton: a study in retired elite gymnasts. Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, et al. Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline. Int J Clin Endocrinol Metab. Desbrow B, McCormack J, Burke LM, Cox GR, Fallon K, Hislop M, et al. Sports Dietitians Australia position statement: sports nutrition for the adolescent athlete. Int J Sport Nutr Exerc Metab. Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Ackerman KE, Singhal V, Baskaran C, Slattery M, Reyes KJC, Toth A, et al. Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial. Ackerman KE, Singhal V, Slattery M, Eddy KT, Bouxsein ML, Lee H, et al. Effects of estrogen replacement on bone geometry and microarchitecture in adolescent and young adult oligoamenorrheic athletes: a randomized trial. Singhal V, Ackerman KE, Bose A, Flores LPT, Lee H, Misra M. Impact of route of estrogen administration on bone turnover markers in oligoamenorrheic athletes and its mediators. De Souza MJ, Koltun KJ, Williams NI. The role of energy availability in reproductive function in the female athlete triad and extension of its effects to men: an initial working model of a similar syndrome in male athletes. Fredericson M, Kussman A, Misra M, Barrack MT, De Souza MJ, Kraus E, et al. The male athlete triad-a consensus statement from the Female and Male Athlete Triad Coalition part II: diagnosis, treatment, and return-to-play. Cherian KS, Sainoji A, Nagalla B, Yagnambhatt VR. Energy balance coexists with disproportionate macronutrient consumption across pretraining, during training, and posttraining among Indian junior soccer players. Pediatr Exerc Sci. Koehler K, Achtzehn S, Braun H, Mester J, Schaenzer W. Comparison of self-reported energy availability and metabolic hormones to assess adequacy of dietary energy intake in young elite athletes. Appl Physiol Nutr Metab. Tenforde AS, Fredericson M, Sayres LC, Cutti P, Sainani KL. Identifying sex-specific risk factors for low bone mineral density in adolescent runners. Barrack MT, Fredericson M, Tenforde AS, Nattiv A. Evidence of a cumulative effect for risk factors predicting low bone mass among male adolescent athletes. Kraus E, Tenforde AS, Nattiv A, Sainani KL, Kussman A, Deakins-Roche M, et al. Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury. Baim S, Leonard MB, Bianchi M-L, Hans DB, Kalkwarf HJ, Langman CB, et al. Official positions of the International Society for Clinical Densitometry and executive summary of the ISCD Pediatric Position Development Conference. J Clin Densitom. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport RED-S. Download references. is supported by the VA Eastern Colorado Geriatric Research, Education, and Clinical Center GRECC , as well as R01 HL Swanson PI, grant from NHLBI. Department of Orthopedics, University of Colorado School of Medicine, E. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Department of Medicine-Endocrinology, Diabetes, and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA. You can also search for this author in PubMed Google Scholar. Correspondence to Aubrey Armento. There were no human or animal participants directly involved in this narrative review. Informed consent was not indicated for this narrative review. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Springer Nature or its licensor e. a society or other partner holds exclusive rights to this article under a publishing agreement with the author s or other rightsholder s ; author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions. Armento, A. et al. Bone Health in Young Athletes: a Narrative Review of the Recent Literature.
Bone health in the young athlete – part of the new UK SEM Trainee Blog Series	Mental agility boost by Community Users on Fitness. Accessed 17 Oct Recent evidence demonstrates bome in addition to addressing the underlying low Supprting Reactive oxygen species, transdermal estradiol should Reactive oxygen species considered healtb adjunct treatment for young female athletes with oligo-amenorrhea to improve skeletal health. Services Canvas One. Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Additionally, physically active adolescents can suffer from the male and female athlete triad, defined by the interplay of low energy availability, hypogonadotropic hypogonadism or hypothalamic amenorrhea, and impaired bone health [ 56 ].
Bone Health for Young Athletes	Sport and triad risk factors influence bone mineral density in collegiate athletes. On the balance of the available evidence it would seem unlikely that higher animal protein intakes, in the amounts recommended to athletes, are harmful to bone health, particularly with adequate calcium intake. Osteoporosis is a long-term effect of poor bone health. doi: PubMed Google Scholar Stellingwerff T. Shah AS, Guzek RH, Miller ML, Willey MC, Mahan ST, Bae DS, et al.

Healthy, well-balanced Fast-acting carbohydrates and snacks give yonug the nutrients they Ahtletes to do yohng in sports. Besides Strengthen immune system the right Supporting bone health in young athletes of calories, eating boe variety of nutritious foods will help them play at their best. Most young athletes eat the right amount of food their bodies need. Some young athletes, though, have higher energy and fluid needs. All-day competitions or intense endurance sports like rowing, cross-country running, or competitive swimming can involve 1½ to 2 hours or more of activity at a time.

Supporting bone health in young athletes -

The consequences of poor bone health in later life are significant. In India, around 50 million people are estimated to be either osteoporotic with less than T-score 2.

This makes bone health the most important aspect for athletes. Exercise benefits bone health at every age and is a critical factor in osteoporosis prevention and treatment.

Vitamin D, calcium , and hormones play vital roles in ensuring optimal bone health. When there is an imbalance between exercise and nutrition, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Both can lead to morbidity and lost time from training and competition.

To optimize bone health, adequate nutrition, appropriate weight-bearing exercise, strength training, adequate calcium, and vitamin D are necessary throughout life.

Most importantly, athletes must properly protect their joints by wearing the right equipment and exercising in a way that promotes joint health. They should also care for their joints by maintaining a healthy weight, eating a healthy diet, taking time for recovery, and consulting a physical therapist.

By choosing joint-healthy activities and working to maintain a healthy lifestyle, they can maintain better bone health. Senior Consultant-Orthopedic Surgery, Fortis Hiranandani Hospital, Vashi Read More.

Home Fitness Staying Fit Listen up, athletes! Improve your joints and bone health with these tips. Staying Fit. If you are a young athlete, your joint and bone health is of prime importance. Dr Manish Sontakke Published: 8 Jan , pm IST.

Channel Channel. Best wrist support band for gym: 5 picks to improve your workout performance Read Now. Stronger starts here Are you ready to take your fitness to the next level? BMI not being correlated with duration of return to play is interesting, as higher BMI is a risk factor for calcaneal apophysitis itself [ 29 , 30 ].

Bone stress injuries BSI occur when excessive repetitive stress is applied to normal bone resulting in structural bone weakness and pain [ 31 ]. Return to sport after BSI varies based on the severity and location of the injuries [ 31 ].

The gold standard for diagnosis of BSIs is magnetic resonance imaging MRI to evaluate for the presence of periosteal edema, bone marrow edema, and fracture lines.

These findings inform various MRI-based grading systems that have been developed to classify the severity of BSIs with the intent to guide the anticipated time to healing and return to sport [ 32 ].

Several studies have evaluated the correlation between MRI grading of BSIs and duration of return to sport, with mixed findings. This is in line with prior studies that found that MRI severity grade was not significantly associated with time to recovery in adolescent and adult athletes with BSIs at different locations [ 35 , 36 ].

However, a more recent systematic review and meta-analysis of 16 studies including BSIs did find that higher MRI-based grading was significantly associated with increased time to return to sport [ 32 ].

Additionally, BSIs at trabecular-rich sites took longer to heal than BSIs at cortical-rich sites. Generally, MRI grading and fracture location may be useful for prognostication of return to sport after BSI, while also considering clinical presentation and other associated risk factors [ 32 ].

Considering other risk factors for BSI, a systematic review and meta-analysis of 17 prospective observational studies examined the relationship between adiposity and sports injury risk in young athletes, including BSIs [ 37 ].

Young athletes with a BSI were more likely to have a lower BMI than uninjured peers. This was in contrast to all sport-related injuries and lower extremity injuries for which higher BMI, not lower, was a risk factor. Low BMI should prompt clinicians to screen for other risk factors for BSIs, such as the athlete triad noted in more detail below.

In a recent epidemiological study of distal radius fractures in children 4—18 years old, Participation in high-impact sports such as gymnastics, karate, and volleyball during adolescence has many skeletal benefits, including increased bone mass and decreased rates of osteoporosis later in life [ 41 , 42 ].

A recent month longitudinal study of adolescents examined the association between sports participation and fracture risk [ 43 ]. Sports participation was not significantly correlated with incidence of traumatic fractures compared to peers not engaged in sports regardless of sport type martial arts, impact sports, or swimming [ 43 ].

This was consistent with prior findings [ 44 - 46 ], suggesting that the long-term benefits of youth sports participation likely outweigh the risk of acute fractures related to sport.

The importance of vitamin D for bone health is well-established, and young athletes can be at risk for vitamin D insufficiency and deficiency, particularly in those who train mostly indoors, during the winter months, and in those who wear protective equipment that limits skin exposure to the sun [ 4 , 47 ].

Using these cut-offs, a recent study by Herrick et al. reviewed vitamin D status from the National Health and Nutrition Examination Survey NHANES — and showed that the prevalence of vitamin D insufficiency and deficiency in adolescents between the ages of 12—19 was Low dietary calcium intake, physical inactivity, obesity, dark skin pigment, northern geographic location, low exposure to sunlight, and history of fractures are associated with low vitamin D, which has important implications for attainment of optimal peak bone mineral density BMD in adolescence [ 50 - 53 ].

A study by Song et al. analyzed the association between vitamin D status and BMD with data from the Korea National Health and Nutritional Examination Survey. In a group of adolescents, they found that higher vitamin D levels were correlated with higher BMD Z -scores at the lumbar spine and femoral neck, after adjusting for calcium intake, physical activity, and BMI [ 53 ].

A summary of key relevant studies on this topic area can be found in Table 2. Several recent studies evaluated the relationships between vitamin D status, physical activity, and bone health.

Mesquita et al. Constable et al. evaluated the independent and interactive associations of vitamin D status, physical activity, and BMD in prepubertal Finnish children aged 6—8 years.

They discovered that while the amount of moderate and moderate-to-vigorous physical activity and 25 OH D levels were both independently associated with total body less head and lower limb BMD, there were not interactions between physical activity intensity and 25 OH D levels with BMD, suggesting that these may be independent determinants of BMD in prepubertal children [ 54 ].

Vitamin D levels can vary throughout the year, which can be affected by the season of the sport, sun exposure, and home isolation such as the COVID lockdown. A study conducted by Jastrzębska et al.

A follow-up study published in assessed 25 OH D levels of 24 elite young soccer players throughout an entire calendar year and found that the highest levels were during August and September months when there was more sunlight exposure in Northern Europe.

In contrast, the lowest 25 OH D levels were found in the months of May and December after more indoor training occurred [ 56 ]. During this study, there was the unexpected COVID lockdown, which lead to lower vitamin D levels, likely secondary to less sunlight exposure.

Interestingly, the group that received vitamin D supplementation IU daily from January to March did not demonstrate significantly higher 25 OH D levels at follow-up compared to the no supplementation group [ 56 ].

Bone fractures have a negative impact on daily activities and participation in sports, and also can be financially and socially impactful for families due to the increased amount of care and attention bone fractures require [ 50 ]. Vitamin D deficiency can lead to nutritional rickets in children, leading to reduced bone mineralization and increased fracture risk [ 48 ].

While it is accepted that vitamin D is important for bone mineralization, the role of vitamin D in bone fracture prevention in children and adolescents is still debated [ 50 , 57 ].

Therefore, understanding whether 25 OH D levels have a meaningful impact on fracture risk is crucial. Yang et al. recently published a systematic review and meta-analysis study on the relationship between 25 OH D levels and fracture in children and adolescents.

In contrast, a recent systematic review and meta-analysis study by Zheng et al. The conclusions of these studies highlight that there is no consensus on whether low 25 OH D levels are significantly related to increased risk of bone fractures in the pediatric population.

The discrepant findings may be related to the variation in studies included in both meta-analysis, as well as the statistical approach, but both highlight the need for future prospective randomized controlled trials to better understand what role, if any, vitamin D has in fracture risk reduction in children.

However, it is important to note that there is no evidence that vitamin D increases the risk of fractures and ensuring adequate vitamin D status is necessary for the prevention of nutritional rickets in the pediatric population [ 48 ].

The first position stand on the female athlete triad was published by the American College of Sports Medicine in [ 58 ]. It outlined the three interrelated components of the triad to include disordered eating, amenorrhea, and osteoporosis [ 58 ]. Since that time, several more iterations on the female athlete triad have been published up to the most recent consensus statement in [ 5 ].

The components of the triad have evolved to be defined as 1 low energy availability with or without disordered eating, 2 menstrual dysfunction, and 3 low BMD [ 5 ].

The most clinically significant outcomes of the triad include clinical eating disorders, amenorrhea, and osteoporosis; however, many athletes suffer from less severe but still harmful conditions such as reduced energy availability without disordered eating, subclinical menstrual disturbances i.

A review of the recent literature by Logue et al. The primary etiology of the triad is low energy availability, or lack of adequate energy to support physiologic functioning after removing the energy expenditure from exercise, leading to various hormonal alterations [ 60 ].

However, energy availability thresholds are subject to individual variability and have not been clearly delineated in the pediatric population [ 61 ]. The hormonal disturbances that occur in the setting of low energy availability, particularly hypoestrogenism, lead to not only declines in areal BMD aBMD , but also impairments in bone microarchitecture and strength [ 60 ].

In the period of adolescence during peak bone mass accrual, low energy availability and its downstream effects on bone may result in lack of attainment of optimal bone mass [ 62 ].

In a recent study by Singhal et al. Eumenorrheic athletes had higher failure loads, suggesting greater estimated bone strength, at the weight-bearing tibia compared to non-athletes at baseline and 12 months and oligo-amenorrhoeic athletes at 12 months , although this became non-statistically significant after adjusting for changes in weight in addition to other covariates.

Across the month period, there were no significant differences in change in aBMD between the three groups. The key takeaways of this study are that despite the weight-bearing exercise of oligo-amenorrhoeic athletes, their aBMD and bone strength estimates did not significantly differ from non-athletes, suggesting that hypoestrogenism negates the benefit of weight-bearing exercise on bone and may account for the increased risk of lower extremity BSIs.

This is in line with prior studies revealing both reduced aBMD [ 63 ] and impaired bone microarchitecture [ 64 ] in amenorrhoeic adolescent athletes compared to eumenorrheic athletes and controls, as well as the long-term negative effect of amenorrhea on bone health and ability to achieve peak bone mass in young athletes [ 65 ].

Further research is needed to better understand the combined and independent effects of both amenorrhea and low energy availability on bone density, microarchitecture, and strength. There have been several important studies published in the last few years regarding treatment of the female athlete triad.

The first line of treatment continues to be non-pharmacologic management to address the underlying energy deficiency and restore adequate energy status. This is typically achieved in a multidisciplinary manner with a team including but not limited to a clinician experienced in treating the triad, a sports dietitian, and a mental health practitioner if there is any concern for disordered eating, body dysmorphia, or other psychological issues contributing to the low energy availability [ 5 ].

The following include the recommended dietary intake of macronutrients for adolescent athletes: protein: 0. The dietitian can also assess for micronutrient deficiencies, mostly commonly iron, vitamin D, and calcium, and make recommendations for supplementation if medically warranted, preferably guided by laboratory testing [ 67 ].

In the event that an athlete may be unsuccessful with lifestyle changes to address energy availability, has a decline in BMD, or has a new fracture over the course of 1 year of non-pharmacologic management, then the pharmacological treatment should be considered [ 5 ].

Combined oral contraceptives COCs are often prescribed to treat functional hypothalamic amenorrhea, despite there being limited data to support this practice [ 68 ]. A recent randomized clinical trial led by Ackerman et al.

compared changes in BMD [ 69 ] and bone geometry and microarchitecture [ 70 ] in 14—year-old oligo-amenorrhoeic, normal weight, female athletes treated with transdermal 17β-estradiol versus a common COC versus no estrogen.

In the same study population, high-resolution peripheral computed tomography HR-pQCT was performed at baseline and 12 months, with findings demonstrating significantly greater percent increases in total and trabecular volumetric BMD, cortical area, cortical thickness, and trabecular number in the PATCH vs PILL group at the weight-bearing distal tibia [ 70 ].

These studies were the first to compare the effects of transdermal 17β-estradiol versus COC on bone outcomes in young female athletes with oligo-amenorrhea, and the first to demonstrate the greater efficacy of transdermal 17β-estradiol in improving BMD, bone geometry, and microarchitecture compared to COCs.

One proposed explanation for these findings is that 17β-estradiol, the physiological form of estradiol, does not undergo first-pass metabolism in the liver, therefore bypassing the downregulation of insulin-like growth factor-1 IGF-1 as occurs with ethinyl estradiol in COCs [ 69 ].

With assessment of bone markers in the same study population, Singhal et al. reported a significant decline in IGF-1 in the PILL group compared to the PATCH and NONE groups, which supports this explanation [ 71 ]. Additionally, ethinyl estradiol in COCs stimulates sex hormone-binding globulin, which may lower bioavailable estradiol, leading to negative impacts on bone accrual [ 69 , 70 ].

The conclusion of these studies was that transdermal 17β-estradiol with cyclic progesterone should be considered an adjunct treatment for young female athletes with oligo-amenorrhea to improve skeletal health, while also focusing on non-pharmacologic measures to restore energy availability.

However, future research is necessary to understand how different estradiol formulations and doses in COCs may impact bone health, the role of progesterone supplementation, and how these findings translate to fracture and bone stress injury risk. Research over the last decade has led to the recognition of the athlete triad in male athletes [ 72 ], culminating in a two-part consensus statement on the male athlete triad published in [ 6 , 73 ].

Like the female athlete triad, the male athlete triad includes low energy availability with and without disordered eating and low BMD, but with hypogonadotropic hypogonadism in place of menstrual dysfunction [ 6 ]. It appears that low energy availability and hypogonadism impair bone health with declines in BMD in male athletes, particularly in sports that emphasize leanness [ 6 ].

The Male Athlete Triad Coalition consensus statement recommends screening young male athletes for the triad starting in middle or high school and through college for early identification of those at risk to optimize bone health during the critical years of adolescence [ 73 ]. This should be done at the time of the preparticipation physical examination, and when an athlete presents with any one component of the triad [ 73 ].

These recommendations mirror those outlined for young female athletes, and the suggested screening questions for both male and female athletes can be found in Fig. Using baseline responses from the triad screening questions, in addition to individual BMI, BMD Z -scores, and number of prior BSIs, to calculate a cumulative risk score, Kraus et al.

Recommended screening questions for the Female and Male Athlete Triad, adapted from the Female and Male Athlete Triad Coalition consensus statements [ 5 , 73 ].

Assessment of energy availability, disordered eating, and bone health with dual X-ray absorptiometry DXA is also indicated [ 73 ]. For pediatric patients under the age of 19, total body less head and lumbar spine sites should be assessed by DXA [ 79 ].

Like the management of the female athlete triad, the first line of treatment is addressing the underlying energy deficiency and restoring adequate energy status.

Data is lacking regarding the safety and efficacy of pharmacologic therapies including testosterone replacement [ 73 ]. The and consensus statements on RED-S [ 61 , 80 ] outline the physiological, psychological, and performance impairments that occur in the setting of low energy availability [ 61 ].

The RED-S expands the female athlete triad to highlight the multiple other body systems affected by energy deficiency [ 61 ]. While the focus of this review is on bone health in the young athlete, it is important to acknowledge the other implications of low energy availability in athletes, and the need for more research to better understand these relationships and lifelong consequences in the young athlete population.

When approaching the pediatric athlete, clinicians and researchers should consider the unique attributes of the growing skeleton and how this relates to musculoskeletal injury incidence and risk.

BSIs are an inherent risk due to the repetitive nature of sport and can occur in the setting of low BMD related to the athlete triad. The female athlete triad can lead to suboptimal bone accrual despite regular weight-bearing activity in female adolescent athletes.

Recent evidence demonstrates that in addition to addressing the underlying low energy availability, transdermal estradiol should be considered an adjunct treatment for young female athletes with oligo-amenorrhea to improve skeletal health.

It is essential to recognize that young male athletes can suffer from the male athlete triad, a condition that parallels the female athlete triad and can lead to reduced BMD in the setting of low energy availability and reproductive hormonal suppression.

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Healh of Supporting bone health in young athletes The aim youhg this review Cooking techniques and tips to discuss the most recent published scientific evidence athlees bone health in the Antibacterial surface wipes athlete. Recent findings: Pediatric athletes commonly suffer from Supporting bone health in young athletes injuries to the physes healtth apophyses, as well as Supporring stress injuries, Supporting bone health in young athletes which Supportinb resonance imaging grading of the severity of injuries may be useful in guiding return to sport. Adolescent athletes, particularly those who train indoors and during the winter season, are at risk for vitamin D deficiency, which has important implications for bone mineral density. However, the relationship between vitamin D status and traumatic fracture risk is still unclear. While the female athlete triad is a well-established condition, the current work has led to the recognition of parallel pathophysiology in male athletes, referred to as the male athlete triad. Recent evidence suggests that transdermal 17β-estradiol treatment in amenorrhoeic female athletes is an effective adjunctive treatment to improve bone mineral density in treatment of the female athlete triad.