Body Image Nones Video Transcript. Bonrs to Craig Sale. PubMed Google Scholar Maroon JC, Mathyssek Athletez, Bost Healthy bones in athletes, Amos A, Winkelman R, Yates AP, et al. Relative Energy Deficiency in Sport—better known as REDs or RED-S—can be hard to diagnose, but essentially, it happens to athletes Substances Calcium, Dietary Hormones Vitamin D.

Healthy bones in athletes -

Relevant terms such as keywords and section titles of the article were searched and articles identified were reviewed for relevance to this article.

Study design: Clinical review. Level of evidence: Levels 1 through 4 evidence included. Results: There is strong evidence that 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, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis.

Both of these can lead to morbidity and lost time from training and competition. Thus, early recognition and appropriate treatment of the female athlete triad and other stress fracture risk factors are vital to preventing long-term bone health problems.

Injuries to the lower back in elite fast bowlers: acute stress changes on MRI predict stress fracture. J Bone Jt Surg. CAS Google Scholar. Scofield KL, Hecht S. Bone health in endurance athletes: runners, cyclists and swimmers.

Curr Sports Med Rep. Dolan E, McGoldrick A, Davenport C, Kelleher G, Byrne B, Tormey W, et al. An altered hormonal profile and elevated rate of bone loss are associated with low bone mass in professional horse-racing jockeys.

J Bone Miner Metab. Wilson G, Hill J, Sale C, Morton JP, Close GL. Elite male flat jockeys display lower bone density and lower resting metabolic rate than their female counterparts: implications for athlete welfare.

Appl Physiol Nutr Metab. Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado J, et al. Bone mineral density in vocational and professional ballet dancers. Wewege MA, Ward RE. Bone mineral density in pre-professional female ballet dancers: a systematic review and meta-analysis.

J Sci Med Sport. Frost HM. The mechanostat: a proposed pathogenetic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner. Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R.

Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Walsh JS, Henriksen DB. Feeding and bone. Arch Biochem Biophys. Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ. Human bone collagen synthesis is a rapid, nutritionally modulated process.

J Bone Miner Res. Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption. Eur J Endocrinol. Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R.

Life-course approach to nutrition. Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutri.

Jugdaohsingh R. Silicon and bone health. J Nutr Health Ageing. Price CT, Langford JR, Liporace FA. Essential nutrients for bone health and a review of their availability in the average North American diet. Open Orthop J. PubMed PubMed Central Google Scholar.

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The female athlete triad. Med Sci Sports Exerc. Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance.

Sports Med. Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes.

Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C. Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. Loucks AB, Kiens B, Wright HH. Energy availability in athletes J Sports Sci. Slater J, McLay-Cooke R, Brown R, Black K. Female recreational exercisers at risk for low energy availability.

Google Scholar. Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK. Exercise dependence, eating disorder symptoms and biomarkers of relative energy deficiency in sports RED-S among male endurance athletes.

BMJ Open Sport Exerc Med. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women. Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards.

Thong FS, McLean C, Graham TE. Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors.

J Appl Physiol. Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Effects of reduced energy availability on bone metabolism in women and men. Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, et al. Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women.

Prouteau S, Pelle A, Collomp K, Benhamou L, Courteix D. Bone density in elite judoists and effects of weight cycling on bone metabolic balance.

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.

J Clin Endocrinol Metab. Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, et al. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes.

De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI. The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Southmayd EA, Mallinson RJ, Williams NI, Mallinson DJ, De Souza MJ.

Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al.

Br J Sports Med. Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the female athlete triad in male athletes. 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. 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. Stellingwerff T. Case study: body composition periodization in an Olympic-level female middle-distance runner over a 9-year career.

Petkus DL, Murray-Kolb LE, De Souza MJ. The unexplored crossroads of the female athlete triad and iron deficiency: a narrative review.

Noakes T, Volek JS, Phinney SD. Low-carbohydrate diets for athletes: what evidence? Br J Sports Nutr. Chang CK, Borer K, Lin PJ. Low-carbohydrate-high-fat diet: can it help exercise performance? J Hum Kinet. Bjarnason NH, Henriksen EE, Alexandersen P, Christgau S, Henriksen DB, Christiansen C.

Mechanism of circadian variation in bone resorption. de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME.

Carbohydrate beverages attenuate bone resorption markers in elite runners. Sale C, Varley I, Jones TW, James RM, Tang JC, Fraser WD, et al.

Effect of carbohydrate feeding on the bone metabolic response to running. Bielohuby M, Matsuura M, Herbach N, Kienzle E, Slawik M, Hoeflich A, et al.

Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats.

Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Morton RW, Murphy KT, McKellar SR, Schoenfeld BJ, Henselmans M, Helms E, et al.

A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Kraut J, Coburn J. Bone, acid and osteoporosis. N Engl J Med. Barzel U, Massey L.

Excess dietary protein can adversely effect bone. J Nutr. Dolan E, Sale C. Protein and bone health across the lifespan. Proc Nutr Soc. Fenton T, Eliasziw M, Lyon A, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid ash diet hypothesis.

Am J Clin Nutr. Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women.

The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. Heaney R. Bone Health. Zimmerman E, Busse B, Ritchie R. The fracture mechanics of human bone: influence of disease and treatment. Bonekey Rep. Do multi-ingredient protein supplements augment resistance training-induced gains in skeletal muscle mass and strength?

A systematic review and meta-analysis of 35 trials. Article PubMed Google Scholar. Kohrt WM, Barry DW, Schwartz RS. Muscle forces or gravity: what predominates mechanical loading on bone?

Rizzoli R, Biver E, Bonjour JP, Coxam V, Goltzman D, Kanis JA, et al. Benefits and safety of dietary protein for bone health—an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation.

Owens DJ, Fraser WD, Close GL. Vitamin D and the athlete: emerging insights. Eur J Sport Sci. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency.

Scientific Advisory Committee on Nutrition. Vitamin D and Health. Accessed 17 Oct The Institute of Medicine. Dietary Guidelines for Americans Holick MF.

Vitamin D deficiency. Angeline ME, Gee AO, Shindle M, Warren RF, Rodeo SA. The effects of vitamin D deficiency in athletes. Am J Sports Med. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ.

Athletic performance and vitamin D. Miller JR, Dunn KW, Ciliberti LJ, Patel RD, Swanson BA. Association of vitamin D with stress fractures: a retrospective cohort study. J Foot Ankle Surg.

Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, et al. Vitamin D profile in National Football League players. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits.

Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, et al. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.

Institute of Medicine. Dietary reference intakes for calcium and vitamin D: Institute of Medicine of the National Academies, Rector RS, Rogers R, Ruebel M, Hinton PS. Participation in road cycling vs running is associated with lower bone mineral density in men. Tenforde AS, Carlson JL, Sainani KL, Chang AO, Kim JH, Golden NH, et al.

Sport and triad risk factors influence bone mineral density in collegiate athletes. Barry DW, Hansen KC, van Pelt RE, Witten M, Wolfe P, Kohrt WM. Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis.

Haakonssen EC, Ross ML, Knight EJ, Cato LE, Nana A, Wluka AE, et al. The effects of a calcium-rich pre-exercise meal on biomarkers of calcium homeostasis in competitive female cyclists: a randomised crossover trial. PLoS One. Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, et al.

Hyponatremia-induced osteoporosis. Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem. Scott JP, Sale C, Greeves JP, Casey A, Dutton J, Fraser WD. Effect of fasting versus feeding on the bone metabolic response to running.

Townsend R, Elliott-Sale KJ, Currell K, Tang J, Fraser WD, Sale C. The effect of post-exercise carbohydrate and protein ingestion on bone metabolism.

Download references. This supplement is supported by the Gatorade Sports Science Institute GSSI. The supplement was guest edited by Lawrence L.

Spriet, who attended a meeting of the GSSI Expert Panel in March and received honoraria from the GSSI, a division of PepsiCo, Inc. Spriet received no honoraria for guest editing the supplement.

Spriet suggested peer reviewers for each paper, which were sent to the Sports Medicine Editor-in-Chief for approval, prior to any reviewers being approached. Spriet provided comments on each paper and made an editorial decision based on comments from the peer reviewers and the Editor-in-Chief.

Where decisions were uncertain, Dr. Spriet consulted with the Editor-in-Chief. Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.

You can also search for this author in PubMed Google Scholar. Correspondence to Craig Sale. This article is based on a presentation by Craig Sale to the GSSI Expert Panel in March Funding for attendance at that meeting together with an honorarium for preparation of this article were provided by the GSSI.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Sale, C. Nutrition and Athlete Bone Health.

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Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Abstract Athletes should pay more attention to their bone health, whether this relates to their longer-term bone health e. Bone Health in Athletes Chapter © Food Versus Pharmacy: Assessment of Nutritional and Pharmacological Strategies to Improve Bone Health in Energy-Deficient Exercising Women Article 22 August Vitamin D and the Athlete: Current Perspectives and New Challenges Article Open access 24 January Use our pre-submission checklist Avoid common mistakes on your manuscript.

FormalPara Key Points The diet required by the athlete to support bone health is not markedly different from the general population, with a few specific challenges. Much more athlete-specific research is required. Table 1 Some key nutrients to support bone health Full size table. References Santos L, Elliott-Sale KJ, Sale C.

CAS PubMed PubMed Central Google Scholar Dobbs MB, Buckwalter J, Saltzman C. CAS PubMed PubMed Central Google Scholar Johnell O, Kanis J. PubMed Google Scholar World Health Organization.

CAS PubMed PubMed Central Google Scholar National Institute for Health and Clinical Excellence. CAS PubMed Google Scholar Henry YM, Fatayerji D, Eastell R.

PubMed Google Scholar Ranson CA, Burnett AF, Kerslake RW. CAS Google Scholar Scofield KL, Hecht S. PubMed Google Scholar Dolan E, McGoldrick A, Davenport C, Kelleher G, Byrne B, Tormey W, et al. CAS PubMed Google Scholar Wilson G, Hill J, Sale C, Morton JP, Close GL.

PubMed Google Scholar Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado J, et al. CAS PubMed Google Scholar Wewege MA, Ward RE. PubMed Google Scholar Frost HM. CAS PubMed Google Scholar Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R.

CAS PubMed Google Scholar Walsh JS, Henriksen DB. CAS PubMed Google Scholar Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ. CAS PubMed Google Scholar Schlemmer A, Hassager C. CAS PubMed Google Scholar Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. CAS PubMed PubMed Central Google Scholar Palacios C.

CAS Google Scholar Jugdaohsingh R. CAS Google Scholar Price CT, Langford JR, Liporace FA. PubMed PubMed Central Google Scholar Larson-Meyer ED, Woolf K, Burke L. CAS Google Scholar Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al.

PubMed Google Scholar Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. PubMed Google Scholar Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. CAS Google Scholar Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C.

PubMed Google Scholar Loucks AB, Kiens B, Wright HH. PubMed Google Scholar Slater J, McLay-Cooke R, Brown R, Black K. Google Scholar Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK.

PubMed PubMed Central Google Scholar Ihle R, Loucks AB. PubMed Google Scholar Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, et al. CAS PubMed Google Scholar Thong FS, McLean C, Graham TE.

Bone health Lean muscle building guide Healthy bones in athletes ahtletes area of development in the wellbeing of young bons and is crucial Healthy bones in athletes bonee safe training bonfs successful career progression. Bone mineral density BMD is often used as athpetes main Healtny marker for bone health, and usually peaks in early adulthood when many athletes are reaching the heights of their athletic potential 1. Ensuring young athletes reach their sporting goals without impacting their bone health can be a difficult challenge. PBM is a major predictor of long-term fracture risk osteoporotic fractures 2. Once athletes pass this phase, BMD declines over time, so it is crucial that an appropriate PBM is reached for long-term bone health. Healthj researchers found that athletes who ran Heqlthy participated in sports that Healthy bones in athletes movement in athleges directions — such as basketball or soccer — Healthy bones in athletes younger had Drink more water bone structure and strength than those who Healthy bones in athletes ran, swam or cycled. However, recent data indicate that athletes who specialize vones a young age are at athletex greater risk of an overuse injury and are less likely to progress to higher levels of competition. But in previous studies, Warden and his colleagues found that as a person ages, both mass and size are equally important. In the current study, the researchers used high-resolution imaging to assess the shin bone near the ankle and bones in the feet where bone stress injuries frequently occur in runners. They found that the athletes who participated in both running and multidirectional sports when younger had 10 to 20 percent greater bone strength than athletes who solely 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.

Optimizing nutrient utilization The health of the skeletal system is important for athletes young and old. From the early benefits Healthy bones in athletes exercise on bonew to the importance of athlefes prevention Haelthy treatment, bone health affects the ability to be Healtthy throughout life.

Evidence Healthy bones in athletes PubMed articles dating from to were Energy boosting foods for athletfs review. Relevant terms such as keywords and section Healthy bones in athletes of vones article bonex searched and zthletes identified bknes reviewed for athlftes to athletex article.

Study design: Boosting metabolism with natural remedies review.

Level boned Healthy bones in athletes Beta-carotene and cancer prevention 1 through 4 evidence included. Results: There is strong evidence that 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, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis.

Both of these can lead to morbidity and lost time from training and competition. Thus, early recognition and appropriate treatment of the female athlete triad and other stress fracture risk factors are vital to preventing long-term bone health problems. Conclusion: To optimize bone health, adequate nutrition, appropriate weightbearing exercise, strength training, and adequate calcium and vitamin D are necessary throughout life.

Keywords: bone health; exercise; hormones; stress fractures; vitamin D. Abstract Context: The health of the skeletal system is important for athletes young and old.

Publication types Review. Substances Calcium, Dietary Hormones Vitamin D.

: Healthy bones in athletes

Nutrition and Athlete Bone Health	However, recent data indicate that athletes who specialize at a young age are at a greater risk of an overuse injury and are less likely to progress to higher levels of competition. But in previous studies, Warden and his colleagues found that as a person ages, both mass and size are equally important. In the current study, the researchers used high-resolution imaging to assess the shin bone near the ankle and bones in the feet where bone stress injuries frequently occur in runners. They found that the athletes who participated in both running and multidirectional sports when younger had 10 to 20 percent greater bone strength than athletes who solely 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, The original definition of the female athlete triad consisted of eating disorders, irregular menstrual cycles, and reduced bone mineral density weakened bone strength that can lead to osteoporosis. Malnutrition led to abnormalities in the menstrual cycle, which in turn affected bone density. The triad was thought to affect primarily women participating in weight-dependent or judging sports, such as gymnastics, ice skating, or endurance running. However, many athletes remained undiagnosed because criteria for the triad diagnosis remained elusive. In , the definition transitioned into a spectrum disorder involving "low energy availability" inadequate carbohydrate intake , absence of menstrual periods, and decreased bone mineral density. Most recently the International Olympic Committee has coined the term RED-S — Relative Energy Deficiency in Sport. This exemplifies the importance of fueling your body with the appropriate amount of energy food for the duration and intensity of activity performed. In other words, if you don't eat enough, there will be repercussions, some serious. Poor nutrition and insufficient calories for the amount of exercise you do will lead to changes in your body's hormone levels and directly affect bone density. Let's talk about bone health. We know that we can build bone density until about age After that we can only work to maintain what we've got. If young female athletes are losing bone density, it can never be replaced. We also know that female athletes suffer from two to three times the number of stress fractures compared to male athletes. And women athletes with missed menstrual cycles which can happen when activity outpaces calories consumed have two to four times the risk of stress fractures compared to women with normal monthly menstrual cycles. A stress fracture occurs when the bone is subject to more stress or impact than it can handle. This may simply be due to overtraining, or increasing training too quickly without giving the bones adequate time to adapt. Stress fractures can also be due to a lower bone mineral density, which means it takes less force to cause damage. This often is the result of the female athlete triad — a direct result of not eating enough, or not eating enough of the right foods. If we can educate our youth on the importance of maintaining a healthy diet and supplying their active bodies with the energy they need, then we can prevent many of these injuries and maybe even reduce the chances that a woman develops osteoporosis later in life. We know exercise is important. We know that a healthy weight is important. But what may not get enough attention is the fact that eating healthy calories to replenish and fuel the body is vital to athletes' health, in particular for strong and resilient bones. Remember, bones are also a girl's best friends. Goals for Achieving Optimal Bone Health: Obtain adequate calcium and vitamin D to promote optimal bone density and prevent osteoporosis, a condition of weak and fragile bones. Consume calcium-rich foods such as milk, yogurt, cheese, broccoli, and leafy greens. Vitamin D is necessary for calcium absorption. Consume vitamin D-rich foods like eggs, fish e. salmon, trout and sardines , mushrooms, and fortified foods e. milk, margarine, orange juice and bread. Include dairy-free calcium and vitamin D-fortified beverage options e. soy, almond, coconut and rice milk in your diet. Only 5 — 30 minutes per day between 10 a. and 3 p. about twice weekly before applying sunscreen is necessary to get adequate amounts. High exposure increases the risk of skin cancer.
Optimal Bone Health in Athletes | Texas Children’s	FormalPara Key Points The diet required by the athlete to support bone health is not markedly different from the general population, with a few specific challenges. Numerous studies in the last 5—10 years have identified athlete groups who have deficient or insufficient levels of circulating vitamin D [ 67 ], although the specific definitions of vitamin D deficiency and insufficiency have been debated. In addition to adequate nutritional support, activity level plays a huge role in boosting bone mineral density. We know exercise is important. As such, further research is needed to identify whether or not there is a means to maintain bone health without compromising training practices to optimise endurance performance. Kids who participate in youth sports achieve greater peak bone mineral density in their 20s than kids who watch from the bleachers, but only with adequate nutritional support. Athletes are often recommended to consume more protein than is recommended for the general population, in order to support the additional demands of athletic training.
Bone Health in Athletes	Sign up now and get a FREE copy of the Best Diets for Cognitive Fitness. Stay on top of latest health news from Harvard Medical School. Recent Blog Articles. Flowers, chocolates, organ donation — are you in? What is a tongue-tie? What parents need to know. Which migraine medications are most helpful? How well do you score on brain health? Shining light on night blindness. Can watching sports be bad for your health? Beyond the usual suspects for healthy resolutions. Share This Page Share this page to Facebook Share this page to Twitter Share this page via Email. Print This Page Click to Print. Related Content. Women's Health. Osteoporosis Staying Healthy Women's Health. Free Healthbeat Signup Get the latest in health news delivered to your inbox! Newsletter Signup Sign Up. Close Thanks for visiting. The Best Diets for Cognitive Fitness , is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more. I want to get healthier. Close Health Alerts from Harvard Medical School Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss Close Stay on top of latest health news from Harvard Medical School. Plus, get a FREE copy of the Best Diets for Cognitive Fitness. Dairy products like milk and yogurt are great ways to get calcium in your body. Vitamin D is important because it enables your body to absorb calcium. The best way to get vitamin D is through direct sunlight — which can be difficult when you play sports indoors or are covered from head to toe in a uniform or sunscreen. You can, however, ramp up your vitamin D intake through foods like orange juice, egg yolks, and salmon. Osmani may recommend supplementation. Weight-bearing exercises are those that put excess pressure on your bones and muscles against the force of gravity. These exercises cause your bones to work harder, making them stronger and less prone to injury. Examples of this type of exercise include running, basketball, and tennis. It creates an acidic environment that your body needs to neutralize, which it does with calcium. This takes the stored calcium out of your bones, which leads to decreased density and an increased risk for osteoporosis. What Every Athlete Should Know About Supporting Their Bone Health. You Might Also Enjoy Is your neck pain causing your headache? Or is it your headache causing problems in your neck? The shoulder is the most flexible joint in the body and one of the most complex. BMD is influenced by numerous modifiable and non-modifiable risk factors see Figure 1. Low BMD is reported to be more common in Caucasian and Asian populations as well as in post-menopausal women 2. 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.
Sports like soccer, basketball better for young athletes’ bone health than running alone: IU News	Level of evidence: Levels 1 through 4 evidence included. Results: There is strong evidence that 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, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Both of these can lead to morbidity and lost time from training and competition. Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB. Bone gain in young adult women. CAS PubMed Google Scholar. Henry YM, Fatayerji D, Eastell R. Attainment of peak bone mass at the lumbar spine, femoral neck and radius in men and women: relative contributions of bone size and volumetric bone mineral density. Ranson CA, Burnett AF, Kerslake RW. Injuries to the lower back in elite fast bowlers: acute stress changes on MRI predict stress fracture. J Bone Jt Surg. CAS Google Scholar. Scofield KL, Hecht S. Bone health in endurance athletes: runners, cyclists and swimmers. Curr Sports Med Rep. Dolan E, McGoldrick A, Davenport C, Kelleher G, Byrne B, Tormey W, et al. An altered hormonal profile and elevated rate of bone loss are associated with low bone mass in professional horse-racing jockeys. J Bone Miner Metab. Wilson G, Hill J, Sale C, Morton JP, Close GL. Elite male flat jockeys display lower bone density and lower resting metabolic rate than their female counterparts: implications for athlete welfare. Appl Physiol Nutr Metab. Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado J, et al. Bone mineral density in vocational and professional ballet dancers. Wewege MA, Ward RE. Bone mineral density in pre-professional female ballet dancers: a systematic review and meta-analysis. J Sci Med Sport. Frost HM. The mechanostat: a proposed pathogenetic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner. Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R. Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Walsh JS, Henriksen DB. Feeding and bone. Arch Biochem Biophys. Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ. Human bone collagen synthesis is a rapid, nutritionally modulated process. J Bone Miner Res. Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption. Eur J Endocrinol. Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. Life-course approach to nutrition. Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutri. Jugdaohsingh R. Silicon and bone health. J Nutr Health Ageing. Price CT, Langford JR, Liporace FA. Essential nutrients for bone health and a review of their availability in the average North American diet. Open Orthop J. PubMed PubMed Central Google Scholar. Larson-Meyer ED, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Int J Sports Nutr Exerc Metab. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance. Sports Med. Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C. Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. Loucks AB, Kiens B, Wright HH. Energy availability in athletes J Sports Sci. Slater J, McLay-Cooke R, Brown R, Black K. Female recreational exercisers at risk for low energy availability. Google Scholar. Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK. Exercise dependence, eating disorder symptoms and biomarkers of relative energy deficiency in sports RED-S among male endurance athletes. BMJ Open Sport Exerc Med. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women. Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Thong FS, McLean C, Graham TE. Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors. J Appl Physiol. Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Effects of reduced energy availability on bone metabolism in women and men. Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, et al. Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women. Prouteau S, Pelle A, Collomp K, Benhamou L, Courteix D. Bone density in elite judoists and effects of weight cycling on bone metabolic balance. 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. J Clin Endocrinol Metab. Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, et al. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI. The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Southmayd EA, Mallinson RJ, Williams NI, Mallinson DJ, De Souza MJ. Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. Br J Sports Med. Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the female athlete triad in male athletes. 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. 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. Stellingwerff T. Case study: body composition periodization in an Olympic-level female middle-distance runner over a 9-year career. Petkus DL, Murray-Kolb LE, De Souza MJ. The unexplored crossroads of the female athlete triad and iron deficiency: a narrative review. Noakes T, Volek JS, Phinney SD. Low-carbohydrate diets for athletes: what evidence? Br J Sports Nutr. Chang CK, Borer K, Lin PJ. Low-carbohydrate-high-fat diet: can it help exercise performance? J Hum Kinet. Bjarnason NH, Henriksen EE, Alexandersen P, Christgau S, Henriksen DB, Christiansen C. Mechanism of circadian variation in bone resorption. de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME. Carbohydrate beverages attenuate bone resorption markers in elite runners. Sale C, Varley I, Jones TW, James RM, Tang JC, Fraser WD, et al. Effect of carbohydrate feeding on the bone metabolic response to running. Bielohuby M, Matsuura M, Herbach N, Kienzle E, Slawik M, Hoeflich A, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats. Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Morton RW, Murphy KT, McKellar SR, Schoenfeld BJ, Henselmans M, Helms E, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Kraut J, Coburn J. Bone, acid and osteoporosis. N Engl J Med. Barzel U, Massey L. Excess dietary protein can adversely effect bone. J Nutr. Dolan E, Sale C. Protein and bone health across the lifespan. Proc Nutr Soc. Fenton T, Eliasziw M, Lyon A, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid ash diet hypothesis. Am J Clin Nutr. Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. Heaney R. Bone Health. Zimmerman E, Busse B, Ritchie R. The fracture mechanics of human bone: influence of disease and treatment. Bonekey Rep. Do multi-ingredient protein supplements augment resistance training-induced gains in skeletal muscle mass and strength? A systematic review and meta-analysis of 35 trials. Article PubMed Google Scholar. Kohrt WM, Barry DW, Schwartz RS. Muscle forces or gravity: what predominates mechanical loading on bone? Rizzoli R, Biver E, Bonjour JP, Coxam V, Goltzman D, Kanis JA, et al. Benefits and safety of dietary protein for bone health—an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation. Owens DJ, Fraser WD, Close GL. Vitamin D and the athlete: emerging insights. Eur J Sport Sci. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. Scientific Advisory Committee on Nutrition. Vitamin D and Health. Accessed 17 Oct The Institute of Medicine. Dietary Guidelines for Americans Holick MF. Vitamin D deficiency. Angeline ME, Gee AO, Shindle M, Warren RF, Rodeo SA. The effects of vitamin D deficiency in athletes. Am J Sports Med. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Miller JR, Dunn KW, Ciliberti LJ, Patel RD, Swanson BA. Association of vitamin D with stress fractures: a retrospective cohort study. J Foot Ankle Surg. If we can educate our youth on the importance of maintaining a healthy diet and supplying their active bodies with the energy they need, then we can prevent many of these injuries and maybe even reduce the chances that a woman develops osteoporosis later in life. We know exercise is important. We know that a healthy weight is important. But what may not get enough attention is the fact that eating healthy calories to replenish and fuel the body is vital to athletes' health, in particular for strong and resilient bones. Remember, bones are also a girl's best friends. And they should be like diamonds — strong and dense. We need to work to make sure they are. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Thanks for visiting. Don't miss your FREE gift. The Best Diets for Cognitive Fitness , is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School. Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more. Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss from exercises to build a stronger core to advice on treating cataracts. PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts. Sign up now and get a FREE copy of the Best Diets for Cognitive Fitness. Stay on top of latest health news from Harvard Medical School. Recent Blog Articles. Flowers, chocolates, organ donation — are you in? What is a tongue-tie? What parents need to know. Which migraine medications are most helpful?

Healthy bones in athletes -

Wewege MA, Ward RE. Bone mineral density in pre-professional female ballet dancers: a systematic review and meta-analysis. J Sci Med Sport. Frost HM. The mechanostat: a proposed pathogenetic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents.

Bone Miner. Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R. Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Walsh JS, Henriksen DB. Feeding and bone. Arch Biochem Biophys. Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ.

Human bone collagen synthesis is a rapid, nutritionally modulated process. J Bone Miner Res. Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption.

Eur J Endocrinol. Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. Life-course approach to nutrition. Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutri. Jugdaohsingh R. Silicon and bone health. J Nutr Health Ageing. Price CT, Langford JR, Liporace FA.

Essential nutrients for bone health and a review of their availability in the average North American diet. Open Orthop J. PubMed PubMed Central Google Scholar.

Larson-Meyer ED, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Int J Sports Nutr Exerc Metab. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al. American College of Sports Medicine position stand.

The female athlete triad. Med Sci Sports Exerc. Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance.

Sports Med. Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C.

Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. Loucks AB, Kiens B, Wright HH. Energy availability in athletes J Sports Sci. Slater J, McLay-Cooke R, Brown R, Black K.

Female recreational exercisers at risk for low energy availability. Google Scholar. Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK.

Exercise dependence, eating disorder symptoms and biomarkers of relative energy deficiency in sports RED-S among male endurance athletes. BMJ Open Sport Exerc Med. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women.

Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Thong FS, McLean C, Graham TE.

Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors. J Appl Physiol. Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Effects of reduced energy availability on bone metabolism in women and men. Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, et al.

Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women. Prouteau S, Pelle A, Collomp K, Benhamou L, Courteix D. Bone density in elite judoists and effects of weight cycling on bone metabolic balance.

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. J Clin Endocrinol Metab.

Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, et al. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI.

The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Southmayd EA, Mallinson RJ, Williams NI, Mallinson DJ, De Souza MJ. Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women.

De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. Br J Sports Med. Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the female athlete triad in male athletes. 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. 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.

Stellingwerff T. Case study: body composition periodization in an Olympic-level female middle-distance runner over a 9-year career. Petkus DL, Murray-Kolb LE, De Souza MJ.

The unexplored crossroads of the female athlete triad and iron deficiency: a narrative review. Noakes T, Volek JS, Phinney SD.

Low-carbohydrate diets for athletes: what evidence? Br J Sports Nutr. Chang CK, Borer K, Lin PJ. Low-carbohydrate-high-fat diet: can it help exercise performance? J Hum Kinet. Bjarnason NH, Henriksen EE, Alexandersen P, Christgau S, Henriksen DB, Christiansen C.

Mechanism of circadian variation in bone resorption. de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME. Carbohydrate beverages attenuate bone resorption markers in elite runners. Sale C, Varley I, Jones TW, James RM, Tang JC, Fraser WD, et al. Effect of carbohydrate feeding on the bone metabolic response to running.

Bielohuby M, Matsuura M, Herbach N, Kienzle E, Slawik M, Hoeflich A, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats.

Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Morton RW, Murphy KT, McKellar SR, Schoenfeld BJ, Henselmans M, Helms E, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults.

Kraut J, Coburn J. Bone, acid and osteoporosis. N Engl J Med. Barzel U, Massey L. Excess dietary protein can adversely effect bone. J Nutr. Dolan E, Sale C. Protein and bone health across the lifespan.

Proc Nutr Soc. Fenton T, Eliasziw M, Lyon A, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid ash diet hypothesis. Am J Clin Nutr. Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM.

Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women.

Heaney R. Bone Health. Zimmerman E, Busse B, Ritchie R. The fracture mechanics of human bone: influence of disease and treatment. Bonekey Rep. Do multi-ingredient protein supplements augment resistance training-induced gains in skeletal muscle mass and strength?

A systematic review and meta-analysis of 35 trials. Article PubMed Google Scholar. Kohrt WM, Barry DW, Schwartz RS. Muscle forces or gravity: what predominates mechanical loading on bone? Rizzoli R, Biver E, Bonjour JP, Coxam V, Goltzman D, Kanis JA, et al. Benefits and safety of dietary protein for bone health—an expert consensus paper endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases and by the International Osteoporosis Foundation.

Owens DJ, Fraser WD, Close GL. Vitamin D and the athlete: emerging insights. Eur J Sport Sci. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. Scientific Advisory Committee on Nutrition. Vitamin D and Health. Accessed 17 Oct The Institute of Medicine. Dietary Guidelines for Americans Holick MF.

Vitamin D deficiency. Angeline ME, Gee AO, Shindle M, Warren RF, Rodeo SA. The effects of vitamin D deficiency in athletes.

Am J Sports Med. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Miller JR, Dunn KW, Ciliberti LJ, Patel RD, Swanson BA.

Association of vitamin D with stress fractures: a retrospective cohort study. J Foot Ankle Surg. Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, et al. Vitamin D profile in National Football League players. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K.

Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, et al. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.

Institute of Medicine. Dietary reference intakes for calcium and vitamin D: Institute of Medicine of the National Academies, Rector RS, Rogers R, Ruebel M, Hinton PS. Participation in road cycling vs running is associated with lower bone mineral density in men. Tenforde AS, Carlson JL, Sainani KL, Chang AO, Kim JH, Golden NH, et al.

Sport and triad risk factors influence bone mineral density in collegiate athletes. Barry DW, Hansen KC, van Pelt RE, Witten M, Wolfe P, Kohrt WM.

Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis. Haakonssen EC, Ross ML, Knight EJ, Cato LE, Nana A, Wluka AE, et al. The effects of a calcium-rich pre-exercise meal on biomarkers of calcium homeostasis in competitive female cyclists: a randomised crossover trial.

PLoS One. Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, et al. Hyponatremia-induced osteoporosis. Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss.

J Biol Chem. Scott JP, Sale C, Greeves JP, Casey A, Dutton J, Fraser WD. Effect of fasting versus feeding on the bone metabolic response to running. Townsend R, Elliott-Sale KJ, Currell K, Tang J, Fraser WD, Sale C.

The effect of post-exercise carbohydrate and protein ingestion on bone metabolism. Download references. This supplement is supported by the Gatorade Sports Science Institute GSSI. The supplement was guest edited by Lawrence L. Spriet, who attended a meeting of the GSSI Expert Panel in March and received honoraria from the GSSI, a division of PepsiCo, Inc.

Spriet received no honoraria for guest editing the supplement. Spriet suggested peer reviewers for each paper, which were sent to the Sports Medicine Editor-in-Chief for approval, prior to any reviewers being approached.

Spriet provided comments on each paper and made an editorial decision based on comments from the peer reviewers and the Editor-in-Chief. Where decisions were uncertain, Dr. Spriet consulted with the Editor-in-Chief.

Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK. You can also search for this author in PubMed Google Scholar.

Correspondence to Craig Sale. This article is based on a presentation by Craig Sale to the GSSI Expert Panel in March Funding for attendance at that meeting together with an honorarium for preparation of this article were provided by the GSSI.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Sale, C. Nutrition and Athlete Bone Health. Sports Med 49 Suppl 2 , — Download citation. Published : 13 November Issue Date : December Anyone you share the following link with will be able to read this content:.

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Download PDF. Abstract Athletes should pay more attention to their bone health, whether this relates to their longer-term bone health e. Bone Health in Athletes Chapter © Food Versus Pharmacy: Assessment of Nutritional and Pharmacological Strategies to Improve Bone Health in Energy-Deficient Exercising Women Article 22 August Vitamin D and the Athlete: Current Perspectives and New Challenges Article Open access 24 January Use our pre-submission checklist Avoid common mistakes on your manuscript.

FormalPara Key Points The diet required by the athlete to support bone health is not markedly different from the general population, with a few specific challenges.

Much more athlete-specific research is required. Table 1 Some key nutrients to support bone health Full size table. References Santos L, Elliott-Sale KJ, Sale C. CAS PubMed PubMed Central Google Scholar Dobbs MB, Buckwalter J, Saltzman C.

CAS PubMed PubMed Central Google Scholar Johnell O, Kanis J. PubMed Google Scholar World Health Organization. CAS PubMed PubMed Central Google Scholar National Institute for Health and Clinical Excellence.

CAS PubMed Google Scholar Henry YM, Fatayerji D, Eastell R. PubMed Google Scholar Ranson CA, Burnett AF, Kerslake RW. CAS Google Scholar Scofield KL, Hecht S. PubMed Google Scholar Dolan E, McGoldrick A, Davenport C, Kelleher G, Byrne B, Tormey W, et al. CAS PubMed Google Scholar Wilson G, Hill J, Sale C, Morton JP, Close GL.

PubMed Google Scholar Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado J, et al. CAS PubMed Google Scholar Wewege MA, Ward RE. PubMed Google Scholar Frost HM. CAS PubMed Google Scholar Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R.

CAS PubMed Google Scholar Walsh JS, Henriksen DB. CAS PubMed Google Scholar Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ.

CAS PubMed Google Scholar Schlemmer A, Hassager C. CAS PubMed Google Scholar Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R.

CAS PubMed PubMed Central Google Scholar Palacios C. CAS Google Scholar Jugdaohsingh R. CAS Google Scholar Price CT, Langford JR, Liporace FA. PubMed PubMed Central Google Scholar Larson-Meyer ED, Woolf K, Burke L. CAS Google Scholar Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al.

PubMed Google Scholar Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. PubMed Google Scholar Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. CAS Google Scholar Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C. PubMed Google Scholar Loucks AB, Kiens B, Wright HH.

PubMed Google Scholar Slater J, McLay-Cooke R, Brown R, Black K. Google Scholar Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK.

PubMed PubMed Central Google Scholar Ihle R, Loucks AB. PubMed Google Scholar Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, Trenti T, et al. CAS PubMed Google Scholar Thong FS, McLean C, Graham TE.

CAS PubMed Google Scholar Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. CAS PubMed Google Scholar Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, et al. PubMed Google Scholar Prouteau S, Pelle A, Collomp K, Benhamou L, Courteix D.

PubMed Google Scholar Ackerman KE, Nazem T, Chapko D, Russell M, Mendes N, Taylor AP, et al. CAS PubMed PubMed Central Google Scholar Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, et al.

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Most recently the International Olympic Committee has coined the term RED-S — Relative Energy Deficiency in Sport. This exemplifies the importance of fueling your body with the appropriate amount of energy food for the duration and intensity of activity performed.

In other words, if you don't eat enough, there will be repercussions, some serious. Poor nutrition and insufficient calories for the amount of exercise you do will lead to changes in your body's hormone levels and directly affect bone density.

Let's talk about bone health. We know that we can build bone density until about age After that we can only work to maintain what we've got. If young female athletes are losing bone density, it can never be replaced.

We also know that female athletes suffer from two to three times the number of stress fractures compared to male athletes. And women athletes with missed menstrual cycles which can happen when activity outpaces calories consumed have two to four times the risk of stress fractures compared to women with normal monthly menstrual cycles.

A stress fracture occurs when the bone is subject to more stress or impact than it can handle. This may simply be due to overtraining, or increasing training too quickly without giving the bones adequate time to adapt.

Stress fractures can also be due to a lower bone mineral density, which means it takes less force to cause damage. This often is the result of the female athlete triad — a direct result of not eating enough, or not eating enough of the right foods.

If we can educate our youth on the importance of maintaining a healthy diet and supplying their active bodies with the energy they need, then we can prevent many of these injuries and maybe even reduce the chances that a woman develops osteoporosis later in life.

We know exercise is important. We know that a healthy weight is important. But what may not get enough attention is the fact that eating healthy calories to replenish and fuel the body is vital to athletes' health, in particular for strong and resilient bones.

Remember, bones are also a girl's best friends. And they should be like diamonds — strong and dense. We need to work to make sure they are.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Thanks for visiting. Don't miss your FREE gift. The Best Diets for Cognitive Fitness , is yours absolutely FREE when you sign up to receive Health Alerts from Harvard Medical School.

Sign up to get tips for living a healthy lifestyle, with ways to fight inflammation and improve cognitive health , plus the latest advances in preventative medicine, diet and exercise , pain relief, blood pressure and cholesterol management, and more.

Get helpful tips and guidance for everything from fighting inflammation to finding the best diets for weight loss from exercises to build a stronger core to advice on treating cataracts.

PLUS, the latest news on medical advances and breakthroughs from Harvard Medical School experts. Sign up now and get a FREE copy of the Best Diets for Cognitive Fitness.

Stay on top of latest health news from Harvard Medical School. Recent Blog Articles. Flowers, chocolates, organ donation — are you in? What is a tongue-tie?

Between grueling Holistic health remedies and Athlehes intensity of your games, your body uses and loses vital nutrients, which can ultimately take a toll on your Healthh health. However, taking Healthy bones in athletes time to optimize your athletea, calcium intake, and overall strength helps you stay on top of your sport for the long haul. Our orthopedic specialists diagnose common and serious sports-related injuries and tailor your treatment specifically to you, which gets you back in the game quickly and efficiently. Your bones are growing, living organisms that constantly break down and rebuild themselves. This keeps your bones strong and dense, which protects them from injuries.