Bone Health in Athletes

Abstract

Context: The health of the skeletal system is important for athletes young and old. From the early benefits of exercise on bones to the importance of osteoporosis prevention and treatment, bone health affects the ability to be active throughout life.

Evidence acquisition: PubMed articles dating from 1986 to 2016 were used for the review. 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.

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.

Figure 1.

Mechanical loading applied at the whole bone level is transmitted through the bone tissue to the cellular level and causes movement of the interstitial fluid surrounding osteocytes in the mineralized matrix. The osteocytes are distributed throughout bone tissue and connect to each other and to bone-lining cells and osteoblasts on the bone surfaces. Figure adapted from Rubin CT, McLeod KJ, Bain SD. Functional strains and cortical bone adaptation: epigenetic assurance of skeletal integrity. J Biomech. 1990;23(suppl 1):43-54. Reprinted with permission from Elsevier.

Figure 2.

Schematic of the spectrum of the female athlete triad, composed of 3 interrelated components of energy availability, menstrual function, and bone health. BMD, bone mineral density. Used with permission from Lippincott Williams & Wilkins/Wolters Kluwer Health. As published in Br J Sports Med.

Figure 3.

Imaging studies of a right compression-sided femoral neck stress fracture in a 26-year-old female runner with the female athlete triad. Anteroposterior pelvis radiograph (a) does not show any abnormality. Coronal inversion recovery (b) and proton density–weighted (c) magnetic resonance images show bone marrow edema with a fracture line that involves approximately 50% of the diameter of the neck. A repeat coronal proton density–weighted magnetic resonance imaging done 6 weeks later (d) shows interval healing with decreased fracture line.