Nutrition and Athlete Bone Health

Abstract

Athletes should pay more attention to their bone health, whether this relates to their longer-term bone health (e.g. risk of osteopenia and osteoporosis) or their shorter-term risk of bony injuries. Perhaps the easiest way to do this would be to modify their training loads, although this advice rarely seems popular with coaches and athletes for obvious reasons. As such, other possibilities to support the athletes' bone health need to be explored. Given that bone is a nutritionally modified tissue and diet has a significant influence on bone health across the lifespan, diet and nutritional composition seem like obvious candidates for manipulation. The nutritional requirements to support the skeleton during growth and development and during ageing are unlikely to be notably different between athletes and the general population, although there are some considerations of specific relevance, including energy availability, low carbohydrate availability, protein intake, vitamin D intake and dermal calcium and sodium losses. Energy availability is important for optimising bone health in the athlete, although normative energy balance targets are highly unrealistic for many athletes. The level of energy availability beyond which there is no negative effect for the bone needs to be established. 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. Dermal calcium losses might be an important consideration for endurance athletes, particularly during long training sessions or events. In these situations, some consideration should be given to pre-exercise calcium feeding. The avoidance of vitamin D deficiency and insufficiency is important for the athlete to protect their bone health. There remains a lack of information relating to the longer-term effects of different dietary and nutritional practices on bone health in athletes, something that needs to be addressed before specific guidance can be provided.

Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention

“…Similar to female athletes, progesterone and oestradiol levels are reduced in response to LEA in male athletes [90]. Consistently, architecture and turnover markers of bone were significantly reduced in endurance runners [89].…”

“…Furthermore, during LEA, oestradiol and progesterone are reduced in female athletes with RED-S [90]. In females, oestradiol levels are extremely sensitive to and are attenuated by within-day LEA [91].…”

“…Of course, there are other factors affecting BMD. The interested reader may refer to a more comprehensive review on the athletes' bone health (see Sale and Elliot-Sale, 2019 [90]).…”

“…Long-term caloric restriction in male lean body builders lasting 11 weeks reduced IGF-1 in the period prior to competition [99]. In contrast, growth hormone (GH) levels mediating IGF-1 are greater in male and female athletes positive for RED-S [90] and may indicate the development of a GH resistance [101]. For instance, in male power athletes with low body fat, growth hormone treatment administered in a double-blind controlled trial neither influenced body composition nor muscle strength [106].…”

Can the sedentary behavior of young male basketball and volleyball players impact the bone mass and bone geometry?

“…For magnesium consumption, the same did not happen with vitamin D and calcium. It is known that one of the main functions of magnesium is to indirectly facilitate the absorption of these nutrients [35], which in turn, did not show signi cant differences between the modalities. As seen in this study, it is necessary to meet the recommended values of nutrients that are important to bone status.…”