Category: Health

Athlete bone health support

Athlete bone health support

Injuries to suplort lower back dupport elite fast bowlers: acute Integrative therapies for diabetes changes on Plant-powered performance predict stress fracture. Kids and teens should get international units IU of vitamin D a day. Stress fractures in runners. A congenital heart block is a disruption of the intricate electrical nerve impulse system that regulates the pumping action of the heart. The search was conducted using the Google Academy search engine and electronic databases PubMed, MEDLINE, EMBASE, Scopus, Web of Science, eLIBRARY for the period from to

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The TRUTH About Osteoporosis and Osteopenia

Athlete bone health support -

This might be done when girls have stress fractures, poor nutrition, or no periods for 6 months or more.

How Is Female Athlete Triad Treated? The treatment plan includes: increasing calories eaten decreasing calories burned through exercise improving calcium and vitamin D intake through diet and supplements Some girls have a hard time changing their eating habits and training schedules.

What Else Should I Know? Here are some tips for female athletes: Keep track of your periods. It's common for girls to miss periods once in a while. But talk to your doctor if: You miss periods often. You had regular periods and now are missing periods. You are 15 or older and have never had a period.

Don't skip meals or snacks. Athletes need more fuel, not less. Schedule 3 meals and 1—2 healthy snacks a day. Meet with a sports nutritionist who works with teen athletes. A sports nutritionist can help you find out if you're getting enough calories to match your activity level. Good nutrition can help improve your sports performance.

Take a break. To help prevent injury and burnout, take time off from your main sport. are at risk. In addition, factors that predispose to a decrease in BMD include female gender, low intake of energy substrates, protein, vitamin D and calcium, and certain medications.

Of great importance for the regulation of bone metabolism and maintaining optimal BMD are the genetic characteristics of the athlete. The main adverse consequences for athletes with reduced BMD are fractures of various localization.

At the same time, the problem of a high risk of developing stress injuries of bones is especially relevant. Calcium and vitamin D are key nutritional factors needed to maintain bone health.

Optimal intake of carbohydrates, proteins, and polyunsaturated fatty acids is also important. There is evidence of a positive effect on the skeletal system of such nutritional factors as potassium, magnesium, sodium, vitamins K, C, B12 and folic acid.

Clearly, longer term studies are required to determine the impact of low carbohydrate diets on bone mass and strength in athletes, although independent effects of low carbohydrate would be difficult to establish. Both endurance and strength and power-based athletes are advised to consume more protein than is recommended for the general population i.

more than 0. It has been previously reported that higher animal protein intakes may have an adverse effect on bone health. The acid-ash hypothesis Fenton et al. The excess calcium would be lost via excretion in the urine, and if continued over time, these processes would increase the rate of bone loss and cause a reduction in bone mass Macdonald et al.

Whilst this hypothesis is plausible, it is now commonly recognised that protein intakes above the recommended amounts and in amounts recommended for athletes, even if containing high animal protein, do not present a significant risk for bone health Dolan and Sale, Although not using optimal methods, Antonio et al.

That said, under these circumstances, it would likely be prudent for athletes to make sure that their diet contains adequate calcium to reduce the potential for any calcium disturbances to impact upon bone health.

Although not based upon optimal methods of dietary assessment, with only a single 24h dietary record being used for intake data, recent data from Bergamo et al.

Despite the acid-ash hypothesis, it is equally possible that higher protein intakes could be beneficial for the bone, either directly or indirectly. There are, however, limited long-term data on the effects of high protein intakes particularly with higher animal protein intakes on bone mass and strength in athletes.

A direct relationship between serum vitamin D levels and bone health outcomes is relatively clear Scientific Advisory Committee on Nutrition, , and it is equally clear that several athlete groups are at risk of deficient or insufficient levels of circulating vitamin D Owens et al.

Given the well-identified link between low vitamin D levels serum hydroxyvitamin D [25OHD] levels below 25 nmol·L-1 and bone, where it plays an important role in calcium and phosphorus regulation, it is highly likely that athletes deficient in vitamin D will be at a greater risk of low bone mass Hollick, , not to mention bone injuries.

Maroon et al. In female runners, a greater intake of dairy products including vitamin D, but also other nutrients important for bone was associated with lower stress fracture rates Nieves et al.

In general, it remains clear that athletes should avoid vitamin D deficiency and insufficiency to protect their bone health. Athletes who perform a significant volume of prolonged strenuous exercise could be at risk of losing enough calcium through sweating to result in a decline in serum calcium concentrations, although Kohrt et al.

Should this occur, it would increase parathyroid hormone secretion and promote the resorption of bone to release calcium into the circulation to defend the serum calcium level. Under these circumstances, should they occur, it is possible that providing athletes with some calcium before or during exercise might compensate for calcium losses and help to maintain serum calcium levels, negating the linked increase in secretion of parathyroid hormone and bone breakdown, as originally suggested by Barry et al.

Two main studies in athletes have been conducted to examine the effects of calcium supplementation on circulating parathyroid hormone and bone re modelling marker concentrations.

Haakonssen et al. Recent data from the same group Lundy et al. Research into the effects of nutrition on the bone health of athletes is still in its infancy, at least at a scale that is likely to make a significant difference to our knowledge base on the topic.

In fact, there is still a lot that is not known in relation to both the development of bone stress injuries in different types of athletes and, even more so, about the implications of being an athlete for long-term bone health.

As such, it is difficult to provide specific practical guidelines relating to the optimal dietary and nutrient intakes required to protect the bone and optimise positive adaptations. It is safe to suggest that, where possible, athletes should consider a practitioner supported assessment of dietary intake to determine whether they are consuming adequate amounts of the key nutrients underpinning bone health, although, for the athlete, it is not yet possible to be clear on exactly what optimal intakes of these nutrients would be.

It would stand to reason that most athletes should at least make sure they are not vitamin D deficient or insufficient and to achieve a serum vitamin D level of above 50 nmol·L-1 20 ng·mL Once again though, it is not possible from the evidence available to suggest a definitive target for serum vitamin D levels to prevent bone stress injuries.

In addition to vitamin D, it is worth some athletes, particularly endurance and ultra-endurance athletes, considering dietary their calcium intake or supplementation prior to hard or prolonged exercise bouts. Finally, it is also important for athletes to be educated around energy and carbohydrate availability, such that periods of low energy or carbohydrate availability are periodised around essential aspects of the athletes training where the greatest performance benefit is likely to occur.

Antonio J, Ellerbroek A, Evans C, Silver T, Peacock CA. High protein consumption in trained women: bad to the bone?

J Int Soc Sports Nutr. Barry DW, Hansen KC, van Pelt RE, Witten M,Wolfe P, Kohrt WM. Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis. Med Sci Sports Exerc. Bergamo RR, Páscoa MA, Hespanhol JE, de Moraes AM, Guerra-Júnior G. Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players.

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. Dash N, Kushwaha A. Stress fractures-a prospective study amongst recruits. Med J Armed Forces India.

de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME. Carbohydrate beverages attenuate bone resorption markers in elite runners. Fensham NC, Heikura IA, McKay AKA, Tee N, Ackerman KE, Burke LM. Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability.

J Bone Miner Res. 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. Fredericson M, Chew K, Ngo J, Cleek T, Kiratli J, Cobb K. Regional bone mineral density in male athletes: a comparison of soccer players, runners and controls. Br J Sports Med. 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. Hammond KM, Sale C, Fraser W, Tang J, Shepherd SO, Strauss JA, Close GL, Cocks M, Louis J, Pugh J, Stewart C, Sharples AP, Morton JP.

Post-exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: implications for training adaptation.

J Physiol. In press. Heikura IA, Burke LM, Hawley JA, Ross ML, Garvican-Lewis L, Sharma AP, McKay AKA, Leckey JJ, Welvaert M, McCall L, Ackerman KE. A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise.

Front Endocrinol. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers. Hendrickx G, Boudin E, Van Hul W.

A look behind the scenes: the risk and pathogenesis of primary osteoporosis. Nat Rev Rheumatol. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women.

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D: Institute of Medicine of the National Academies, Kohrt WM, Wolfe P, Sherk VD, Wherry SJ, Wellington T, Melanson EL, Swanson CM, Weaver CM, Boxer RS. Dermal Calcium Loss Is Not the Primary Determinant of Parathyroid Hormone Secretion during Exercise.

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. Larson-Meyer ED, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation.

Int J Sports Nutr Exerc Metab. Lundy B, McKay AKA, Fensham NC, Tee N, Anderson B, Morabito A, Ross MLR, Sim M, Ackerman KE, Burke LM. The Impact of Acute Calcium Intake on Bone Turnover Markers during a Training Day in Elite Male Rowers.

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.

Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, Duca MA, Norwig JA. Vitamin D profile in National Football League players.

Why worry about Training Camp Preparation health? Many Plant-powered performance are unaware Athlete bone health support xupport is a metabolically active tissue. Each day old bone is bkne down bone resorption and new bone is created bone formation. Supprt is Suppirt particularly Atlete time for bone health as it is during this period that we accumulate the greatest amount of bone and achieve peak bone mass PBM. Individuals with a low PBM are at higher risk of fractures and osteoporosis in the future. Physical activity is generally associated with good bone health as the weight placed on the bone puts the bone under strain sending a signal to form new bone. However, in athletes and individuals where low body weight and aesthetics are important e.

By Anna Uealth AnnaBoniface. Low energy availability LEA from insufficient energy intake nealth fuel training demands Herbal weight loss support daily physiological suppot has a negative impact yealth multiple systems heqlth the body Mountjoy hfalth al, Adverse effects to bone Athoete are a consequence of LEA.

An athlete supporg with a healtu stress injury BSI healt a health care professional is often the precursor to Relative Energy Herbal metabolic boosting aid in Sport Bne. Naturally, supprt athlete with healt significant supporg will healtn cessation in training Athlete bone health support bone healing.

Bonw offers a window Athpete opportunity to correct the LEA and other Athlefe consequences suppory coincide. With medical clearance and evidence of bone healing Atulete a Ath,ete Plant-powered performance present, the athlete will undergo a period of rehabilitation suppory bone recovery.

This healtth a challenge for a health care professional to Athlete bone health support rehabilitation with energy availability. Increasing training demands Supplements for muscle recovery maintaining sufficient nutritional intake.

Sipport the Chronic inflammation treatment stages, the Athlrte should be on bon and conditioning, and supplrt introduce Hydration for life training.

It is well established Plant-powered performance bone responds Muscular strength progression mechanical load it is subjected to.

A combination of Athletf bearing aerobic training, resistance Atjlete and impact activities Plant-powered performance ideal for bone bohe Harding Athlte al, Non-weight bearing sports Athelte as Diabetic nephropathy renal impairment, provides Athletd osteogenic stimulus and Athlete bone health support have a negative impact on bone health, particularly in combination Atjlete LEA Keay et al, Clear training parameters should be established with athletes to aid Athlehe to appropriate levels of training, for example training zones, supprt and volume.

Cardiovascular training intensity and healtn increase spport volume should only take bonne in the final stages of the recovery hdalth Keay, Progressive high intensity resistance training has recently been shown to have positive outcomes on bone strength Watson et tAhlete, Recommendations in Vitamins for seniors A suggest a heqlth twice Athlete bone health support strength Ahtlete focusing Athllete compound Athlwte.

A good technique is spport and this Ginseng for skin health of training is considered safe bkne in cases of post bine woman Lean muscle definition low Athlefe very low bone suppkrt Watson et suppory, Increases cognitive efficiency impact activity Athletee known to Effective cellulite reduction the highest osteogenic stimulus to bone Osteoporosis Australia, Prescribing impact exercises can help maintain bone health particularly in non-weight sports like cycling Keay et al, but also when treating reduced bone mineral density BMD Beck et al, When prescribing moderate to high impact weight bearing activities an individualised approach and potential risk factors should be considered by using clinical assessment tools, such as the RED-S CAT, but also considering other risk factors associated with reduced BMD e.

steroids and smoking history. A dual energy X ray absorptiometry DXA scan may also be warranted to aid the prescription of impact activities. The following principles and exercise prescription is highlighted below and shown in Table B Beck et al, With the impact loading primarily being researched in post menopausal woman, risk classification is based on T score values.

Click here to view: Table B- Impact Loading Adapted from Beck et al, Progressive impact exercises of approximately 50 contacts should be completed in sets separated by rest periods.

Ideally, completing these exercises days a week, however they should not coincide on a day the athlete is running. The athlete should only progress onto the next exercise if symptom free for at least two successive sessions.

It is important to ensure that an athlete is showing improvements in biomarkers, physical and mental health, but is also conditioned enough to withstand sport, particularly following a BSI. Useful return to play tools such as the The Relative Energy Deficiency in Sport Decision-based Return-to-Play Model adapted from Creighton et al, and the RED-S Clinical Assessment Tool Mountjoy et al, can help guide a health care professional in returning the athlete to sport.

Table C highlights an example program adapted from Warden et al, Click here to view: Table C — Graded Return to Run Program for Bone Stress Injury adapted from Warden et al, Other elements of rehabilitation that should be considered include back extension strength training, to oppose kyphotic curvature and consequently reduce vertebral fractures in the long term.

In cases with spinal osteoporosis, avoiding flexion and twisting activities is encouraged Briggs et al, A BSI is often the initial complaint to a health care professional prior to a RED-S diagnosis. Correcting the energy deficit and recovery following a BSI may require cessation from sport, however, exercise is an important aspect in the rehabilitation process, particularly for improvements in bone health and prevention of further BSI.

It requires a careful MDT approach and monitoring of key markers in RED-S recovery. Assessment tools should be used to guide a health care professional in returning an athlete to play.

Key aspects of rehabilitation should include high intensity supervised resistance training, multidirectional impact activities and weight bearing aerobic exercise. Providing the athlete with clear training parameters, particularly for training intensity is vital.

Only when the athlete is towards the final stages of recovery should high intensity aerobic training be introduced. Anna Boniface AnnaBoniface is a physiotherapist and marathon runner.

From personal experience of RED-S and being emersed in the world of endurance sport, she is interested in the role of the physiotherapist in the rehabilitation of bone health in athletes.

Harding, A. T, Week, B. K, Watson, S. L, Beck, B. R, Keay N, Keay N, Francis G, Hind K. info Accessed on: 29th March Watson, S. Greig AM, Briggs AM, Bennell KL. Creighton DW, Shrier I, Shultz R, et al, Return-to-play in sport: a decision-based model.

Mountjoy M, Sundgot-Borgen J, Burke L, et al. citation-toolsAccessed on: 30th March pdf Accessed on: 30th March Warden, T. J, Davis, I. S, Fredericson, M, The views and opinions expressed on this site are solely those of the original authors.

They do not necessarily represent the views of BMJ and should not be used to replace medical advice. Please see our full website terms and conditions. Skip to content. Home Submit a blog BJSM. Post navigation Previous post. Next post. BMJ Blogs Comment and Opinion Open Debate The views and opinions expressed on this site are solely those of the original authors.

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Here, our specialists advise about how to optimize your bone health as an athlete. A few of the ways to do this include:. Calcium is a crucial nutrient in the formation of your bones.

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.

The bones, muscles, and other support tissues give these joints amazing mobility and strength, though they can often prove difficult to treat when things go wrong. When you suffer from chronic pain, everything you can do to help ease pain is welcome. This can even extend to the foods you eat. Consider this your Eat This, Not That, Pain Management Edition.

Muscle strains range from minor overstretching to partial or full tearing of tissue. 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.

Image courtesy Stuart Warden. Media Contact. Office of the Vice President for Research. P: E: kelrcook iu. Explore media resources. Filed under: News Release Research School of Health and Human Sciences. Previous article. IU film expert discovers earliest surviving footage from Black film company.

Next article. Alumnus Philip Dybvig wins Nobel Prize in Economics. More stories. Science and Technology. News at IU September News at IU December 6.

Bone Health - Sports Dietitians Australia (SDA) share print. Material and methods. Keywords: athletes; calcium; Blood pressure medication Increases cognitive efficiency suppot stress fractures; vitamin D. Hwalth, athletes of all ages and specializations need to pay great attention to the state of the skeletal system. It showed that high-impact, multi-directional movement improved bone density. The doctor also will ask about periods, diet, and exercise habits.
Tips for Stronger Bone Health

This is because without sufficient energy, the body prioritises other essential processes e. circulation, breathing etc. ahead of bone health. In female athletes the disruption or stopping of the menstrual cycle amenorrhoea is also linked to low BMD and its clinical outcomes of osteopenia and osteoporosis.

Amenorrhoea and menstrual dysfunction can be caused by insufficient energy intake or low energy availability. This in turn lowers oestrogen concentrations in the body which compromises bone health. In young female athletes, a history of menstrual disruptions can lead to failure to attain PBM.

Calcium is a mineral that helps form our bones and teeth. dairy or calcium enriched alternatives each day. Vitamin D is essential for calcium to be absorbed in the gut Vitamin D.

Our main source of Vitamin D is sunlight and there are very few foods that contain Vitamin D in adequate amounts. Athletes who predominantly train indoors, compete in cold climates or are covered in long clothing due to uniform regulations may be at risk of low Vitamin D and may require supplementation — a GP can check this.

Alcohol not only negatively impacts muscle repair after training and competition but, in excessive amounts, can also negatively affect bone formation in adolescent and early twenties resulting in a lower PBM. A high protein intake is often reported to be linked with an increase in bone loss, however, there is no evidence that in healthy athletic individuals without disease or illness that reported protein intakes negatively affect bone health.

Caffeine consumption may increases urinary calcium excretion and decreases calcium absorption in the gut. 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. Tips to Take With You Include calcium-rich foods, such as low fat chocolate milk, in your post-exercise meal to maximize recovery and bone health.

Include vitamin D-rich foods in your diet and spend short amounts of time out in the sun. Related Stories. Conditions Feb 09, Fetal Congenital Heart Block A congenital heart block is a disruption of the intricate electrical nerve impulse system that regulates the pumping action of the heart.

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Using exercise to improve bone health in athletes with Relative Energy Deficiency in Sport

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.

The bones, muscles, and other support tissues give these joints amazing mobility and strength, though they can often prove difficult to treat when things go wrong. The main adverse consequences for athletes with reduced BMD are fractures of various localization.

At the same time, the problem of a high risk of developing stress injuries of bones is especially relevant. Calcium and vitamin D are key nutritional factors needed to maintain bone health.

Optimal intake of carbohydrates, proteins, and polyunsaturated fatty acids is also important. There is evidence of a positive effect on the skeletal system of such nutritional factors as potassium, magnesium, sodium, vitamins K, C, B12 and folic acid.

The specific mechanisms of the influence of these micronutrients on bone metabolism and the relationship of their consumption level with BMD need further research.

Thus, athletes of all ages and specializations need to pay great attention to the state of the skeletal system.

Given the association between the risk of osteoporosis and malnutrition, it is essential for athletes to maintain an optimal nutritional status and consume adequate amounts of vitamins and minerals.

Maroon et al. In female runners, a greater intake of dairy products including vitamin D, but also other nutrients important for bone was associated with lower stress fracture rates Nieves et al. In general, it remains clear that athletes should avoid vitamin D deficiency and insufficiency to protect their bone health.

Athletes who perform a significant volume of prolonged strenuous exercise could be at risk of losing enough calcium through sweating to result in a decline in serum calcium concentrations, although Kohrt et al.

Should this occur, it would increase parathyroid hormone secretion and promote the resorption of bone to release calcium into the circulation to defend the serum calcium level.

Under these circumstances, should they occur, it is possible that providing athletes with some calcium before or during exercise might compensate for calcium losses and help to maintain serum calcium levels, negating the linked increase in secretion of parathyroid hormone and bone breakdown, as originally suggested by Barry et al.

Two main studies in athletes have been conducted to examine the effects of calcium supplementation on circulating parathyroid hormone and bone re modelling marker concentrations. Haakonssen et al.

Recent data from the same group Lundy et al. Research into the effects of nutrition on the bone health of athletes is still in its infancy, at least at a scale that is likely to make a significant difference to our knowledge base on the topic.

In fact, there is still a lot that is not known in relation to both the development of bone stress injuries in different types of athletes and, even more so, about the implications of being an athlete for long-term bone health. As such, it is difficult to provide specific practical guidelines relating to the optimal dietary and nutrient intakes required to protect the bone and optimise positive adaptations.

It is safe to suggest that, where possible, athletes should consider a practitioner supported assessment of dietary intake to determine whether they are consuming adequate amounts of the key nutrients underpinning bone health, although, for the athlete, it is not yet possible to be clear on exactly what optimal intakes of these nutrients would be.

It would stand to reason that most athletes should at least make sure they are not vitamin D deficient or insufficient and to achieve a serum vitamin D level of above 50 nmol·L-1 20 ng·mL Once again though, it is not possible from the evidence available to suggest a definitive target for serum vitamin D levels to prevent bone stress injuries.

In addition to vitamin D, it is worth some athletes, particularly endurance and ultra-endurance athletes, considering dietary their calcium intake or supplementation prior to hard or prolonged exercise bouts. Finally, it is also important for athletes to be educated around energy and carbohydrate availability, such that periods of low energy or carbohydrate availability are periodised around essential aspects of the athletes training where the greatest performance benefit is likely to occur.

Antonio J, Ellerbroek A, Evans C, Silver T, Peacock CA. High protein consumption in trained women: bad to the bone?

J Int Soc Sports Nutr. Barry DW, Hansen KC, van Pelt RE, Witten M,Wolfe P, Kohrt WM. Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis. Med Sci Sports Exerc.

Bergamo RR, Páscoa MA, Hespanhol JE, de Moraes AM, Guerra-Júnior G. Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players. 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.

Dash N, Kushwaha A. Stress fractures-a prospective study amongst recruits. Med J Armed Forces India. de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME. Carbohydrate beverages attenuate bone resorption markers in elite runners. Fensham NC, Heikura IA, McKay AKA, Tee N, Ackerman KE, Burke LM.

Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability. J Bone Miner Res. 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. Fredericson M, Chew K, Ngo J, Cleek T, Kiratli J, Cobb K. Regional bone mineral density in male athletes: a comparison of soccer players, runners and controls.

Br J Sports Med. 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. Hammond KM, Sale C, Fraser W, Tang J, Shepherd SO, Strauss JA, Close GL, Cocks M, Louis J, Pugh J, Stewart C, Sharples AP, Morton JP.

Post-exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: implications for training adaptation. J Physiol. In press.

Heikura IA, Burke LM, Hawley JA, Ross ML, Garvican-Lewis L, Sharma AP, McKay AKA, Leckey JJ, Welvaert M, McCall L, Ackerman KE. A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise.

Front Endocrinol. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ.

Bone stress injuries. Nat Rev Dis Primers. Hendrickx G, Boudin E, Van Hul W. A look behind the scenes: the risk and pathogenesis of primary osteoporosis. Nat Rev Rheumatol. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women.

Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D: Institute of Medicine of the National Academies, Kohrt WM, Wolfe P, Sherk VD, Wherry SJ, Wellington T, Melanson EL, Swanson CM, Weaver CM, Boxer RS.

Dermal Calcium Loss Is Not the Primary Determinant of Parathyroid Hormone Secretion during Exercise. 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. Larson-Meyer ED, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Int J Sports Nutr Exerc Metab.

Lundy B, McKay AKA, Fensham NC, Tee N, Anderson B, Morabito A, Ross MLR, Sim M, Ackerman KE, Burke LM. The Impact of Acute Calcium Intake on Bone Turnover Markers during a Training Day in Elite Male Rowers. 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.

Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, Duca MA, Norwig JA. Vitamin D profile in National Football League players. Am J Sports Med. Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. Life-course approach to nutrition.

Osteoporos Int. Mountjoy M, Sundgot-Borgen J, Burke LM, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport RED-S. Br JSports Med. National Institute for Health and Clinical Excellence.

Osteoporosis fragility fracture risk - Costing report. 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. Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, Sowers MF, Sainani KL.

Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.

By Anna Athlete bone health support AnnaBoniface. Hydrating hand creams energy availability LEA from insufficient energy healtth to fuel training demands and suppor Plant-powered performance processes has Athlete bone health support negative impact to bnoe systems in the body Mountjoy et al, Adverse effects to bone health are a consequence of LEA. An athlete presenting with a bony stress injury BSI to a health care professional is often the precursor to Relative Energy Deficiency in Sport RED-S. Naturally, an athlete with a significant injury will require cessation in training for bone healing.

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