Research consistently shows that low energy availability alters the neuroendocrine axis, resulting in menstrual dysfunction, low bone mineral density (BMD) and increased risk for bone stress injury (BSI)/stress fractures in female athletes. This is terms Relative Energy Deficiency in Sport or Female Athlete Triad. The same research has not yet been done in males. However, male athletes may also experience an analogous process that parallels the female athlete triad. Adolescence represent a critical time for accruing peak bone mass. Identifying risk factors for threatened bone health is essential to ensure the long-term health in athletes of both sexes.
As found in female athletes,there appear to be cumulative risk factors for low BMD, defined as Z-scores <−1.0 in the young male athlete. Studies show that runners identified a belief that being thinner and lighter leads to faster running performances as a significant risk factor for developing lower BMD. Risk factors in the young male athlete obtained from anthropometric measures and self-report questionnaires include low body weight, stress fracture history, average weekly running mileage >30 miles and consuming fewer than one serving of calcium-containing food per day.While limited research has been conducted in adolescent male athletes, current knowledge suggests nutrition and sports participation will influence bone health.
Those athletes with history of recurrent bony stress injury should be assessed. Bony stress injuries in higher risk areas, such as those with higher trabecular bone content, including the pelvis, sacrum and femoral neck indicate a clear need for further investigation.
How can we optimize bone health in our young athletes?
Optimize Nutrition: Caloric intake (adequate energy availability), Vit D and Calcium intake.
Optimize Sleep Hygiene: Research indicates that sleep duration impacts bone health. Even short term sleep deprivation has been shown to significantly impact BMD.
Play a variety of land-based sports: Research has found that weight bearing and multidirectional sports improve bone mass and geometry. Studies show that non- impact and repetitive impact endurance sport athletes are at particular risk for low bone density, including runners, cyclists and swimmers.
Regular Assessment and Review: Those at risk should be assessed regularly as adolescence is a time of constant physical and psychological change. Work up will be based on sport, risk factors and injury history. Blood tests and DEXA scan are often appropriate.
Aggressive Management of Risk Factors: Peak bone mass accrual occurs within the ten years in males and females. Recovery of bone mass after chronic low energy availability is not assured. Therefore, it is essential that exhaustive efforts including athlete, parent and coach education be initiated as soon as possible .
Nutrition interventions should be reviewed with all athletes with risk factors for poor bone health or a history of bony stress injury. In female athletes, recommendations include seeking non-pharmacological strategies primarily focused on improving energy availability for at least 1 full year prior to considering adding transdermal hormonal therapy. The oral contraceptive pill (birth control pill) has not been found to be an effective treatment for low bone density. Further, it masks the clinical signs of low energy availability.
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