Nutrition and Athlete Bone Health

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Introduction:

Welcome to this week’s newsletter, where I will discuss nutrition and athlete bone health, inspired by my We Do Science Podcast interview with Prof Craig Sale and Prof Kirsty Elliot-Sale.

Athletes need to pay special attention to their bone health, both in the short term to reduce the risk of injury and in the long term when they have retired from the sport. While the general diet required by athletes to support bone health is not markedly different from the general population, it is unclear whether dietary recommendations for the general population are sufficient to offset any deficiency or insufficiency in the athlete. In this post, I will explore the key nutrients that support healthy bone development, the impact of energy availability and protein intake on bone health, and practical recommendations for athletes and practitioners.

What is Bone Health in the Context of an Athlete?

Bone health is a critical aspect of overall health and well-being for everyone. Additionally, in the context of athletes, bone health refers to the ability of bones to withstand the stresses and strains of training and competition and to resist injury. Athletes are at increased risk of bone injuries, particularly stress fractures, due to the repetitive and high-impact nature of many sports.

Stress fractures are the most common bone injuries suffered by athletes, occurring relatively regularly in many sports and being caused by the rhythmic and repeated application of mechanical loading in a sub-threshold manner. Stress fractures can be debilitating and can lead to significant time away from training and competition, as well as long-term consequences such as decreased bone density and increased risk of future fractures.

Therefore, maintaining good bone health is essential for athletes to perform at their best and to reduce the risk of injury. This involves ensuring adequate intake of key nutrients such as calcium, vitamin D, vitamin K, magnesium, and phosphorus and monitoring energy availability and protein intake. Athletes should also aim to consume a varied and balanced diet that includes a range of nutrient-dense foods, such as fruits, vegetables, whole grains, lean protein sources, and healthy fats.

In addition, athletes should consider a well-conducted nutritional assessment of their dietary intake by a relevant qualified nutrition or medical professional to identify whether or not they are consuming the required amounts of the key nutrients to underpin bone health and, where necessary, consider fortified foods or supplements. By taking a proactive approach to athlete bone health, we can help to reduce the risk of injury and support long-term health and performance.

Sub-Optimal Diets Can Negatively Impact Bone Health

A sub-optimal diet can negatively impact bone health in athletes in several ways. Firstly, inadequate intake of key nutrients such as calcium, vitamin D, vitamin K, magnesium, and phosphorus can lead to decreased bone density and increased risk of stress fractures. Secondly, low energy availability, which can occur when an athlete is not consuming enough calories to support their training and other physiological functions, can also lead to decreased bone density and increased risk of stress fractures. Finally, inadequate protein intake can lead to decreased bone density and increased risk of stress fractures, as protein provides the building blocks for bone tissue.

Key Nutrients for Bone Health

Calcium is the most abundant mineral in the body and is essential for bone health. It is required to form and maintain bone tissue and plays a role in muscle contraction, nerve function, and blood clotting. Adults' recommended daily calcium intake is 1000-1200 mg daily, depending on age and gender. Good dietary sources of calcium include dairy products, leafy green vegetables, nuts, and fortified foods.

Vitamin D is also essential for bone health, as it helps the body absorb calcium from the diet. Vitamin D is produced in the skin when exposed to sunlight, but it can also be obtained from dietary sources such as fatty fish, egg yolks, and fortified foods. Adults' recommended daily vitamin D intake is 600-800 IU per day, depending on age and gender.

Vitamin K is important for bone health as it helps activate proteins involved in bone mineralisation. Good dietary sources of vitamin K include leafy green vegetables, broccoli, and Brussels sprouts. Adults' recommended vitamin K intake is 90-120 mcg daily, depending on age and gender.

Magnesium is required to form and maintain bone tissue and plays a role in muscle and nerve function. Good dietary sources of magnesium include nuts, seeds, whole grains, and leafy green vegetables. Adults' recommended daily magnesium intake is 310-420 mg, depending on age and gender.

Phosphorus is also important for bone health, as it is a major component of bone tissue. Good dietary sources of phosphorus include dairy products, meat, fish, and whole grains. The recommended daily intake of phosphorus for adults is 700 mg.

Energy Availability and Protein Intake

Energy availability and protein intake are important factors for athlete bone health. Low energy availability, which can occur when an athlete is not consuming enough calories to support their training and other physiological functions, can lead to decreased bone density and increased risk of stress fractures. Therefore, athletes should aim to consume enough calories to support their training and other physiological functions and monitor their energy availability regularly.

In addition, protein is a key nutrient for bone health, providing the building blocks for bone tissue. Athletes should aim to consume enough protein to support their training and other physiological functions and monitor their protein intake regularly. The recommended daily protein intake for athletes is 1.2-2.0 g/kg body weight per day, depending on the type and intensity of the sport.

Practical Recommendations

It is difficult to provide specific practical recommendations for the effects of diet on bone health in athletes, as the detailed evidence base upon which to make recommendations does not exist. However, based on the interpretation of the information currently available, athletes should consider a well-conducted nutritional assessment of their dietary intake to identify whether or not they are consuming the required amounts of the key nutrients to underpin bone health. Where food preferences and/or intolerances prevent or limit the intake of nutrients important for bone health, athletes and practitioners could consider fortified foods or supplements, fully considering the safety aspects of doing so.

In addition, athletes should aim to consume a varied and balanced diet that includes a range of nutrient-dense foods, such as fruits, vegetables, whole grains, lean protein sources, and healthy fats. They should also aim to stay hydrated by drinking enough fluids throughout the day, especially during exercise.

Conclusion

In conclusion, athlete bone health is an important area of focus for athletes and practitioners. While the general diet required by athletes to support bone health is similar to the general population, it is important to pay attention to key nutrients, energy availability, and protein intake. Athletes should consider a well-conducted nutritional assessment of their dietary intake to identify whether or not they are consuming the required amounts of the key nutrients to underpin bone health, and where necessary, consider fortified foods or supplements.

Take-Home Messages

Take Home Messages:

1. Athletes need to pay special attention to their bone health in the short term to reduce the risk of injury and in the long term when they have retired from the sport.

2. Key nutrients for bone health include calcium, vitamin D, vitamin K, magnesium, and phosphorus.

3. Low energy availability and inadequate protein intake can lead to decreased bone density and increased risk of stress fractures.

4. Athletes should aim to consume enough calories to support their training and other physiological functions and monitor their energy availability regularly.

5. Athletes should aim to consume enough protein to support their training and other physiological functions and monitor their protein intake regularly.

6. Athletes should consider a well-conducted nutritional assessment of their dietary intake to identify whether or not they are consuming the required amounts of the key nutrients to underpin bone health, and where necessary, consider fortified foods or supplements.

7. Athletes should aim to consume a varied and balanced diet that includes a range of nutrient-dense foods, such as fruits, vegetables, whole grains, lean protein sources, and healthy fats.

8. Athletes should aim to stay hydrated by drinking enough fluids throughout the day, especially during exercise.

That’s it for today! I hope you found this of interest and value.

Have a great week, and see you next week for another edition of Fueling Greatness, in which we will continue to explore key topics in sport and exercise nutrition and unpack the “science-to-application” to help you achieve your performance, body composition and well-being goals.

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Have a great week!

Best regards,

Dr Laurent Bannock