However, taking the time to optimize your nutrition, calcium intake, and overall strength helps you stay on top of your sport for the long haul.

Our orthopedic specialists diagnose common and serious sports-related injuries and tailor your treatment specifically to you, which gets you back in the game quickly and efficiently.

Your bones are growing, living organisms that constantly break down and rebuild themselves. This keeps your bones strong and dense, which protects them from injuries.

You reach the peak of your bone mass around the age of As you get older, however, your bones begin to break down much faster than they can rebuild themselves. This decreases your bone mass, leaving them weaker and more brittle.

Taking care of your bone health is essential to staying healthy and competing in sports. Osteoporosis is a long-term effect of poor bone health. Female athletes are especially prone to this condition because of the female athlete triad, a combination of issues that result from insufficient energy, menstrual irregularities, and bone loss.

As a female athlete, you may experience only one, or all three, of these issues. Being involved in a sport means your body is working hard through every practice, workout, and game.

In order to avoid an injury, you need to support the extra exertion through your nutrition. This means adequate caloric intake, proper protein consumption, and nutrient-dense foods. According to the American College of Sports Medicine, athletes should be taking in 0. Click here for our Short films on How to build up exercise for your bones and a new Exercising safely film.

Remember - Any exercise you do for your bone health should be in addition to the exercise you do for your general health, as recommended by the government. Exercise or keeping moving is important for bone health and osteoporosis - whatever your age or wellness and whether you have broken bones in the past or not.

Being physically active and exercising helps you in so many ways and is very unlikely to cause a broken bone. Find out more about exercise and physical activity for osteoporosis. Exercise for bones. Exercise for bones Being physically active and doing exercise helps to keep bones strong and healthy throughout life.

Exercise that's good for your bones Bones stay strong if you give them work to do. For exercise to be most effective at keeping bones strong, you need to combine: weight-bearing exercise with impact muscle strengthening exercise Variety is good for bones, which you can achieve with different movements, directions and speeds - in an activity like dancing for example.

Weight-bearing exercise with 'impact' You are weight bearing when you are standing, with the weight of your whole body pulling down on your skeleton. Looking after your bones Bone health checklist Nutrition for bones Vitamin D Dance for your bones. Watch our new exercise for bones films.

Learn how to build up impact and muscle-strengthening exercise. What is low, moderate and high impact exercise? Lower impact Moderate impact High impact Walks Highland dancing Basketball Brisk walking Jogging or running Volleyball Marching Team and racket sports Track events Stair climbing Skipping and hopping Star jumps Gentle heel drops Low level jumping Tuck jumps Stamping Vigorous heel drops and stamping High level jumps Muscle-strengthening exercise When your muscles pull on your bones it gives your bones work to do.

Increasing muscle resistance can be done by adding a load for the muscles to work against, such as: a weight in your hand using an elastic muscle resistance band using your body weight during a press up. How often do you need to exercise to help your bone and muscle strength?

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 to 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.

These results also suggest that the athlete must focus on adequate dietary intake during hard training periods. Given the potential for low energy availability to negatively influence the short-term responses of bone, it would seem sensible to suggest that if this state was maintained over longer periods, more serious consequences might be experienced.

This raises an important, but as yet unanswered, question over whether it is the magnitude of the low energy availability i. there is a threshold below which there is a negative effect on the bone that is important or whether it is more an issue of continuous low energy availability over time that negatively influences bone health.

Added to this is the evidence from the many studies conducted since relating to the female athlete triad [ 25 , 42 ]. More recently, this same group has also suggested the potential for a similar syndrome in male athletes referred to as the male athlete triad; see Tenforde et al.

Whilst further discussion of these conditions the male athlete triad and RED-S is vitally important and would be highly relevant herein, these topics are covered more extensively in another article within this supplement. Certainly, it seems unlikely that elite endurance athletes male or female would be able to attain these levels of energy availability given the high energy expenditures induced by training and the limited time for refuelling that their demanding training schedules allow.

Another complication here is that endurance athletes might be directly opposed to trying to maintain a balanced energy intake, since many consider an energy deficit as essential to drive the endurance phenotype. Taken together, these points highlight the difficulty in maintaining balanced energy availabilities for the promotion of bone health in the endurance athlete when stacked against the competing interests of optimising their sporting performance.

As such, further research is needed to identify whether or not there is a means to maintain bone health without compromising training practices to optimise endurance performance. One possibility might be to periodise low energy availability into the training cycle to develop the endurance phenotype without the need to have constantly low energy availability, a recent approach suggested by Stellingwerff [ 46 ].

Further research is also required to tease out the nuances of the effects of energy and nutrient availability on bone. In the laboratory, energy intake is often limited by simply determining habitual dietary energy intake and then cutting this intake down by a certain percentage.

The issue with this is that nutrient intake is also reduced by the same relative amount, which begs the question of whether the effects on bone are wholly energy availability dependent or whether the concomitant reduction in the availability of carbohydrate, protein, calcium, vitamin D and other micronutrients also contributes to the negative impact on bone.

In addition, there might also be an interaction between elements of the female athlete triad and certain nutrients that could exacerbate the effects on bone. For example, iron deficiency might directly interact with reduced energy availability to further disrupt thyroid function and to suppress anabolic factors for bone formation, as recently postulated by Petkus et al.

Whilst no studies have directly examined the effects of low carbohydrate availability on bone health parameters in athletes, it has been shown that carbohydrate feeding can reduce bone turnover [ 50 ]. Bjarnason et al. Similarly, the provision of carbohydrate has been shown to attenuate the bone resorption response to acute exercise in athletes involved in an 8-day overloaded endurance training trial [ 51 ].

Sale et al. There is some more direct information to suggest that following a low-carbohydrate diet would negatively affect bone health, albeit from animal models and when concomitantly followed with a high-fat diet [ 53 ].

Bielohuby et al. Conversely, in humans, albeit osteoarthritis patients and not athletes, there was no effect on bone turnover as assessed by urinary N-telopeptide and bone-specific alkaline phosphatase concentrations when patients were fed less than 20 g of carbohydrate per day for 1 month and then less than 40 g of carbohydrate per day for the next 2 months [ 54 ].

Future research work is required to determine whether low-carbohydrate dietary practices would negatively impact the bone health of athletes in the longer term. Athletes are often recommended to consume more protein than is recommended for the general population, in order to support the additional demands of athletic training.

The recommendations for athletes is to consume between 1. This may result in a conflict of interest, as there is a long-held belief that higher protein intakes may have a negative influence on bone health [ 56 , 57 ], a topic that has recently been covered in detail by Dolan and Sale [ 58 ]; herein we will summarise the salient points.

The theory suggests that, in order to protect the homeostatic state, the body increases the availability of alkaline minerals, such as calcium, most of which are stored within the bone tissue. The calcium released from the bone in order to counteract a high potential renal acid load is also associated with increased losses of calcium in the urine, along with lower BMD and an increased rate of bone loss [ 60 ].

Taken together, the results of these studies would suggest that, as a result of the acid-ash hypothesis, an athlete consuming a high particularly animal protein diet would run the risk of inducing demineralisation of the bone over the longer term with potential adverse effects on bone health.

Taken alone, however, this theory does not provide a fully balanced account of the potential influences of a high protein intake on bone. The main negative effect of a high animal protein diet on bone according to the acid-ash hypothesis relies upon the clear assumption that the calcium used to neutralise the high potential renal acid load resulting from animal protein consumption comes from the bone and that any excess calcium subsequently excreted in the urine comes from the bone.

This might not, however, be the case given that Kerstetter et al. Of further consideration is the fact that dietary acid load could just as easily be influenced by a reduction in the intake of alkaline foods, such as fruits and vegetables, as by an increase in the intake of acidic foods, such as animal proteins.

This would compound the issue, especially given that alkaline foods are also rich in a wide range of micro- and phyto-nutrients that are important for bone health [ 21 ]. Therefore, it is possible that the poorer bone outcomes reported in those consuming an acidic diet [ 60 ] were not due to high protein, but were as a result of a shortage of nutrient rich fruits and vegetables.

This gives further support to the point made in Sect. It is equally important to consider the possibility that protein is, in fact, beneficial and not harmful to bone for a review, see Dolan and Sale [ 58 ].

As such, athletes need to consume sufficient protein to support the increased rate of bone turnover caused by athletic training.

Additionally, protein ingestion increases the production of a number of hormones and growth factors, such as IGF-1, which are also involved in the formation of bone. Of further relevance for the athlete is the fact that higher protein intakes also support the development of muscle mass and function [ 64 ]; the associated increases in muscular force would likely act upon the bone to enhance bone mass and strength [ 65 ].

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. This is evidenced by the results of a number of studies albeit not in athletes per se that have been well summarised and statistically combined in high-quality meta-analyses as summarised by Rizzoli et al.

It might, however, be sensible to recommend to athletes that they maintain adequate calcium during periods of higher protein consumption to be sure of no negative effects on the bone. A small positive effect of protein on BMD and fracture risk has been identified, suggesting that the protein intakes of athletes, which are usually in excess of the recommended daily allowance, might be ultimately beneficial to the bone, although this requires further specific research.

Numerous studies in the last 5—10 years have identified athlete groups who have deficient or insufficient levels of circulating vitamin D [ 67 ], although the specific definitions of vitamin D deficiency and insufficiency have been debated. Whilst the causes of vitamin D deficiency in the general population are clearly multifactorial, it is most likely that the main cause in the athletic population is a reduction of ultraviolet B radiation absorption into the skin, which is the major source of vitamin D [ 72 , 73 ].

Whilst this seems fairly obvious in relation to those athletes who largely train and compete indoors and those who live and train in latitudes furthest from the equator, it might also be of relevance to those who train and compete outside, but who have to wear a significant amount of equipment e.

A direct relationship between serum vitamin D levels and musculoskeletal outcomes is relatively clear [ 69 ] and makes sense given the important role for vitamin D in calcium and phosphorus metabolism. Miller et al. Similarly, Maroon et al. Whilst not directly causal, low-fat dairy products and the major nutrients in milk calcium, vitamin D, and protein were associated with greater bone gains and lower stress fracture rates in young female runners [ 77 ].

Interestingly, a higher potassium intake was also associated with greater gains in hip and whole-body BMD. It would seem relatively clear that the avoidance of vitamin D deficiency and insufficiency is important for the athlete to protect their bone health.

Athletes who undertake a high volume of prolonged exercise, particularly when that exercise is not weight bearing, are at risk of having lower BMDs [ 79 , 80 ]. One of the potential contributors to this might be an increase in bone resorption mediated by the activation of parathyroid hormone due to reductions in serum calcium levels, which, in turn, occur as the result of dermal calcium losses [ 81 ].

It is likely that the level of dermal calcium loss required to cause a decline in serum calcium concentrations, which is sufficient to activate parathyroid hormone secretion and thus bone demineralisation, would only occur during prolonged hard exercise. Given that calcium plays an important role in many cellular processes that occur while exercising, the body vigorously defends serum calcium concentrations, predominantly by the demineralisation of bone, which, in turn could lead to a reduction in bone mass over time.

As such, Barry et al. Barry et al. Twenty male endurance athletes completed a km cycling time trial on three occasions having consumed either 1 mg of calcium 20 min before exercise and a placebo during exercise; 2 a placebo before exercise and mg of calcium every 15 min during exercise; or 3 a placebo before and during exercise.

The results showed that when mg of calcium was ingested as a single bolus prior to exercise, there was an attenuated parathyroid hormone response to the subsequent exercise bout.

There was a smaller attenuation of the parathyroid hormone response when calcium was supplemented during exercise, and this did not reach statistical significance. This latter possibility has not been explored and future research is required.

In line with this, there is also the possibility that the challenge to fluid and sodium homeostasis that would occur under these circumstances might influence bone metabolism and health. This, to our knowledge, has not been directly or well-studied in relation to the athlete, but there is some suggestion from the osteoporosis focussed literature suggesting that bone might be negatively affected by hyponatraemia.

Verbalis et al. The same paper also reported on a cross-sectional analysis of human adults from the Third National Health and Nutrition Examination Survey, showing that mild hyponatraemia was associated with significantly increased odds of osteoporosis, in line with the rodent data presented.

This might be explained by novel sodium signalling mechanisms in osteoclasts resulting in the release of sodium from bone stores during prolonged hyponatraemia [ 84 ].

Nutrient ingestion around acute exercise can alter the bone resorption marker response to that exercise bout. Many athletes exercise in the morning after an overnight fast, which has the potential to promote an increase in bone turnover.

Scott et al. As anticipated, the ingestion of food reduced pre-exercise bone resorption as measured by β-CTX , but, contrary to what was proposed, the bone resorption response to exercise was greater in the fed condition than in the fasted condition and, over time, there was no difference in the response between fasting and feeding.

As such, it seemed that the mechanical loading induced by exercise might have provided a more powerful stimulus than that of pre-exercise feeding.

In line with this theory, Sale et al. Carbohydrate feeding attenuated bone resorption β-CTX and formation P1NP in the hours but not days following exercise, indicating an acute effect of carbohydrate feeding on bone turnover.

The total amount of glucose ingested was Given the fact that the post-exercise period might provide a longer timeframe and a greater scope for intervention, Townsend et al.

There were three trials conducted in this study: 1 placebo: ingested immediately and 2 h post-exercise; 2 immediate feeding: carbohydrate plus protein 1. When carbohydrate plus protein was ingested immediately post-exercise, there was a suppression of the exercise-induced bone resorption β-CTX response when compared to the control trial, along with a smaller increase in the bone formation P1NP response 3—4 h post-exercise.

It would seem clear that feeding around exercise can moderate the bone metabolic response to that exercise bout, with the post-exercise period being perhaps the most useful timeframe for intervention. Longer-term studies are therefore required to determine whether or not these shorter-term or acute responses to feeding around exercise are positive for bone health.

The studies in this area have largely been conducted in men, and it would be of interest to determine whether the same effects are seen in exercising women. Bone health is an important issue for some athletes, particularly those who are at a greater risk of low or lower BMD.

These athletes should develop strategies to take care of their bones, particularly during adolescence and early adulthood, even at the expense of their training and performance, given that trying to overcome an already low bone mass in later life is extremely difficult.

Taking care of their diet and nutrition might help athletes to better protect their bones against the demands of their sport. Dietary advice for athletes in this regard should remain in line with the advice given to the general population, with some consideration given to where there would be a need for higher intakes to match the needs of the sport and to optimise function, although there are several specific challenges that certain athletes might face over and above those faced by the general population.

In this review, we have attempted to acknowledge some of these potential issues and highlight the information that is currently available to support these views. There is, however, a dearth of information relating to the effects particularly the longer-term effects of different dietary and nutritional practices on bone health in athletes, and significant research effort is required on this topic in the future.

There is still a requirement to clearly define which types of athlete are and which types of athlete are not at risk of longer-term bone health issues, such as osteopenia and osteoporosis.

Further research is needed to determine the wider implications of reduced energy availability, beyond bone, as suggested by the RED-S syndrome; currently these are not well researched. It remains to be clearly established whether there is or is not a male athlete triad and whether the bone health implications of reduced energy availability are seen at the same level as in females or whether males are a little more resistant to the effects of low energy availability.

Further research is required into the periodisation of low energy availabilities in endurance athletes, such that they can benefit from the positive effects of calorie restriction on the endurance phenotype but without putting their bone health at risk.

More work is required in athletes to determine the effects of nutrient availability particularly of carbohydrate separately from energy availability on bone health.

The amounts of calcium lost during training in endurance and ultra-endurance athletes are still not well known, nor is the amount of calcium lost during more passive sweating, particularly in hot environments, such as might be performed by weight-making athletes.

No research has been conducted in athletes to determine whether or not there is an effect of sweat sodium loss on bone. Longer-term studies are needed to determine whether or not the shorter-term or acute responses of bone metabolism to feeding are positive for bone health.

These studies should also seek to determine whether feeding should be periodised around hard training blocks rather than constant so as not to reduce the potential adaptation of the bone to exercise training.

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When you add resistance to your routine, your muscles release calcium, magnesium, and other minerals that strengthen your bones, Krupskas says. These exercises use mechanical resistance from weight-bearing, such as resistive bands or weights.

Do three sets of 10 repetitions of these exercises, she suggests. Your core encompasses your stomach muscles, back muscles, and pelvic girdle. Stretching is important to elongate the muscle fibers.

There are many variations of stretches for the upper body and lower body, including the hamstrings and calf muscles, which can get very tight from sitting. If you can get out of the house, a walk can offer a cardiovascular workout for your heart and lungs. If you have a gym setup available, you can exercise on the treadmill or an elliptical machine.

If you need to stay home and have no aerobic equipment available, try gentle marching in place. Set a timer for 30 seconds or 1 minute at a time. Krupskas cautions that people with skeletal problems or joint replacements should avoid YouTube or Zoom workouts, as they tend to be impersonal.

Those who have Gaucher disease can follow specialized video workouts such as Movement for Life, which was created by NGF and Krupskas. Krupskas include exercises designed for those who have low mobility as well as moderate to high mobility.

After a while, with high-impact activities, there is a possibility the prosthetic will loosen from the bone. In the long run, exercising to your capacity will be one of the most important things you can do for yourself.

If any questions arise before you begin exercising, please do not hesitate to contact Krupskas. It is important to take advantage of available resources to ensure you are set up for success to increase bone density. Connect with Suzanna Krupskas today. Back Exercise is great for just about everyone.

What Are Osteopenia and Osteoporosis? Osteopenia is when the bones lose some of their mineral content especially calcium. With a lower mineral content, bones become weak, and the chance of a fracture broken bone increases.

Osteoporosis is more severe and occurs when bones become more porous, making them likely to fracture easily. People with osteoporosis lose bone faster than they can grow new bone. Gaucher Disease and Osteoporosis Many people living with Gaucher disease develop osteoporosis.

Krupskas categorized those needs by how much Gaucher affects your mobility: Low mobility function: People with Gaucher-related skeletal effects may use a wheelchair or walk with an assistive device.

They might need seated exercise and gentler movements to avoid breaks. Often, highly impacted people are those who received a Gaucher diagnosis late, after substantial bone damage had occurred.

These individuals may be on treatment , but their bone disease progression was significant before diagnosis and treatment.

Moderate mobility function: Moderately impacted people have some skeletal involvement and may have had joint replacements. Strength training Strength-training exercises are at the heart of building bone density. Tensing your muscles releases chemicals that can help increase bone density.

Here are a couple examples of these exercises: 2. Resistance exercises When you add resistance to your routine, your muscles release calcium, magnesium, and other minerals that strengthen your bones, Krupskas says.

Try something different from a traditional pushup. Standing pushups: Stand approximately 3 feet away from a wall, facing it. Place your hands shoulder-width apart at chest level against the wall.

Bend your elbows as you lean into the wall. Straighten your elbows, pushing your body weight away from the wall. Seated pushups adapted : Hold a lightweight pole, like a broomstick, palms down with your arms shoulder-width apart at chest level.

Push the pole away from your chest, straightening your arms. Then bend your elbows, returning your arms to your chest. Resistance bands: Resistance bands like TheraBand are a light, portable way to strengthen. They are color-coded to indicate various resistance levels. For those who are just beginning an exercise program or have joint issues, it is best to use a lighter resistance band and gradually work up to moderate and then heavier resistance bands.

Remember, Krupskas advises, how important it is not to force any movement. Band pull: You can do this exercise while seated or standing. Again, if seated, it is important to support your feet on the floor or footrests. Hold onto the band approximately 5 inches away from your chest, arms shoulder-width apart.

Hands are palms-down at chest level. Slowly pull the band, extending your arms beyond shoulder width. Try to straighten your arms as far as possible while creating tension in the arms.

Slowly return to the beginning position, releasing the tension in your arms. Balance and core exercises Your core encompasses your stomach muscles, back muscles, and pelvic girdle. Balance on one leg while lifting the other off the floor. Count to 10 while engaging your stomach muscles.

Return your leg to the floor and alternate legs. Repeat several times. When you first try it, stabilize with two hands on the kitchen counter. As your core strengthens and your balance improves, you can transition to stabilizing with just one or two fingers from each hand.

Eventually, you will be able to eliminate the hands. Standing straight: Contract hold in your abdomen belly , so your belly button pulls toward your spine. Stand straighter as you stabilize your core.

Seated core: Even seated, you can build your core muscles by: Sitting on a firm seat, arms crossed over your chest, legs bent. Alternate raising each thigh 1 to 2 inches, engaging your core.

Lower thigh to starting position.