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A sports dietitian's guide: Bone health \u0026 injuries in athletesAthlete bone health guidelines -
Farm-raised salmon has lower concentrations of vitamin D than does fresh, wild-caught salmon. In the United States and Canada, all infant formula is fortified with vitamin D.
Cow milk, infant formula, and fortified fruit juices each contain approximately IU of vitamin D per 8 oz Table 4. The RDA is IU for children 1 year and older. Daily supplementation of breastfed infants with IU of vitamin D during the first months of life increases OH-D amounts to normal concentrations.
For those who are unable to achieve adequate amounts of vitamin D in their diet or who have vitamin D deficiency, vitamin D supplements are available in 2 forms: vitamin D 2 ergocalciferol , derived from plants, and vitamin D 3 cholecalciferol , synthesized by mammals.
Some calcium preparations also contain vitamin D. In adolescent girls, supplementation of to IU of vitamin D 3 was effective in increasing BMD in a dose-response manner. Measurement of serum OH-D concentration reflects both endogenous synthesis and dietary intake of vitamin D and is the optimal method of assessment of vitamin D status.
This value was derived on the basis of an assumption of minimal exposure to sunlight and minimal solar vitamin D conversion. In a population of healthy white Danish and Finnish girls, a daily intake of approximately IU of vitamin D was necessary to enable Evidence is insufficient to recommend universal screening for vitamin D deficiency.
The IOM and existing AAP reports do not make recommendations specific to screening. More evidence is needed before recommendations can be made regarding screening of healthy black and Hispanic children or children with obesity.
The recommended screening is measuring serum OH-D concentration, and it is important to be sure this test is chosen instead of measurement of the 1,OH 2 -D concentration, which has little, if any, predictive value related to bone health. Both vitamin D 2 and vitamin D 3 increase serum OH-D concentrations.
In adults, some 52 , 53 but not all 54 studies have suggested that vitamin D 3 is more effective in increasing serum OH-D concentrations than is vitamin D 2. It is not unusual for a second course of treatment to be necessary to achieve adequate concentrations of serum OH-D. In , The replacement of milk in the diet by soda can prevent adolescents from achieving adequate calcium and vitamin D intake, and because soda consumption has no health benefit, it should be avoided.
Diets low in protein or high in sodium will predispose subjects to reduced calcium retention. Mechanical forces applied to the skeleton mechanical loading increase bone formation, and weight-bearing exercise improves bone mineral accrual in children and adolescents. A population-based prospective controlled trial in Sweden demonstrated that a school-based, moderately active, 4-year exercise program increased bone mass and size in children aged 7 through 9 years without increasing fracture risk.
When female athletes become amenorrheic, the protective effect of exercise on BMD is lost. Increases in BMD are site specific, depending on the loading patterns of the specific sport. For example, BMD is greater in gymnasts at the hip and spine, in runners at the femoral neck, and in rowers at the lumbar spine; tennis players have higher radial BMD in the dominant arm than in the nondominant arm.
High-impact sports eg, gymnastics, volleyball, karate or odd-impact sports eg, soccer, basketball, racquet sports are associated with higher BMD and enhanced bone geometry.
For most children and adolescents, walking, jogging, jumping, and dancing activities are better for bone health than are swimming or bicycle riding. Excessive high-impact exercise can, however, increase fracture risk.
A prospective longitudinal study of high school girls found that those who participated in more than 8 hours per week of running, basketball, cheerleading, or gymnastics were twice as likely to sustain a fracture compared with less active girls.
The authors suggested that girls who participate in these sports should also include cross-training in lower impact activities. Lifestyle choices may also confer additional risk for BMD deficits.
In adults, smoking, caffeine, and alcohol intake are all associated with reduced BMD, 68 , — 70 and these behaviors should be avoided in children and adolescents. Body weight and composition are important modifiable determinants of bone mass. Mechanical loading during weight-bearing activities stimulates bone formation, and multiple studies in healthy adolescents 8 , 71 , — 73 and in those with anorexia nervosa 74 , — 77 have demonstrated that BMD is directly correlated with BMI.
Lean body mass is most strongly associated with BMD, 78 but increased adiposity can also be associated with increased fracture risk. Several hormones affect bone mass. Estrogen plays an important part in maintaining BMD in women, and estrogen deficiency is associated with increased bone resorption and increased fracture risk.
Testosterone, growth hormone, and IGF-1 all promote bone formation, whereas glucocorticoid excess both increases bone resorption and impairs bone formation. Conditions associated with reduced bone mass and increased fracture risk in children and adolescents are listed in Table 6. Osteogenesis imperfecta, idiopathic juvenile osteoporosis, and Turner syndrome are rare conditions with increased bone fragility, best managed by pediatric endocrinologists, geneticists, and specialists in pediatric bone health.
Children with chronic illnesses are, however, frequently managed by general pediatricians. Cystic fibrosis, systemic lupus erythematosus, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease, chronic renal failure, childhood cancers, and cerebral palsy can all be associated with reduced bone mass.
Children with cerebral palsy are at particular risk. Eating disorders are prevalent in adolescents. The degree of reduction of BMD is directly related to the degree of malnutrition, and in girls, is related to the duration of amenorrhea.
Low BMD is also found in boys with anorexia nervosa and is associated with low testosterone concentrations. The energy deficit may be unintentional secondary to a lack of knowledge regarding the increased energy requirements of athletes or it may be intentional and associated with an underlying eating disorder.
There is suppression of the hypothalamic-pituitary-ovarian axis, resulting in amenorrhea, a low estrogen state, reduced bone mass, and increased fracture risk.
Endocrine conditions associated with glucocorticoid or PTH excess, hypogonadism, hyperthyroidism, or deficiency of growth hormone or IGF-1 are all associated with low bone mass Table 6.
Certain medications, including anticonvulsants and chemotherapeutic agents, prolonged use of proton pump inhibitors, and selective serotonin reuptake inhibitors, can also have a negative effect on bone mass. Depot medroxyprogesterone acetate DMPA is a very effective long-acting contraceptive that has been credited, to some degree, for the reduction in adolescent pregnancy rates in the United States over the past decade.
Prolonged use of DMPA in adolescent girls is associated with hypothalamic suppression and reduced bone mass, however. Discontinuation of DMPA is associated with rapid improvements in bone mass, although it is not known how much of potential maximum peak bone mass is recovered.
The Society for Adolescent Health and Medicine recommends continuing to prescribe DMPA to adolescent girls needing contraception but recommends explanation of the risks and benefits.
The ideal method of assessment of clinically relevant bone health is determination of fracture risk on the basis of longitudinal data.
However, there is a paucity of longitudinal studies examining factors affecting bone health in children on the basis of incidence of fractures.
Fracture risk depends not only on skeletal fragility but also on age, body weight, history of fractures, and the force of an injury. Skeletal fragility, in turn, is dependent on a number of factors in addition to bone mass, including bone size, geometry, microarchitecture, and bending strength.
For example, bending strength depends on the radius of a bone, and a large bone will be more resistant to fracture than a smaller bone, even when both bones have the same BMC or BMD. Dual-energy x-ray absorptiometry DXA is the preferred method of assessment of bone mass because of its availability, speed, precision, and low dose of radiation 5—6 mSv for the lumbar spine, hip, and whole body, which is less than the radiation exposure of a transcontinental flight and one-tenth that of a standard chest radiograph.
DXA machines are widely available, and robust pediatric reference databases for children older than 5 years are included with the software of the major DXA manufacturers. Scanning time of the hip or spine is less than 1 minute; for the whole body, it is approximately 5 minutes.
In adults, each SD reduction in BMD below the young adult mean doubles the fracture risk. Osteoporosis is operationally defined as a BMD 2. However, caution should be used in interpreting DXA results in children. First, because children have not yet achieved peak bone mass, z scores the number of SDs below the age-matched mean should be used instead of T scores.
Second, DXA measures 2-dimensional areal BMD expressed as grams per square centimeter , as opposed to 3-dimensional volumetric BMD expressed in grams per cubic centimeter , and areal BMD underestimates true volumetric BMD in subjects with smaller bones.
Third, many children with chronic illness have growth retardation and delayed puberty. Therefore, a correction should be made for height or height age, and a number of mathematical corrections have been proposed. In contrast to adults, in pediatrics, there is no specific BMD z score below which fractures are more likely to occur, but there is a growing body of literature demonstrating an association between low bone mass measured by using DXA and fracture risk in children.
Limited evidence is available to guide pediatricians regarding when to order a DXA. In general, a DXA should be performed to identify children and adolescents at risk for skeletal fragility fractures and to guide treatment decisions. DXA scans are usually repeated after 1 year and should not be repeated at an interval of less than 6 months.
Quantitative computed tomography measures true volumetric BMD, but the radiation exposure dose is high 30— mSv. Newer modalities, such as peripheral quantitative computed tomography, can measure volumetric BMD of the appendicular skeleton with much lower radiation doses but are not widely available for clinical use.
Quantitative ultrasonography is a noninvasive method of assessing bone health by measuring speed of an ultrasound wave as it is propagated along the surface of bone. This method is difficult to interpret because of a lack of pediatric reference data, however, and poor precision in the pediatric population.
In most chronic diseases associated with low BMD, treatment of the underlying condition helps improve bone mass, and specific interventions will depend on the underlying condition. Depending on the medical condition, for those children and adolescents who are unable to consume enough calcium from dietary sources, including fortified foods, calcium supplementation can be prescribed.
Calcium carbonate should be taken with meals to promote absorption, but calcium citrate does not require gastric acid for absorption and can be taken on an empty stomach. Screening for vitamin D deficiency by obtaining a serum OH-D concentration is recommended in patients at increased risk of bone fragility and in those with recurrent low-impact fractures.
Bisphosphonates inhibit osteoclast-mediated bone resorption and have been used to increase BMD and reduce fracture risk in children with osteogenesis imperfecta, , — cerebral palsy, and connective tissue disorders , and children treated with corticosteroids.
Bisphosphonates are incorporated into bone and may be slowly released from the bone even after the medication has been discontinued. Because of the paucity of studies on efficacy and long-term safety, at this time these agents should not be used to treat asymptomatic reduction in bone mass in children, and their use should be restricted to osteogenesis imperfecta and other select conditions with recurrent fractures, severe pain, or vertebral collapse.
Adolescent girls with anorexia nervosa or the female athlete triad are frequently prescribed oral contraceptives to improve bone mass, even with no evidence of their efficacy. In girls with anorexia nervosa, oral contraceptives will induce monthly menstruation, which may be incorrectly interpreted as an indication of adequate weight restoration.
Suggested ages to ask these questions are 3 years, 9 years, and during the annual adolescent health maintenance visits. Encourage increased dietary intake of calcium- and vitamin D—containing foods and beverages. Dairy products constitute the major source of dietary calcium, but calcium-fortified drinks and cereals are available.
Low-fat dairy products, including nonfat milk and low-fat yogurts, are good sources of calcium. Children 4 through 8 years of age require 2 to 3 servings of dairy products or equivalent per day. Adolescents require 4 servings per day Table 3. The RDA of vitamin D for children 1 year and older is IU.
Children who are obese and children on anticonvulsant, glucocorticoid, antifungal, or retroviral medications may require higher doses, but specific end points and targets remain poorly defined. Encourage weight-bearing activities. Walking, jumping, skipping, running, and dancing activities are preferable to swimming or cycling to optimize bone health.
Routine screening of healthy children and adolescents for vitamin D deficiency is not recommended. Those with conditions associated with reduced bone mass Table 6 or recurrent low-impact fractures should have a serum OH-D concentration measured.
Those who have vitamin D deficiency should be treated and have OH-D concentrations measured after completion of treatment. Consider a DXA in medical conditions associated with reduced bone mass and increased bone fragility and in children and adolescents with clinically significant fractures sustained after minimal trauma.
In children, z scores should be used instead of T scores. In those with growth or maturational delay, corrections should be made for height or height age.
In adolescent female subjects, discourage preoccupation with extreme thinness. A DXA should be considered in an adolescent athlete who has been amenorrheic for more than 6 months. Athletes, parents, and coaches should be educated about the female athlete triad.
There is no evidence to support prescribing oral contraceptives to increase bone mass in those with anorexia nervosa or the female athlete triad.
Until more studies demonstrating safety and efficacy in other populations have been conducted, use of bisphosphonates in children and adolescents should be restricted to osteogenesis imperfecta and conditions associated with recurrent fractures, severe pain, or vertebral collapse.
The authors have indicated they do not have a financial relationship relevant to this article to disclose. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.
All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may be appropriate. This clinical report has been endorsed by American Bone Health, a national, community-based organization that provides education programs, tools, and resources to help the public understand bone disease and bone health.
All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
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Previous Article Next Article. Bone Acquisition During Childhood and Adolescence. Primary Prevention: Optimizing Bone Health in Healthy Children.
Sources of Calcium. Calcium Supplementation. Vitamin D. Sources of Vitamin D. Recommended Daily Intake and Vitamin D Supplementation. Assessment of Vitamin D Status. Screening for Vitamin D Deficiency.
Treatment of Vitamin D Deficiency. Soda Consumption, Protein, and Other Minerals. Exercise and Lifestyle. Body Weight. Hormonal Status. Secondary Prevention: Assessment of Populations at Risk for Increased Bone Fragility. Conditions Associated With Reduced Bone Mass in Children and Adolescents.
Assessment of Bone Health. Tertiary Prevention: Specific Treatments to Increase Bone Mass in Populations at Increased Risk of Fracture.
Oral Contraceptives. The Role of the Pediatrician. Lead Authors. Committee on Nutrition, — Former Committee Member. POTENTIAL CONFLICT OF INTEREST:. Article Navigation. From the American Academy of Pediatrics Clinical Report October 01 Optimizing Bone Health in Children and Adolescents Neville H.
Golden, MD ; Neville H. Golden, MD. This Site. Google Scholar. Steven A. Abrams, MD ; Steven A. Abrams, MD. COMMITTEE ON NUTRITION ; COMMITTEE ON NUTRITION. Stephen R. Daniels, MD ; Stephen R. Daniels, MD.
Mark R. Corkins, MD ; Mark R. Corkins, MD. Sarah D. de Ferranti, MD ; Sarah D. de Ferranti, MD. Sheela N.
Magge, MD ; Sheela N. Magge, MD. Sarah Jane Schwarzenberg, MD Sarah Jane Schwarzenberg, MD. Pediatrics 4 : e—e Cite Icon Cite. toolbar search toolbar search search input Search input auto suggest.
TABLE 1 Factors Affecting Bone Mass. View Large. TABLE 2 Calcium and Vitamin D Dietary Reference Intakes. a Upper limit UL indicates level above which there is risk of adverse events. b Reflects adequate intake reference value rather than RDA. TABLE 3 Dietary Sources of Calcium. Serving Size.
Calories per Portion. Calcium Content mg. a Not all soy beverages are fortified to this level. TABLE 4 Sources of Vitamin D. Vitamin D Content a IU. a The activity of 40 IU of vitamin D is equivalent to 1 µg.
b Not all brands of orange juice, yogurt, and cheese are fortified with vitamin D. TABLE 5 Treatment of Vitamin D Deficiency. Preparation and Dose a. Vitamin D 2 , ergocalciferol; vitamin D 3 , cholecalciferol. a Vitamin D 3 may be more potent than vitamin D 2.
TABLE 6 Conditions Associated With Reduced Bone Mass in Children and Adolescents. Daniels, MD, PhD, Chairperson. Sarah Jane Schwarzenberg, MD.
Jatinder J. Bhatia, MD, Immediate Past Chairperson. Laurence Grummer-Strawn, PhD — Centers for Disease Control and Prevention.
Rear Admiral Van S. Hubbard, MD, PhD — National Institutes of Health. Jeff Critch, MD — Canadian Pediatric Society. Benson M.
Valery Soto, MS, RD, LD — US Department of Agriculture. Debra L. Burrowes, MHA. The authors have indicated they have no potential conflicts of interest to disclose.
AAP Academy of Pediatrics. BMC bone mineral content. BMD bone mineral density. DMPA depot medroxyprogesterone acetate. DXA dual-energy x-ray absorptiometry.
IGF-1 insulin-like growth factor 1. IOM Institute of Medicine. PTH parathyroid hormone. 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-tools , Accessed on: 30th March
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From a practical perspective, it is important to identify those nutrients and foods that best support the skeleton and, equally, to identify whether there are any dietary conditions that place guodelines at increased risk of bone injury or reduced BMD and strength.
In general terms, the dietary requirements to support the nutritional needs of bone are not likely to be any different for the athlete than for the general population. Whilst much of the general dietary information around the impact of diet on musculoskeletal health has largely focused upon calcium, vitamin D, and protein, it is important to note that guideliines exists to support the beneficial effects of other aspects of the diet.
For example, vegetables provide key nutrients e. Although there is reasonable information on some of the key nutrients supporting bone health and there are recommended daily intakes for these nutrients for examples, see the guidelines from the European Food Safety Authority, National Health and Medical Research Council and the Institute of Medicineit remains unclear what impact the strenuous exercise training performed by many athletes might have upon the requirement for these nutrients.
It is possible, or even likely, that the required intakes of various nutrients are increased significantly in the athlete, particularly when referring to optimising the intake of these nutrients rather than simply trying to avoid a deficiency Larson-Meyer et al.
As such, some consultation with a performance nutritionist or sports dietitian is recommended to attain a quality dietary assessment related to bone health, which should consider the intakes of dairy, fish, fruits and vegetables particularly of the green leafy kindsince these are the most cited sources of the main nutrients supporting bone health.
The athlete, as with members of the general population, will have food preferences and intolerances that might prevent or limit the intake of certain nutrients important for bone health.
For example, the increased prevalence of plant-based dietary approaches in the general population is mirrored in the athlete population, making it important to consider the effect of such dietary practices on not only performance, guideoines also health outcomes including bone health.
Diets high in fruits and vegetables are linked to improved health outcomes, although this might not be quite as straight forward in relation to bone, since animal-based foods including dairy products contain high amounts of the nutrients that relate to positive outcomes for bone health.
Some recent epidemiological data support this notion, indicating poorer bone health in heakth and vegetarians, particularly in relation to a higher risk of fragility fractures Thorpe halth al. That said, there is only limited investigation of the possible impact of plant-based diets on bone related outcomes in athletes.
Of some relevance is a prospective study conducted to examine incidence of stress fractures amongst Indian military recruits, which reported that the incidence of stress fracture injury was significantly greater in vegetarian recruits compared with non-vegetarian recruits Dash and Kushwaha, Changes in energy balance and energy availability have both been used to identify energy deficiency in athletes and athletic individuals, with energy balance being calculated as total energy expenditure minus dietary energy intake; and energy availability as dietary energy intake minus exercise energy expenditure, which is adjusted for fat free mass.
Although similar, the two differ slightly, but importantly in this context in the fact that energy balance assumes that bodily systems are functioning normally. For example, the increased energy expenditure observed with strenuous exercise and training might suppress some bodily functions and so, at least in theory, individuals could be in energy balance, but still experience low energy availability Papageorgiou et al.
The investigation of this link is significantly hampered by the fact that it is difficult to accurately assess energy availability, particularly in the longer-term. For example, it could often be the case that energy intake is underestimated, whilst energy expenditure is overestimated.
Whilst being in a very low energy availability state in the long-term is likely to be bad for bone health, it is less clear whether a quantitative level can be applied above which bone health is protected, even if this level falls below energy balance, which has often been suggested to be at 45 kcal·kgLBM-1·d Ihle and Loucksin a short-term laboratory study, showed that bone formation gain was significantly reduced at an energy availability of 30 kcal·kgLBM-1·d-1, but that bone resorption loss remained unaffected.
Indeed, it is highly unlikely that this would provide a diagnostic endpoint, especially when considering a the likely large individual differences in response to specific levels of energy availability and b the significant difficulties in accurately measuring energy availability, particularly in athletes.
In addition to the magnitude of low energy availability, it also remains unclear whether there is a particular duration of low energy availability that negatively influences bone health. Taken together, this suggests significant difficulty in determining the direct impact of low energy availability on bone health that is intermittently applied or not continuously applied over the longer-term.
Further research is clearly required in larger numbers of athletes and employing optimal methods to significantly improve our understanding of this area. It is becoming clear that many athletes, including endurance athletes, do not meet recommended carbohydrate intake patterns in competition Sampson et al.
Part of this might relate to the reported benefits of lower carbohydrate intakes for body composition or because it is suggested that it might help improve the endurance adaptations to training.
In addition to the possible direct effects of low carbohydrate availability on bone health, which will be discussed below, there might also be a concern that these dietary approaches could increase the risk of a low energy availability state.
Hammond et al. These findings are in line with prior studies showing that carbohydrate provision reduces the bone resorption response to acute exercise in athletes completing 8 days of overloaded endurance training de Sousa et al.
As such, there is a small but developing body of work suggesting that carbohydrate feeding before, during or after exercise might be guuidelines useful way to modify the acute bone response to hard exercise and training, although further research is required to confirm this.
Although no long-term studies of athletes following a low carbohydrate diet are available in relation to bone health, evidence from shorter term studies with athletes following a low carbohydrate, high fat diet would seem to indicate altered bone metabolism.
Heikura et al. They showed that the low carbohydrate, high fat diet increased fasting markers of bone resorption loss and decreased markers of bone formation gainwith carbohydrate restoration in the diet returning bone resorption marker concentrations to pre-intervention levels.
In a follow-on study from the same group again in elite racewalkersFensham et al. In addition, exercise in the carbohydrate restricted state resulted in increased in bone resorption marker concentrations. By contrast, no alterations to bone re modelling marker concentrations were shown when athletes maintained adequate carbohydrate intake.
Taken together, these results suggest that low carbohydrate availability might have a negative impact upon athlete bone health, should these acute and shorter-term effects continue over the longer-term. 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 Yuidelines 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 bonw 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 healtu bone breakdown, as originally suggested by Barry et al.
Two main studies in athletes have been conducted to examine guodelines 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.
: Athlete bone health guidelines| Filed under: | Our Bone Densitometry technologists are all Medical Radiation Technologists M. Indiana Avenue Bloomington, IN Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Prevalence of vitamin D deficiency among overweight and obese US children. Nutrition X-Change X-CHANGE VOL |
| X-CHANGE VOL AN IN-DEPTH LOOK AT THE ROLE OF NUTRITION IN ATHLETE BONE HEALTH - Nutrition X | Other guideelines of rehabilitation that should be considered Athlete bone health guidelines back guivelines strength training, guideliness oppose kyphotic curvature and consequently reduce vertebral Eating patterns and habits Athlete bone health guidelines the Non-GMO sauces term. Cheeses b. Nordic Pole Halth Offered once ghidelines month, this Athlete bone health guidelines hezlth an introduction to the sport of Nordic Pole Walking. Assessment tools should be used to guide a health care professional in returning an athlete to play. Breakfast cereals b. It is generally accepted that vitamin D plays a key role for the athlete in order to prevent stress fractures and muscle injury 6. Craig Sale is the Research Lead of both the Institute of Sport and Department of Sport and Exercise Sciences at Manchester Metropolitan University. |
| Nutrition and Athlete Bone Health | It is important to ensure Athlete bone health guidelines an guiddlines is showing improvements in biomarkers, healhh and mental health, but is healtu conditioned Athlete bone health guidelines to withstand sport, Obesity awareness campaign following a BSI. Occult Athltee D deficiency in postmenopausal Boen women Athlete bone health guidelines Atjlete hip fracture JAMA ; PubMed Google Scholar Crossref. 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, Prospective study of physical activity and risk of developing a stress fracture among preadolescent and adolescent girls. Mountjoy M, Sundgot-Borgen J, Burke LM, Carter S, Constantini N, Lebrun C, et al. |
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