Athletes of all ages and ability levels rely on a healthy musculoskeletal system to stay at the top of their game. Unfortunately, many athletes are sidelined during their career because of non-contact skeletal injuries, and up to 20 percent of athletes experience skeletal stress reactions and fractures at some point in their athletic career. While most athletes are fortunate to avoid these injuries, the risk may increase as bone health declines with advancing age. Risks may be compounded if proper attention to sound training and healthy nutrition habits are not maintained throughout the lifespan.

Fortunately, there are warning signs to watch out for and healthy eating habits to adopt that can help athletes optimize bone health.

Red Flags

  • Low Energy Availability: A persistent pursuit of a low body weight or fat percentage, skipping meals, and busy schedules may lead to a chronic insufficient calorie intake resulting in negative effects on bone.
  • History of Bone Injury: Stress reactions, stress fractures, and reoccurring bone injuries may serve as an alarm that the body needs more rest, calories and bone building nutrients, like calcium and vitamin D.
  • Athlete Types: Characteristics associated with athlete bone injury, include age (i.e. adolescent and Masters), long-distance runners, history of restricting calories or food groups (knowingly or unknowingly), and history of menstrual dysfunction.

Nutrition Strategies to Promote Bone Health

  • Adequate energy intake (calories), beyond what is needed for performance, to support the growth and maintenance of bone tissue. Adjust calorie intake upward with nutrient and energy dense foods from all food groups to match increased training volume.
  • Consume protein and nutrient-rich meals or snacks every 3-5 hours to maximize calcium absorption and protein synthesis.
  • Milk, yogurt, cheese, calcium-fortified tofu, leafy greens, seeds, eggs, salmon, trout, and UV-exposed mushrooms are dietary sources of energy, protein and bone-building vitamins and minerals.
  • Dairy foods provide a unique, comprehensive and convenient nutrient package to help protect bone integrity, decrease fracture risk and enhance the healing process after a fracture.


Optimizing bone health through diet and exercise starts during childhood and must be continued throughout the lifespan. A diet rich in calcium, vitamin D and protein, alongside an adequate amount of calories, is needed to support healthy growth and maintenance of bone tissue in all athletes.

Dr. Travis Thomas is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. He is an Associate Professor of Clinical and Sports Nutrition in the College of Health Sciences at the University of Kentucky.

References

Thomas, D.T. Burke L, Erdmann KA. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.  Can J Diet Pract Res. 2016;77(1):54. 

Nieves, J; Melsop, K; Curtis, M et al. (2010). Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. PM&R, 2(8): 740-750.

Karpouzos, A; Diamantis, E; Farmaki, P. et al (2017). Nutritional aspects of bone health and fracture healing. Journal of Osteoporosis, Article ID 4218472, 10 pages. https://doi.org/10.1155/2017/4218472.