The Triad and Bone Health

Energy deficiency/ low energy availability detrimentally impact bone health. When a person does not eat enough food to supply energy needs for a healthy body, the energy needed to keep bones healthy is suppressed.

Hormones responsible for stimulating bone growth inhibited and a loss in bone mass can result from not having enough energy in the body. If energy deficiency persists, this can lead to stress fractures and osteoporosis.

Risk Factors for Low Bone Mass

Bone Health Consequences  

Osteoporosis

A disease in which the density and quality of bone is diminished, which in some cases can result from the low estrogen (an important hormone for maintaining bone), due to inadequate energy availability, or energy deficiency. Severe consequences of this disease include increased fracture risk, chronic pain, reduced mobility, functional long-term limitation, loss of independent living and an overall reduced quality of life. Importantly, osteoporosis can impact young exercising individuals in cases where chronic energy deficiency is left unchecked.

Stress Fracture/ Bone Stress Injuries

A stress fracture is a bone fracture that develops over time, often as a result of overuse, and it is important to remember that recurrent stress fractures or other bone stress injuries are never a normal response to exercise training.

Sustaining stress fractures or experiencing prolonged shin splints may be an indication that an individual’s bone health is compromised. While not all individuals who develop fractures or shin splints have the Athlete Triad, it is important to take a look at their diet and exercise habits to ensure that they are properly fueling their body and consuming enough calories, calcium, and Vitamin D.

Bone Basics

Bone is a living tissue and therefore, is constantly being renewed throughout life. At all times within your bones, old bone is being removed by bone cells called osteoclasts, and new bone is being laid down by bone building cells called osteoblasts. Although it may sound hard to believe, due to these processes, the entire human skeleton is completely replaced about every 7-10 years.

Bone Remodeling

Bone remodeling is the predominant process by which bone tissue is turned over via the couples actions of osteoclasts and osteoblasts. Bone remodeling is dominant in the non-growing skeleton whereas bone modeling is dominant in the growing skeleton and is responsible for the growth and expansion of developing bones.

• Osteoclasts: responsible for bone resorption, and continually breakdown bone
• Osteoblasts: responsible for bone formation, and continually build new bone

Bone Remodeling Varies Based on Energetic and Hormonal Status

How to Build Strong Bones and Keep Them Healthy

Peak bone mass is reached around age 18 in women and age 22 in men, so it is essential to act early when it comes to building and maintaining strong bones. The higher peak bone mass is, the lower the risk for developing osteoporosis and fractures later in life.

Factors that Influence Peak Bone Mass

• Nutritional Factors:
  • Energy Intake (amount of calories consumed)
  • Vitamin D
    • Essential for calcium absorption
    • Sources include sunlight, Vitamin D fortified foods, and fish oils
  • Calcium
    • In addition to its role in bone health, calcium is needed for muscle contractions, blood vessel contractions, and secretion of hormones and enzymes
    • Sources of calcium include dairy, eggs, dark leafy green vegetables, beans, fish, calcium-fortified food, and supplementation
  • Protein
    • Sources of protein include beef, chicken, turkey, eggs, tofu, soy beans, nuts, fish, and dairy

• Hormonal Factors:
  • Sex Hormones
    • Estrogen (inhibits bone breakdown)
    • Testosterone (anabolic, bone building affects)
  • Cortisol
    • Increased cortisol can lead to decreased bone health
  • IGF-1
    • Stimulates bone formation
  • Growth Hormone
    • Stimulates bone formation and growth
  • Parathyroid Hormone (PTH)
  • Calcitonin

• Genetic Factors

• Mechanical factors:
  • Physical Activity
  • Body Weight

Tips to Keep Your Bones Healthy

• Eat a well-rounded diet and consume a variety of fruits and vegetables, whole grains, fats, and proteins
• Consume foods high in calcium and Vitamin D, and add supplementation is you aren’t meeting the recommended daily values in your diet alone
• Maintain a stable, healthy weight
• Avoid extreme diets
• Engage in regular exercise: Both strength training and weight-bearing exercise aid in building and maintaining strong bones
  • 
    Strength Training:

• Examples Include:
  • Weight Lifting
  • Body weight, strength-based exercises such as pushups and squats
• Weight-bearing exercise:
  • Examples Include:
    • Jump Roping
    • Walking/Jogging/Running
    • Many sports such as soccer, basketball, and tennis
    • Dancing