The DOI matches its Crossref record; 16 of the 16 references it cites were found in a registry or an index.
Nutrition and Athlete Bone Health
Abstract
Athletes should pay more attention to their bone health, whether this relates to their longer-term bone health (e.g. risk of osteopenia and osteoporosis) or their shorter-term risk of bony injuries. Perhaps the easiest way to do this would be to modify their training loads, although this advice rarely seems popular with coaches and athletes for obvious reasons. As such, other possibilities to support the athletes’ bone health need to be explored. Given that bone is a nutritionally modified tissue and diet has a significant influence on bone health across the lifespan, diet and nutritional composition seem like obvious candidates for manipulation. The nutritional requirements to support the skeleton during growth and development and during ageing are unlikely to be notably different between athletes and the general population, although there are some considerations of specific relevance, including energy availability, low carbohydrate availability, protein intake, vitamin D intake and dermal calcium and sodium losses. Energy availability is important for optimising bone health in the athlete, although normative energy balance targets are highly unrealistic for many athletes. The level of energy availability beyond which there is no negative effect for the bone needs to be established. 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, particularly with adequate calcium intake. Dermal calcium losses might be an important consideration for endurance athletes, particularly during long training sessions or events. In these situations, some consideration should be given to pre-exercise calcium feeding. The avoidance of vitamin D deficiency and insufficiency is important for the athlete to protect their bone health. There remains a lack of information relating to the longer-term effects of different dietary and nutritional practices on bone health in athletes, something that needs to be addressed before specific guidance can be provided.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“The periodization of nutritional intake to maintain energy availability around 30 kcal/kg LBM/day and a high protein intake throughout the different phases of the rehabilitation also likely contributed to the maintenance of BMC in our athlete (Sale and Elliott-Sale, 2019).”
From Retraining and Nutritional Strategy of an Endurance Master Athlete Following Hip Arthroplasty: A Case Study (2020) · cites this paper as Sale and Elliott-Sale, 2019
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Holick, M. F. (2007) · New England Journal of Medicine · doi:10.1056/nejmra070553 · Cited by 13,720
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318149f111 · Cited by 1,554
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., et al. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2014-093502 · Cited by 1,469
Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., Aragon, A. A., Devries, M. C., Banfield, L., Krieger, J. W., et al. (2018) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-097608 · Cited by 1,269
for the IOF-IFCC Bone Marker Standards Working Group, Vasikaran, S., Eastell, R., Bruyère, O., Foldes, A. J., Garnero, P., Griesmacher, A., McClung, M., Morris, H. A., Silverman, S., et al. (2011) · Osteoporosis International · doi:10.1007/s00198-010-1501-1 · Cited by 1,212
Heikura, I. A., Uusitalo, A. L. T., Stellingwerff, T., Bergland, D., Mero, A. A., & Burke, L. M. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2017-0313 · Cited by 318
The fracture mechanics of human bone: influence of disease and treatment
Zimmermann, E. A., Busse, B., & Ritchie, R. O. (2015) · BoneKEy Reports · doi:10.1038/bonekey.2015.112 · Cited by 164
Rizzoli, R., Biver, E., Bonjour, J.-P., Coxam, V., Goltzman, D., Kanis, J. A., Lappe, J., Rejnmark, L., Sahni, S., Weaver, C., et al. (2018) · Osteoporosis International · doi:10.1007/s00198-018-4534-5 · Cited by 164
Acute calcium ingestion attenuates exercise-induced disruption of calcium homeostasis
BARRY, D. W., HANSEN, K. C., VAN PELT, R. E., WITTEN, M., WOLFE, P., & KOHRT, W. M. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181f79fa8 · Cited by 116
The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review
Petkus, D. L., Murray-Kolb, L. E., & De Souza, M. J. (2017) · Sports Medicine · doi:10.1007/s40279-017-0706-2 · Cited by 92
Research works printed but not linked: 65
- Santos L, Elliott-Sale KJ, Sale C. Exercise and bone health across the lifespan. Biogerontology. 2017;18(6):931–46. · DOI
- Dobbs MB, Buckwalter J, Saltzman C. Osteoporosis: the increasing role of the orthopaedist. Iowa Orthop J. 1999;19:43–52.
- Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005;16(Suppl. 2):S3–7. · DOI · Paper page
- Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136. · DOI · Paper page
- Recker RR, Davies KM, Hinders SM, Heaney RP, Stegman MR, Kimmel DB. Bone gain in young adult women. JAMA. 1992;268:2403–8. · DOI · Paper page
- Henry YM, Fatayerji D, Eastell R. Attainment of peak bone mass at the lumbar spine, femoral neck and radius in men and women: relative contributions of bone size and volumetric bone mineral density. Osteoporos Int. 2004;15:263–73. · DOI
- Ranson CA, Burnett AF, Kerslake RW. Injuries to the lower back in elite fast bowlers: acute stress changes on MRI predict stress fracture. J Bone Jt Surg. 2010;92(12):1664–8. · DOI
- Scofield KL, Hecht S. Bone health in endurance athletes: runners, cyclists and swimmers. Curr Sports Med Rep. 2012;11(6):328–34. · DOI
- Dolan E, McGoldrick A, Davenport C, Kelleher G, Byrne B, Tormey W, et al. An altered hormonal profile and elevated rate of bone loss are associated with low bone mass in professional horse-racing jockeys. J Bone Miner Metab. 2012;30(5):534–42. · DOI
- Wilson G, Hill J, Sale C, Morton JP, Close GL. Elite male flat jockeys display lower bone density and lower resting metabolic rate than their female counterparts: implications for athlete welfare. Appl Physiol Nutr Metab. 2015;40(12):1318–20. · DOI
- Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado J, et al. Bone mineral density in vocational and professional ballet dancers. Osteoporos Int. 2017;28:2903–12. · DOI
- Wewege MA, Ward RE. Bone mineral density in pre-professional female ballet dancers: a systematic review and meta-analysis. J Sci Med Sport. 2018;21:783–8. · DOI
- Frost HM. The mechanostat: a proposed pathogenetic mechanism of osteoporoses and the bone mass effects of mechanical and nonmechanical agents. Bone Miner. 1987;2(2):73–85.
- Clowes JA, Hannon RA, Yap TS, Hoyle NR, Blumsohn A, Eastell R. Effect of feeding on bone turnover markers and its impact on biological variability of measurements. Bone. 2002;30(6):886–90. · DOI · Paper page
- Walsh JS, Henriksen DB. Feeding and bone. Arch Biochem Biophys. 2010;503(1):11–9. · DOI
- Babraj JA, Smith K, Cuthbertson DJ, Rickhuss P, Dorling JS, Rennie MJ. Human bone collagen synthesis is a rapid, nutritionally modulated process. J Bone Miner Res. 2005;20(6):930–7. · DOI
- Schlemmer A, Hassager C. Acute fasting diminishes the circadian rhythm of biochemical markers of bone resorption. Eur J Endocrinol. 1999;140(4):332–7. · DOI
- Mitchell PJ, Cooper C, Dawson-Hughes B, Gordon CM, Rizzoli R. Life-course approach to nutrition. Osteoporos Int. 2015;26:2723–42. · DOI
- Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutri. 2006;46(8):621–8. · DOI · Paper page
- Jugdaohsingh R. Silicon and bone health. J Nutr Health Ageing. 2007;11(2):99–110.
- Price CT, Langford JR, Liporace FA. Essential nutrients for bone health and a review of their availability in the average North American diet. Open Orthop J. 2012;6:143–9. · DOI
- Larson-Meyer ED, Woolf K, Burke L. Assessment of nutrient status in athletes and the need for supplementation. Int J Sports Nutr Exerc Metab. 2018;28:139–58. · DOI
- Logue D, Madigan SM, Delahunt E, Heinen M, McDonnell SJ, Corish CA. Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance. Sports Med. 2018;48(1):73–96. · DOI · Paper page
- Papageorgiou M, Dolan E, Elliott-Sale KJ, Sale C. Reduced energy availability: implications for bone health in physically active populations. Eur J Nutr. 2018;57(3):847–59. · DOI · Paper page
- Loucks AB, Kiens B, Wright HH. Energy availability in athletes J Sports Sci. 2011;29(Suppl 1):S7–15.
- Torstveit MK, Fahrenholtz IL, Lichtenstein MB, Stenqvist TB, Melin AK. Exercise dependence, eating disorder symptoms and biomarkers of relative energy deficiency in sports (RED-S) among male endurance athletes. BMJ Open Sport Exerc Med. 2019;5(1):e000439. · DOI
- Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res. 2004;19(8):1231–40. · DOI · Paper page
- Thong FS, McLean C, Graham TE. Plasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors. J Appl Physiol. 2000;88(6):2037–44. · DOI
- Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Effects of reduced energy availability on bone metabolism in women and men. Bone. 2017;105:191–9. · DOI · Paper page
- Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, et al. Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women. Bone. 2018;114:181–8. · DOI
- Prouteau S, Pelle A, Collomp K, Benhamou L, Courteix D. Bone density in elite judoists and effects of weight cycling on bone metabolic balance. Med Sci Sports Exerc. 2006;38(4):694–700. · DOI · Paper page
- Ackerman KE, Nazem T, Chapko D, Russell M, Mendes N, Taylor AP, et al. Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab. 2011;96(10):3123–33. · DOI
- Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, et al. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. Bone. 2012;51(4):680–7. · DOI
- De Souza MJ, West SL, Jamal SA, Hawker GA, Gundberg CM, Williams NI. The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women. Bone. 2008;43(1):140–8. · DOI
- Southmayd EA, Mallinson RJ, Williams NI, Mallinson DJ, De Souza MJ. Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women. Osteoporos Int. 2017;28(4):1365–76. · DOI
- De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014;48(4):289. · DOI · Paper page
- Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the female athlete triad in male athletes. Sports Med. 2016;46(2):171–82. · DOI · Paper page
- Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687–97. · DOI · Paper page
- Noakes T, Volek JS, Phinney SD. Low-carbohydrate diets for athletes: what evidence? Br J Sports Nutr. 2014;48(14):1077–8. · DOI · Paper page
- Chang CK, Borer K, Lin PJ. Low-carbohydrate-high-fat diet: can it help exercise performance? J Hum Kinet. 2017;56:81–92. · DOI
- Bjarnason NH, Henriksen EE, Alexandersen P, Christgau S, Henriksen DB, Christiansen C. Mechanism of circadian variation in bone resorption. Bone. 2002;30:307–13. · DOI · Paper page
- de Sousa MV, Pereira RM, Fukui R, Caparbo VF, da Silva ME. Carbohydrate beverages attenuate bone resorption markers in elite runners. Metabolism. 2014;63(12):1536–41. · DOI
- Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int. 2006;17(9):1398–403. · DOI
- Kraut J, Coburn J. Bone, acid and osteoporosis. N Engl J Med. 1998;330:1821–2. · DOI
- Barzel U, Massey L. Excess dietary protein can adversely effect bone. J Nutr. 1998;128:1051–3. · DOI · Paper page
- Dolan E, Sale C. Protein and bone health across the lifespan. Proc Nutr Soc. 2018;78(1):45–55. · DOI
- Fenton T, Eliasziw M, Lyon A, Tough SC, Hanley DA. Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid ash diet hypothesis. Am J Clin Nutr. 2008;88:1159–66. · DOI
- Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr. 2005;81:923–33. · DOI
- Kerstetter JE, O’Brien KO, Caseria DM, Wall DE, Insogna KL. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab. 2005;90(1):26–31. · DOI · Paper page
- Heaney R. Bone Health. Am J Clin Nutr. 2007;85:300–3. · DOI
- O’Bryan KR, Doering TM, Morton RW, Coffey VG, Phillips SM, Cox GR. Do multi-ingredient protein supplements augment resistance training-induced gains in skeletal muscle mass and strength? A systematic review and meta-analysis of 35 trials. Br J Sports Med. 2019. https://doi.org/10.1136/bjsports-2018-099889. · DOI
- Kohrt WM, Barry DW, Schwartz RS. Muscle forces or gravity: what predominates mechanical loading on bone? Med Sci Sports Exerc. 2009;41:2050–5. · DOI
- Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010;340:b5664. · DOI · Paper page
- Angeline ME, Gee AO, Shindle M, Warren RF, Rodeo SA. The effects of vitamin D deficiency in athletes. Am J Sports Med. 2013;41:461–4. · DOI
- Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41:1102–10. · DOI · Paper page
- Miller JR, Dunn KW, Ciliberti LJ, Patel RD, Swanson BA. Association of vitamin D with stress fractures: a retrospective cohort study. J Foot Ankle Surg. 2016;55(1):117–20. · DOI
- Maroon JC, Mathyssek CM, Bost JW, Amos A, Winkelman R, Yates AP, et al. Vitamin D profile in National Football League players. Am J Sports Med. 2015;43(5):1241–5. · DOI · Paper page
- Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741–9. · DOI · Paper page
- Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK, Greendale G, et al. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. PM R. 2010;2:740–50. · DOI
- Rector RS, Rogers R, Ruebel M, Hinton PS. Participation in road cycling vs running is associated with lower bone mineral density in men. Metabolism. 2008;57(2):226–32. · DOI · Paper page
- Tenforde AS, Carlson JL, Sainani KL, Chang AO, Kim JH, Golden NH, et al. Sport and triad risk factors influence bone mineral density in collegiate athletes. Med Sci Sports Exerc. 2018;50(12):2536–43. · DOI · Paper page
- Verbalis JG, Barsony J, Sugimura Y, Tian Y, Adams DJ, Carter EA, et al. Hyponatremia-induced osteoporosis. J Bone Miner Res. 2010;25(3):554–63. · DOI · Paper page
- Barsony J, Sugimura Y, Verbalis JG. Osteoclast response to low extracellular sodium and the mechanism of hyponatremia-induced bone loss. J Biol Chem. 2011;286(12):10864–75. · DOI
- Scott JP, Sale C, Greeves JP, Casey A, Dutton J, Fraser WD. Effect of fasting versus feeding on the bone metabolic response to running. Bone. 2012;51(6):990–9. · DOI
- Townsend R, Elliott-Sale KJ, Currell K, Tang J, Fraser WD, Sale C. The effect of post-exercise carbohydrate and protein ingestion on bone metabolism. Med Sci Sports Exerc. 2017;49(6):1209–18. · DOI · Paper page
Cited by
Kasper, A. M., Langan-Evans, C., Hudson, J. F., Brownlee, T. E., Harper, L. D., Naughton, R. J., Morton, J. P., & Close, G. L. (2021) · Nutrients · doi:10.3390/nu13041075 · Cited by 196
Wasserfurth, P., Palmowski, J., Hahn, A., & Krüger, K. (2020) · Sports Medicine - Open · doi:10.1186/s40798-020-00275-6 · Cited by 190
Fensham, N. C., Heikura, I. A., McKay, A. K. A., Tee, N., Ackerman, K. E., & Burke, L. M. (2020) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.4658 · Cited by 65
Hutson, M. J., O’Donnell, E., Brooke-Wavell, K., Sale, C., & Blagrove, R. C. (2021) · Sports Medicine · doi:10.1007/s40279-020-01396-4 · Cited by 64
Self-citationProtein Requirements for Master Athletes: Just Older Versions of Their Younger Selves
Moore, D. R. (2021) · Sports Medicine · doi:10.1007/s40279-021-01510-0 · Cited by 33
Nutrition for Older Athletes: Focus on Sex-Differences
Strasser, B., Pesta, D., Rittweger, J., Burtscher, J., & Burtscher, M. (2021) · Nutrients · doi:10.3390/nu13051409 · Cited by 25
Kopiczko, A., Adamczyk, J. G., Gryko, K., & Popowczak, M. (2021) · European Review of Aging and Physical Activity · doi:10.1186/s11556-021-00262-0 · Cited by 24
Chapman, S., Chung, H. C., Rawcliffe, A. J., Izard, R., Smith, L., & Roberts, J. D. (2021) · Nutrients · doi:10.3390/nu13051416 · Cited by 17
Louis, J., Tiollier, E., Lamb, A., Bontemps, B., Areta, J., & Bernard, T. (2020) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2020.00009 · Cited by 4
Association of Energy, Macronutrients, and Fiber Intakes with Bone Health in Adolescent Athletes
Miranda, C. C., de Araújo Pinto, A., de Lima, T. R., Bim, M. A., Fernandes, R. A., & Pelegrini, A. (2025) · Calcified Tissue International · doi:10.1007/s00223-025-01430-5 · Cited by 2
Ayar, M., & Özbey, F. (2024) · Ankara Üniversitesi Beden Eğitimi ve Spor Yüksekokulu SPORMETRE Beden Eğitimi ve Spor Bilimleri Dergisi · doi:10.33689/spormetre.1413785
Metadata
- Authors
- Sale, C., & Elliott-Sale, K. J.
- Venue
- Sports Medicine
- Published
- 2019-11-13
- Volume
- 49
- Issue
- S2
- Pages
- 139-151
- ISSN
- 0112-1642
- 1179-2035
- Cited by
- 127
- References
- 16
- Language
- en
- Licence
- creativecommons.org/licenses/by/4.0 (tdm)
- creativecommons.org/licenses/by/4.0 (vor)
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.