Bone Health in Athletes: The Role of Exercise, Nutrition, and Hormones
Open accessAbstract
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 1986 to 2016 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. Level of Evidence: Levels 1 through 4 evidence included. Results: There is strong evidence that exercise benefits bone health at every age and is a critical factor in osteoporosis prevention and treatment. Vitamin D, calcium, and hormones play vital roles in ensuring optimal bone health. When there is an imbalance between exercise and nutrition, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Both of these can lead to morbidity and lost time from training and competition. Thus, early recognition and appropriate treatment of the female athlete triad and other stress fracture risk factors are vital to preventing long-term bone health problems. Conclusion: To optimize bone health, adequate nutrition, appropriate weightbearing exercise, strength training, and adequate calcium and vitamin D are necessary throughout life.
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
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?
A significantly greater bone density has been observed in athletic cohorts, with effects depending on the type, intensity, and duration of exercise training and the characteristics of the athletes.
“A significantly greater bone density has been observed in athletic cohorts, with effects depending on the type, intensity, and duration of exercise training and the characteristics of the athletes [298].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [298]
Exceptions include non-weight-bearing activities (e.g., swimming, cycling) and competitive distance runners, whose bone density appears similar to, or lower than, the non-exercising controls.
“Exceptions include non-weight-bearing activities (e.g., swimming, cycling) and competitive distance runners, whose bone density appears similar to, or lower than the non-exercising controls.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [298]
Exceptions include non-weight-bearing activities such as swimming and cycling and competitive distance runners, whose bone density appears similar to or lower than non-exercising controls.
“Exceptions include non-weight-bearing activities (e.g., swimming, cycling) and competitive distance runners, whose bone density appears similar to, or lower than the non-exercising controls.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [298]
Significantly greater bone density has been observed in athletic cohorts, with effects depending on type, intensity, and duration of exercise training and characteristics of athletes.
“A significantly greater bone density has been observed in athletic cohorts, with effects depending on the type, intensity, and duration of exercise training and the characteristics of the athletes [298].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [298]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Writing Group for the Women's Health Initiative Investigators (2002) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.288.3.321 · Cited by 15,889 · cited 1× · see citing works
“Because of these concerns and the availability of other osteoporosis medications, estrogen has a role but is no longer a first-line agent for postmenopausal osteoporosis.(14,16,24,88)”
BackgroundHolick, M. F. (2007) · New England Journal of Medicine · doi:10.1056/nejmra070553 · Cited by 13,720 · see citing works
Breast cancer and hormone-replacement therapy in the Million Women Study
Beral, V. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14065-2 · Cited by 2,986 · see citing works
Holick, M. F. (2004) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/80.6.1678s · Cited by 2,768 · cited 1× · see citing works
“Vitamin D insufficiency is defined as a level of 20 to 31 ng/mL, and a level of ≥32 ng/mL demonstrates sufficient levels.(45,46) The prevalence of vitamin D insufficiency and deficiency in athletes is about 56% overall with a higher incidence in the winter and spring, indoor sports, and mixed sports.”
BackgroundDietary Reference Intakes for Calcium and Vitamin D
Institute of Medicine (2011) · National Academies Press eBooks · doi:10.17226/13050 · Cited by 2,597 · see citing works
Normal Bone Anatomy and Physiology
Clarke, B. (2008) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.04151206 · Cited by 2,192 · cited 1× · see citing works
“Cortical bone is dense, solid, and surrounds the marrow space, whereas trabecular bone consists of a honeycomb-like network of trabecular plates and rods distributed throughout the bone marrow compartment.(29) Mechanotransduction refers to bone’s recognition of and response to loading, with mechanoreceptors primarily…”
BackgroundSex Steroids and the Construction and Conservation of the Adult Skeleton
Riggs, B. L., Khosla, S., & Melton, L. J. (2002) · Endocrine Reviews · doi:10.1210/edrv.23.3.0465 · Cited by 1,846 · cited 1× · see citing works
“It inhibits bone turnover and maintains balance between bone resorption and formation.(86) Estrogen acts on osteoblasts and osteoclasts in a receptor-mediated fashion and has indirect effects on other hormones, including calcitonin, parathyroid hormone, cytokines, and growth factors.”
BackgroundBlack, D. M., & Rosen, C. J. (2016) · New England Journal of Medicine · doi:10.1056/nejmcp1513724 · Cited by 1,763 · see citing works
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318149f111 · Cited by 1,554 · see citing works
Breast cancer and hormone-replacement therapy: the Million Women Study
Beral, V., Banks, E., REEVES, G. K., & Bull, D. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14596-5 · Cited by 1,270 · see citing works
Boutroy, S., Bouxsein, M., Munoz, F., & Delmas, P. D. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1258 · Cited by 1,190 · cited 1× · see citing works
“Finite element analysis applied to HR-pQCT images allows estimation of bone strength and mechanical properties, including stiffness and failure load, which are associated with fracture risk, but independent of bone density.(23) For example, in 1 study looking at postmenopausal women, those with fractures had 13% to 17…”
Bolland, M. J., Avenell, A., Baron, J. A., Grey, A., MacLennan, G. S., Gamble, G. D., & Reid, I. R. (2010) · BMJ · doi:10.1136/bmj.c3691 · Cited by 1,099 · cited 1× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.(19,32) On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among…”
BackgroundExercise for preventing and treating osteoporosis in postmenopausal women
Howe, T. E., Shea, B., Dawson, L., Downie, F., Murray, A., Ross, C., Harbour, R., Caldwell, L. M., & Creed, G. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000333.pub2 · Cited by 1,090 · see citing works
Physical Activity and Bone Health
Kohrt, W. M., Bloomfield, S. A., Little, K. D., Nelson, M. E., & Yingling, V. R. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000142662.21767.58 · Cited by 1,043 · see citing works
Matheson, G. O., Clement, D. B., McKenzie, D. C., Taunton, J. E., Lloyd-Smith, D. R., & Macintyre, J. (1987) · The American Journal of Sports Medicine · doi:10.1177/036354658701500107 · Cited by 981 · see citing works
(2005) · The Lancet · doi:10.1016/s0140-6736(05)63013-9 · Cited by 970 · cited 1× · see citing works
“There still exists controversy over the benefit of vitamin D and calcium supplementation in reducing the risk of fractures.(15,18,42) The role of calcium in strengthening bones is unclear.”
BackgroundTrabecular Bone Score: A Noninvasive Analytical Method Based Upon the DXA Image
Silva, B. C. C., Leslie, W. D., Resch, H., Lamy, O., Lesnyak, O. M., Binkley, N., McCloskey, E. V., Kanis, J. А., & Bilezikian, J. P. (2014) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.2176 · Cited by 840 · cited 1× · see citing works
“The advantage of TBS is that it may predict fracture risk in postmenopausal women and is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality.(91)”
BackgroundTen Year Probabilities of Osteoporotic Fractures According to BMD and Diagnostic Thresholds
Kanis, J. А., Johnell, O., Odén, A., Laet, C. E. D. H. D., Dawson, A., & Jönsson, B. (2001) · Osteoporosis International · doi:10.1007/s001980170006 · Cited by 833 · cited 1× · see citing works
“Maintenance of bone mass can reduce fracture risk by 50% to 80%.(48,51,79,80) In older adults, the goals for exercise are fall prevention and ensuring safe exercise with modifications for those with osteoporosis.”
BackgroundA Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
Bischoff-Ferrari, H. A., Willett, W. C., Orav, E. J., Lips, P. T. A. M., Meunier, P. J., Lyons, R. A., Flicker, L. A., Wark, J. D., Jackson, R. D., Cauley, J. A., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1109617 · Cited by 805 · cited 2× · see citing works
“In older populations (age ≥65 years), high-dose vitamin D supplementation (>800 IU daily) prevented hip and nonvertebral fractures.(15) A recent study of professional football players also showed a higher incidence of fractures in vitamin D-deficient players and, perhaps, decreased performance.”
BackgroundCurhan, G. C., Willett, W. C., Speizer, F. E., Spiegelman, D. L., & Stampfer, M. J. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-7-199704010-00001 · Cited by 740 · cited 1× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.(19,32) On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among…”
BackgroundDe Souza, M. J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., Gibbs, J. C., Olmsted, M., Goolsby, M., Matheson, G., et al. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-093218 · Cited by 661 · see citing works
Self-citationInternational Society for Clinical Densitometry 2007 Adult and Pediatric Official Positions
Lewiecki, E. M., Gordon, C. M., Baim, S., Leonard, M. B., Bishop, N. J., Bianchi, M.-L., Kalkwarf, H. J., Langman, C. B., Plotkin, H., Rauch, F., et al. (2008) · Bone · doi:10.1016/j.bone.2008.08.106 · Cited by 583 · cited 1× · see citing works
“5 SDs below the young adult mean value (t score) with or without fractures.(58) Athletes participating in weightbearing sports should have an approximately 10% higher BMD than nonathletes, and athletes in high-impact sports have a higher BMD compared with medium- or low-impact sports.”
BackgroundRobling, A. G., Hinant, F. M., Burr, D. B., & Turner, C. H. (2002) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2002.17.8.1545 · Cited by 551 · cited 1× · see citing works
“4% increase in BMD is equal to a 64% increase in ultimate force and 94% increase in energy to failure.(87) Weightbearing activity was found to have a profound impact on BMD in female athletes, with site-specific mechanical loading significantly affecting bone accrual.”
BackgroundACSM Position Stand: The Female Athlete Triad
Otis, C. L., Drinkwater, B., Johnson, M., Loucks, A., & Wilmore, J. (1997) · Medicine &amp Science in Sports &amp Exercise · doi:10.1097/00005768-199705000-00037 · Cited by 515 · see citing works
WEISSBERGER, A. J., HO, K. K. Y., & LAZARUS, L. (1991) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-72-2-374 · Cited by 514 · see citing works
Lappe, J. M., Cullen, D. M., Haynatzki, G. R., Recker, R. R., Ahlf, R. L., & Thompson, K. L. (2008) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.080102 · Cited by 476 · see citing works
Effects of biomechanical stress on bones in animals
Burr, D. B., Robling, A. G., & Turner, C. H. (2002) · Bone · doi:10.1016/s8756-3282(02)00707-x · Cited by 469 · cited 1× · see citing works
“Stresses that cause osteogenesis must be variable, dynamic, and progressive; static loading does not cause osteogenesis.(25) A key principle of bone formation and adaptation is that physical deformation of the bone directly stimulates bone formation.”
BackgroundThe female athlete triad: disordered eating, amenorrhea, osteoporosis
YEAGER, K. K., AGOSTINI, R., NATTIV, A., & DRINKWATER, B. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199307000-00003 · Cited by 436 · cited 1× · see citing works
“The Triad was originally described in 1992 as 3 interrelated components: disordered eating, amenorrhea, and osteoporosis.(82,105) This definition has expanded to now describe a spectrum of pathology that includes less severe forms of these 3 factors.”
BackgroundLow Bone Density Is an Etiologic Factor for Stress Fractures in Athletes
Myburgh, K. H., Hutchins, J., Fataar, A. B., Hough, S. F., & Noakes, T. D. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-10-754 · Cited by 425 · see citing works
High-Risk Stress Fractures: Evaluation and Treatment
Boden, B. P., & Osbahr, D. C. (2000) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/00124635-200011000-00002 · Cited by 418 · cited 1× · see citing works
“Surgery is rarely indicated but may be necessary in high-risk fracture sites such as the tension side of the femoral neck or anterior tibia.(10,17,36,38,90) Supplementation of calcium and vitamin D in a diet that is deficient in these reduces the incidence of stress fractures by as much as 20%.”
BackgroundMoyer, V. A., & on behalf of the U.S. Preventive Services Task Force* (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-6-201303190-00588 · Cited by 408 · see citing works
MacNeil, J. A., & Boyd, S. K. (2007) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2006.11.002 · Cited by 386 · cited 1× · see citing works
“While BMD is more frequently measured using DXA in the clinical setting, high-resolution peripheral quantitative computed tomography (HR-pQCT) can better distinguish healthy microarchitecture of bone from suboptimal bone, using 3-dimensional information to provide estimates of bone geometry.(54,64) Finite element anal…”
BackgroundFredericson, M., Jennings, F., Beaulieu, C. F., & Matheson, G. O. (2006) · Topics in Magnetic Resonance Imaging · doi:10.1097/rmr.0b013e3180421c8c · Cited by 382 · see citing works
Physical Activity in the Prevention and Amelioration of Osteoporosis in Women
Borer, K. T. (2005) · Sports Medicine · doi:10.2165/00007256-200535090-00004 · Cited by 372 · see citing works
Barrack, M. T., Gibbs, J. C., De Souza, M. J., Williams, N. I., Nichols, J. F., Rauh, M. J., & Nattiv, A. (2014) · The American Journal of Sports Medicine · doi:10.1177/0363546513520295 · Cited by 349 · cited 7× · see citing works
“The risk of incurring a stress injury increases as the number of Triad-related risk factors increases.(6) Although the Triad is specifically describing the syndrome seen in women, a parallel syndrome is seen in men with low energy availability, hypogonadism, and low BMD, with further research needed in this area.”
BackgroundInfluentialPhysiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa
Misra, M., Katzman, D. K., Miller, K. K., Mendes, N., Snelgrove, D., Russell, M., Goldstein, M. A., Ebrahimi, S., Clauss, L., Weigel, T. J., et al. (2011) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.447 · Cited by 348 · cited 6× · see citing works
“Insulin-like growth factor 1 is a bone trophic hormone and oral estrogen decreases its systemic concentration but transdermal estrogen does not, thus leading researchers to investigate the effects of transdermal estrogen on BMD.(50,70,103) When low BMD is from low energy availability and a hypoestrogenic state as seen…”
BackgroundInfluentialRisk Factors for Stress Fractures
Bennell, K. L., Matheson, G. O., Meeuwisse, W. H., & Brukner, P. D. (1999) · Sports Medicine · doi:10.2165/00007256-199928020-00004 · Cited by 338 · cited 1× · see citing works
“Athletes with amenorrhea are 2 to 4 times more likely to suffer a stress fracture than eumenorrheic subjects.(11) In a study of college athletes, the lower the BMD the longer the recovery from a stress injury.”
Background(2007) · PubMed · Cited by 337 · see citing works
EPIDEMIOLOGY AND SITE SPECIFICITY OF STRESS FRACTURES
Bennell, K. L., & Brukner, P. D. (1997) · Clinics in Sports Medicine · doi:10.1016/s0278-5919(05)70016-8 · Cited by 304 · cited 1× · see citing works
“7% to 21% in athletes.(12) Stress injuries of the foot and lower leg are most common,(3,68) but they can occur in any bone that is subjected to repetitive stress.”
BackgroundMenstrual irregularity and stress fractures in collegiate female distance runners
Barrow, G. W., & Saha, S. (1988) · The American Journal of Sports Medicine · doi:10.1177/036354658801600302 · Cited by 304 · see citing works
Arendt, E. A., & Griffiths, H. J. (1997) · Clinics in Sports Medicine · doi:10.1016/s0278-5919(05)70023-5 · Cited by 291 · see citing works
Correlation of MRI Grading of Bone Stress Injuries With Clinical Risk Factors and Return to Play
Nattiv, A., Kennedy, G., Barrack, M. T., Abdelkerim, A., Goolsby, M. A., Arends, J. C., & Seeger, L. L. (2013) · The American Journal of Sports Medicine · doi:10.1177/0363546513490645 · Cited by 285 · cited 9× · see citing works
“Up to 15.9% of athletes have all 3 most severe components of the Triad.”
BackgroundInfluentialSelf-citationVitamin D Status and Muscle Function in Post-Menarchal Adolescent Girls
Ward, K. A., Das, G., Berry, J., Roberts, S. A., Rawer, R., Adams, J. E., & Zulf Mughal, M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1284 · Cited by 282 · see citing works
Athletic Performance and Vitamin D
Cannell, J. J., Hollis, B. W., Sorenson, M. B., Taft, T. N., & Anderson, J. J. B. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181930c2b · Cited by 279 · cited 3× · see citing works
“The active metabolite, 1,25(OH)D3, promotes gene transcription, increasing cell protein synthesis and growth.(28) Muscle biopsies of adults with low vitamin D levels have shown fatty infiltration and fibrosis, but changes appear reversible with vitamin D supplementation.”
BackgroundMoyer, V. A., & on behalf of the U.S. Preventive Services Task Force* (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-9-201305070-00603 · Cited by 251 · see citing works
Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects
the Scientific Committee of the GRIO (Groupe de Recherche et d’Information sur les Ostéoporoses), Bousson, V., Bergot, C., Sutter, B., Levitz, P., & Cortet, B. (2012) · Osteoporosis International · doi:10.1007/s00198-011-1824-6 · Cited by 250 · see citing works
Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis
Farrokhyar, F., Tabasinejad, R., Dao, D., Peterson, D., Ayeni, O. R., Hadioonzadeh, R., & Bhandari, M. (2015) · Sports Medicine · doi:10.1007/s40279-014-0267-6 · Cited by 249 · cited 1× · see citing works
“The prevalence of vitamin D insufficiency and deficiency in athletes is about 56% overall with a higher incidence in the winter and spring, indoor sports, and mixed sports.(37) In a study of NCAA (National Collegiate Athletic Association) athletes, the prevalence was 33.”
BackgroundLaib, A., & Ruegsegger, P. (1999) · Bone · doi:10.1016/s8756-3282(98)00159-8 · Cited by 245 · see citing works
Pothuaud, L., Barthe, N., Krieg, M.-A., Mehsen, N., Carceller, P., & Hans, D. B. (2009) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2008.11.006 · Cited by 238 · cited 1× · see citing works
“TBS values tend to be lower in postmenopausal women and in men with previous fractures compared with their nonfractured peers.(57,83) The advantage of TBS is that it may predict fracture risk in postmenopausal women and is associated with fracture risk in individuals with conditions related to reduced bone mass or bon…”
BackgroundSouza, M. J. D., West, S., Jamal, S. A., HAWKER, G. A., Gundberg, C. M., & Williams, N. I. (2008) · Bone · doi:10.1016/j.bone.2008.03.013 · Cited by 236 · cited 1× · see citing works
“Low energy availability often causes menstrual dysfunction and hypoestrogenism, leading to negative effects on bone health and endothelial cell dysfunction.(34,85) Bone stress injuries, which include stress reactions and fractures, are more often seen in athletes with menstrual irregularities and/or low BMD.”
BackgroundAckerman, K. E., Nazem, T. G., Chapko, D., Russell, M., Mendes, N., Taylor, A. P., Bouxsein, M., & Misra, M. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1614 · Cited by 207 · cited 1× · see citing works
“Both amenorrheic and eumenorrheic athletes were found to have greater total cross-sectional area, trabecular area, and cortical perimeter compared with nonathletes at the distal tibia.(1)”
ResultFactors that Affect Bone Mineral Accrual in the Adolescent Growth Spurt
Whiting, S. J., Vatanparast, H., Baxter-Jones, A. D. G., Faulkner, R. A., Mirwald, R. L., & Bailey, D. A. (2004) · Journal of Nutrition · doi:10.1093/jn/134.3.696s · Cited by 200 · cited 3× · see citing works
“Adolescence and young adulthood are the most beneficial times for longterm bone density gains, with nearly 90% of peak bone mass gained by age 18 years.(104) However, it is also the most susceptible time, when negative consequences can occur from eating disorders, poor nutrition, hypoestrogenism, and inadequate calciu…”
BackgroundParallels with the Female Athlete Triad in Male Athletes
Tenforde, A., Barrack, M., Nattiv, A., & Fredericson, M. (2016) · Sports Medicine · doi:10.1007/s40279-015-0411-y · Cited by 199 · cited 1× · see citing works
“Although the Triad is specifically describing the syndrome seen in women, a parallel syndrome is seen in men with low energy availability, hypogonadism, and low BMD, with further research needed in this area.(95) The fact that the Triad is a spectrum of disease makes determining prevalence challenging.”
BackgroundPrevalence of Individual and Combined Components of the Female Athlete Triad
Gibbs, J. C., Williams, N. I., & Souza, M. J. D. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31827e1bdc · Cited by 199 · cited 1× · see citing works
“8%.(39) Early detection is critical to prevent the negative consequences of the Triad.”
BackgroundRickenlund, A. M., Eriksson, M. J., Schenck-Gustafsson, K. G., & Hirschberg, A. L. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1286 · Cited by 198 · cited 1× · see citing works
“Low energy availability often causes menstrual dysfunction and hypoestrogenism, leading to negative effects on bone health and endothelial cell dysfunction.(34,85) Bone stress injuries, which include stress reactions and fractures, are more often seen in athletes with menstrual irregularities and/or low BMD.”
BackgroundIdentifying Sex-Specific Risk Factors for Stress Fractures in Adolescent Runners
Tenforde, A. S., Sayres, L. C., McCurdy, M. L., Sainani, K. L., & Fredericson, M. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182963d75 · Cited by 197 · cited 6× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.19,32 On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among f…”
BackgroundInfluentialRisk Factors for Stress Fracture among Young Female Cross-Country Runners
Kelsey, J. L., Bachrach, L. K., Procter-Gray, E., Nieves, J. W., Greendale, G. A., Sowers, M. R., Brown, B. W., MATHESON, K. A., Crawford, S. L., & Cobb, K. L. (2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318074e54b · Cited by 194 · cited 6× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.19,32 On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among f…”
BackgroundInfluentialStress Injuries to Bone in College Athletes
Arendt, E. A., Agel, J. A., Heikes, C. S., & Griffiths, H. (2003) · The American Journal of Sports Medicine · doi:10.1177/03635465030310063601 · Cited by 183 · see citing works
Nazem, T. G., & Ackerman, K. E. (2012) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738112439685 · Cited by 180 · see citing works
Vitamin D and the Athlete: Risks, Recommendations, and Benefits
Ogan, D., & Pritchett, K. (2013) · Nutrients · doi:10.3390/nu5061856 · Cited by 180 · see citing works
Risk Factors for Stress Fractures in Female Track-and-Field Athletes
Bennell, K. L., Malcolm, S. A., Thomas, S. A., Ebeling, P. R., McCrory, P. R., Wark, J. D., & Brukner, P. D. (1995) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-199510000-00004 · Cited by 178 · cited 1× · see citing works
“Runners with oligomenorrhea were 6 times more likely to sustain a stress injury.(13) Stress injuries can be diagnosed clinically but imaging is often used to assist with the diagnosis of certain stress injuries.”
BackgroundLow Energy Availability in the Marathon and Other Endurance Sports
Loucks, A. B. (2007) · Sports Medicine · doi:10.2165/00007256-200737040-00019 · Cited by 177 · cited 1× · see citing works
“Energy availability is defined as energy intake (kcal) minus exercise energy expenditure (kcal) divided by kilograms of fat-free mass or lean body mass.(63) These components can be difficult to measure outside the research setting but estimates and less precise measurements can be done and an energy availability calcu…”
BackgroundMisra, M., Prabhakaran, R., Miller, K. K., Goldstein, M. A., Mickley, D. W., Clauss, L., Lockhart, P., Cord, J., Herzog, D. B., Katzman, D. K., et al. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1434 · Cited by 172 · cited 1× · see citing works
“Restoration of weight and resumption of normal menses are the main goals of treatment and are important in preventing further bone loss.(33,71) The majority of athletes can be treated successfully with a nonpharmacologic approach, but in those with osteoporosis and/or history of multiple fractures who do not respond t…”
BackgroundLooker, A. C., Borrud, L. G., Dawson-Hughes, B. F., Shepherd, J., & Wright, N. C. (2012) · PubMed · Cited by 165 · see citing works
Bone Loss and Fracture Risk After Reduced Physical Activity
Nordström, A., Karlsson, C., Nyquist, F., Olsson, T., Nordström, P., & Karlsson, M. K. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.041012 · Cited by 150 · cited 1× · see citing works
“Maintenance of bone mass can reduce fracture risk by 50% to 80%.(48,51,79,80) In older adults, the goals for exercise are fall prevention and ensuring safe exercise with modifications for those with osteoporosis.”
BackgroundLiu, S. L., & Lebrun, C. M. (2006) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.020065 · Cited by 150 · cited 1× · see citing works
“Estrogen acts on osteoblasts and osteoclasts in a receptor-mediated fashion and has indirect effects on other hormones, including calcitonin, parathyroid hormone, cytokines, and growth factors.(5,60) Adolescence is a particularly crucial period for skeletal development.”
BackgroundThe Effect of Oral Contraceptives on Bone Mass and Stress Fractures in Female Runners
Cobb, K. L., Bachrach, L. K., Sowers, M. R., Nieves, J. W., Greendale, G. A., Kent, K., Brown, B. W., Pettit, K., Harper, D. M., & Kelsey, J. L. (2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318074e532 · Cited by 148 · cited 2× · see citing works
“In the athletic population, use of hormones in treatment of amenorrhea, oligomenorrhea, and low bone density has been controversial or inconclusive.(30,33,35,78) The impact of oral hormones on insulin-like growth factor 1 in the liver may negate the benefit of estrogen on bone.”
BackgroundHegsted, D. M. (1986) · Journal of Nutrition · doi:10.1093/jn/116.11.2316 · Cited by 143 · see citing works
Effect of osteoporosis medications on fracture healing
Hegde, V. V., Jo, J. E., Andreopoulou, P., & Lane, J. M. (2015) · Osteoporosis International · doi:10.1007/s00198-015-3331-7 · Cited by 142 · see citing works
Busse, J. W., Kaur, J., Mollon, B., Bhandari, M., Tornetta, P., Schünemann, H. J., & Guyatt, G. H. (2009) · BMJ · doi:10.1136/bmj.b351 · Cited by 134 · cited 1× · see citing works
“External bone stimulators have also been used, although human evidence is lacking for their effectiveness in stress fractures and data are primarily found in studies of traumatic fractures.(27,59,99)”
BackgroundStress Fractures of the Pelvis and Legs in Athletes
Behrens, S. B., Deren, M. E., Matson, A. P., Fadale, P. D., & Monchik, K. O. (2012) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738112467423 · Cited by 126 · cited 1× · see citing works
“Surgery is rarely indicated but may be necessary in high-risk fracture sites such as the tension side of the femoral neck or anterior tibia.(10,17,36,38,90) Supplementation of calcium and vitamin D in a diet that is deficient in these reduces the incidence of stress fractures by as much as 20%.”
BackgroundSex steroids and bone: current perspectives
Balasch, J. (2003) · Human Reproduction Update · doi:10.1093/humupd/dmg017 · Cited by 116 · cited 1× · see citing works
“Estrogen acts on osteoblasts and osteoclasts in a receptor-mediated fashion and has indirect effects on other hormones, including calcitonin, parathyroid hormone, cytokines, and growth factors.(5,60) Adolescence is a particularly crucial period for skeletal development.”
BackgroundSabatier, J., Guaydier-Souquières, G., Benmalek, A., & Marcelli, C. (1999) · Osteoporosis International · doi:10.1007/s001980050173 · Cited by 115 · cited 1× · see citing works
“Because of the significant impact puberty has on bone growth, there is up to a 50% increase in total body bone mass between the ages of 12 and 18 years.(89) Increases in growth hormone, insulin-like growth factor 1, and estrogen that occur between Tanner stages 2 and 4 coincide with maximal rates of bone mineral gains.”
BackgroundVitamin D, Muscle Function, and Exercise Performance
Bartoszewska, M., Kamboj, M., & Patel, D. R. (2010) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2010.03.008 · Cited by 104 · cited 1× · see citing works
“Muscle biopsies of adults with low vitamin D levels have shown fatty infiltration and fibrosis, but changes appear reversible with vitamin D supplementation.(9) In girls aged 12 to 14 years, there is a direct correlation between 25(OH)D3 levels and muscle power, force, velocity, and jump height measured by jump mechan…”
BackgroundTorstveit, M. K., & Sundgot‐Borgen, J. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.012781 · Cited by 103 · cited 1× · see citing works
“Athletes participating in weightbearing sports should have an approximately 10% higher BMD than nonathletes, and athletes in high-impact sports have a higher BMD compared with medium- or low-impact sports.(98) Children, adolescents, and premenopausal women require different definitions that take into account age, spor…”
BackgroundSouza, M. D. D., & Williams, N. (2005) · Current sports medicine reports · doi:10.1097/01.csmr.0000306070.67390.cb · Cited by 101 · cited 2× · see citing works
“The impact of oral hormones on insulin-like growth factor 1 in the liver may negate the benefit of estrogen on bone.(33,35,78) Insulin-like growth factor 1 is a bone trophic hormone and oral estrogen decreases its systemic concentration but transdermal estrogen does not, thus leading researchers to investigate the eff…”
BackgroundThe Effects of Vitamin D Deficiency in Athletes
Angeline, M. E., Gee, A. O., Shindle, M. K., Warren, R. F., & Rodeo, S. A. (2013) · The American Journal of Sports Medicine · doi:10.1177/0363546513475787 · Cited by 99 · cited 3× · see citing works
“Many studies have identified a direct relationship between serum vitamin D levels and BMD in adults of all races.(2) When vitamin D levels fall below 30 ng/mL, parathyroid hormone levels are increased, which triggers an increase in osteoclastic activity in bone.”
BackgroundMilgrom, C., Finestone, A. S., Novack, V., Pereg, D., Goldich, Y., Kreiss, Y., Zimlichman, E., Kaufman, S., Liebergall, M., & Burr, D. B. (2004) · Bone · doi:10.1016/j.bone.2004.04.016 · Cited by 98 · see citing works
Kam, G. Y. W., Leung, K., Baxter, R. C., & Ho, K. K. Y. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.5.6527 · Cited by 97 · see citing works
Stress Fracture Sites Related to Underlying Bone Health in Athletic Females
Marx, R. G., Saint‐Phard, D., Callahan, L. R., Chu, J., & Hannafin, J. A. (2001) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200104000-00002 · Cited by 94 · cited 1× · see citing works
“Not all stress fractures are the same; cancellous bone stress fractures occur more often in patients with osteopenia, compared with cortical stress fractures.(67,76) More severe stress fractures by magnetic resonance grading are correlated with lower BMD.”
BackgroundBone Density and Young Athletic Women
Nichols, D. L., Sanborn, C. F., & Essery, E. V. (2007) · Sports Medicine · doi:10.2165/00007256-200737110-00006 · Cited by 93 · cited 1× · see citing works
“Maintenance of bone mass can reduce fracture risk by 50% to 80%.(48,51,79,80) In older adults, the goals for exercise are fall prevention and ensuring safe exercise with modifications for those with osteoporosis.”
BackgroundFatigue Fractures of the Femoral Neck in Athletes
Shin, A. Y., & Gillingham, B. L. (1997) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/00124635-199711000-00001 · Cited by 88 · cited 1× · see citing works
“Surgery is rarely indicated but may be necessary in high-risk fracture sites such as the tension side of the femoral neck or anterior tibia.(10,17,36,38,90) Supplementation of calcium and vitamin D in a diet that is deficient in these reduces the incidence of stress fractures by as much as 20%.”
BackgroundImaging of Lower Extremity Stress Fracture Injuries
Moran, D. S., Evans, R. K., & Hadad, E. (2008) · Sports Medicine · doi:10.2165/00007256-200838040-00005 · Cited by 87 · see citing works
Physical activity and bone health.
White, S. (2002) · British Journal of Sports Medicine · doi:10.1136/bjsm.36.1.76-b · Cited by 86 · see citing works
Vitamin D Profile in National Football League Players
Maroon, J. C., Mathyssek, C. M., Bost, J. W., Amos, A., Winkelman, R., Yates, A. P., Duca, M. A., & Norwig, J. A. (2015) · The American Journal of Sports Medicine · doi:10.1177/0363546514567297 · Cited by 86 · cited 1× · see citing works
“A recent study of professional football players also showed a higher incidence of fractures in vitamin D-deficient players and, perhaps, decreased performance.(66)”
BackgroundClassification and Return-to-Play Considerations for Stress Fractures
Diehl, J. J., Best, T. M., & Kaeding, C. C. (2006) · Clinics in Sports Medicine · doi:10.1016/j.csm.2005.08.012 · Cited by 84 · cited 1× · see citing works
“Surgery is rarely indicated but may be necessary in high-risk fracture sites such as the tension side of the femoral neck or anterior tibia.(10,17,36,38,90) Supplementation of calcium and vitamin D in a diet that is deficient in these reduces the incidence of stress fractures by as much as 20%.”
BackgroundPeak bone mass, bone loss and risk of fracture
Johnston, C. C., & Slemenda, C. W. (1994) · Osteoporosis International · doi:10.1007/bf01623435 · Cited by 78 · see citing works
Parathyroid hormone and bisphosphonate have opposite effects on stress fracture repair
Sloan, A. V., Martin, J. R., Li, S., & Li, J. (2010) · Bone · doi:10.1016/j.bone.2010.05.015 · Cited by 74 · cited 1× · see citing works
“There has been some promising evidence for recombinant parathyroid hormone improving BMD, bone mineral content, and stress fracture healing in animal studies but further research is needed in humans.(92) External bone stimulators have also been used, although human evidence is lacking for their effectiveness in stress…”
BackgroundAbnormal Microarchitecture and Stiffness in Postmenopausal Women with Ankle Fractures
Stein, E. M., Liu, X. S., Nickolas, T. L., Cohen, A., Thomas, V., McMahon, D. J., Zhang, C. A., Cosman, F., Nieves, J. W., Greisberg, J., et al. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0309 · Cited by 70 · cited 1× · see citing works
“For example, in 1 study looking at postmenopausal women, those with fractures had 13% to 17% lower stiffness at the tibia and radius than those without fractures, despite similar BMDs measured via DXA scans.(93) An additional objective tool to assess bone integrity is the trabecular bone score (TBS), a gray-level text…”
BackgroundBUSEN, N., BRITT, R., & RIANON, N. (2003) · Journal of Adolescent Health · doi:10.1016/s1054-139x(02)00567-0 · Cited by 66 · cited 1× · see citing works
“5 without exogenous estrogen replacement.(26) A higher body weight correlates with higher BMD, regardless of treatment with hormonal contraception, suggesting that body weight and body fat may override potential detrimental effects of Depo-Provera.”
BackgroundVertebral microarchitecture and fragility fracture in men: A TBS study
Leib, E. S., Winzenrieth, R., Aubry‐Rozier, B., & Hans, D. B. (2013) · Bone · doi:10.1016/j.bone.2013.12.015 · Cited by 65 · cited 2× · see citing works
“TBS values tend to be lower in postmenopausal women and in men with previous fractures compared with their nonfractured peers.(57,83) The advantage of TBS is that it may predict fracture risk in postmenopausal women and is associated with fracture risk in individuals with conditions related to reduced bone mass or bon…”
BackgroundPrevalence of Abnormal Vitamin D Levels Among Division I NCAA Athletes
Villacis, D. C., Yi, A., Jahn, R., Kephart, C. J., Charlton, T. P., Gamradt, S. C., Romano, R., Tibone, J. E., & Hatch, G. F. R. (2014) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738114524517 · Cited by 64 · cited 1× · see citing works
“6%, despite taking place in southern California during the summer months.(100) The causes of vitamin D deficiency can be multifactorial, including reduced skin synthesis, absorption of dietary vitamin D, and acquired and heritable disorders of vitamin D metabolism.”
BackgroundWarren, M. P., Miller, K. K., Olson, W. H., Grinspoon, S. K., & Friedman, A. J. (2005) · Contraception · doi:10.1016/j.contraception.2005.03.007 · Cited by 64 · cited 1× · see citing works
“Combined oral contraceptive pills do not improve bone density in young women.(30,102) For athletes in whom the Triad has been diagnosed, clearance and return to play can be challenging, and clinicians want to ensure participation is safe for the athlete.”
BackgroundCross-sectional evidence of suppressed bone mineral accrual among female adolescent runners
Barrack, M. T., Rauh, M. J., & Nichols, J. F. (2010) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.63 · Cited by 63 · cited 6× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.19,32 On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among f…”
BackgroundInfluentialBowring, C. E., & Francis, R. M. (2011) · Menopause international · doi:10.1258/mi.2011.011012 · Cited by 63 · cited 1× · see citing works
“Because of these concerns and the availability of other osteoporosis medications, estrogen has a role but is no longer a first-line agent for postmenopausal osteoporosis.(14,16,24,88)”
BackgroundTreatment of Stress Fractures in Athletes With Intravenous Pamidronate
Stewart, G. W., Brunet, M., Manning, M. R., & Davis, F. A. (2005) · Clinical Journal of Sport Medicine · doi:10.1097/01.jsm.0000152716.06883.e0 · Cited by 61 · see citing works
Antioxidant and Vitamin D supplements for athletes: Sense or nonsense?
Powers, S. K., Nelson, W. B., & Larson‐Meyer, E. (2011) · Journal of Sports Sciences · doi:10.1080/02640414.2011.602098 · Cited by 60 · cited 1× · see citing works
“When vitamin D levels fall below 30 ng/mL, parathyroid hormone levels are increased, which triggers an increase in osteoclastic activity in bone.(84) Concomitantly, 1,25(OH)D3 directly stimulates osteoblasts to produce receptor activator nuclear factor-κB, which increases osteoclastogenesis and mobilization of calcium…”
BackgroundLi, J., Waugh, L. J., Hui, S. L., Burr, D. B., & Warden, S. J. (2007) · Journal of Orthopaedic Research® · doi:10.1002/jor.20461 · Cited by 49 · cited 1× · see citing works
“External bone stimulators have also been used, although human evidence is lacking for their effectiveness in stress fractures and data are primarily found in studies of traumatic fractures.(27,59,99)”
BackgroundA Displaced Femoral Neck Stress Fracture in an Amenorrheic Adolescent Female Runner
Goolsby, M. A., Barrack, M., & Nattiv, A. (2012) · Sports health · doi:10.1177/1941738111429929 · Cited by 32 · cited 6× · see citing works
“Consuming calcium in diet, such as dairy products, however, does not seem to pose risks for kidney stones or cardiovascular events as seen with artificial forms of calcium supplementation.19,32 On the other hand, both calcium and vitamin D supplementation can decrease the incidence of stress fractures, as seen among f…”
BackgroundInfluentialSelf-citationRelationship between Weight and Bone Mineral Density in Adolescents on Hormonal Contraception
Bonny, A. E., Secic, M., & Cromer, B. A. (2010) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2010.06.007 · Cited by 28 · cited 2× · see citing works
“The mechanism for loss in BMD among Depo-Provera users is estrogen deficiency because of suppression of the hypothalamic-pituitary-ovarian axis Mar • Apr 2017Goolsby and Boniquit without exogenous estrogen replacement.26 A higher body weight correlates with higher BMD, regardless of treatment with hormonal contracepti…”
ResultUchiyama, Y., Nakamura, Y., Mochida, J., & Tamaki, T. (2007) · PubMed · Cited by 26 · see citing works
CrossRef Listing of Deleted DOIs
Souza, M. J. D., & Williams, N. I. (2007) · CrossRef Listing of Deleted DOIs · doi:10.1007/s11932-005-0029-1 · Cited by 25 · see citing works
Disordered Eating, Menstrual Irregularity, and Musculoskeletal Injury in High School Athletes
Thein-Nissenbaum, J., Carr, K., Hetzel, S., & Dennison, E. (2014) · Sports health · doi:10.1177/1941738113498852 · Cited by 25 · cited 1× · see citing works
“Among high school athletes, those taking hormonal contraceptive pills were more likely to have disordered eating despite the same injury and menstrual patterns as those not taking hormonal contraceptive pills.(97) If there are any concerns about the responses to the questions, further in-depth evaluation using a team…”
BackgroundLorincz, C., Manske, S., & Zernicke, R. (2009) · Sports health · doi:10.1177/1941738109334213 · Cited by 24 · see citing works
Manske, S. L., Lorincz, C., & Zernicke, R. F. (2009) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738109338823 · Cited by 20 · see citing works
Jeon, S., Cho, K. H., Ok, G., Lee, S., & Park, H. (2018) · Physical Activity and Nutrition · doi:10.20463/jenb.2018.0021 · Cited by 14 · see citing works
Dadgostar, H., Soleimany, G., Movaseghi, S., Dadgostar, E., & Lotfian, S. (2018) · Medical Journal of the Islamic Republic of Iran · doi:10.14196/mjiri.32.27 · Cited by 12 · see citing works
Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-sectional Study
Zürcher, S. J., Quadri, A., Huber, A., Thomas, L., Close, G. L., Brunner-Agten, S., Noack, P., Gojanovic, B., & Kriemler, S. (2018) · Sports Medicine International Open · doi:10.1055/a-0669-0791 · Cited by 11 · see citing works
The Role of Vitamin D Supplements in Women's Health
Bohon, T. M., & Goolsby, M. A. (2013) · Clinical Medicine Insights Women s Health · doi:10.4137/cmwh.s11067 · Cited by 8 · see citing works
Self-citationSports hip injuries : diagnosis and management
Kelly, B. T., Bedi, A., Larson, C. M., & O’Sullivan, E. (2015) · SLACK eBooks · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
International exercise recommendations in older adults (ICFSR): Expert consensus guidelines
Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., et al. (2021) · The Journal of nutrition, health and aging · doi:10.1007/s12603-021-1665-8 · Cited by 1,247 · see citing works
Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273 · see citing works
Bioaccessibility and Bioavailability of Minerals in Relation to a Healthy Gut Microbiome
Bielik, V., & Kolísek, M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22136803 · Cited by 175 · see citing works
“Further, strong evidence suggests that exercise benefits bone health at all ages and is a critical factor in osteoporosis prevention and treatment in both sexes [33].”
BackgroundCondo, D., Lohman, R., Kelly, M., & Carr, A. (2019) · Nutrients · doi:10.3390/nu11050971 · Cited by 122 · see citing works
“Adequate intakes of calcium, which plays a vital role in bone health and injury risk [34,35], and iron, essential to carry oxygen and maintaining energy release [36], are important for females, in particular when performing high-intensity contact sport.”
BackgroundTranswomen in elite sport: scientific and ethical considerations
Knox, T. R., Anderson, L. C., & Heather, A. K. (2019) · Journal of Medical Ethics · doi:10.1136/medethics-2018-105208 · Cited by 102 · see citing works
Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review
Knechtle, B., Jastrzębski, Z., Hill, L., & Nikolaidis, P. Τ. (2021) · Medicina · doi:10.3390/medicina57030223 · Cited by 76 · see citing works
“, adequate calcium and 25(OH)D) together with appropriate weightbearing exercise and strength training are necessary throughout life [18].”
BackgroundAbsence of menstruation in female athletes: why they do not seek help
Verhoef, S. J., Wielink, M. C., Achterberg, E. A., Bongers, M. Y., & Goossens, S. M. T. A. (2021) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-021-00372-3 · Cited by 60 · see citing works
The female athlete triad: special considerations for adolescent female athletes
Brown, K. A., Dewoolkar, A. V., Baker, N., & Dodich, C. (2017) · Translational Pediatrics · doi:10.21037/tp.2017.04.04 · Cited by 56 · see citing works
Daily, J. P., & Stumbo, J. R. (2018) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2018.07.004 · Cited by 55 · see citing works
Relative Energy Deficiency in Sport (RED-S) in Adolescents – A Practical Review
Gould, R., Ridout, A., & Newton, J. (2021) · International Journal of Sports Medicine · doi:10.1055/a-1947-3174 · Cited by 51 · see citing works
Cheng, J., Santiago, K. A., Abutalib, Z., Temme, K., Hulme, A., Goolsby, M. A., Esopenko, C., & CASEY, E. K. (2020) · PM&R · doi:10.1002/pmrj.12539 · Cited by 45 · see citing works
Self-citationOveruse Knee Pain in the Pediatric and Adolescent Athlete
Sweeney, E. A., Rodenberg, R. E., & MacDonald, J. P. (2020) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000773 · Cited by 39 · see citing works
Książek, A., Zagrodna, A., & Słowińska-Lisowska, M. R. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228567 · Cited by 35 · see citing works
“In addition, inadequate calcium intake combined with reduced energy availability increases the risk of lowering bone mineral density, which promotes injury [41,42].”
BackgroundNutritional Aspects of the Female Athlete
Rossi, K. A. (2017) · Clinics in Sports Medicine · doi:10.1016/j.csm.2017.05.007 · Cited by 34 · see citing works
Nose‐Ogura, S., Yoshino, O., Dohi, M., Kigawa, M., Harada, M., Kawahara, T., Osuga, Y., & Saito, S. (2018) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000571 · Cited by 33 · see citing works
Nutritional Risks Among Female Athletes
Gastrich, M. D., Quick, V., Bachmann, G. A., & Moriarty, A. M. (2020) · Journal of Women s Health · doi:10.1089/jwh.2019.8180 · Cited by 33 · see citing works
Hamstra-Wright, K. L., Bliven, K. C. H., & Napier, C. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.665683 · Cited by 33 · see citing works
“Estrogen is an especially critical hormone in maintaining bone mass in both sexes (Goolsby and Boniquit, 2017).”
BackgroundTirla, A. G., Islam, F., Islam, M. R., Vicaş, S. I., & Cavalu, S. D. (2022) · Applied Sciences · doi:10.3390/app12178611 · Cited by 36 · see citing works
Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes
Millward, D., Root, A. D., Dubois, J., Cohen, R. P., Valdivia, L., Helming, B., Kokoskie, J., Waterbrook, A. L., & Paul, S. (2020) · Orthopaedic Journal of Sports Medicine · doi:10.1177/2325967120966967 · Cited by 30 · see citing works
“Known risk factors for bone-related stress injuries include female sex, low bone density, female athlete triad (energy deficiency, menstrual irregularities, and low bone density), relative energy deficiency in sports, and other nutritional deficiencies.(7) Stress fractures result in significant pain for *Address corre…”
BackgroundGreen strength: The role of micronutrients in plant-based diets for athletic performance enhancement
Ayaz, A., Zaman, W., Radak, Z. O., & Gu, Y. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e32803 · Cited by 26 · see citing works
Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners
Høeg, T. B., Miller, E. K., Skaggs, K. F., Sainani, K. L., Fredericson, M., Roche, M. D., & Kraus, E. (2021) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000956 · Cited by 24 · see citing works
“Unlike most other running injuries, injuries related to poor bone health are associated with long-term health consequences such as osteoporosis and fragility fractures later in life.(4) ABSI is an overuse injury resulting from the inability of bone to withstand repetitive loading.”
BackgroundSagayama, H., Kondo, E., Tanabe, Y., Ohnishi, T., Yamada, Y., & Takahashi, H. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2020.01.008 · Cited by 24 · see citing works
Bone stress injuries in female athletes
Bishop, M. E., Ahlmen, A., Rosendorf, J., Erickson, B. J., & Cohen, S. A. (2021) · Annals of Joint · doi:10.21037/aoj.2020.04.04 · Cited by 23 · see citing works
“However, trials evaluating the safety and efficacy of these medications in this young patient population are limited, particularly with bisphosphonates as they have possible long lasting teratogenic effects (46).”
BackgroundZanella, P. B., August, P. M., Alves, F. D., Matté, C., & de Souza, C. G. (2018) · Nutrition · doi:10.1016/j.nut.2018.10.017 · Cited by 23 · see citing works
Common and Less Well-known Upper-limb Injuries in Elite Tennis Players
Shannon, N., Cable, B., Wood, T., & Kelly, J. D. A. (2020) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000760 · Cited by 23 · see citing works
“25-hydroxycholecalciferol vitamin D levels should be ascertained because deficiency may potentiate bone stress injury (61).”
BackgroundClemente, F. M., González-Férnandez, F. T., Ceylan, H. İ., Silva, R., Younesi, S., Chen, Y., Bădicu, G., Wolański, P. M., & Murawska‐Ciałowicz, E. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235576 · Cited by 23 · see citing works
Physical Activity and Bone Vascularization: A Way to Explore in Bone Repair Context?
Wazzani, R., Pallu, S., Bourzac, C., Ahmaı̈di, S., Portier, H., & Jaffré, C. (2021) · Life · doi:10.3390/life11080783 · Cited by 22 · see citing works
Álvarez‐Herms, J., González, A., Corbi, F., Odriozola, I., & Odriozola, A. (2023) · AIMS Public Health · doi:10.3934/publichealth.2023049 · Cited by 19 · see citing works
“Bone homeostasis is related to vitamin D levels, the capacity of calcium absorption, and other anabolic hormones such as estrogens [129].”
BackgroundMedical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies
Dutton, R. A. (2019) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000560 · Cited by 19 · see citing works
Normative fat-free mass index values for a diverse sample of collegiate female athletes
Blue, M. N. M., Hirsch, K. R., Pihoker, A. A., Trexler, E. T., & Smith‐Ryan, A. E. (2019) · Journal of Sports Sciences · doi:10.1080/02640414.2019.1591575 · Cited by 18 · see citing works
“Low BMD may lead to increased risk of bone stress injuries and early osteoporosis in exercising females (Barrack et al., 2014; Goolsby & Boniquit, 2016).”
BackgroundThapa, M., Neupane, A., Shrestha, S. K. D., Nepal, P., Upadhyaya, A., Niraula, P., Shrestha, R. K., & Sunuwar, D. R. (2023) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-023-00691-7 · Cited by 17 · see citing works
Fields, J. B., Gallo, S., Worswick, J. M., Busteed, D. R., & Jones, M. T. (2020) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk5020032 · Cited by 15 · see citing works
Sebastiá-Rico, J., Sanz, J. M. M., Sanchis-Chordà, J., Alonso-Calvar, M., López-Mateu, P., Romero-García, D., & Soriano, J. M. (2024) · Healthcare · doi:10.3390/healthcare12040496 · Cited by 14 · see citing works
“However, it is important to consider the dietary needs of young soccer players, such as calcium, iron, and vitamin D, as their requirements differ from those of adults [5,74].”
BackgroundBone fracture healing within a continuum bone remodelling framework
Schmidt, I., Albert, J., Ritthaler, M., Papastavrou, A., & Steinmann, P. (2021) · Computer Methods in Biomechanics & Biomedical Engineering · doi:10.1080/10255842.2021.1998465 · Cited by 14 · see citing works
“At first, a fracture pattern motivated by Goolsby and Boniquit (2017) is considered, see Figure 1.”
Jeon, S., Cho, K. H., Ok, G., Lee, S., & Park, H. (2018) · Physical Activity and Nutrition · doi:10.20463/jenb.2018.0021 · Cited by 14 · see citing works
Investigation of bone toxicity in drug development: review of current and emerging technologies
Tuladhar, A., Guffroy, M., Finnema, S. J., Christmann, R., Vleet, T. R. V., Mayana, S. A. K., & Fossey, S. L. (2025) · Toxicological Sciences · doi:10.1093/toxsci/kfaf131 · Cited by 14 · see citing works
Wojtys, E. M. (2017) · Sports Health A Multidisciplinary Approach · doi:10.1177/1941738117692555 · Cited by 13 · see citing works
Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature
Xu, A. L., Beck, J. J., Sweeney, E. A., Severson, M. N., Page, A. S., & Lee, R. J. (2022) · Orthopaedic Journal of Sports Medicine · doi:10.1177/23259671211067222 · Cited by 12 · see citing works
“Improving bone strength in adolescence may prevent age-related osteoporosis.(50,169) In addition, for women, the culture of a structured, femaledominated sport may reduce the risks of future substance dependence, learning and memory impairments, and unintentional injury or death.”
BackgroundBone health in Norwegian female elite runners: a cross-sectional, controlled study
Kyte, K. H., Haakstad, L. A. H., Hisdal, J., Sunde, A., & Stensrud, T. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2022-001472 · Cited by 12 · see citing works
Dadgostar, H., Soleimany, G., Movaseghi, S., Dadgostar, E., & Lotfian, S. (2018) · Medical Journal of the Islamic Republic of Iran · doi:10.14196/mjiri.32.27 · Cited by 12 · see citing works
Rueda-Córdoba, M., Martín-Olmedo, J. J., Espinar, S., Ruiz, J. R., & Jurado‐Fasoli, L. (2025) · Nutrients · doi:10.3390/nu17071172 · Cited by 11 · see citing works
“Bone parameters are physiologically essential for athletes, providing structural support, reducing fracture risk, and enhancing resilience to the mechanical demands of intense physical activity [45].”
Jówko, E., Długołęcka, B., Cieśliński, I., & Kotowska, J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24043373 · Cited by 11 · see citing works
“Among different factors, androgens take part in building the skeleton of young men and help to prevent bone loss in elderly men [37] by having antiapoptotic effects on osteocytes and osteoblasts and apoptotic effects on osteoclasts [38].”
Backgroundda Gama, E. M. F., Kasuki, L., Paranhos‐Neto, F. D. P., Madeira, M., Mendonça, L., Schtscherbyna, A., & Farias, M. (2021) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2021.01.013 · Cited by 11 · see citing works
Predictive Factors for Vitamin D Concentrations in Swiss Athletes: A Cross-sectional Study
Zürcher, S. J., Quadri, A., Huber, A., Thomas, L., Close, G. L., Brunner-Agten, S., Noack, P., Gojanovic, B., & Kriemler, S. (2018) · Sports Medicine International Open · doi:10.1055/a-0669-0791 · Cited by 11 · see citing works
“In athletes, circulating 25(OH)D has been associated with maintained muscle function including improvements in muscle contractions, enhanced growth and regeneration following muscle damage, and optimal bone health [7, 17, 43, 48, 56].”
Influentialde Almeida‐Neto, P. F., Arrais, R. F., de Matos, D. G., Cesário, T. D. M., Bulhões-Correia, A., SILVA, L. F., Aidar, F. J., Santana, E. E., Dantas, P. M. S., & Cabral, B. G. D. A. T. (2021) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.20.11497-x · Cited by 10 · see citing works
Brzeziański, M., Migdalska‐Sęk, M., Stuss, M., Jastrzębski, Z., Radzimiński, Ł., Brzeziańska‐Lasota, E., & Sewerynek, E. (2021) · Biology of Sport · doi:10.5114/biolsport.2022.109956 · Cited by 10 · see citing works
“It is documented that vitamin D stimulates bone formation and increases the level of parathyroid hormone (PTH), which stimulates the activity of osteoclasts in the bone [28, 37].”
BackgroundInfluentialBrown, A. F., Brooks, S. J., Smith, S. R., Stephens, J. M., Lotstein, A. K., Skiles, C. M., Alfiero, C. J., & Meenan, M. J. (2020) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk5010017 · Cited by 10 · see citing works
Bone metabolism, bone mass and structural integrity profile in professional male football players
Filippella, M., Altieri, B., Falchetti, A., Cosso, R., Cena, H., Musso, C., Geronutti, E., Rassat, L., Cipriani, G., Colao, A., et al. (2020) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.20.09913-2 · Cited by 9 · see citing works
Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training
Liddle, D. G., Changstrom, B. G., Senter, C., Meirick, P., Stern, N. G., Putukian, M., Shah, S., Powell, A. P., Dixit, S., Eerkes, K., et al. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000811 · Cited by 9 · see citing works
Lyu, F. F., Ramoo, V., Chui, P. L., & Ng, C. G. (2023) · Clinical Nursing Research · doi:10.1177/10547738231198561 · Cited by 8 · see citing works
“Previous studies have shown that exercise or physical training can improve bone mass (Kemmler et al., 2020), bone composition (Goolsby & Boniquit, 2017), and bone calcium content (Al Dahamsheh et al., 2019) with less adverse reactions.”
BackgroundTeam Approach: Bone Health Optimization in Orthopaedic Surgery
Pasqualini, I., Huffman, N., Keller, S. F., McLaughlin, J. P., Molloy, R. M., Deren, M. E., & Piuzzi, N. S. (2023) · JBJS Reviews · doi:10.2106/jbjs.rvw.23.00178 · Cited by 8 · see citing works
Banerjee, A., Basu, B., Saha, S., & Chowdhury, A. R. (2023) · Journal of Biomedical Materials Research Part B Applied Biomaterials · doi:10.1002/jbm.b.35311 · Cited by 8 · see citing works
Weijer, V., van Dijk, J., van Dam, L., Risvang, L. C., Bons, J. A. P., Raastad, T., van Loon, L. J. C., & Jonvik, K. L. (2024) · Bone Reports · doi:10.1016/j.bonr.2024.101767 · Cited by 8 · see citing works
“Such a low BMD may predispose athletes to (stress)fractures as well as early osteoporosis (Goolsby and Boniquit, 2017).”
Femoral Neck Stress Fracture of a Male, Healthy Marathon Runner – Case Report and Literature Review
Weinrich, L., Dahne, M., Lindner, T., Stöckle, U., & Tsitsilonis, S. (2021) · Zeitschrift für Orthopädie und Unfallchirurgie · doi:10.1055/a-1401-0375 · Cited by 8 · see citing works
Impact of Eccentric or Concentric Training on Body Composition and Energy Expenditure
Touron, J., Perrault, H., Julian, V., Maisonnave, L., Deat, P., Auclair-Ronzaud, J., Salles, J., Walrand, S., Hermet, J., Rigaudière, J., et al. (2019) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001992 · Cited by 7 · see citing works
Nutritional Considerations for the Female Vegan Athlete
Schoenfeld, M. L. (2018) · Strength and conditioning journal · doi:10.1519/ssc.0000000000000405 · Cited by 7 · see citing works
“This may be due to plant proteins not being as easily digested as animal proteins (53), or it may be due to low total caloric intake or a lack of sufficient variety in plant protein sources (7,15,22).”
BackgroundActive urbanism: The potential effect of urban design on bone health
Boldina, A., Gomes, B. B., & Steemers, K. (2021) · Cities & Health · doi:10.1080/23748834.2021.1921512 · Cited by 7 · see citing works
“cycle of bone resorption, formation, and mineralization takes 3 to 4 months to complete (Goolsby and Boniquit 2017).”
BackgroundGremillion, M., Martinez, A., Ghanta, R. B., Borici, N., & Kushare, I. V. (2022) · The Physician and Sportsmedicine · doi:10.1080/00913847.2022.2143247 · Cited by 6 · see citing works
Martins, P. C., Moraes, M. S., & Silva, D. A. S. (2021) · Physiological Measurement · doi:10.1088/1361-6579/ac114b · Cited by 6 · see citing works
Ricart-Luna, B., Monteagudo, P., & Blasco-Lafarga, C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105446 · Cited by 5 · see citing works
Female athlete triad epidemiology among adult athletes: A systematic review
Almousa, S., & van Loon, A. B. (2023) · Science & Sports · doi:10.1016/j.scispo.2023.04.004 · Cited by 5 · see citing works
The aetiology of fracture and nonunion in the hook of the hamate
Campbell, F. C., Jones, S. W., & Campbell, D. A. (2024) · Journal of Hand Surgery (European Volume) · doi:10.1177/17531934241235803 · Cited by 5 · see citing works
“Young, healthy, optimally nourished athletes have greater bone mass than non-athlete individuals (Goolsby and Boniquit, 2017), and it is difficult to accept that the energy imparted by the butt end of a club through the thick skin would be sufficient to create a fracture in healthy athlete bone.”
Marco, J. C. P. D., de Lima, T. R., Tanimoto, P. B., Miranda, C. C., Bim, M. A., & Pelegrini, A. (2025) · Physiological Measurement · doi:10.1088/1361-6579/adfffb · Cited by 4 · see citing works
“Thus, it is speculated that PhA may serve as a predictor of injury in athletes by identifying low bone mass (Goolsby and Boniquit 2016), representing a potentially valuable tool in sports contexts.”
Bascharon, R. A., Sethi, N. K., Estevez, R., Gordon, M., Guevara, C., Twohey, E. E., & deWeber, K. (2023) · The Physician and Sportsmedicine · doi:10.1080/00913847.2023.2286943 · Cited by 4 · see citing works
“Cis-males have biological advantages in most sports, and these differences are most significant at the professional and elite levels [24,68,73,76].”
Magro, D. O. (2019) · Springer eBooks · doi:10.1007/978-3-030-10433-7_8 · Cited by 4 · see citing works
Vitamin A intake is related to stress fracture occurrence in male collegiate long-distance runners
Toraishi, M., Uenishi, K., Iwamoto, J., & Otani, T. (2021) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.20.11792-4 · Cited by 4 · see citing works
Effects of Weight-Bearing and Weight-Supporting Sports on Bone Mass in Males
Długołęcka, B., & Jówko, E. (2022) · Polish Journal of Sport and Tourism · doi:10.2478/pjst-2022-0015 · Cited by 4 · see citing works
Lipszyc, R. T., Rodda, C. P., Wright, M., & Duckham, R. L. (2025) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.70063 · Cited by 3 · see citing works
Fibula Stress Fractures: A Systematic Review
Encinas, R., Sharpe, J., Bakaes, Y., Mazoué, C. G., Jackson, B., & Gonzalez, T. A. (2023) · Foot & Ankle Specialist · doi:10.1177/19386400231184124 · Cited by 3 · see citing works
Parathyroid hormone and trabectedin have differing effects on macrophages and stress fracture repair
Zweifler, L. E., Sinder, B. P., Stephan, C., Koh, A. J., Do, J., Ulrich, E., Grewal, J., Woo, C., Batoon, L., Kozloff, K. M., et al. (2023) · Bone · doi:10.1016/j.bone.2023.116983 · Cited by 3 · see citing works
Nutritional Considerations for Female Rock Climbers
Leslie-Wujastyk, M., & Gibson-Smith, E. (2024) · Journal of Science in Sport and Exercise · doi:10.1007/s42978-023-00267-4 · Cited by 3 · see citing works
“Multidirectional load bearing exercise, such as climbing, has an independent positive effect on bone health [23].”
Bone health and the masters runner
Raiser, S. N., Schroeder, A. N., Lawley, R. J., & Tenforde, A. S. (2024) · PM&R · doi:10.1002/pmrj.13175 · Cited by 3 · see citing works
“32,33”
Knechtle, B., Jastrzębski, Z., & Nikolaidis, P. Τ. (2021) · Praxis · doi:10.1024/1661-8157/a003550 · Cited by 3 · see citing works
Florio, C. S. (2018) · International Journal for Numerical Methods in Biomedical Engineering · doi:10.1002/cnm.2976 · Cited by 3 · see citing works
Nutritional factors of bone health in athletes
Самойлов, А. С., Zholinsky, A. V., Рылова, Н. В., & Bolshakov, I. V. (2023) · Voprosy Pitaniya · doi:10.33029/0042-8833-2023-92-3-25-35 · Cited by 3 · see citing works
Stress fracture risk factors in soccer players: A systematic review
Hoveidaei, A. H., Oskouie, I. M., Karbasi, S., Eghdami, S., Hosseini-Asl, S. H., Nakhostin-Ansari, A., Forogh, B., Cham, M. B., & Conway, J. D. (2025) · Annals of Medicine and Surgery · doi:10.1097/ms9.0000000000003136 · Cited by 2 · see citing works
Evolution of Research on the Female Athlete Triad and Relative Energy Deficiency in Sport" (RED-S).
Emran, Z., & Ganti, L. (2026) · Orthopedic Reviews · doi:10.52965/001c.157624 · Cited by 2 · see citing works
Relative energy deficiency in sport: modern approaches to diagnostics, treatment and prevention
Самойлов, А. С., Zholinsky, A. V., Рылова, Н. В., & Bolshakov, I. V. (2022) · Voprosy Pitaniya · doi:10.33029/0042-8833-2022-91-3-32-41 · Cited by 2 · see citing works
Metabolic Workup for Bone Stress Injury: A Practical Approach for Evaluating Bone Health in Athletes
Nye, N. S., Kasper, K. B., Hoang, T. D., Gee, S. M., McClung, J. P., Crutchfield, A., Childress, M. A., Tenforde, A. S., & Boden, B. P. (2026) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381251398501 · Cited by 4 · see citing works
“47 When the demands of physical activity, particularly from sustained repetitive loading (ie, long-distance running or military training), exceed remodeling and adaptation, a BSI may result.”
MORAES, M. S., MARTINS, P. C., FERREIRA, F. E., & SILVA, D. A. (2022) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.12297-2 · Cited by 2 · see citing works
Factors associated with stress fracture: A case-control study in a Peruvian navy medical center
Sandoval, J. C. B., Huamán, L. V., & Cruz-Vargas, J. A. D. L. (2020) · Medwave · doi:10.5867/medwave.2020.05.7936 · Cited by 2 · see citing works
Muscle Mass and Gait Characteristics in Older Women Fallers vs. Non-Fallers
Lin, Y., Tseng, I.-J., Lu, Y.-C., Yang, S.-W., Wu, C.-C., Lin, Y.-N., & Chan, W. P. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10173924 · Cited by 2 · see citing works
“Although optimal bone health may be obtained from nutrition (such as vitamin D and calcium) and hormones supplement [32], this study also demonstrated that exercise (such as increased gait speed) could have a role in improving bone mineral content.”
BackgroundCOMPARISON OF BONE PARAMETERS BY BODY REGION IN UNIVERSITY ATHLETES: SYSTEMATIC REVIEW
Moraes, M. S., Martins, P. C., & Silva, D. A. S. (2021) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-8692202127062020_0051 · Cited by 2 · see citing works
Mendes, A. F., Tabet, C. G., Mendes, S. L., Abreu, M. D. M., & de Figueirêdo, N. C. (2021) · Revista Brasileira de Ortopedia · doi:10.1055/s-0041-1739404 · Cited by 2 · see citing works
Bone and body characteristics of freestyle and non-freestyle skiers
Schwarz, I., Houck, D. A., Shah, V. N., Jolly, A., Lindsay, A. D., Bravman, J. T., & Frank, R. M. (2022) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.12055-9 · Cited by 1 · see citing works
Moraes, M. S., Fernandes, R. A., Moreno, Y. M. F., Pelegrini, A., & Silva, D. A. S. (2022) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004132 · Cited by 1 · see citing works
“However, the simultaneous influence of other multiple factors that explain BMD and bone geometry variation in athletes, such as the other body composition components, training volume and intensity, dietary calcium, vitaminD and protein supplementation, andmenstrual status and use of oral contraceptives, has been littl…”
BackgroundInfluentialSíndrome de estrés tibial medial en deportistas: una mirada global en diagnóstico y tratamiento
Guzman, J. M., Rodríguez, J. P., & Sanhueza, A. N. (2023) · Archivos de la Sociedad Chilena de Medicina del Deporte · doi:10.59856/arch.soc.chil.med.deporte.v68i2.69 · Cited by 1 · see citing works
“Se debe realizar una evaluación nutricional y determinar el nivel de disponibilidad de energía e ingesta de calcio (38).”
BackgroundPrediction of Low Bone Mass for Japanese Female Athletes Using Machine Learning
Kruse, J. G. S., Kaneko, M., Nose‐Ogura, S., Kinoshita, S., Nakamura, H., Hiraike, O. W., Osuga, Y., & Kiyono, K. (2024) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc53108.2024.10781821 · Cited by 1 · see citing works
de Lima, T. R., Bim, M. A., Marco, J. C. P. D., Fernandes, R. A., & Pelegrini, A. (2025) · Sports Medicine and Health Science · doi:10.1016/j.smhs.2025.07.010 · Cited by 1 · see citing works
Nose‐Ogura, S., Yoshino, O., Kinoshita, S., Nakamura-Kamoto, H., Tabei, K., Komatsu, T., Hamai, A., Iida, K., Koshimizu, T., Nakayama, H., et al. (2025) · The Physician and Sportsmedicine · doi:10.1080/00913847.2025.2586448 · Cited by 1 · see citing works
“Awareness, early detection and timely intervention during the teenage years, when approximately 90% of maximum bone mass is acquired [24,36– 39], are particularly useful for preventing low BMD.”
Changes of Lower Limb Bone Mineral Density in Division I Female Athletes During an Athletic Season
Tolzman, J., Collins, K. A., Parmar, A. S., Grozier, C. D., Frederick, I., VanEtten, L., VanEtten, K. T., Ajit, S., & Harkey, M. S. (2025) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s555396 · Cited by 1 · see citing works
Why Exercise as Punishment Doesn’t Work in Educational Athletics
Barnes, K. R. (2026) · Journal of Physical Education Recreation & Dance · doi:10.1080/07303084.2026.2619970 · Cited by 1 · see citing works
“Lastly, weight-bearing activities like running stimulate bone remodeling, leading to improved bone density, which is especially important for injury prevention in young athletes (Goolsby & Boniquit, 2017).”
Movement and Nutrition Principles
Güldaş, M., Yeşildemir, Ö., Gürbüz, O., Ozder, S., & Yıldız, E. (2023) · Springer eBooks · doi:10.1007/978-3-031-27184-7_27 · Cited by 1 · see citing works
Comprehensive multi-level expression profiling of key biomarkers in breast cancer patients.
Zia, T., Liu, B., Nadeem, A., Hussain, A., Abdel-Maksoud, M. A., Zakri, A. M., Bashir, M. K., Ali, M., Jabeen, N., Jamil, M., et al. (2023) · PubMed Central · Cited by 1 · see citing works
Saju, A., Swaminathan, N., Janani, G., & Sivaraman, A. (2023) · Journal of Datta Meghe Institute of Medical Sciences University · doi:10.4103/jdmimsu.jdmimsu_395_23 · Cited by 1 · see citing works
Waza, N. U. D., & Deol, N. S. (2025) · Physical Education Theory and Methodology · doi:10.17309/tmfv.2025.2.05 · Cited by 1 · see citing works
“These physical traits can be influenced differently by various sports, and it is crucial for athletes and healthcare professionals to understand these differences (Goolsby & Boniquit, 2017; Reza et al., 2024).”
Kussman, A. L., & Nattiv, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-44754-0_11 · Cited by 1 · see citing works
Endothelial Dysfunction in Women Athletes: Integrative Review of the Literature
Lima, B. L., Cabral, F. D. S., de Jesus, S. S., Santana, K. S., & Fonseca, S. J. (2021) · Acta Scientific Orthopaedics · doi:10.31080/asor.2021.04.0401 · Cited by 1 · see citing works
- Authors
- Goolsby, M. A., & Boniquit, N.
- Affiliations
- Hospital for Special Surgery (US)
- Rush University (US)
- Corresponding author
- Goolsby, Marci A.
- Venue
- Sports Health: A Multidisciplinary Approach
- Publisher
- SAGE Publications
- Published
- 2016-11-30
- Volume
- 9
- Issue
- 2
- Pages
- 108-117
- ISSN
- 1941-0921 (ISSN-L)
- 1941-7381
- PMC
- PMC5349390
- OpenAlex
- W2550789070
- Cited by
- 136
- References
- 111
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 12 · 2023: 20 · 2022: 14 · 2021: 26 · 2020: 14 · 2019: 9 · 2018: 12 · 2017: 3
- FWCI
- 9.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sports Health A Multidisciplinary Approach (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- bone health, athletes, osteoporosis prevention, exercise and bone health, female athlete triad, stress fractures, vitamin D, calcium, bone stress injuries, resistance training, nutrition and bone health
- MeSH terms
- Calcium, Dietary, Female, Hormones, Humans, Osteoporosis, Risk Factors, Vitamin D, Vitamin D Deficiency, Exercise, Bone Density, Fractures, Stress, Female Athlete Triad Syndrome, Sports Nutritional Physiological Phenomena
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
