Bone health is the wellness and strength of the bones in the body.
Bone is living material that is constantly broken down by cells called osteoclasts and built up again by cells called osteoblasts. This process, called bone remodeling, continues throughout an individual's life. Normally, from birth through adolescence, more bone is built up than is broken down. In the late teens or early 20s, people reach their peak bone mass—the most bone they will ever have. For 20 or so years, bone gain and bone loss remain approximately balanced in healthy people with good nutrition. However, in the first five to seven years following menopause, women, usually in their mid- to late forties, lose bone at a rate of 1%–5% a year. Men tend to lose less bone, and the loss often begins later in life.
Good bone health is important for everyone, but it is especially important for athletes. Bones play many important roles in the body, including providing structure for the body, protecting internal organs, and anchoring muscles. They also store calcium that is used by the body. Poor bone health can lead to pain in the bones and especially the lower back. Most importantly, however, poor bone health can drastically increase the chance that a traumatic impact to a bone will result in a fracture or break. Athletes who participate in any sports or fitness activities put strain on their bones, and weak bones can lead to stress fractures. Athletes who participate in high-impact sports such as basketball and running are at especially increased risk. Sports that involve person-to-person contact such as football, rugby, and ice hockey are extremely dangerous for athletes with poor bone health. The force of impact of running into another athlete, or falling to the ground or ice, can sometimes be enough to cause a break or fracture in even those athletes with very strong bones. For athletes with poor bone health, such problems are almost inevitable.
Calcium and vitamin D are both essential to building and maintaining strong bones. Dairy products are a good source of these nutrients. Calcium supplements might be recommended for individuals who have difficulty getting enough calcium in their diet. Fluoride also is needed to develop healthy bones and teeth. Other nutrients that are important in maintaining excellent bone health include protein, magnesium, vitamin K, and silicon.
The recommended daily intake of calcium is 1000 mg/day for individuals ages 19–50 and 1200 mg/day for individuals older than 50. Children age 4 to 18 years old should have 1300 mg/day. Athletes often need more calcium than recommended each day to maintain good bone health. Individuals who participate in endurance events or train rigorously should consult a sports nutritionist for help determining the amount of calcium required in their diet. Foods that contain calcium include milk and dairy products, dark green leafy vegetables, nuts (e.g., almonds, brazil nuts), dried fruit (e.g., apricots), fish with edible bones, sesame seeds, and tofu. Some commercially available products such as orange juice and soymilk are fortified with calcium.
Most vitamin D is obtained from the action of sunlight on the skin, For vitamin D to be made in the skin, the skin must be exposed to UVB light of wavelengths between the range of 290–320 nanometers. During the winter months, the sunlight in some parts of the United States falls outside this range, so the skin cannot make vitamin D even on a bright sunny day. The recommended daily intake of vitamin D is 600 international units (IU)/day for individuals between the ages of 18 and 70, and 800 IU/day for individuals over the age of 70. Good sources of vitamin D are more difficult to find than good sources of calcium. Fatty fish and fish oils are good sources of vitamin D, and smaller amounts are found in beef liver and egg yolks. In the United States, almost all milk is fortified with vitamin D, and most individuals get their vitamin D in this way. Some breakfast cereals, orange juices, and other products are also fortified with vitamin D.
Regular exercise has been shown to promote good bone health. Any kind of weight-bearing exercise is considered beneficial. Weight-bearing exercises are activities such as walking or running where the body is straining against gravity. Regular exercise throughout life has been shown to have a significant positive effect on bone health in later years. Exercise can also help keep weight down, which is especially important to prevent permanent bone loss in obese teens.
Medications are an important part of treatment for osteoporosis. Various drugs have been shown effective in preventing or slowing bone loss and increasing bone mass. These include:
Recommended lifestyle changes that can reduce the rate of bone loss include regular exercise, particularly weight-bearing forms of exercise such as walking, dancing, treadmill exercises, and jumping. Other measures include quitting smoking, taking supplemental vitamin D and calcium, and watching one's alcohol intake.
A healthful diet low in fats and animal products and containing whole grains, fresh fruits and vegetables, and calcium-rich foods, such as dairy products, dark-green leafy vegetables, sardines, salmon, and almonds, along with nutritional supplements, such as calcium, magnesium, and vitamin D, are important components of nutritional approaches to treating poor bone health.
Elite athletes can be at increased risk of osteoporosis and poor bone health. Extreme training regimens and diets that lack the required amounts of calcium, vitamin D, and other nutrients involved in bone health can be problematic. It is especially important for elite athletes to have strong, healthy bones because of the repeated pressures and strains often put on them during training and competition. Repetitive stress on the bones, such as during running of marathons or track and field events, and repeated jumping during basketball, figure skating, or ballet can lead to fractures in athletes who do not have good bone health. Many sports can involve sudden strains on bones, such as gymnastics, wrestling, and baseball, which can lead to fractures and breaks if bones are brittle. These kinds of injuries, while painful and difficult for everyone, can be especially problematic for elite and professional athletes, as serious injuries can lead to missing seasons, forgoing important competitions, and loss of income.
See also Calcium status and exercise ; Osteoporosis .
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National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center, 2 AMS Circle, Bethesda, MD, 20892-3676, (202) 223-0344, Fax: (202) 293-2356, (800) 624-2663, NIHBoneInfo@ mail.nih.gov, https://www.niams.nih.gov/Health_Info/Bone .
National Osteoporosis Foundation, 251 18th St., Ste. 630, Arlington, VA, 22202, (202) 223-2226, Fax: (202) 223-2237, (800) 231-4222, email@example.com, http://www.nof.org .
Osteoporosis Canada, 1200 Eglinton Ave. East, Ste. 500, Toronto, Ontario, Canada, M3C 1H9, (416) 696-2663, Fax: (416) 696-2673, (800) 463-6842 (English), (800) 977-1778 (French), http://www.osteoporosis.ca .
Tish Davidson, AM
Revised by Teresa Odle, BA, ELS