Bone Density in Athletes – It’s not just a girl thing

Posted by:

The diagnosis of a stress fracture can be the most disheartening bit of news for any athlete. It means an immediate disruption in training and potentially the end to a competitive season. Not much can be done to speed up the healing other than wait it out and be compliant to rest and therapy. It’s been general knowledge that stress fractures happen primarily in female athletes. Sports that have a strong emphasis on ideal body weight can drive an athlete into extreme dieting. Without realizing it an athlete can develop the “female athlete triad” defined as having the following conditions:

  •  Energy Availability

Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.

  • Menstrual function

Poor nutrition, low calorie intake, high-energy demands, physical and emotional stress, or low percentage of body fat can lead to hormonal changes that stop menstrual periods (amenorrhea).

  • Bone Health

Lack of periods disrupts the body’s bone-building processes and weakens the skeleton, making bones more likely to break.


Katherine Beals, PhD, RD, FACSM, CSSD, at the University of Utah is conducting exciting research on the possibility that male athletes have similar conditions. Of course menstrual dysfunction is not relative to males but research is looking at male athletes who restrict calories (low energy availability) could be a reason for low testosterone which can lead to low bone mineral density (BMD). Research in this area is sparse. But, as with all sports nutrition related topics often the best lab is in the field. More and more presumably healthy male athletes are showing up with stress fractures. Many of these male athletes are participating in sports that rely on power to weight ratio, such as cycling and running. A very competitive athlete is often enticed to be a restrictive eater with the hopes it will improve performance. Disordered eating among male athletes may be hard to recognize because it is not the norm – compromised eating habits in males is not something that coaches and medical providers typically look for.


A study published in the International Journal of Eating Disorders found that males with anorexia restricting or binge/purge often have severe bone disease that can be worse than females.

What can be done about a “male athlete triad?” Prevention is the key.

  1. Have your Vitamin D levels checked. An optimal range for athletes is > 50 ng/ml. Supplementation is often necessary despite being outdoors. Vitamin D helps the body use calcium from food.
  2. Assess your calcium intake from dairy and fortified grains. If it is low and supplementation is necessary take a supplement that includes the cofactors magnesium and Vitamin K to promote calcium absorption.
  3. Assess your calorie intake. With the help of a Sports Dietitian you can determine what an adequate calorie level should be to support your sport.
  4. Men – have your testosterone levels checked. Chronic endurance training seems to lower total and free testosterone.
  5. Strength train. The shearing forces of strength training can improve bone density and increase testosterone.
  6. If you recognize symptoms of disordered eating make an appointment with a qualified Sports Dietitian.  Find a sports dietitian.

Sheila Leard, RD, CSSD

Board Certified Sports Dietitian

My Nutrition Zone

SCAN, Sports Cardiovascular and Wellness Dietitians. Katherine Beals, PhD, RD, FACSM, CSSD, is an associate professor in the Division of Nutrition at the University of Utah.

Mehler PS, Sabel AL,Watson T, et al. High risk of osteoporosis in male patients with eating disorders. IntJ Eat Disord. 2008;41:666-672.

Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the Female Athlete Triad in Male Athletes. Sports Med. 2015 Oct 26.

  Related Posts
  • No related posts found.


  1. Chris Rankin  May 2, 2016

    Hi Sheila,
    Is there a certain age that density lose seems to occur? I wander if there a link between muscle loss and bone density loss? Great Article!


Add a Comment