Evidence of a cumulative effect for risk factors predicting low bone mass among male adolescent athletes

Abstract

Male adolescent runners exhibited lower body weight, BMI and spine BMD Z-score values. The risk of low BMD displayed a graded relationship with increasing risk factors, highlighting the importance of using methods to optimise bone mass in this population.

Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury

“…We found that a modified version of the Female Athlete Triad Cumulative Risk Assessment score6—including low EA, low BMI, prior BSI and low BMD values—was associated with prospective BSI in male runners. While cumulative risk factors for low bone mass have been reported in young male athletes,14 to our knowledge this investigation is the first to report cumulative risk factors being associated with a greater rate of BSI in male runners. Our findings may provide an evidence-based method to quantitatively evaluate male runners at elevated risk for BSI.…”

Energy Availability in Athletics: Health, Performance, and Physique

“…The main challenges continued: Inadvertent (high training loads and/or loss of appetite) or purposeful (targeted weight loss) periods of LEA may lead to negative health and performance effects, including fatigue, poor training quality, and low BMD. Higher risk for reduced BMD compared to athletes in jump events as the lower BM of a distance athlete and the moderate-impact nature of distance running are less efficient to stimulate bone formation (Barrack et al, 2017;Melin et al, 2015;Tenforde et al, 2015). Low BMD may increase the risk for bone stress injury, which impairs training availability.…”

“…Bone mineral density Z score <−1.0 has been proposed as low BMD for both female and male athletes participating in land-based sports (Barrack et al, 2017;Mountjoy et al, 2015;Nattiv et al, 2007). Risk factors for low BMD identified in female runners include prolonged distance running, lower BMI, menstrual dysfunction, history of BSI, and lower FFM (Barrack et al, 2017;Tenforde et al, 2015).…”

Optimising bone health in the young male athlete

“…A prior investigation in 42 male runners identified BMI ≤17.5 kg/m 2 and a belief that being thinner leads to faster running performances as risk factors for having lower BMD 5. Risk factors in the young male athlete obtained from anthropometric measures and self-report questionnaires include low body weight (<85% expected weight), stress fracture history, average weekly running mileage >30 and consuming fewer than one serving of calcium-containing food/day 6. These results suggest that a combination of sports participation and bone loading, dietary behaviour and injury history may help guide sports medicine professionals to identify which young male athletes are at increased risk for impaired bone health.…”

“…Insufficient scientific evidence currently exists to provide guidelines for when to complete a dual-energy X-ray absorptiometry (DXA) in male athletes. However, based on current research and expert opinion, we propose further workup for impaired bone health for male athletes with multiple risk factors for low BMD6 and in those who sustain a BSI in a location that has higher trabecular bone content, including the pelvis, sacrum and femoral neck 12. The basic workup for the at-risk young male athlete should include DXA to measure bone density of the total body less head and lumbar spine (LS) if the age is <20 (or LS and total hip/femoral neck if older), using age, sex and ethnicity appropriate cut-offs.…”