Joint and bone health in young athletes

Sports activities provide many health benefits to young athletes. However, a subset of athletes may suffer from unrecognised low bone density and impaired skeletal health, predisposing them to an increased risk of fracture.

To add to this, delayed diagnosis and inappropriate treatment of low bone density among young athletes may have severe consequences in future longevity in sport as well as long-term bone health.

Therefore, athletes need to pay more attention to their bone health, in the short term, to reduce the risk of injury, and in the long term when they have retired from the sport.

Bone health and athletes

Bone health relates to two main factors, with the primary factor in the minds of athletes and/or coaches being the avoidance of a bone injury, largely because this is the immediate danger to performance outcomes. Stress fractures are the most common bone injuries suffered by athletes, occurring relatively regularly in many sports, especially in terms of high-volume high-intensity training that increases the risk of developing a stress fracture.

In addition to the risk of injury, there is, at least for some sports, a longer-term risk to bone health and the avoidance of Osteopenia and Osteoporosis becomes necessary, particularly when the bone mass is already recorded as being low in some athletes during early adulthood.

This is particularly pertinent given that around 90% of peak bone mass is attained during the athlete’s early 20s. In fact, the amount of bone mass attained by the time an athlete is 30yrs of age is about the highest they will have across the lifespan.

Having said that, it is not only bone mass that is important but also the strength of the bone, including its geometry and microarchitectural structure. The consequences of poor bone health in later life are significant. Osteoporosis which is characterised by low bone mass accompanied by the slow deterioration of bone tissues leads to enhanced bone fragility and thus increases a person’s susceptibility to fractures.

In India, around 50 million people are estimated to be either osteoporotic with less than T-score 2.5 or have a low bone mass with T-Score ranging between 1 to 2.5.
This makes bone health the most important aspect for athletes.

Maintaining bone health

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, bone health is compromised and can lead to bone stress injuries and early Osteoporosis. Both 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. To optimise bone health, adequate nutrition, appropriate weight-bearing exercise, strength training, adequate Calcium and Vitamin D are necessary throughout life.

Most importantly, athletes must properly protect their joints by wearing the right equipment and exercising in a way that promotes joint health. They should also care for their joints by maintaining a healthy weight, eating a healthy diet, taking time for recovery, and consulting a physical therapist. By choosing joint-healthy activities and working to maintain a healthy lifestyle, they can maintain better bone health