Nutrition, in sufficient amount and substance, is crucial for healthy growth and development of the skeleton and surrounding tissues, especially in physically active populations. Inadequate nutrition has been linked to maladies such as the female athlete triad, as well as poor training or competitive performance and increased risk of injury. Dietary choices favoring items high in quality protein of animal or plant origin, polyunsaturated fatty acids, fruits and vegetables high in potassium and fiber, and dairy products or other beverages fortified with calcium and vitamin D are essential to athletes to ensure adequate vitamin and mineral availability to the skeleton, which in turn can affect peak physical performance.
AbramsSAGriffinIJHawthorneKMA combination of prebiotic short- and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents. Am J Clin Nutr. 2005;82(2): 471–476.
2.
American Academy of Pediatrics, Committee on Sports Medicine and FitnessMedical concerns in the female athlete. Pediatrics. 2000;106(3):610–613.
3.
BengoaJMSitrinMDWoodRJRosenbergIHAmino acid-induced hypercalciuria in patients on total parenteral nutrition. Am J Clin Nutr. 1983;38(2):264–269.
4.
BlanchardJAeschlimannJMCalcium absorption in man: some dosing recommendations. J Pharmacokinet Biopharm. 1989;17(6):631–644.
5.
Bolton-SmithCMcMurdoMEPatersonCRTwo-year randomized controlled trial of vitamin K1 (phylloquinone) and vitamin D3 plus calcium on the bone health of older women. J Bone Miner Res. 2007;22(4):509–519.
6.
BoneHGHoskingDDevogelaerJPTen years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350(12):1189–1199.
7.
BonjourJPDietary protein: an essential nutrient for bone health. J Am Coll Nutr. 2005;24(6 Suppl):526S–536S.
8.
BoonenSLipsPBouillonRBischoff-FerrariHAVanderschuerenDHaentjensPNeed for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007;92(4): 1415–1423.
9.
BraamLAKnapenMHGeusensPVitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int. 2003;73:21–26.
10.
BullenBASkrinarGSBeitinsIZvon MeringGTurnbullBAMcArthurJWInduction of menstrual disorders by strenuous exercise in untrained women. N Engl J Med. 1985;312(21):1349–1353.
11.
ChenTCChimehFLuZFactors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys. 2007;460(2):213–217.
12.
ChuJYMargenSCostaFMStudies in calcium metabolism, II: effects of low calcium and variable protein intake on human calcium metabolism. Am J Clin Nutr. 1975;28(9):1028–1035.
13.
CooperCAtkinsonEJHensrudDDDietary protein intake and bone mass in women. Calcif Tissue Int. 1996;58(5):320–325.
14.
CorwinRLHartmanTJMaczugaSAGraubardBIDietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. J Nutr. 2006;136(1):159–165.
15.
CoudrayCBellangerJCastiglia-DelavaudCRemesyCVermorelMRayssignuierYEffect of soluble or partly soluble dietary fibres supplementation on absorption and balance of calcium, magnesium, iron and zinc in healthy young men. Eur J Clin Nutr. 1997;51:375–380.
16.
CoxamVCurrent data with inulin-type fructans and calcium, targeting bone health in adults. J Nutr. 2007;137(11 Suppl):2527S–2533S.
17.
CummingsJHMacfarlaneGTEnglystHNPrebiotic digestion and fermentation. Am J Clin Nutr. 2001;73(2 Suppl):415S–420S.
18.
DeFronzoRACookeCRAndresRFaloonaGRDavisPJThe effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man. J Clin Invest. 1975;55(4):845–855.
19.
DelmasPDEnsrudKEAdachiJDEfficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab. 2002;87(8):3609–3617.
20.
EricssonYAngmar-ManssonBFloresMUrinary mineral ion loss after sugar ingestion. Bone Miner. 1990;9(3):233–237.
21.
FrenchCEThe interrelation of calcium and fat utilization in the growing albino rat. J Nutr. 1942;23:375–384.
22.
GabelKASpecial nutritional concerns for the female athlete. Curr Sports Med Rep. 2006;5(4):187–191.
23.
Garcia-ContrerasFPaniaguaRAvila-DiazMCola beverage consumption induces bone mineralization reduction in ovariectomized rats. Arch Med Res. 2000;31(4):360–365.
24.
GrielAEKris-EthertonPMHilpertKFZhaoGWestSGCorwinRLAn increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007;6:2.
25.
GropperSSSmithJLGroffJLAdvanced Nutrition and Human Metabolism. 4th ed. Belmont, CA: Wadsworth Thompson Learning; 2004.
26.
HanleyDADavisonKSVitamin D insufficiency in North America. J Nutr. 2005;135(2):332–337.
27.
HannanMTTuckerKLDawson-HughesBCupplesLAFelsonDTKielDPEffect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res. 2000;15(12):2504–2512.
28.
HeaneyRPThe Vitamin D requirement in health and disease. J Steroid Biochem Mol Biol. 2005;97(1–2):13–19.
29.
HeaneyRPDowellMSBiermanJHaleCABendichAAbsorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr. 2001;20(3):239–246.
30.
HeaneyRPLaymanDKAmount and type of protein influences bone health. Am J Clin Nutr. 2008;87(5):1567S–1570S.
31.
HeaneyRPRaffertyKCarbonated beverages and urinary calcium excretion. Am J Clin Nutr. 2001;74(3):343–347.
32.
HegstedMSchuetteSAZemelMBLinkswilerHMUrinary calcium and calcium balance in young men as affected by level of protein and phosphorus intake. J Nutr. 1981;111(3):553–562.
33.
HeinGWhiteJStoreyMLinebackDHighs and lows of high fructose corn syrup. Nutr Today. 2005;40:253–256.
34.
HolickMFMatsuokaLYWortsmanJAge, vitamin D, and solar ultraviolet. Lancet. 1989;2(8671):1104–1105.
35.
HollMGAllenLHSucrose ingestion, insulin response and mineral metabolism in humans. J Nutr. 1987;117(7):1229–1233.
36.
HollisBWCirculating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr. 2005;135(2):317–322.
37.
HolmLOlesenJLMatsumotoKProtein-containing nutrient supplementation following strength training enhances the effect on muscle mass, strength, and bone formation in postmenopausal women. J Appl Physiol. 2008;105(1):274–281.
38.
HuiSLSlemendaCWJohnstonCCJrBaseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989;111(5):355–361.
39.
IhleRLoucksABDose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res. 2004;19(8):1231–1240.
40.
IrvingLThe relation of solubility to the absorption of calcium salts from the intestine. J Biol Chem. 1926;68:518.
41.
JacksonRDLaCroixAZGassMCalcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669–683.
42.
JonesJThe influence of fat on calcium and phosphorus metabolism. J Nutr. 1940;20:367.
43.
Kass-WolffJHCalcium in women: healthy bones and much more. J Obstet Gynecol Neonatal Nurs. 2004;33(1):21–33.
44.
KerstetterJECaseriaDMMitnickMEIncreased circulating concentrations of parathyroid hormone in healthy, young women consuming a protein-restricted diet. Am J Clin Nutr. 1997;66(5):1188–1196.
45.
KerstetterJEO’BrienKOInsognaKLDietary protein affects intestinal calcium absorption. Am J Clin Nutr. 1998;68(4):859–865.
46.
KerstetterJEO’BrienKOInsognaKLDietary protein, calcium metabolism, and skeletal homeostasis revisited. Am J Clin Nutr. 2003; 78(3 Suppl):584S–592S.
47.
KerstetterJESvastisaleeCMCaseriaDMMitnickMEInsognaKLA threshold for low-protein-diet-induced elevations in parathyroid hormone. Am J Clin Nutr. 2000;72(1):168–173.
48.
KimYYLeeEYChoYHThe effect of chicory fructan fiber on calcium absorption and bone metabolism in Korean postmenopausal women. Nutr Sci. 2004;7:151–157.
49.
Kinne-SaffranEKinneRLocalization of a calcium-stimulated ATPase in the basal-lateral plasma membranes of the proximal tubule of rat kidney cortex. J Membr Biol. 1974;17:263–274.
50.
Kopp-WoodroffeSAManoreMMDueckCASkinnerJSMattKSEnergy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program. Int J Sport Nutr. 1999;9(1):70–88.
51.
KunstelKCalcium requirements for the athlete. Curr Sports Med Rep. 2005;4(4):203–206.
52.
Lanham-NewSAImportance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc Nutr Soc. 2008;67(2):163–176.
53.
LemannJJrLennonEJPieringWRPrienELJrRicanatiESEvidence that glucose ingestion inhibits net renal tubular reabsorption of calcium and magnesium in man. J Lab Clin Med. 1970;75(4):578–585.
54.
LiKCZernickeRFBarnardRJLiAFEffects of a high fat-sucrose diet on cortical bone morphology and biomechanics. Calcif Tissue Int. 1990;47(5):308–313.
55.
LoucksABThe response of luteinizing hormone pulsatility to 5 days of low energy availability disappears by 14 years of gynecological age. J Clin Endocrinol Metab. 2006;91(8):3158–3164.
56.
LoucksABHeathEMDietary restriction reduces luteinizing hormone (LH) pulse frequency during waking hours and increases LH pulse amplitude during sleep in young menstruating women. J Clin Endocrinol Metab. 1994;78(4):910–915.
57.
LoucksABStachenfeldNSDiPietroLThe female athlete triad: do female athletes need to take special care to avoid low energy availability?Med Sci Sports Exerc. 2006;38(10):1694–1700.
58.
LoucksABThumaJRLuteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 2003;88(1):297–311.
59.
LoucksABVerdunMHeathEMLow energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol. 1998; 84(1):37–46.
60.
MacLaughlinJHolickMFAging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985;76(4):1536–1538.
61.
MargenSChuJYKaufmannNACallowayDHStudies in calcium metabolism, I: the calciuretic effect of dietary protein. Am J Clin Nutr. 1974;27(6):584–589.
62.
MasseyLKDietary animal and plant protein and human bone health: a whole foods approach. J Nutr. 2003;133(3):862S–865S.
63.
MaughanRNutrition and the young athlete. Medicina Sportiva. 2000;4: E51–E58.
64.
MeunierPJRouxCSeemanEThe effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004;350(5):459–468.
65.
MilneDBNielsenFHThe interaction between dietary fructose and magnesium adversely affects macromineral homeostasis in men. J Am Coll Nutr. 2000;19(1):31–37.
66.
MorganKTNutritional determinants of bone health. J Nutr Elder. 2008;27(1–2): 3–27.
67.
MungerRGCerhanJRChiuBCProspective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr. 1999;69(1):147–152.
68.
MyburghKHHutchinsJFataarABHoughSFNoakesTDLow bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med. 1990;113(10):754–759.
69.
National Institutes of Health. Consensus Development Conference Statement: Osteoporosis Prevention, Diagnosis, and Therapy. Bethesda, MD: National Institutes of Health; 2000:27–29.
70.
NattivALoucksABManoreMMSanbornCFSundgot-BorgenJWarrenMPAmerican College of Sports Medicine position stand: the female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–1882.
71.
NewSARobinsSPCampbellMKDietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health?Am J Clin Nutr. 2000;71(1):142–151.
72.
NordinBENeedAGMorrisHAHorowitzMThe nature and significance of the relationship between urinary sodium and urinary calcium in women. J Nutr. 1993;123(9):1615–1622.
73.
North American Menopause Society. The role of calcium in peri- and post-menopausal women: 2006 position statement of the North American Menopause Society. Menopause. 2006;3:862–877.
74.
Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC: US Department of Agriculture and US Department of Health and Human Services; 2000.
75.
OgurRUysalBOgurTEvaluation of the effect of cola drinks on bone mineral density and associated factors. Basic Clin Pharmacol Toxicol. 2007;100(5):334–338.
76.
PershadsinghHAMcDonaldJMDirect addition of insulin inhibits a high affinity Ca2+-ATPase in isolated adipocyte plasma membranes. Nature, 1979;281(5731):495–497.
77.
PetrieHJStoverEAHorswillCANutritional concerns for the child and adolescent competitor. Nutrition. 2004;20(7–8):620–631.
78.
RamalingamLMesserLBReynoldsECAdding casein phosphopeptideamorphous calcium phosphate to sports drinks to eliminate in vitro erosion. Pediatr Dent. 2005;27(1):61–67.
79.
RaschkaLDanielHMechanisms underlying the effects of inulin-type fructans on calcium absorption in the large intestine of rats. Bone. 2005;37(5):728–735.
80.
RizzoliRBoonenSBrandiMLBurletNDelmasPReginsterJYThe role of calcium and vitamin D in the management of osteoporosis. Bone. 2008;42(2):246–249.
81.
RougheadZKHuntJRJohnsonLKBadgerTMLykkenGIControlled substitution of soy protein for meat protein: effects on calcium retention, bone, and cardiovascular health indices in postmenopausal women. J Clin Endocrinol Metab. 2005;90(1):181–189.
82.
RousseauJHKleppingerAKennyAMSelf-reported dietary intake of omega-3 fatty acids and association with bone and lower extremity function. J Am Geriatr Soc. 2008Aug22 [Epub ahead of print].
83.
SalemGJZernickeRFBarnardRJDiet-related changes in mechanical properties of rat vertebrae. Am J Physiol. 1992;262(2 Pt 2):R318–R321.
84.
SchurchMARizzoliRSlosmanDVadasLVergnaudPBonjourJPProtein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1998;128(10): 801–809.
85.
ShapsesSARobinsSPSchwartzEIChowdhuryHShort-term changes in calcium but not protein intake alter the rate of bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion. J Nutr. 1995;125(11):2814–2821.
86.
SheaBWellsGCranneyAMeta-analyses of therapies for postmenopausal osteoporosis, VII: meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev. 2002;23(4):552–559.
87.
SunDKrishnanAZamanKLawrenceRBhattacharyaAFernandesGDietary n-3 fatty acids decrease osteoclastogenesis and loss of bone mass in ovariectomized mice. J Bone Miner Res. 2003;18(7):1206–1216.
88.
TadayyonBLutwakLInterrelationship of triglycerides with calcium, magnesium and phosphorus in the rat. J Nutr. 1969;97(2):246–254.
89.
TeradaMInabaMYanoYGrowth-inhibitory effect of a high glucose concentration on osteoblast-like cells. Bone. 1998;22:17–23.
90.
ThongFSMcLeanCGrahamTEPlasma leptin in female athletes: relationship with body fat, reproductive, nutritional, and endocrine factors. J Appl Physiol. 2000;88(6):2037–2044.
91.
TjaderhaneLLarmasMA high sucrose diet decreases the mechanical strength of bones in growing rats. J Nutr. 1998;128(10):1807–1810.
92.
TsanziELightHRTouJCThe effect of feeding different sugar-sweetened beverages to growing female Sprague-Dawley rats on bone mass and strength. Bone. 2008;42(5):960–968.
93.
WatkinsBALiYLippmanHEFengSModulatory effect of omega-3 polyunsaturated fatty acids on osteoblast function and bone metabolism. Prostaglandins Leukot Essent Fatty Acids. 2003;68(6):387–398.
94.
WhitingSJCalvoMSDietary recommendations to meet both endocrine and autocrine needs of Vitamin D. J Steroid Biochem Mol Biol. 2005;97(1–2):7–12.
95.
WilliamsMHDietary supplements and sports performance: minerals. J Int Soc Sports Nutr. 2005;2:43–49.
96.
WilliamsNIHelmreichDLParfittDBCaston-BalderramaACameronJLEvidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. J Clin Endocrinol Metab. 2001;86(11):5184–5193.
97.
WillisKSPetersonNJLarson-MeyerDEShould we be concerned about the vitamin D status of athletes?Int J Sport Nutr Exerc Metab. 2008;18(2): 204–224.
98.
WolfeRRThe underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475–482.
99.
WoodRJAllenLHEvidence for insulin involvement in arginine- and glucose-induced hypercalciuria in the rat. J Nutr. 1983;113(8):1561–1567.
100.
WyshakGTeenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154(6):610–613.
101.
WyshakGFrischRECarbonated beverages, dietary calcium, the dietary calcium/phosphorus ratio, and bone fractures in girls and boys. J Adolesc Health. 1994;15(3):210–215.
102.
WyshakGFrischREAlbrightTEAlbrightNLSchiffIWitschiJ. Nonalcoholic carbonated beverage consumption and bone fractures among women former college athletes. J Orthop Res. 1989;7(1):91–99.
103.
ZemelMBCalcium utilization: effect of varying level and source of dietary protein. Am J Clin Nutr. 1988;48(3 Suppl):880–883.
104.
ZernickeRFSalemGJBarnardRJSchrammELong-term, high-fat-sucrose diet alters rat femoral neck and vertebral morphology, bone mineral content, and mechanical properties. Bone. 1995;16(1):25–31.
105.
ZernickeRFSalemGJBarnardRJWoodwardJSJrMeduskiJWMeduskiJDAdaptations of immature trabecular bone to exercise and augmented dietary protein. Med Sci Sports Exerc. 1995;27(11):1486–1493.
