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Effects of Low Energy Availability on Bone Health in Exercising Premenopausal Women

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Nutritional Influences on Bone Health

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Abstract

The development of optimal peak bone mass during the adolescent years and the associated rate of decline in bone mass with aging are the key determinants of bone health. Because both are influenced by lifestyle behaviors such as exercise and dietary intake, an understanding of the effects of low energy availability and exercise on bone health in premenopausal women is paramount. Although exercise is osteogenic, in the context of low energy availability due to inadequate dietary intake, mechanotransduction and bone metabolism are compromised. If prolonged, both low energy availability and associated hypoestrogenism can cause bone loss, increasing the risk of osteoporotic fracture and bone stress injury. The female athlete triad is the clinical and physiological context in which bone loss in exercising women occurs. Three decades of research have defined the causal relations between low energy availability, hypoestrogenism, and bone loss. Whether complete reversal of bone loss with improved energy availability and menstrual resumption is possible or unclear, recent studies are addressing this. Evidence-based recommendations for clinicians have recently been developed and include a user-friendly algorithm to predict the risk of bone loss and bone stress injury. Future research that capitalizes on improved imaging and quantitative approaches to determine bone strength and design effective dietary interventions to prevent and treat bone loss in exercising women are necessary.

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Authors and Affiliations

  1. Women’s Health and Exercise Laboratories, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA

    Nancy I. Williams & Mary Jane De Souza

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  1. Nancy I. Williams
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  2. Mary Jane De Souza
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Correspondence to Nancy I. Williams .

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Editors and Affiliations

  1. Nutrition and Science, Purdue University, West Lafayette, IN, USA

    Connie M. Weaver

  2. Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland

    Heike Bischoff-Ferrari

  3. Institute for Physical Activity and Nutrition, Deakin University , Melbourne, VIC, Australia

    Robin M. Daly

  4. Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

    Man-Sau Wong

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Williams, N.I., De Souza, M.J. (2019). Effects of Low Energy Availability on Bone Health in Exercising Premenopausal Women. In: Weaver, C., Bischoff-Ferrari, H., Daly, R., Wong, MS. (eds) Nutritional Influences on Bone Health. Springer, Cham. https://doi.org/10.1007/978-3-319-98464-3_10

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