Athletes and Bone Health


Illinois Sport and Performance Institute

Bone Health and Physical Activity

In general, bone mineral density (BMD) directly coincides with the amount of exercise performed. Exercise is often associated with healthy bone density and improved overall bone health. This is true for both casual gym-goers and elite athletes.

However, not all exercises are equally effective when it comes to building strong bones or preventing osteoporosis (bone mineral loss).

Low Impact Physical Activities

According to a study published in 2015 by researchers from Brigham Young University,, certain kinds of exercise arguably offer greater benefit than others. Results showed that high weight loading activities such as jumping have a strong relationship with improved hip bone mass density (BMD) and more so than low weight bearing activities such as swimming.

Not every sport or exercise activity is linked to sustained BMD. Running, for example, is linked to greater BMD than low-impact activities like cycling because of the direct stress that it places on the legs and hips.

In fact, elite-level cyclists appear to have a greater propensity for bone loss compared to their running counterparts. The causes of this are many. In addition to low bone stress, some experts believe that the loss of calcium or other nutritional or energy deficits may play a key role. It is possible that endurance sports prompt bone loss as more calories tend to be burned than consumed.

Exercise and Bone Growth

In a paper by Elizabeth Quinn published in 2019, researchers from the University of Michigan reviewed data from 1961 to 2009 to determine the effect of exercise on bone density. In their research, the investigators found three characteristics of exercise having the largest impact on bone mass density (BMD):

The magnitude of muscle strain:
Exercises that fit into this category include weightlifting and gymnastics because the amount of force placed on muscles and bones.

The rate of muscle strain:
This indicates the speed by which repetitive, high-impact exercises, such as tennis or plyometrics, are performed.

The frequency of muscle strain:
Running is a prime example of this as the impact on muscles is not only repetitive but continues for a long period of time.

Although the researchers did not establish which of the three factors is the most important, they concluded that increased density can be achieved with weight-bearing exercise.

Energy Deficits

The Female Athlete Triad is a syndrome that links three health conditions related to insufficient nutrition or caloric energy needed to fuel the level of physical activity. Low energy availability, menstrual dysfunction, and low bone density appear to co-occur.


Relative Energy Deficiency in Sport

RED-S is the broader, more comprehensive name for what was formerly known as Female Athlete Triad, which was a condition seen in females participating in sports that emphasize leanness or low body weight. As it was also seen in males, the name was changed to the comprehensive term RED-S. The triad is a serious illness with lifelong health consequences. 

The Female Athlete Triad, though more common in the athletic population, can also occur in the nonathletic population. However, even though this triad was first described at the 1993 meeting of the American College of Sports Medicine (ACSM), [3, 4] associations between bone mineral density (BMD), stress fractures, eating disorders, and female athletics had been observed for decades before the syndrome was formally named.