exercise • safe movement • tai chi • overtraining
Fitness & Bone
The Skeletal Risk of
Are you exercising too much? Eating too little? Have
your periods become irregular or stopped? If so, you may
be putting yourself at high risk for several serious
health problems that could affect your health, your
ability to remain active, and your risk for injuries.
You also may be putting yourself at risk for developing
osteoporosis, a disease in which bone density is
decreased, leaving your bones vulnerable to fracture
missing my period such a big deal?
Some athletes see amenorrhea (the absence of menstrual
periods) as a sign of appropriate levels of training.
Others see it as a great answer to a monthly
inconvenience. And some young women accept it blindly,
not stopping to think of the consequences. But missing
your menstrual periods is often a sign of decreased
estrogen levels. And lower estrogen levels can lead to
osteoporosis, a disease in which your bones become
brittle and more likely to break.
Usually, bones become brittle and
break when women are much older, but some young women,
especially those who exercise so much that their periods
stop, develop brittle bones and may start to have
fractures at a very early age. Some 20-year-old female
athletes have been described as "having the bones of an
80-year-old woman." Even if bones don't break when
you're young, low estrogen levels during the peak years
of bone-building, the pre-teen and teen years, can
affect bone density for the rest of your life. And
studies show that bone growth lost during these years
may not ever be regained.
Broken bones don't just hurt--they
can cause lasting deformities. Have you noticed that
some older women and men have a stooped posture? This is
not a normal sign of aging. Fractures from osteoporosis
have left their spines permanently altered.
By the way, missing periods isn't the
only problem. Not eating adequate amounts of calcium and
vitamin D (among other nutrients) can also cause bone
loss, and may lead to decreased athletic performance,
decreased ability to exercise or train at desired levels
of intensity or duration, and increased risk of injury.
at risk for these problems?
Girls and women who may be trying to lose weight by
restricting their eating and/or engaging in rigorous
exercise regimes are at risk for these health problems.
This may include serious athletes, "gym rats" (who spend
considerable amounts of time and energy working out),
and/or girls and women who believe "you can never be too
How can I tell
if someone I know, train with, or coach may be at risk
for bone loss, fracture and other health problems?
Here are some signs to look for:
irregular menstrual periods
||extreme or rapid
behaviors such as:
||not eating in front of
||trips to the bathroom
||preoccupation with thinness
||focus on low-calorie and
||possible increase in the
consumption of water and other no- and
low-calorie foods and beverages (possible
increase in gum chewing, as well)
||limiting diet to one food
group or eliminating a food group
bouts of exercise such as:
||continuous exercise or
training sessions (e.g., taking an aerobics
class, then running five miles, then swimming
for an hour, followed by weight-lifting, etc.)
||an "I can't miss a day of
||an overly anxious
preoccupation with an injury
||exercising in spite of
conditions that might lead others to "take the
day off," including illness, inclement weather,
||high levels of
self-criticism and/or self-dissatisfaction
||high levels of
psychological or physical stress, such as:
||anxiety or nervousness
||inability to concentrate
||low levels of self-esteem
||feeling cold all the time
||talking about weight
How can I make necessary changes in the interest of my
If you recognize some of these signs in
yourself, the best thing you can do is to begin eating a
more healthful diet, including enough calories to
support your activity level. It's best to check with a
doctor to make sure your missed periods aren't a sign of
some other problem, and to get his or her help as you
work toward a more healthy balance of food and exercise.
Also, a doctor can help you take steps to protect your
bones from further damage.
What can I do
if I suspect a friend may have some of these signs?
First, be supportive. Approach
your friend or teammate carefully and sensitively. She
probably won't appreciate a lecture about how she should
be taking better care of herself. But maybe you could
share a copy of this brochure with her, or suggest that
she talk to a trainer, coach, or doctor about the
symptoms she's experiencing.
friend drinks a lot of diet sodas. She says that this
helps keep her trim.
Often, girls and women who may be dieting will drink
diet sodas rather than much-needed milk. (Milk and other
dairy products are a good source of calcium, an
essential ingredient for healthy bones.) Drinking sodas
instead of milk can be a problem, especially during the
teen years when peak bone growth occurs. If you (or your
friend) find yourself addicted to sodas, try drinking
half as many sodas each day, and gradually add more milk
and dairy products to your diet. A frozen yogurt shake
can be an occasional low fat, tasty treat. Or try a
fruit smoothie made with frozen yogurt, fruit, and/or
calcium-enriched orange juice!
and I think I should lose just a little more weight. I
want to be able to excel at my sport!
Years ago, it was not unusual for coaches to encourage
athletes to be as thin as possible for many sports
(dancing, gymnastics, figure skating, swimming, diving,
running, etc.). However, many coaches are realizing that
being too thin is unhealthy and can negatively affect
performance. It is important to exercise and watch what
you eat. However, it's also important to develop and
maintain healthy bones and bodies. Without these, it
will not matter how fast you can run, how thin you are,
or how long you exercise each day. Balance is the key!!!
still not convinced. If my bones become brittle, so
what? What's the worst thing that could happen to me?
Brittle bones may not sound as scary as some other fatal
or rare disease. The fact is, osteoporosis can be very
painful. It can cause disability. Imagine having so many
spine fractures that you've lost inches in height and
walk bent over. Imagine looking down at the ground
everywhere you go because you can't straighten your
back. Imagine not being able to find clothes that fit
you. Imagine having difficulty breathing and eating
because your lungs and stomach are compressed into a
smaller space. Imagine having difficulty walking, let
alone exercising, because of pain and deformity. Imagine
constantly having to be aware of what you are doing and
having to do things so slowly and carefully because of a
very real fear and dread of a fracture...a fracture that
could lead to a drastic change in your life - including
pain, loss of independence, loss of mobility, loss of
freedom and more.
But osteoporosis isn't just an "older
person's" disease. Young women also experience
fractures. Imagine being sidelined because of a broken
bone and not being able to get those good feelings you
get from regular activity.
for Healthy Bones:
calcium do I need?
It is very important to your bone health that you
receive adequate daily amounts of calcium, vitamin D,
phosphorus, and magnesium. These are the vitamins and
minerals that are most influential in building bones and
teeth. This chart will help you decide how much calcium
Calcium Intakes (mg/day)
Source: National Academy of Sciences, 1997
can I get calcium and Vitamin D?
Dairy products are the primary food sources of calcium.
Choose milk, yogurt, cheeses, ice cream, or products
made or served with these choices to fulfill your daily
requirement. Three servings of dairy products per day
should give you at least 900 milligrams of calcium.
Green vegetables are another source. A cup of broccoli,
for example, has about 136 milligrams of calcium.
Sunlight is one important source of vitamin D, but when
the sun isn't shining, milk is also a good source of
There are many great snack and meal
items that contain calcium. With a little planning and
"know how," you can make meals and snacks calcium-rich!
Wouldn't a tall, cold glass of
this refreshing thirst quencher be great right
now? If you're concerned about fat and calories,
you can drink 1% or skim milk. You can drink it
plain, or with a low/no-fat syrup or flavoring,
such as chocolate syrup, vanilla extract,
hazelnut flavoring, cinnamon, etc.
Again, you can choose the low/no
fat varieties. Use all different types of cheese
for sandwiches, bagels, omelets, vegetable
dishes, pasta creations...or as a snack by
(prepared with milk)...
You can now purchase (or make
your own from a mix) a variety of flavors with
little or no fat. Rocky road, butterscotch,
vanilla, chocolate, pistachio....Try them all!
Add fruit. Eat it plain. Add a
low/no fat sauce or syrup. No matter how you
choose to eat this calcium-rich food, it remains
a quick, easy, and convenient choice. It's also
available in a variety of flavors. Try
mocha-fudge-peppermint-swirl for the more
adventurous at heart, and vanilla for the more
traditional yogurt snacker!
(or fat free ice cream)...
Everybody loves ice cream...And
now, without the unnecessary fat grams, you can
enjoy it more often! Mix yogurt, milk, and fruit
to create a breakfast shake. Have a cone at
lunchtime or as a snack. A scoop or two after
dinner can be cool and refreshing.
other sources of calcium?
Many foods you already buy and eat may be
"calcium-fortified". Try calcium-fortified orange juice
or calcium-fortified cereal. Check food labels to see if
some of your other favorite foods may be good sources of
calcium. By the way, you can also take calcium
supplements if you think you may not be getting enough
from your diet.