Best Practice Case Studies-Case 113 Asset 7 Bone Health

Video Transcription

Video Summary

This AMSSM National Fellow Online Lecture introduces Dr. Adam Tenforde’s talk on bone health and its relevance to sports medicine, particularly bone stress injuries in young athletes. He reviews key concepts: Wolff’s law (bone adapts to loading) and the muscle-bone unit theory (muscle forces help build peak bone mass in youth). Bone density is typically assessed by DXA (DEXA), a 2D proxy for bone strength; research tools like HR-pQCT provide 3D geometry but are not routine clinically. Terminology is emphasized: for athletes, “low bone mass for age” is often flagged at a Z-score < -1.0 (vs < -2.0 in the general population) because weight-bearing athletes usually have ~10% higher bone mass.<br /><br />Peak bone mass is mostly achieved by late adolescence, with a critical pubertal window when large gains occur, making youth activity choices important. High-impact and multidirectional sports (gymnastics, volleyball, soccer, basketball) best improve bone density/geometry, while endurance running shows inconsistent benefit and non-impact sports (swimming/cycling) can be associated with lower bone density. Prior ball-sport participation markedly reduces later stress fracture risk.<br /><br />He details biological risk factors via the Female Athlete Triad and the broader IOC RED-S model, highlighting low energy availability’s endocrine effects (sex hormones, thyroid, cortisol) and links to low bone mass and stress fractures in both sexes. Triad risk scoring predicts future bone stress injury and higher-risk sites (pelvis/femoral neck) suggest greater concern for low BMD.<br /><br />Prevention strategies include screening for RED-S/triad factors (including menstrual history), adequate energy intake, calcium (meeting RDAs) and vitamin D supplementation when low, prioritizing sleep, and promoting sport sampling during growth.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 3

Topic Ankle

Keywords

4th Edition

4th Edition, Case 3

Ankle

bone health

sports medicine

bone stress injuries

Wolff's law

muscle-bone unit theory

DXA (DEXA) Z-score

peak bone mass adolescence

high-impact multidirectional sports

Female Athlete Triad / RED-S

low energy availability