Sports Nutrition for Skeletal Injuries

Author: Dana Angelo White, MS, RDN, ATC

Skeletal injuries like stress fractures and bone breaks are some of the most common injuries in athletes. Diet plays a huge role in bone health and the prevention and treatment of athletic injuries to bone.

Bone Growth

Bone growth and remodeling happens throughout the early part of the life. Bone growth continues through adolescence, typically ending between ages 16 and 18, while bone density continues to develop into ones 20s. This makes nutrition for bone health tremendously important for younger athletes as they continue to play at a higher level. If nutrition doesn’t match exercise output, often referred to as “low energy availability” (LEA), the risk of damaging bone significantly increases.

Muscle Loss from Immobilization

Skeletal injuries require immobilization and immobilization will cause muscle loss. The good news is this loss can be attenuated with plenty of healthy calories and ample amounts of protein. Many athletes believe they should eat considerably less when they are injured but eating too little risks increased muscle loss as well as a delay in healing. Maintaining a balanced diet of nutrient dense fruits and vegetables, lean plant and animal proteins and whole grains is crucial. Depending on the type and severity of the injury, athletes’ protein needs should be at least 1.6 grams per kilogram body weight per day. In some cases, needs may exceed 2.4 grams per kilogram body weight per day. Supplementing with creatine monohydrate may help maintain existing muscle following immobilization.* A daily dose of 5 grams a day has been found effective in both men and women.

Vitamin D

Inadequate levels of vitamin D are highly prevalent in athletes. A study published in 2022 found that power-focused athletes were even more likely than endurance athletes to suffer from low levels. This deviation is possibly related to the way these athletes also utilize vitamin D for skeletal muscle function as Vitamin D is involved in more than just bone health. Vitamin D is also limited in the food supply, sources include fatty fish, fortified dairy and dairy alternatives and other fortified foods. Egg yolks and cheese also contain small amounts. When it comes to strong and healthy bones, vitamin D plays an important role in promoting the absorption of calcium and low levels of either nutrient can put bone health and bone healing at risk. Ideally, blood levels of vitamin D should be checked prior to or at the time of injury to assess proper supplement dosages. If levels are low, a higher dose supplement may be required temporarily to help correct the deficiency before transitions to a lower, maintenance dose.

Calcium

Many athletes also struggle to meet their needs for calcium since the daily requirement is quite high. A combination of calcium rich foods along with a safe and properly dosed supplement can make hitting those daily targets easier, especially when aiming to prevent and treat injured bones. Be sure to take calcium supplements as directed to optimize absorption and since some forms of calcium can interfere with iron absorption, those also taking iron supplements should take calcium at a different time of day.  

Other Nutrients to Consider for Bone Health

Magnesium, Vitamin K and phosphorus are nutrients that also play a role in bone health. They are plentiful in the food supply, with many being found in plant based foods like leafy green vegetables, seeds, beans and avocado as well as peanuts, nuts and nut butters.