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Adolescent Stress Fractures and their link to Sport and Diet

Playing sport and keeping active are vitally important for every child’s health and development. Physical activity that incorporates high impact, multi-directional loading has been shown to increase bone health and muscle quality during the very important years of growth and development. Playing high-impact games such as ball sports has also been shown to have a greater outcome on bone mineral density and improvements in bone geometry when compared to low impact sports like running or swimming.

However some children unfortunately, due certain circumstances, are at a greater risk of developing decreased bone density increasing the likelihood of stress fractures.

The importance of a healthy diet is paramount when it comes to bone density. Decreased calorie intake can have a high impact on bone health, as can negative psycho-social relationships to food and body image in young children. Adequate nutritional status is vital to sustaining healthy development.

Girls have a higher predisposition for developing stress fractures especially if there has been a delay in puberty and menarche, as estrogen exposure is protective for bone health in females. Delayed puberty can occur if calorie intake is low and/or a high amount of physical activity is being carried out.

There are two nutritional components that, synergistically, play a vital role when looking at bone health; Calcium, due to its function in strengthening and repairing bones, and Vitamin D, which helps the absorption of calcium into the bone resulting in increased bone strength. An adequate intake of both these nutrients is essential for bone health and ultimately for the prevention of stress fractures. According to a study of 5200 female army recruits conducted by Joan Lappe, supplementation with vitamin D and calcium decreased stress fracture development by 20% compared to the control group.

Ways that you can increase your vitamin D exposure are by getting out in the sun and exposing the backs of your arms. Early morning sun is best for approximately 5 to 10 minutes, depending on how fair your skin is. Foods that are rich in vitamin D include halibut, herring, tuna, butter, egg yolks, milk, sprouted seeds and cod liver oil.

Foods rich in calcium include almonds, broccoli, buckwheat, dairy products, egg yolks, green leafy vegetables, molasses, sardines, soybeans, turnips and tahini. Be mindful that food high in phytic acid can decrease calcium absorption; these include rhubarb, spinach, chard, grains and cereals.

A diverse and balanced diet is always best for optimal health rather than sticking to eating the same foods day in and day out.

In summary, playing sports that include multi-directional loading activity, a good healthy diet full of variety, moderate exposure to sunlight and informing yourself on best ways to absorb nutrients will help strengthen your bones to protect against potential stress fractures and minimise healing time.


Lappe, J.; Cullen, D.; Haynatzki, G.; Recker, R.; Ahlf, R.; Thompson, K., Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. Journal of Bone and Mineral Research 2008, 23 (5), 741-749

Warren, P., 1990. Nutrition in ballet of stress. American Journal of Clinical Nutrition, 51, pp.779–83.

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