Bone health is crucial to optimizing your performance. Think about it: your skeletal structure supports literally everything in your body. Without it, you're just a meat sack of muscle and soft tissue. Healthy bones play into balance, coordination, joint health and several other functions necessary to crush it at OCR—and stay active for the long game. But, by not prioritizing bone health, or being aware of risk factors that contribute to fragility, you can screw yourself not only out of big gains but also into longer-term injury. 

Calcium is the key mineral that hardens bones making them more resilient to stress, as opposed to soft, supple and injury prone. “Healthy bones mean less risk for a fracture, which can lead to time lost—being out of work, out of training and out of play,” says orthopedic surgeon and Spartan Anthony DeLuise, MD, FAAOS, CAQSH, and Clinical Assistant Professor at Brown University. “Endurance athletes are at risk for lower bone mineral density and therefore weaker bones (osteopenia and osteoporosis).” Yeah… we know... not great news when all you want to do is crush single track, scale walls, swing from monkey bars and keep a consistent training regimen. 

Vitamin D deficiencies and hormonal changes—which go hand in hand with aging and endurance sports—can often also be the culprit for decreased bone health, according to a recent study in Sports Health. “If bones undergo injuries like stress fractures, improving athletic performance will be extremely difficult,” says Jackie S Womble, MS, RDN, LDN, ACSM-EP. Because endurance athletes have a higher risk of stress fractures and bone fragility, it’s crucial to care for your skeleton with proper nutrition and strength exercises. 

Here's what you need to know about risks and red flags that should inspire you to take a closer look at how you're treating your bones. Hint: injuries suck—but with these expert tips, you can make bone vitality and longevity a top health prerogative and race well into old age. 

Bone Health in Endurance Athletes: What You Should Know

1. Start Your Calcium Intake Early On

Vitamin D helps assist in calcium homeostasis for optimal skeletal health. The two work together to build bone density when you’re young, but your body actually stops storing calcium around the age of 25-30. From there onward, you need to supplement with a calcium-rich diet. If you’re a younger Spartan, start prioritizing your calcium intake now and aim for 1,300 mg per day. “Building up your calcium stores when you are younger is a huge factor for limiting the risk of lower bone mineral density as we age,” says DeLuise. “There are no symptoms for a non-healthy bone unless you fracture a bone,” and often, then, you’re looking at a long road to recovery. One in every 20 fractures fails to heal properly, and while there’s everything from surgery to ultrasound treatments that assist in bone healing, consuming proper amounts of calcium (1,000 mg per day for most adults, and 1,200 mg for women over 50 and everyone over 70) can help prevent injury. 

2. Ensure You’re Getting Enough Protein + Vitamin D, Too

In addition to getting enough calcium, athletes need about 1,500-2,000 IU per day of vitamin D and 20-30 g per meal of high-quality protein. “Consuming foods high in calcium coupled with vitamin D and protein will help the absorptivity of the nutrients in these foods,” says Womble. “For context, a cup of cooked broccoli has about 62 mg of calcium, and one cup of milk has about 300 mg of calcium and 120 IU of vitamin D.” Good sources of protein and calcium include salmon, cheese, yogurt and milk. 

“Foods that inhibit calcium and vitamin D absorption should be known, but not avoided,” Womble says. “They just shouldn’t be eaten for their calcium content.” Oxalic acid, found in spinach, collard greens, sweet potatoes, rhubarb and beans is known to decrease calcium absorption, as is phytic acid from fibrous foods like whole grains, seeds, nuts and soy. “Both oxalic and phytic acid containing foods are great sources of a variety of other nutrients and energy, so don’t avoid them—just intentionally consume [other calcium-rich foods, too].”

3. Keep A Consistent Recovery Routine

According to DeLuise, the most common injuries in athletes are typically tendon related, or stress fractures from overuse. “This is generally from taking on too much load too quickly when you’re getting back into activities, or exercising too much without letting your body recover,” he says. “Recovery is quite important as we age since we don’t heal as quickly as we once did.” Listen to your body, get good sleep, and make myofascial release, mobility and stability exercise a priority on off days. Weight bearing exercises also help maintain healthy bones. “Stress fractures occur when activity is super high and recovery is just not enough,” says DeLuise. So in short, don’t overdo it. 

4. Avoid the Classic Poor-Health Faux Pas 

Because you’re a Spartan, we know you live for a healthy, active lifestyle. But we have to say it: don’t be an idiot and allow bad habits to creep into your life. “Don’t smoke. Don’t drink excessively,” recommends DeLuise. Among many other negative side effects, over drinking and using tobacco severely compromises bone health and increases the risk of osteoporosis. Heavy alcohol use decreases bone density and weakens the bones’ mechanical properties. So while it’s okay to reach for a hard-earned post-race beer once in a while, don’t make it a daily ritual. Duh. 

The Bottom Line: Diet & Exercise = Aging Well & Injury Prevention

Because our bone mineral density lessens as we age, building calcium stores early on (and maintaining them throughout your life), as well as keeping a solid Spartan training routine, are necessary components for aging athletes who want to avoid injury. “Absolutely, if you want to continue competing, do these things!” says DeLuise. “Pace yourself when training. Be smart on the course.” 

EXOGEN is approved for the accelerated healing of indicated acute fractures and the healing of nonunions* (including infected, instrumented, or poor bone quality nonunions, excluding skull and vertebrae). There are no known contraindications. Patients may experience sensitivity to the ultrasound gel. 

*A nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing.

See EXOGEN User Guide at www.exogen.com.