Whether you are an older runner that’s been pounding the pavement for 50 years, or you’re a college track and field athlete competing in sprints – maintaining good bone health is essential. After attending a session on bone health throughout the lifespan at the Food and Nutrition Conference and Expo (otherwise known as FNCE), I’ve pulled some helpful tips and tricks to share with you to maximize your bone health.
Disclaimer: This post was written by Chrissy Carroll, MPH, RD, RRCA Running Coach. It is for informational purposes only and should not be construed as individual advice. Consult a dietitian or doctor with individual nutrition or medical questions.
Note: A huge thanks to Kate Beard, Jackie Klunk, and Halley Wasserman, who presented the session “Optimizing Bone Health Across the Lifespan: From Infancy to Aging Adults” at FNCE 2024, where some of this information was derived from. Also a big thanks to Lauren Manaker who presented the spotlight session “Becoming a Prunefluencer: How Nutrition Professionals Can Advocate for Prunes” at FNCE, which contributed additional information.
1. Understand the window for peak bone mass
At FNCE, Halley Wasserman, MD, MS, CCD explained that bone mass increases 40-fold from birth to adulthood. The body reaches its peak bone mass by your early 20’s, sometimes earlier depending on the specific area of bone and your gender.
This makes good nutrition and physical activity habits essential during childhood and adolescence. For example, if you’re a cross-country runner in high school, this is the time when you can be optimizing your bone health for later in life! Keep in mind a good portion of peak bone mass is genetically determined, but there are steps you can take to optimize what you have control over (like exercise and nutrition).
However, even if you’re well into adulthood, you still need to pay attention to bone health. As Jackie Klunk, MS, RDN, mentioned in their FNCE presentation, bone is lost gradually as we age. This occurs more rapidly after menopause in women. While you aren’t going to be adding peak bone mass later in life, it’s important to combat the effects of age and reduce the risk of bone breakdown.
2. Understand how running affects bone health
Physical activity is associated with better bone health, but certain types of physical activity are better at optimizing bone health than others. A recent peer reviewed journal article noted “Weight bearing activities incorporating impulsive loading, particularly those involving some degree of intermittent, explosive jumping and/or sprinting with rapid changes in direction, have the greatest osteogenic potential.”
As such, the training done by adolescent sprinters and jumpers likely results in increased likelihood of bone mass adaptations compared to distance runners. Interestingly, both groups fall high in the risk of stress fractures, though, some of which may be predicated by issues with energy or nutrient availability (discussed in the next sections).
While distance running is a weight-bearing exercise and does contribute to bone health, it’s also repetitive exercise. After a few minutes of running, bone cells may get “used to” the motion and lose sensitivity to the impact. The current school of thought is that continuous linear adaptations generally don’t occur for distance runners with bone health.
3. Use a smart training routine
In line with above, you can adjust your training to support your bone health. The recommendations will vary depending on your age and whether or not you’ve reached peak bone pass.
For example, adolescent athletes might…
- Add plyometrics to their routine. For example, doing a run in the morning and a short plyometrics session in the afternoon (bone cells will regain sensitivity after about 4-8 hours). A systematic review found that jumping interventions during childhood and adolescence improve bone mineral density and structural properties of bone, making plyometrics a great choice during peak bone building time frames.
- Incorporate tracks session that includes some quick sprints, focusing on that rapid movement.
- Mix in some trail runs, where the natural changes in terrain change the angles of loading during the run.
- Avoid early sport specialization, instead playing in a wide range of sports that move in different directions.
All of these are stimuli that may help with achieving optimal peak bone mass.
Adult runners who have already achieved peak bone mass could incorporate some of these too. For example, pre-menopausal women had increased bone mineral density in certain locations with plyometric jumping.
However, it’s important to avoid excessive stress on the bones, which could lead to bone stress injury. This is especially true for runners with already weakened bones. A few additional tips for adult and older runners who have already reached peak bone mass:
- Use gradual increases in training workload, as excessive increases are linked to higher risk of bone stress injuries.
- Include at least one full rest day from running (or any intense exercise) each week.
- Build a solid running base before making any increases to speed.
- Avoid overstriding.
- Increase running cadence if yours falls on the lower end.
- Incorporate strength training in your routine with heavy weights. Resistance training has been linked to improved bone mineral density in older adults and post-menopausal women, and is super important for runners outside of bone health too.
Remember, there is no one “perfect” way to train. Training routines should be developed using information from coaches, medical professionals, etc. This will help you put together one that’s optimal for your athletic goals and health.
4. Eat enough calories each day
All athletes are subject to messages of diet culture, but this seems (anecdotally) to be particularly worrisome among female runners and track and field athletes. High school, college, and professional runners often undergo pressure to lose weight in order to improve speed, but this logic is problematic and very risky.
When you do not eat enough to fuel your body and support your training, you are dealing with something called RED-S – relatively energy deficiency in sport.
If you are not eating enough and you start losing weight, your BMI can drop too low. Research has found that a BMI <21 has been found to be a risk factor for bone stress injuries in young female athletes.
Even if you do not lose weight, undereating in relation to your training demands can cause physiological problems including decreased bone mineral density. This can apply to males as well as females.
Research notes that this low energy availability (whether leading to weight loss or not) can lead to a decrease in bone formation and bone turnover. This interferes with the body’s normal repair system for bone issues, resulting in a higher risk of fracture.
The best way to know if you’re meeting your needs? Consult with a dietitian! They can help estimate your energy needs based on height, weight, age, lifestyle, and training regimen.
5. Meet your Calcium and Vitamin D needs
These two nutrients work in tandem – with calcium making up the structure of bone, and Vitamin D helping the body to absorb calcium.
You can find calcium in foods like…
- Milk
- Yogurt
- Tofu
- Leafy green vegetables
- Almonds
- Canned sardines
- Calcium-fortified products (like orange juice or many plant-based dairy alternatives)
You can find Vitamin D in foods like…
- Fatty fish
- Dairy milk
- Egg yolks
- Liver
- Certain mushrooms (mushrooms grown using UV-irradiation; check labels)
- Vitamin D-fortified products (like orange juice or many plant-based dairy alternatives)
Here is a great calcium food chart and Vitamin D food chart if you want to see exact amounts of these nutrients in some different food sources.
(Post-workout chocolate milk is personally one of my favorite ways to increase calcium, Vitamin D, and protein in an athlete’s diet. And it tastes so good!)
The presentation at FNCE noted that there is no current evidence for preventive calcium and vitamin D supplements to increase bone mineral density in healthy young men and women, unless there is a deficiency. It’s best to focus on a balanced diet that has enough of these nutrients when possible, and supplement if a deficiency is found.
Keep in mind, though, that Vitamin D deficiency is one of the more common deficiencies in the US, especially in Northern areas of the country where sunlight exposure is limited for a large chunk of the year. In fact, I have come up deficient in Vitamin D numerous times in the winter, despite eating ample fatty fish and egg yolks. In these types of situations, Vitamin D supplementation can be extremely helpful for runners.
In addition, there was an interesting study that found calcium and Vitamin D supplementation helped reduce the incidence of stress fractures in females in the navy. Since runners and track athletes are at a higher risk of stress fracture compared to other groups, this may be worthwhile to consider if your diet isn’t meeting your needs.
Lastly, if you’re an older adult with osteoporosis, supplementation may be beneficial too. A systematic review and meta-analysis concluded that calcium and Vitamin D supplementation enhanced bone mineral density and was linked to lower rates of fractures in older adults with osteoporosis.
6. Reduce alcohol intake
Excessive drinking can increase bone breakdown, so it’s best to avoid having more than 2 drinks per day. Studies have shown that fracture risk increases at 2-3 drinks per day (for example, this study noted increased risk at 2 drinks and this one noted it at 3 drinks).
At least so far in the research, it doesn’t seem that occasional low consumption of alcohol is risky. If you’re of legal age to drink, have no history of addictive behaviors, and have no medical contraindications, a beer or a glass of wine here and there is probably fine as far as bone health goes.
7. Add prunes to your diet
Prunes have some surprising research on bone health that you might find interesting, as discussed by Lauren Manaker, MS, RDN, at a spotlight session at FNCE!
Here are some highlights:
- A 2022 study found that eating prunes daily can prevent bone loss in the hip over 12 months in postmenopausal women.
- A 2024 study found that eating prunes may have a protective effect on certain bone areas among female oral contraceptive users.
- A 2022 study found that eating prunes led to favorable impacts on bone turnover biomarkers in men aged 55-80.
These are obviously not runner-specific studies, but I think interesting to note, especially since each study used a different population (postmenopausal women, premenopausal women on oral contraceptives, and older men).
Since prunes are great for digestive health and delicious, it seems like a win-win to incorporate them into your diet, despite limited research specific to runners.
One of my personal favorite ways to incorporate prunes is by making chocolate covered prunes, and enjoying them as a sweet treat for dessert. You can also chop them for an oatmeal add-in, use them in homemade trail mix, or just eat ‘em plain.
The Bottom Line
By making smart training and nutrition decisions both early in your running “career” and throughout your life, you can help optimize bone health. As a baseline, be sure to eat enough calories, get enough Calcium and Vitamin D, and structure your training plan in a way that makes sense given your current bone status.
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