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Optimising bone health in the young male athlete
  1. Adam S Tenforde1,
  2. Aurelia Nattiv2,
  3. Kathryn Ackerman3,4,
  4. Michelle T Barrack5,
  5. Michael Fredericson6
  1. 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
  2. 2Department of Family Medicine and Department of Orthopaedic Surgery, Division of Sports Medicine and Non-operative Orthopaedics, University of California, Los Angeles, California, USA
  3. 3Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5Department of Family and Consumer Sciences, California State University, Long Beach, California, USA
  6. 6Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University Medical School, Palo Alto, California, USA
  1. Correspondence to Dr Adam S Tenforde, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA; atenforde{at}partners.org

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Sports participation provides many health benefits to young athletes of both sexes. However, a subset of male athletes may suffer from unrecognised low bone density and impaired skeletal health, predisposing them to an increased risk of fracture. The effects of delayed diagnosis and inappropriate treatment of low bone density among male athletes may have severe consequences in future longevity in sport as well as long-term bone health. It has been well described that low energy availability alters the neuroendocrine axis, resulting in menstrual dysfunction, low bone mineral density (BMD) and increased risk for bone stress injury (BSI) in female athletes.1 ,2 However, male athletes may also experience an analogous process that parallels the female athlete triad (Triad).3 As childhood and adolescence represent a critical time for accruing peak bone mass, identifying modifiable risk factors for impaired skeletal health is important to ensure the long-term health in athletes of both sexes.

Similar to female athletes,4 there appear to be cumulative risk factors for low BMD (Z-scores <−1.0) in the young male athlete. A prior investigation in 42 male runners identified BMI ≤17.5 kg/m2 and a belief that being thinner leads to faster running performances as risk factors for having lower BMD.5 Risk factors in the young male athlete obtained from anthropometric measures and self-report questionnaires include low body weight (<85% expected weight), stress fracture history, average …

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