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The metabolic crossroad of the adolescent athlete: achieving peak bone mass during athletic development
  1. Irfan Ahmed1,
  2. Raj Amarnani2,
  3. Corinne Fisher3
  1. 1 Sports Medicine Department, Homerton University Hospital, London, UK
  2. 2 Sports Medicine Department, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Adolescent Rheumatology Department, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Irfan Ahmed, Sports Medicine Department, Homerton University Hospital, London, Homerton Row, E9 6SR, UK; irfan.ahmed5{at}

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The adolescent athlete faces a number of developmental challenges that occur alongside pursuit of their sporting goals. These include the pressures to perform at a high level but also to develop emotionally and physically to the demands of training and competition. Medical professionals caring for adolescent athletes, must be aware of and help them to achieve a defining metabolic milestone early on in life known as peak bone mass (PBM). With approximately 90% of PBM achieved by the age of 18, this early stage of development is sometimes called the ‘bone bank’1 and is a major predictor of long-term osteoporotic fracture risk.2 The input from medical teams during this window of opportunity is crucial to support appropriate bone development, both for a career during and after sport.3 4

Encouraging PBM development

The peripubertal years are defined by several key milestones that have traditionally been used to assess adolescent development. These include physical signs (peak height velocity/secondary sexual characteristics) as well as radiographic measures of bone age (Tanner-Whitehouse staging). Although these stages can be identified clinically, indications for measuring PBM in this age group when asymptomatic are less well defined.5 The fastest rate of …

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  • IA and RA are joint first authors.

  • Twitter @irfan_SEM, @DrRajAmar

  • Contributors IA and RA conceived and drafted the submission as joint first authors (equal contribution). CF is the last author. IA, RA and CF reviewed and revised the script together. All authors approved the final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.