Bone Health in Female Adaptive Sports Athletes

The potential benefits of participation in adaptive sports are profound and extend far beyond improved cardiovascular health.

Adaptive sport participation has been linked to:

• Decreased pain
• Decreased anxiety/depression
• Improved self-esteem
• Increased opportunities for employment and community engagement
• Improved quality of life

While adaptive sport participation can help to improve bone health in the right conditions, it can also frequently lead to impaired bone health (low bone mineral density, bone stress injuries/stress fractures, and more).

Impaired bone health can affect all athletes regardless of sex or disability, but female adaptive sport athletes may be at even higher risk compared to able-bodied women or men athletes for a variety of reasons. Risk factors for the development of impaired bone health may include the following:

• Low energy availability related to an imbalance in calories consumed versus calories burned during exercise
• Eating disorder or disordered eating
• Menstrual dysfunction or irregularity
• Immobility or reduced weight-bearing
• Altered biomechanics related to impaired muscle strength or range of motion, limb deficiency, leg length differences, short stature, increased muscle tone, movement disorders, visual impairment, and more
• Hormonal changes and imbalances
• Medications (for example, certain anti-seizure medications or steroids)
• And many more…

While current research is limited (though growing), there are various clinical recommendations related to preventative and treatment strategies that are important for bone health in women adaptive sports athletes, including:

• Initiation of an early loading program and return to sport after injury
• Evaluation of vitamin D status and supplementation when indicated
• Consideration of screening bone mineral density testing (DEXA) and/or blood work, especially in the case of contact or collision sport participation
• Dietary counseling to ensure adequate caloric and micronutrient intake to meet individualized needs
• Consideration of menstrual dysfunction as a potential indicator of increased risk

Bottom line:

• The number of women adaptive sports athletes is quickly growing in number!
• The over-arching principles related to optimizing bone health are similar in ALL athletes, regardless of disability.
• However, the women adaptive athletes may have unique risk factors for impaired bone health, which warrant individualized care and consideration.

References

• Blauwet CA, Borgstrom H, Tenforde AS. Bone Health in Adaptive Sports Athletes. Sports Med Arthrosc Rev. 2019 Jun;27(2):60-66.
• Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52:687–697.
• Kljajic D, Eminovic F, Dopsaj M, et al. The impact of sports activities on quality of life of persons with a spinal cord injury. Zdr Varst. 2016;55:94–101.
• Sahlin KB, Lexell J. Impact of organized sports on activity, participation, and quality of life in people with neurologic disabilities. PM R. 2015;7:1081–1088.