PM&R
Volume 2, Issue 8 , Pages 740-750, August 2010

Nutritional Factors That Influence Change in Bone Density and Stress Fracture Risk Among Young Female Cross-Country Runners

  • Jeri W. Nieves, PhD

      Affiliations

    • Clinical Research Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY 10993; Columbia University, New York, NY⁎
    • Corresponding Author InformationAddress correspondence to: J.W.N.
    • ,
  • Kathryn Melsop, MS

      Affiliations

    • Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA†
    • ,
  • Meredith Curtis, BS

      Affiliations

    • Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA‡
    • ,
  • Jennifer L. Kelsey, PhD

      Affiliations

    • Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA; Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA∥
    • ,
  • Laura K. Bachrach, MD

      Affiliations

    • Department of Pediatrics, Stanford University School of Medicine, Stanford, CA§
    • ,
  • Gail Greendale, MD

      Affiliations

    • Geffen School of Medicine at UCLA, Los Angeles, CA
    • ,
  • Mary Fran Sowers, PhD

      Affiliations

    • Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MIa
    • ,
  • Kristin L. Sainani, PhD

      Affiliations

    • Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CAb

Received 18 December 2009; accepted 22 April 2010.

Objective

To identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners.

Design and Setting

Two-year, prospective cohort study. Observational data were collected in the course of a multicenter randomized trial of the effect of oral contraceptives on bone health.

Participants

One hundred and twenty-five female competitive distance runners ages 18-26 years.

Assessment of Risk Factors

Dietary variables were assessed with a food frequency questionnaire.

Main Outcome Measurements

Bone mineral density and content (BMD/BMC) of the spine, hip, and total body were measured annually by dual x-ray absorptiometry (DEXA). Stress fractures were recorded on monthly calendars, and had to be confirmed by radiograph, bone scan, or magnetic resonance imaging.

Results

Seventeen participants had at least one stress fracture during follow-up. Higher intakes of calcium, skim milk, and dairy products were associated with lower rates of stress fracture. Each additional cup of skim milk consumed per day was associated with a 62% reduction in stress fracture incidence (P < .05); and a dietary pattern of high dairy and low fat intake was associated with a 68% reduction (P < .05). Higher intakes of skim milk, dairy foods, calcium, animal protein, and potassium were associated with significant (P < .05) gains in whole-body BMD and BMC. Higher intakes of calcium, vitamin D, skim milk, dairy foods, potassium, and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD.

Conclusions

In young female runners, low-fat dairy products and the major nutrients in milk (calcium, vitamin D, and protein) were associated with greater bone gains and a lower stress fracture rate. Potassium intake was also associated with greater gains in hip and whole-body BMD.

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  • ⁎ Disclosure: nothing to disclose
  • † Disclosure: nothing to disclose
  • ‡ Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • a Disclosure: nothing to disclose
  • b Disclosure: nothing to disclose

 This study was funded by a grant from the U.S. Army Medical Research and Materiel Command, award number DAMD17-98-1-8518. Wyeth-Ayerst provided oral contraceptives for the randomized trial from which these data are derived, but was not involved in the analyses presented in this article.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This CME activity is designated for 1.0 AMA PRA Category 1 Credit™ and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. This activity is FREE to AAPM&R members and $25 for non-members.

PII: S1934-1482(10)00340-0

doi:10.1016/j.pmrj.2010.04.020

PM&R
Volume 2, Issue 8 , Pages 740-750, August 2010

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