Influence of sports participation on bone health in the young athlete: a review of the literature

Peak bone mass is attained during the second and third decades of life. Sports participation during the years that peak bone mass is being acquired may lead to adaptive changes that improve bone architecture through increased density and enhanced geometric properties. A review of the literature evaluating sports participation in young athletes, ages 10-30 years, revealed that sports that involve high-impact loading (eg, gymnastics, hurdling, judo, karate, volleyball, and other jumping sports) or odd-impact loading (eg, soccer, basketball, racquet games, step-aerobics, and speed skating) are associated with higher bone mineral composition, bone mineral density (BMD), and enhanced bone geometry in anatomic regions specific to the loading patterns of each sport. Repetitive low-impact sports (such as distance running) are associated with favorable changes in bone geometry. Nonimpact sports such as swimming, water polo, and cycling are not associated with improvements in bone mineral composition or BMD, and swimming may negatively influence hip geometry. Participating in sports during early puberty may enhance bone mass. Continued participation in sports appears to maintain the full benefits of increased peak bone mass, although former athletes who do not maintain participation in sports may retain some benefits of increased BMD. Long-term elite male cycling was reported to negatively influence bone health, and female adolescent distance running was associated with suppressed bone mineral accrual; confounding factors associated with participation in endurance sports may have contributed to those findings. In summary, young men and women who participate in sports that involve high-impact or odd-impact loading exhibit the greatest associated gains in bone health. Participation in nonimpact sports, such as swimming and cycling, is not associated with an improvement in bone health.