Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners

PM R. 2010 Aug;2(8):740-50; quiz 794. doi: 10.1016/j.pmrj.2010.04.020.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Bone Density*
  • Cohort Studies
  • Contraceptives, Oral
  • Diet*
  • Female
  • Fractures, Stress / diagnosis
  • Fractures, Stress / epidemiology*
  • Humans
  • Nutritional Status
  • Risk Factors
  • Running / injuries*
  • Young Adult


  • Contraceptives, Oral