Stressing about Stress Fractures? Fuel for Healthy Bones

April 24, 2018

Big Topic of Bone Health

The positive effects of proper nutrition and fueling for athletes is far reaching. While delayed muscle fatigue, optimal skill technique, replenishing of glycogen stores, and rebuilding of muscles are all benefits of proper fueling with physical activity, bone health is equally important but often overlooked. It is understood that extended bouts of exercise cause increased bone breakdown. Without adequate bone formation to balance out bone breakdown, it is suggested that this could lead to negative effects on bone mass and bone health. A common injury associated with negative bone health is stress fractures, which consist of tiny cracks in a bone often due to repetitive force or overuse. A stress fracture can be a major setback for an athlete, resulting in an average of 169 days of lost training.3 Stress fractures are a significant concern for athletes, particularly runners, gymnasts, basketball players and tennis players.


Science Behind the Story

Two recent studies evaluated how consuming nutrients during or soon after running can improve bone strength. The studies both consisted of ten healthy, physically active males who completed treadmill runs. In one study, the men consumed a carbohydrate drink before, during and immediately after their run.2 In the other study, the participants consumed a carbohydrate and protein-based drink immediately after or two hours after a run.3 Both studies included placebo trials to serve as a control. The amount of carbohydrates and protein was based on the individual’s body weight. Blood was collected from the participants to look at bone markers of breakdown and formation. From both studies, it can be concluded that consuming carbs during, or a combination of carbs and protein immediately after prolonged bouts of exercise helps to decrease bone break down and increase bone formation, which reduces the risks of stress fractures and other injuries associated with weak bones.


Put It into Practice

To put this knowledge into action, it is recommended that athletes recover with around 1/2g of carbohydrates for every pound the athlete weighs, with an additional 20-40g of protein as soon as possible after completion of physical activity lasting about one hour.1,2,3  This means, an athlete who weighs 150 lbs. should likely consume 75g of carbohydrates plus 20-40g protein immediately following activity. This could include:


Full Meal On-The-Go Parfait
½-1 cup rice/pasta/potatoes 1 cup fruit
Medium piece of fruit 1 cup Greek yogurt
1 cup non-starchy vegetables 2 tbsp peanut butter
3-4 ounces meat/chicken/fish ¼ cup oats or granola


If activity lasts longer than 90 minutes, consuming 30-60g of carbohydrates every hour  of activity is also recommended.1,2 (Be cautious of potential stomach distress- such nutrition practices should be tried prior to performance/game situations.)


Carbohydrate Options During Physical Activity 
8 oz. sports drink

Sports gel packet

Small piece of fruit


Final Takeaway

Proper nutrition during and soon after physical activity has a positive impact on maintaining strong bones. Choosing to refuel with carbohydrates or a mix of carbohydrates and protein reduces bone break down and creates a balance in bone formation, which can decrease the risk of stress fractures. Whether it’s small amounts of sports drink during a long game, a quick smoothie immediately following a workout, or a full meal after practice, planning nutrition in conjunction with exercise has many benefits, with bone health being a main player.

Written By: Courtney High – Dietetic Intern SFA

Edited By: Brett Singer MS,RD,CSSD,LD – Sports Dietitian – Memorial Hermann IRONMAN Sports Medicine Institute


1Kerksick, C. M., Arent, S., Shoenfeld, B. J., Stout, J. R., Campbell, B., Colin, W. D… Antonio, J. (2017). International society of sports nutrition position stand: nutrient timing. Journal of the International Society of Sports Nutrition 14(33). Doi: 10.1186/s12970-017-0189-4

2Sale, C., Varley, I., Jones, T. W., James, R. M., Tang, C. Y., Fraser, W. D., and Greeves, J. P. Effect of carbohydrate feeding on the bone metabolic response to running. Journal of Applied Physiology, 119(7), 824-830. Doi: 10.1152/japplphysiol.00241.2015

3Townsend, R., Elliott-Sale, K. J., Currell, K., Tang, J., Fraser, W. D., and Sale, C. (2017). The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism. Medicine and Science in Sports and Exercise, 49(6), 1209-1218. Doi: 10.1249/MSS.0000000000001211

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