Article
Bone Resilience Score Overview
Benjamin T. House, Andy J. Galpin, Dan Garner, Vince Kreipke, and Thomas R. Wood

What Is Bone Resilience?

The health of the skeletal system (i.e., your bones) is critical to all humans, especially athletes. Bone mineral density (BMD) peaks in early adult life and then typically begins to decline in mid-life [1, 2]. Maintaining bone mass and BMD can reduce fracture risk by 50 to 80%, and even in those with compromised bone health, a 2-6% increase in BMD can decrease fracture risk by as much as 66% [3-6]. Bone stress injuries, especially in the foot and legs, are common in athletes [7, 8], and the risk can potentially be reduced through targeted nutritional, training, and load monitoring interventions [9-12]. The Bone Score aggregates the most pertinent biomarkers related to lower bone mineral density into one integrated value.

Keywords: Bone Mineral Density (BMD), Vitamin D, Injury, Calcium, Parathyroid Hormone

Associated Biomarkers

Female Biomarkers Male Biomarkers
Parathyroid Hormone (PTH) Parathyroid Hormone (PTH)
Calcium Calcium
Magnesium Magnesium
Vitamin D Vitamin D
RBC Magnesium RBC Magnesium
Magnesium:Calcium Ratio Magnesium:Calcium Ratio

Experienced Physiological Effects:

  • Fatigue
  • Increased aches and pains
  • Weakness
  • Frequent bone injuries
  • Bone injuries that take an extended period of time to heal

Physiology Deep Dive:

Chronically low levels of vitamin D and persistently high concentrations of parathyroid hormone are consistently predictive of reduced bone mineral density [13-24]. Calcium and phosphorus intake and absorption are also essential for building and maintaining a healthy skeletal system [25-30]. Magnesium intake and absorption are integral to bone health, and athletes are known to be susceptible to increased losses of magnesium through physical activity and sweat [31-34]. Interestingly, the ratio of serum magnesium to calcium may give a more precise measure of magnesium status than serum magnesium alone [35-37]. Low energy availability is also a major risk factor for bone stress injuries due to its impact on both energy, nutrient, and hormonal status [38-40].

Red:

Constraint Zones:

Dark Green:

Current biomarkers related to bone health are adequate. However, depending on age, prior activity levels, and nutrient intake throughout the life course bone health may not be optimal. If concerned one should pursue direct BMD testing.

Green:

Current biomarkers related to bone health suggest that bone resilience is starting to suggest a potential for impaired bone health. Depending on age, prior activity levels, and nutrient intake throughout the life course bone health may not be optimal. If concerned one should pursue direct BMD testing.

Yellow:

Blood results indicate a likely potential for impaired bone health. Further BMD testing is likely warranted. It is also advisable to assess the low energy availability, injury risk, and training stress scores.

Blood results indicate a strong likelihood for impaired bone health. Further BMD testing is warranted. It is also advisable to assess the low energy availability, injury risk, and training stress scores.

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