Bone density is generally relatively stable in early and middle adulthood when bone formation and resorption are more closely balanced. With advancing age, bone resorption can exceed bone formation. In women, the fall in estrogen around menopause can accelerate this process. Over time, bone structure can also become more porous and less able to withstand stress. [1,2]

If bone loss becomes substantial, osteoporosis can develop. Osteoporosis weakens bone and increases the chance of fractures, particularly at the hip, spine and wrist. It is often called a “silent” condition because many people do not know they have low bone strength until a fracture occurs. [1,5,7]

What increases the risk of bone loss with age?

• Low calcium or vitamin D intake, which can make it harder to maintain bone health. [1,5,7]
• Physical inactivity or prolonged periods of immobility. [1,5,7]
• Smoking and heavy alcohol use. [1,5,7]
• Hormonal changes, particularly after menopause. [1,2]
• Certain medicines or medical conditions that affect bone metabolism. [5,7]
• A personal or family history of osteoporosis or fractures. [5,7]

Osteoarthritis (OA) is the most common type of arthritis and becomes more common with age. However, it is more accurate to think of OA as a whole-joint disease rather than simply “wear and tear.” Changes can involve cartilage, bone, the joint lining, tendons, ligaments and surrounding muscles. [3,4,8]

Common symptoms include pain with movement, short-lasting stiffness after rest, swelling and reduced range of motion. The knees, hips, hands and spine are commonly affected. [3,8]

What can raise the risk of osteoarthritis?

• Older age, although OA is not an unavoidable part of aging. [8]
• Previous joint injury or surgery. [3,4,8]
• Repetitive stress on a joint over time. [3,4,8]
• Overweight or obesity, especially for weight-bearing joints such as the knees and hips. [3,4,8]
• Family history or inherited joint characteristics. [3,8]

1. Strong bones help reduce bone stress injury risk

Bone stress injuries, including stress fractures, develop when repeated loading exceeds the bone’s ability to recover and remodel. Nutritional factors such as inadequate energy intake, low vitamin D status and insufficient calcium intake can contribute to risk, especially when combined with high training loads.[9,10,12,13]

2. Bone supports movement, force transfer and training consistency

Bones form the structural framework that muscles pull against to create movement. Maintaining bone strength helps athletes tolerate repeated training and competition loads. Good bone health does not guarantee faster performance, but avoiding bone-related injury supports consistent training - a key part of long-term performance development.[11]

3. Under-fuelling can affect more than body weight

Athletes can develop low energy availability when food intake does not adequately cover exercise expenditure and normal body functions. The International Olympic Committee describes prolonged or severe low energy availability as the underlying cause of Relative Energy Deficiency in Sport (REDs), which can impair musculoskeletal health, recovery and performance.[13]