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Semin Musculoskelet Radiol
DOI: 10.1055/a-2754-0153
Review Article

Metabolic Bone Disease in Athletes

Authors

  • Maria Pilar Aparisi Gómez 

    1   Department of Radiology, Te Toka Tumai Auckland (Auckland District Health Board), Grafton Auckland, New Zealand
    2   Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, Waipapa Taumata Rau | University of Auckland, Auckland, New Zealand

  • Giuseppe Guglielmi

    3   Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
    4   Radiology Unit, “Dimiccoli” Hospital, Barletta, Italy
    5   Radiology Unit, “IRCCS Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Foggia, Italy

  • Alberto Bazzocchi

    6   Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract

Metabolic bone disease is characterized by impaired bone strength, density, or mineralization, increasingly observed in athletes due to complex nutritional, hormonal, and mechanical factors. The underlying pathophysiology includes dysregulated bone turnover driven by hormonal imbalances, inflammatory cytokines, and microdamage accumulation.

Although weight-bearing activity generally promotes bone health, excessive training, inadequate recovery, and nutritional deficiencies, such as low calcium and vitamin D, disrupt bone remodeling, leading to decreased bone mineral density and heightened fracture risk. Female athletes with menstrual irregularities, disordered eating, and energy deficits are particularly susceptible to osteoporosis and osteopenia, components of the female athlete triad; hormonal disturbances like hypogonadism also affect males.

Imaging techniques such as magnetic resonance imaging and dual-energy X-ray absorptiometry facilitate early detection of microdamage and bone loss, guiding timely interventions. Prevention strategies are nutritional optimization, balanced training, hormonal regulation, and routine bone mineral density screening. An integrated approach of early diagnosis, lifestyle modifications, and education is vital for maintaining skeletal health and preventing long-term complications in athletes.

Keywords

metabolic bone disease - osteoporosis - relative energy deficiency in sport - stress fractures - imaging


Publication History

Received: 24 October 2025

Accepted: 21 November 2025

Article published online:
02 February 2026

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