Also In This Section

Fracture Risk Calculator


Men and Osteoporosis

Think osteoporosis is only an issue for women? Watch this video and learn more about men and o... Read more

The Faces of Osteoporosis

Featured Partners

Thank you for supporting American Bone Health.

Athletic Energy Deficit

You’ve set the stage: intense training and performance goals.

A young female athlete starts to push herself harder than usual, placing incredible stress on her body. She trains intensely, trying to gain a competitive edge.

As she pursues excellence, you reward her for her discipline and focus. Sometimes - at a cost. When your athlete is under-fueled for her activity level, she can come up short on bone development and athletic performance.



“Repeatedly, my mother, my doctors and my nutritionists told me how serious my amenorrhea and low bone density was, but I chose not to

Gaining peak performance by sacrificing nutrition, especially during puberty, may lead to Athletic Energy Deficit (AED) and a decrease in bone formation and increase in bone fractures. AED may even put a young female athlete at risk for early osteoporosis. Fueling the body translates to better performance and better bones. hear it. Running fast and staying skinny were too important to me....” Clara Horowitz, Runner, NCAA 5-time All-American National Cross-country Medalist, Spokesperson for American Bone Health.

Click the image to the right to read the full article.

What is Athletic Energy Deficit (AED)?

AEDAED is a gap in energy. AED results when sustained activity (energy output) is not balanced with a proportional increase in nutrition (energy input). AED often develops when there is pressure to change eating habits, particularly in some sports where a low body weight is encouraged.


Why young female athletes?

The years around puberty are a time of rapid bone formation. Girls build 60% to 80% of their bone mass young female athletesby age 18. Whenever pre-teen and teenage girls do not eat enough to meet their energy needs they face “energy deficit”. If nutrition is insufficient, the body may try to conserve energy by shutting down systems that are important to bone growth and reproductive development.

What is the link between AED and menstrual cycles?

With insufficient energy, estrogen levels may be too low to produce a normal menstrual cycle. Delayed menstruation, irregular cycles or missing cycles are signs that there is a hormone imbalance associated with slower bone formation.

What is the link between AED and bone health?

If AED is severe, low estrogen levels also block functions necessary for proper bone growth. In addition, a diet without adequate calcium and vitamin D contributes to poor bone formation. Should the AED continue unchecked, poor bone growth may result in stress fractures and early osteoporosis, a disease where bones become fragile and are more likely to break.

What can a parent or coach do if they suspect AED?

Cover pageParents should contact their family doctor immediately. The doctor may refer them to a nutritionist or other specialist in behavioral therapy. In some cases, successful treatment may only require a relatively modest reduction in exercise, improved nutrition and a small increase in body weight.

Coaches who are aware of possible AED symptoms - insufficient caloric intake, low weight, menstrual irregularity, stress fractures - should not hesitate to contact their athlete’s parents and tell them about AED and its health risks.

There are many health benefits associated with regular exercise or athletic competition, as long as athletes fuel their bodies with proper nutrition and rest to stay healthy and strong.

Click here to download the "Parents and Coaches Beware: Are Your Girls Coming Up Short?" brochure, or click on the image.