ArticleThe Journal of clinical endocrinology and metabolism2023
Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes.
Article in The Journal of clinical endocrinology and metabolism, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis.Sports medicine (Auckland, N.Z.) · 2025Pooled it
- Sport-Specific Impact Loading is Associated with Bone Mineral Density in Athletes: Implications for Relative Energy Deficiency in Sport (REDs) Assessment.Sports medicine (Auckland, N.Z.) · 2026Article
- Testosterone status and bone mineral density in Finnish male endurance athletes: Baseline associations and 1-year follow-up.Physiological reports · 2026Article
- Low energy availability, the gut microbiome, and bone health in athletes: a mechanistic narrative review based on athlete evidence and clinical analogues.Frontiers in nutrition · 2026Review
- Low Energy Availability and Its Impact on Bone Health and Metabolism in Athletes: A Narrative Review.Physiological research · 2025Review
- Low energy availability surrogates are associated with Relative Energy Deficiency in Sport outcomes in male athletes.British journal of sports medicine · 2024Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
contextFemale athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners.
objectiveTo determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength.
designCross-sectional.
settingClinical research center.
participants39 men (20 runners, 19 controls), ages 16-30 years.
main outcome measuresAreal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability.
resultsMean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA <median had lower lumbar spine (-1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs -0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA <median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P < .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners.
conclusionsDespite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
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