TRIATH-BONE: Three Disciplines to Bone Health


For TriLife Magazine • ISSUE 05 • Jan-Mar 2016

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If we were to think of our body as a building, then that framework that should help keep us upright and keep up with the daily grind is our collective construct of bones – the skeleton. Regardless of your level of activity, it is apparent that we maintain good bone health. Just like any living tissue in our body, our bones go through a natural process of degradation and wear. Maintaining good bone health allows us to keep up with the level of physical activity we desire. For a lot of runners and triathletes, this level of physical activity is pretty high. Does this mean that they will have to make that extra effort to keep their bones strong knowing that the demand and stress they put on their bodies and bones are much more than the rest? Let’s break down the basic components that are essential in maintaining a strong skeletal framework:

Dr. Tony San Juan,  Triathlete and Doctor of  Orthopaedics ; Arthroscopic Surgery And Sports Medicine, Joint Replacement Surgery

Dr. Tony San Juan, Triathlete and Doctor of Orthopaedics; Arthroscopic Surgery And Sports Medicine, Joint Replacement Surgery


    CALCIUM is one of the essential and the most important elements of bone. Adequate levels of calcium in our blood will ensure that the basic scaffold of our bones is kept strong. Normal calcium metabolism allows for a balance in calcium retained in the body and calcium “thrown out” of the body. Metabolism of this element varies and is affected by age, gender, presence of other medical illnesses, hormonal imbalance and even diet/lifestyle. The best sources of calcium in the diet are milk, yoghurt, cheese, leafy greens, seafood, legumes and fruit. There are mineral drinks as well that are fortified with calcium. In our younger years, calcium balance is kept in the positive meaning that we are able to retain calcium better regardless of diet or activity. As we get older however, there is a slight shift to the negative and thus it becomes more important to include calcium sources in our diet.

    This is most important for females who are menopausal already as the absence of hormones that regulate calcium metabolism predisposes them to developing osteoporosis or what we commonly refer to as “brittle bones”. The same may apply to active females who may have stress induced or activity induced irregular or absent menstruation referred to as amenorrhea. In the young active female who has stress induced amenorrhea, it is important that she consult an Obstetrician-Gynecologist for further investigation of the possible causes for the irregular menstruation and that her physical activity has to be decreased until such time that regular menstrual periods are restored. Persons who are on chronic steroid intake are also predisposed to developing brittle bones as are chronic smokers, heavy alcoholic beverage drinkers and those who habitually drink more than 4 cups of coffee per day. Knowing all these, it is not essential for the young active athlete to have regular intake of calcium supplements unless he or she is prone to a negative calcium balance as exemplified by the medical conditions mentioned earlier. A healthy lifestyle will definitely promote better bone health too.


    Exposure as a natural source of vitamin D are essential for normal calcium metabolism. There are very few food sources for vitamin D – flesh of fatty fish like salmon, tuna and mackerel and fish liver oil. The best natural source of vitamin D is still sunlight. Twenty to thirty minutes of daily sunlight exposure is adequate to get your daily dose of vitamin D. Most athletes in training do early morning or early evening runs, rides or swims supposedly to avoid the effect of the scorching heat from the sun. While this is ideal, it deprives the athlete of the opportunity to get his or her dose of vitamin D. This shouldn’t worry the athlete however, as the most ideal time to get sunlight exposure is still high noon. It doesn’t hurt to walk out for a few minutes during your lunch break and bask in the sun – it’s healthy and you don’t have to break a sweat to get your vitamin D, and it’s a good time to catch up with your emails, phone calls and friends.


    ACTIVITY is essential to keep our bones strong. But not just any activity. Weight bearing activity is what our bones need. Compression of the bones stimulates muscle activity around the bones that eventually causes an increase in blood flow that delivers the essential elements like calcium to the bone. Such weight bearing activities may be low impact like biking or brisk walking, or high impact like running or activities that involve jumping like court or field sports (basketball, football, volleyball). Exercises that involve very minimal impact to the bones like yoga or Pilates may still increase blood flow to the muscles and bones but not to the same extent as those activities that entail more weight bearing. Does this mean there has to be constant impact to the bone to ensure adequate stimulation and circulation to the bone? Just like any other living structure in the human body, our bones are subject to fatigue as well when it is overexposed to compression or impact activities. Stress fractures to the bone – microfractures in the bone as a result of repeated loading of the bone beyond the fatigue threshold, e.g “shin splints” – may occur in athletes who progress through training in high impact activities like running too fast beyond what their bones can accommodate.

TriLife Magazine