When athletes don’t eat enough to fuel their training, their bodies can’t recover properly, which raises the risk of burnout and stress fractures—especially because hormones that keep bones strong get thrown off.
Evidence from Studies
No evidence studies found yet.
What Would Prove This
Per GRADE and EBM methodology, here is what ideal scientific evidence would look like to definitively prove or disprove this claim, ordered from strongest to weakest.
Quantify the strength of association between LEA and incidence of OTS and bone stress injuries across multiple studies.
A systematic review and meta-analysis of longitudinal studies measuring energy availability (kcal/kg FFM/day), tracking incidence of OTS (per consensus criteria) and bone stress injuries (via imaging), in elite athletes (including Paralympic), calculating pooled risk ratios and dose-response relationships.
Establish temporal relationship between LEA and development of OTS and bone injuries.
A 3-year prospective cohort of 500 elite athletes (250 Paralympic, 250 Olympic), with quarterly assessment of energy availability, hormone panels, bone density (DXA), and injury surveillance, to determine whether LEA predicts future OTS or stress fractures.
Determine whether increasing energy availability prevents OTS and bone injuries.
A double-blind RCT of 120 endurance athletes with LEA (<30 kcal/kg FFM/day), randomized to nutritional intervention (increase intake by 300–500 kcal/day) vs placebo counseling, over 12 months, measuring incidence of OTS (per diagnostic criteria) and bone stress injuries (via MRI) as primary outcomes.
Synthesize existing evidence and propose biological plausibility of LEA as a risk factor.
A narrative review by sports medicine experts summarizing literature on energy availability, RED-S, and musculoskeletal outcomes in athletes, proposing mechanisms and clinical implications.