Conservative and Pharmacological Strategies for Preventing Osteoporotic Stress Fractures in Older Recreational Competitors

Exercise and bone health are crucial for overall cardiovascular and metabolic well-being. However, certain types of activities can increase the risk of osteoporotic fractures. Preventing injuries while remaining active can be challenging, particularly for older competitive recreational athletes whose training volumes can be comparable to those of professional athletes. While high levels of physical activity in older adults typically lead to thicker cortical bone and improved physical fitness, age-related bone loss, hormonal changes, nutrition, and a history of fractures can significantly raise the risk of osteoporosis. This narrative review provides a descriptive summary of the current understanding of the paradox between exercise and bone fragility, particularly in recreational athletes. Many older athletes may be unaware of their declining bone mineral density, believing that their activity levels are sufficient. Ironically, high-impact activities like running and jumping, which are generally recommended for the prevention of osteoporosis, can also increase the risk of stress fractures. Early detection of osteoporosis is crucial, and this can be achieved through DEXA scans and regular bone density tests, allowing for timely intervention before fractures occur. Alongside medications, strength training, as well as balance and stability exercises, can be very beneficial. It is also important to maintain healthy lifestyle choices, ensure adequate energy levels, and consume sufficient amounts of calcium and vitamin D. Furthermore, monitoring training volume and allowing for proper recovery can help reduce the risk of osteoporotic stress fractures in athletes.