Dancers spend a lot of time training to master skills and technique that expose bone to a great deal of stress. Bone and joint injuries can result from sudden trauma, i.e. fracture or cartilage tear, or from overuse and repeated stress over time. In a healthy person who has adequate recovery and nutrition, bone repairs itself and maintains or improves strength. When dancers, especially those involved in frequent and rigorous dancing, knowingly or unknowingly exercise too much and eat too little, they may be at risk for lone bone mass and bone stress injuries. Whether a dancer is working on balancing on pointe or improving jumps, all dancers need good bone health to stay active and healthy throughout their dance career – and life.

Bone is a living tissue that is constantly changing. Nutrition, weightbearing activity, and certain hormones all play a role in the development and maintenance of healthy bones. In healthy individuals, peak bone mineral density is achieved in their early 20’s. As we age, both bone mass and bone strength gradually decrease, therefore bone disease prevention begins during childhood and adolescence – coincidentally when a dancer ramps up their dance training. Osteoporosis, a bone disease caused by weakened, porous bone, occurs silently and progressively over time, often with no symptoms until a fracture occurs. Bone stress injuries (i.e. stress fractures) lead to pain and lost time from dancing, but may also be an indication of an underlying bone disease. 

To optimize bone health, dancers need to eat enough calories to support their dance training; consume foods that provide adequate calcium, vitamin D and other key nutrients; and, recognize that menstrual irregularity is a warning sign for low bone mass. 

Fuel Up to Prevent Low Energy Availability

Consuming enough calories to fuel dance, daily activities and other body functions is critical. Low energy availability is the result of not having enough energy (or calories) left over and available for other body’s functions after the energy taken in from food is expended for dance and other activities. 

A dancer who suffers from low energy availability may notice physiological and performance consequences, including chronic fatigue, anemia, digestive disorders (bloating, constipation, delayed gastric emptying), irritability, mood changes or depression, disordered eating or a “fixation on eating right”, and as mentioned previously, stress fractures or repeated bone injuries. Avoiding restrictive eating or extreme diets and consuming a variety of foods that provide protein, carbohydrates, and fat, at three meals and two to three snacks throughout the day will generally meet the energy demands of your body and dancing. 

Key Nutrients for Bone Development

Many nutrients work together to support the growth and maintenance of bone tissue. Achieving peak bone mass during childhood and adolescence, as well as preserving bone mass as we age, is dependent on the body having enough protein. Including a source of protein (lean meat, fish, dairy products, soy foods, beans, legumes and nuts) at each of your meals and snacks will provide the building blocks necessary for building a strong matrix of protein fibers in bone. 

Vitamins and minerals, such as calcium, vitamin D and phosphorus are also needed for bone growth and repair. Calcium is critical to bone health since bone is composed mainly of a calcium-phosphate mineral complex along with connective tissue (protein). In addition to maintaining bone strength, calcium is also important for regulating muscle contractions, maintaining blood pressure, and transmitting nerve impulses.  Most of the body’s calcium is stored in our bones (and teeth) – think of it like a “calcium bank”. Without enough calcium each day from the diet, the body will “withdraw” what it needs from the bone (or calcium bank) to keep blood calcium levels normal. If more calcium is removed from the bones than is consumed in the diet, the bones may become fragile or weak.

Good sources of calcium include dairy products (milk, yogurt, kefir, and cheese), calcium-fortified juices or plant milks, some types of tofu, certain vegetables (collard greens, kale, broccoli, bok choy), oranges and almonds. 

Vitamin D is also vital to bone health as it is needed for the absorption of calcium from the intestines and plays a key role in bone mineralization. Vitamin D is present in only a few foods including fatty fish, egg yolks and fortified foods, like milk and cereal. It is also made in the skin when exposed to sunlight. 

The Institute of Medicine (IOM) publishes recommendations for Dietary Reference Intakes for Calcium and Vitamin D, based on substantial research linking adequate calcium intake and vitamin D status to bone strength and bone mineral density. The recommendations are for children, 1 to 18 years of age, to consume 700 to 1,300 milligrams (mg) calcium per day and 600 IU vitamin D per day from food sources of these nutrients.  Adults aged 19 to 50 years of age need 1,000 mg calcium and 600 IU vitamin D.  For those unable to get sunlight or consume sufficient Vitamin D from foods, 2,000 units of Vitamin D daily may be recommended, but you should consult with your doctor before taking any supplement. 

Following is a sample menu providing 1,000 mg of calcium. Of course, food preferences and individual needs for amounts of food vary; however, eating a variety of foods, as illustrated here, provides key nutrients while meeting a dancer’s unique demands for ample energy and nutrient-rich sources of carbohydrate, protein, fat. 

Meal or Snack

Sample menu

(calcium-containing foods in italics)

Calcium (in milligrams)

Breakfast

1 cup cooked oatmeal with 2 tbsp almond butter   2 scrambled egg(s) with ½ cup sautéed spinach1 cup orange slices

150

Lunch

Chicken Caesar wrap: Whole grain tortilla with3 ounces chopped chicken breast, ½ cup romaine2 Tbsp parmesan and dressing1 cup strawberries

100

Snack

Fruit smoothie made with 1 cup milk or yogurt

300

Dinner

Stir fry with 3 oz. shrimp and vegetables that includes ½ cup (cooked) kale, ½ cup broccoli, onions, and carrots1 cup brown rice

80

Snack

1 oz. almonds, 6 oz. Greek yogurt, 1 apple

375

Total Calcium

~ 1,005 milligrams