Assessing the Risk of Low Energy Availability, Bone Mineral Density and Psychological Strain in Endurance Athletes

Background: Adequate energy intake is crucial for athletic performance and recovery. However, many endurance athletes experience Low Energy Availability (LEA), which, if prolonged, can detrimentally impact both health and performance. Methods: A total of 55 endurance athletes (23 females; 45 ± 13 years, 1.64 ± 0.06 m, 64.4 ± 11.4 kg and 32 males; 44 ± 13 years, 1.76 ± 0.18 m, 78.8 ± 9.2 kg) underwent physical assessments and completed questionnaires on dietary habits, training loads, and psychological stress. Dual-Energy X-ray Absorptiometry (DEXA) scans measured bone mineral density (BMD) in the lumbar L1-L4 spine, and body composition. Risk of LEA burnout, and psychological strain were assessed using sport-specific questionnaires. Results: Seventy-seven percent of female athletes were identified as at risk of LEA by the LEAF-Q. These females had higher body weight and fat percentage than those at low risk of LEA. Male athletes had a higher prevalence of low lumbar BMD (31%) compared to females, associated with older age, and longer training histories. Although only 9% of female athletes had low-BMD, those affected had a history of amenorrhea and were identified as at risk of LEA by the LEAF-Q. Conclusion: A high proportion of endurance athletes had low-BMD and were at risk of LEA. This underscores the need for targeted nutritional strategies to mitigate the risks associated with LEA and promote overall athlete well-being.