bone health, Dance Nutrition, Menstrual cycle

There’s more to Bone Health than just Calcium



You could be enjoying a glass of milk, a tub of yoghurt, a few slices of cheese, and even sardines with bones.
And yet you may be suffering from repeated fractures.




That’s what we’re going to talk about today – a particular issue common among dancers.


(If you haven’t read the nutrition basics of bone health from last year, you can read it here)


The reason why your bone health may be compromised, despite getting enough calcium:


Hypothalamic Amenorrhea

This is when the hypothalamus (a gland in the brain that regulates hormonal balance) slows or stops releasing the period hormones.
This can be due to:

  • Emotional/mental stress
  • Strenuous exercise (= too much training, more than what your body can handle)
  • Significant weight loss, low body weight, and/or low percentage body fat
  • Inadequate energy intake (= not eating enough)


Unfortunately, it’s a much more common issue in dancers than non-dancers, because of the amount of training involved and the thin-ideal that perpetuates the class rooms


Dancers with amenorrhea has been found to have lower bone density in sites such as the lumber (lower back) and metatarsal, compared to those with regular periods. Dieting is a risk factor for lone bone density, regardless of your weight.

In addition, the risk of stress fracture is twice as high in amenorrheic dancers than those with regular periods.


When the period stops, the estrogen levels in the body starts dropping.

This is a problem because estrogen has some very important roles, such as:

  • It stimulates bone formation
  • It suppresses bone resorption (= breaking down of bone)
  • It helps vitamin D to build strong bones

So when the estrogen level drops in the body, all these functions are compromised, leading to bone loss and eventually osteoporosis.


How can you treat it?

First, see an endocrinologist. Find someone you can safely talk about the issue with the menses and get appropriate examinations and treatment options.

Increasing energy availability is vital to get the menstrual cycle back.

Eating regularly and plentifully will help support your body bring back the menses.

To start off you can read the nutrition basics articles I and II. If you need you can also refer to the meal planning guide and ideas.

If you are feeling stressed around eating, take a look at how compassionate eating can help you ease into eating.



Fumi x




Note: There are many other reasons why a menstrual cycle may stop, from natural causes (pregnancy, breast-feeding, and menopause) to other medical conditions. If you are concerned it’s best to talk to your doctor and figure out the causes first.


Doyle-Lucas AF, Akers JD and Davy BM. Energetic efficiency, menstrual irregularity, and bone mineral density in elite professional female ballet dancers. J Dance Med Sci. 2010;14(4):146-54

Gordon CM and Nelson LM. Amonorrhea and bone health in adolescents and young women. Curr Opin Obstet Gynecol. 2003 Oct;15(5): 377-84.

Hillard PJA. Menstruation in Adolescents: What’s Normal? Medscape J Med. 2008; 10(12): 295

Kaufman BA, Warren MP, Dominguez JE, Wang J, Heymsfield SB and Pierson RN. Bone density and amenorrhea in ballet dancers are related to a decreased resting metabolic rate and lower leptin levels. J Clin Endrinol Metab. 2002 Jun; 87(6): 2777-83

Miller KK and Klibanski A. Amenorrheic Bone Loss. J Clin Endo & Met. 1999. 84(6): 1775-83

Warren MP, Brooks-Gunn J, Fox RP, Holderness CC, Hyle EP and Hamilton WG. Osteopenia in Exercise-Associated Amenorrhea Using Ballet Dancers as a Model: A Longitudinal Study. The Journal of Clinical Endocrinology & Metabolism. 2002:87(7);3162-3168

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