June 23, 2021 marks the 49th anniversary of Title IX, a federal civil rights law passed as part of the Education Amendments of 1972. This ground breaking legislation states that “no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.” Over the years, Title IX dramatically increased the opportunities for women in education and athletics and in turn has had a positive influence on their overall health and well-being. Proliance Hand, Wrist and Elbow (PHWE) Surgeons would like to take a moment to recognize the impact that Title IX has had for women and more specifically highlight the benefits of building better bones.

How does Title IX build better bones for women? 

Although Title IX’s legislation applies to every aspect of federally funded education, the law is best known for its profound impact on improving girls’ access to school athletics. Allowing young girls and women increased access to sports has yielded a number of positive outcomes. Recent studies have shown that girls who engage in sports have improved physical, social and emotional health as well as educational advancements as compared to girls who do not. Girls who participate in sports are more likely to possess higher grade point averages, higher graduation rates and seek out leadership roles in their careers and communities. They experience higher levels of self-esteem and have reduced rates of depression, suicide, illicit drug use and unintended pregnancies. They are more likely to sustain physically active lifestyles into adulthood making them less likely to experience obesity, diabetes, breast cancer and osteoporosis in the future. Our group has recently highlighted some of the issues regarding osteoporosis and that article can be found by clicking here. For all of these reasons and more, Title IX can be considered more than just an investment in education and athletics, it is a pivotal investment in the long-term health of women and their bones.

How can sports build better bones for women?

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One of the benefits of girls engaging in sports is the effect that physical activity has on their developing skeletal structures. During adolescence and early adulthood, girls lay down the foundation for their long-term bone density or mass. Bone mass is developed by repeatedly loading or stressing bone tissue such as when running or jumping. The growing bones of the tween and teen years respond to these repeated stressors by adding more bone tissue over time. Impact sports and weight bearing activities are key to better bones because they increase density and optimize skeletal health. According to Goolsby et al, “adolescence and young adulthood are the most beneficial times for long-term bone density gains, with nearly 90% of peak bone mass gained by age 18 years”.

How Activity Impacts a Girl’s “Bone Bank”

 Peak bone mass is often referred to as a girl’s “bone bank.” The “bone bank” is analogous to a bank’s savings account by which a person can “deposit” or “withdraw” a sum as needed, in this case bone tissue. According to the National Institute of Health, “during childhood and the teenage years, new bone is added to the skeleton faster than old bone is removed. As a result, bones become larger, heavier, and denser. For most people, bone formation continues at a faster pace than removal until bone mass peaks during the third decade of life. After age 20, bone “withdrawals” can begin to exceed “deposits.”

What happens when the “bone bank” becomes depleted?

 With regards to bone health and orthopedic surgery, a woman’s “bone bank” is critical to reducing her likelihood of developing bone disease as she ages. The most common bone disease women face is known as osteoporosis and related osteopenia. Osteoporosis occurs when bone density and/or mass decreases and results in a fragile skeleton prone to fractures that might not otherwise occur. This process happens naturally as all women age with the highest losses occurring during and following menopause. Osteoporosis and related fragility fractures have an enormous effect on an aging woman’s long-term independence and survival rates making this a top priority for all medical providers.

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Other Ways to Build Better Bones

Impact sports and activity may be key in developing a healthy skeleton but they aren’t the only option for helping girls build better bones. Nutrition plays an enormous role in successful bone development. Bones require a proper balanced diet in order to maximize their density accumulation. Ensuring that a tween and teen girl is consuming the correct quantity of calcium and vitamin D can help to ensure proper mineralization of bones as she builds her peak bone mass.

A young woman can also optimize bone health by developing healthy lifelong habits beyond that of nutrition. Avoiding smoking, alcohol and drug use is important at any age but most critical during the years of such rapid bone development as this can suppress bone mineralization. Eating disorders, most commonly developed during the adolescent years, also have a profound effect on bone development. A lack of proper nutrition can lead to a rapid decline in bone health. Regular visits with your pediatrician can help identify and/or address any of these potential issues.

The Legacy of Title IX on Women’s Health

better bonesPHWE would like to celebrate the contribution that Title IX has had on expanding opportunities for girls in athletics and the lifelong effect of building better bones. By providing expansive opportunities for girls to engage in sports, Title IX has had a significant effect on their bone growth and development. As we slowly begin to emerge from sedentary pandemic life, we at PHWE encourage girls to return to sports and physical activity. We know when they run, jump, leap, spike, kick, dance, bat and dribble that they are building a better future not just for their bones, but for their overall health and well-being. To the parents of these growing girls, we applaud you for encouraging her to remain active. We thank you for investing in gymnastics lessons, taking her on a hike or encouraging her to try out for that cross-country team.  Please know that whether you are shivering on the sidelines of her soccer match or rushing to get to her ballet recital in time, your efforts are an investment in her mental health, physical wellbeing and lifelong better bones.


For additional resources on Title IX, building of your teen girls “bone bank” and osteoporosis please see the following:
45 years of Title IX: The Statue of Women in Intercollegiate Athletics, The National Collegiate Athletic Association
Fast Facts: Title IX, National Center for Education Statistics
Her Life Depends on It III: Sport, Physical Activity & the Health & Well Being of American Girls & Women, Women Sports Foundation
What Is Bone?, National Institute of Health, Osteoporosis and Related Bone Diseases
Position Statement: Physical Activity and Bone Health, American College of Sports Medicine
Osteoporosis: The Brittle Truth, PHWE Blog


About the Author:

Kristin Rosen OTR/L, CHT, CLT is an occupational therapist who specializes in hand and upper extremity rehabilitation in addition to treatment of lymphedema. She has a strong interest in supporting women’s health in the field of orthopedics. She lives in the Seattle area with her husband and when not working she is mostly a professional chauffeur to her teen and tween children.