EC Orthopaedics

This systematic review critically examines the English-language literature on nutrition-bone formation relationships in athletic populations to establish evidence-based foundations for interventions at Cuba’s EIDE Ormani Arenado Llonch (Basic Sports Formation School) in Pinar del Río. Low energy availability triggers hormonal disruptions compromising bone integrity, yet bone recovery following energy restoration may be incomplete. While calcium and carbohydrate supplementation modulate acute bone biomarker responses to exercise, the clinical significance of these acute changes for long-term bone health remains unclear. Olympic nutrition programs demonstrate the value of rational nutrition and educational interventions, though most evidence derives from observational reports. Sports supplements present a complex picture: omega-3 and collagen offer benefits, while glutamine and arginine lack evidence, and widespread contamination with prohibited substances poses serious health risks. Cuba faces import dependence, agricultural limitations, and restricted supplement access due to the blockade, yet grassroots initiatives like Zuca Saludable and institutional coordination models demonstrate local innovation potential. International precedents from Indonesia suggest locally sourced recovery drinks effectively support post-exercise recovery in resource-limited settings. Cuban research confirms strong demand for national sports supplements. Evidence supports prioritizing adequate energy availability and food- based interventions over commercial supplements. Recommendations for EIDE Ormani Arenado include systematic nutritional assessment, strategic supplementation based on deficiencies, development of locally sourced recovery foods, horticultural projects for fresh produce and nutrition education, and systematic bone health monitoring. Future research should investigate Cuban athletic bone health outcomes, evaluate local recovery food efficacy, and assess integrated nutritional-educational interventions. This review provides a critical foundation for nutritional interventions accounting for Cuba’s resource context while optimizing bone formation and athletic performance. A key caveat is that the acute biomarker changes discussed may not translate directly into clinically significant long-term bone health outcomes, and this limitation should be considered when interpreting the evidence presented.

Keywords: Bone Formation; Sports Nutrition; Energy Availability; Cuban Athletes; Supplements

1. Dolan E., et al. “The influence of nutrition intervention on the P1NP- and CTX-1-response to an acute exercise bout: a systematic review with meta-analysis”. Sports Medicine 11 (2024): 2889-2906.
2. Rosie Rudin., et al. “Exploring different interventions for Relative Energy Deficiency in Sport (REDs): a systematic review”. JSAMS Plus 5 (2025): 100085.
3. González R., et al. “Matanzas: la docencia en el deporte, otra víctima del bloqueo”. ACN (2025).
4. Stellingwerff T., et al. “Fueling gold medals: developing a 'periodised nutrition system' for elite athletes”. Performance Nutrition1 (2025): 12-25.
5. Sale C and Elliott-Sale KJ. “Changing nutritional and training practices to improve bone health of elite athletes”. Nottingham Trent University (2026).
6. Nishiyama H. “Case study: nutrition support for Olympic figure skating champions RikuRyu”. Japan Forward (2026).
7. Mountjoy M., et al. “The IOC consensus statement on Relative Energy Deficiency in Sport (RED-S): 2014 update”. International Olympic Committee (2014).
8. Stenqvist TB., et al. “Prevalence of surrogate markers of Relative Energy Deficiency in male Norwegian Olympic-level athletes”. International Journal of Sport Nutrition and Exercise Metabolism 6 (2021): 1-10.
9. Organizaciones médicas y deportivas alertan de que los suplementos nutricionales tienen riesgos para la salud. Servicio de Noticias en Salud Al Día (2025).
10. Castillo Díaz P., et al. “Desarrollo de suplementos nutricionales para deportistas cubanos de alto rendimiento”. Revista Cubana de Medicina del Deporte y la Cultura Física 1 (2023): e144.
11. Jakše B. “Nutritional, cardiovascular health and lifestyle status of elite female swimmers: Olympic cycle comparison”. International Journal of Environmental Research and Public Health 21 (2021): 11245.
12. Siregar M., et al. “Homemade recovery drink effects on physical recovery in adolescent soccer players”. Garuda (2025).
13. Cuba Sports Nutrition and Fitness Supplements Market. 2025-2031.
14. Robling AG., et al. “Biomechanical and molecular regulation of bone remodeling”. Annual Review of Biomedical Engineering 8 (2006): 455-498.
15. Weaver CM., et al. “The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations”. Osteoporosis International 4 (2016): 1281-1386.