Why do I keep getting stress fractures? I menstruate normally, dance on a sprung floor and take calcium supplements to strengthen my bones. I also follow my orthopedist's instructions and did rehab after previous stress fractures. What's wrong with my body?

—Rose, Yonkers, NY

Kudos to you for being aware of the main factors that cause stress fractures. Additional risk factors include being Caucasian, female or underweight; having low bone density; or abusing alcohol, nicotine or steroids. A full medical checkup can help you identify problems related to your weight or bone density.

According to New York City–based dance medicine specialist Dr. Jessica Gallina, there is another factor that is easily overlooked: vitamin D deficiency. She strongly believes that all dancers should be checked for a deficiency, given the associated risk of stress fractures and poor healing after a fracture. A vitamin D deficiency causes you to absorb only about 10 to 15 percent of dietary calcium and 50 to 60 percent of dietary phosphorous needed for bone mineralization and structure. Dancers who spend most of their time in the studio may have low amounts of the "sunshine vitamin." A blood test can pinpoint this problem, and your doctor can discuss how to increase and maintain a safe level.

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Cloud cover and air pollution can make it harder for your skin to produce vitamin D from the sunlight, so dermatologists recommend getting this essential vitamin from food or supplements. Foods high in D include salmon, canned tuna, eggs and fortified products. If you're shopping for a supplement, look for D3 and take it with fatty food to aid absorption.

Send your questions to Dr. Linda Hamilton at advicefordancers@dancemedia.com.

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