Peripubertal female athletes in high-impact sports show improved bone mass acquisition and bone geometry

Metabolism. 2013 Aug;62(8):1088-98. doi: 10.1016/j.metabol.2012.11.010. Epub 2013 Mar 11.


Objective: Intensive physical training may have a sport-dependent effect on bone mass acquisition. This cross-sectional study evaluated bone mass acquisition in girls practicing sports that put different mechanical loads on bone.

Materials/methods: Eighty girls from 10.7 to 18.0 years old (mean 13.83 ± 1.97) were recruited: 20 artistic gymnasts (AG; high-impact activity), 20 rhythmic gymnasts (RG; medium-impact activity), 20 swimmers (SW, no-impact activity), and 20 age-matched controls (CON; leisure physical activity <3h/wk). Areal bone mineral density (aBMD) was determined using DEXA. Hip structural analysis applied at the femur evaluated cross-sectional area (CSA, cm(2)), section modulus (Z, cm(3)), and buckling ratio. Bone turnover markers and OPG/RANKL levels were analyzed.

Results: AG had higher aBMD than SW and CON at all bone sites and higher values than RG in the lumbar spine and radius. RG had higher aBMD than SW and CON only in the femoral region. CSA and mean cortical thickness were significantly higher and the buckling ratio was significantly lower in both gymnast groups compared with SW and CON. In RG only, endocortical diameter and width were reduced, while Z was only increased in AG compared with SW and CON. Reduced bone remodeling was observed in RG compared with AG only when groups were subdivided according to menarcheal status. All groups showed similar OPG concentrations, while RANKL concentrations increased with age and were decreased in SW.

Conclusion: High-impact activity clearly had a favorable effect on aBMD and bone geometry during the growth period, although the bone health benefits seem to be more marked after menarche.

Keywords: AG; BMI; Bone mass acquisition; CON; CSA; CSMI; CTX; DEXA; FFST; FM; Growth period; HAS; IT; Intensive training; L1-L4; Markers of bone turnover; NN; OC; OPG; OPG/RANKL system; PINP; RANKL; RG; SW; TPF; WB; Z; aBMD; areal bone mineral density; artistic gymnasts; body mass index; bone cross-sectional area; controls; cross-sectional moment of inertia; dual-energy x-ray absorptiometry; fat mass; fat-free soft tissue; hip structural analysis; intertrochanteric; lumbar spine; narrow-neck; osteocalcin; osteoprotegerin; procollagen type I N-terminal propeptide; rank-ligand; rhythmic gymnasts; section modulus; swimmers; total proximal femur; type I-C telopeptide breakdown products; whole body.

MeSH terms

  • Absorptiometry, Photon
  • Adolescent
  • Anatomy, Cross-Sectional
  • Athletes*
  • Body Composition / physiology
  • Bone Density / physiology
  • Bone and Bones / anatomy & histology*
  • Case-Control Studies
  • Child
  • Female
  • Femur / anatomy & histology
  • Gymnastics
  • Hip / anatomy & histology
  • Humans
  • Menstruation
  • Motor Activity
  • Osteoprotegerin / blood
  • Physical Fitness / physiology
  • Puberty / physiology*
  • RANK Ligand / blood
  • Sports / physiology*
  • Stress, Mechanical
  • Swimming


  • Osteoprotegerin
  • RANK Ligand
  • TNFSF11 protein, human