Cortical and trabecular bone analysis of professional dancers using 3D-DXA: a case-control study

J Sports Sci. 2019 Jan;37(1):82-89. doi: 10.1080/02640414.2018.1483178. Epub 2018 Jun 18.


Given the lack of relevant data, the aim of this study was to examine femur cortical and trabecular bone in female and male professional ballet dancers. 40 professional ballet dancers and 40 sex- and age-matched non-exercising controls volunteered. Femoral bone density was scanned by dual-energy X-ray absorptiometry (DXA) scan. A 3D-DXA software was used to analyse trabecular and cortical bone. Anthropometry, maturation (Tanner staging), menstrual parameters (age at menarche and primary amenorrhea), energy availability and nutritional analysis (3-day record) were also assessed.Compared to non-exercising participants, dancers exhibited significantly higher volumetric density for integral, cortical and trabecular bone, and thicker cortex at the femur. Ballet dancers demonstrated lower body weight compared to controls (p < 0.01). Female dancers had their menarche later than controls, and the prevalence of primary amenorrhea were significantly higher in dancers than controls (p < 0.01). Dancer's energy availability was below the normal range (<30 kcal/kgFFM/day). Despite the presence of certain osteoporosis risk factors such as low energy availability, primary amenorrhoea and lower body weight, professional ballet dancers revealed higher bone density for both cortical and trabecular bone compartments compared to controls.

Keywords: Bone density; DXA; athletes; dance training; osteoporosis.

MeSH terms

  • Absorptiometry, Photon*
  • Adult
  • Amenorrhea
  • Anthropometry
  • Body Weight
  • Bone Density / physiology*
  • Cancellous Bone / anatomy & histology*
  • Cancellous Bone / diagnostic imaging*
  • Case-Control Studies
  • Cortical Bone / anatomy & histology*
  • Cortical Bone / diagnostic imaging*
  • Dancing / physiology*
  • Diet
  • Energy Metabolism
  • Female
  • Femur / anatomy & histology
  • Femur / diagnostic imaging
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Menstruation
  • Middle Aged
  • Osteoporosis
  • Risk Factors
  • Sexual Maturation