Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners

J Athl Train. 2020 Dec 1;55(12):1239-1246. doi: 10.4085/1062-6050-0547.19.


Context: Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described.

Objective: To evaluate whether sport specialization was associated with BMD in female high school distance runners.

Design: Cross-sectional study.

Setting: Six high schools.

Patients or other participants: Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication.

Main outcome measure(s): Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age.

Results: Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD.

Conclusions: A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.

Keywords: adolescent runners; athletes; menstrual dysfunction.

MeSH terms

  • Absorptiometry, Photon
  • Adolescent
  • Body Mass Index
  • Body Weight
  • Bone Density
  • Bone Diseases, Metabolic / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Menstruation
  • Running*
  • Schools