High prevalence of low bone mineral density in wheelchair users regardless of sports participation: a cross-sectional analysis of the bonewheel study

Linn C Risvang; Jan-Willem van Dijk; Julia K Baumgart; Hannah M Rice; Anja M F Liljegren; Vegard Strøm; Truls Raastad; Kristin L Jonvik

doi:10.1007/s00421-025-06109-1

High prevalence of low bone mineral density in wheelchair users regardless of sports participation: a cross-sectional analysis of the bonewheel study

Eur J Appl Physiol. 2026 May;126(5):2879-2892. doi: 10.1007/s00421-025-06109-1. Epub 2025 Dec 24.

Authors

Linn C Risvang¹, Jan-Willem van Dijk², Julia K Baumgart³, Hannah M Rice¹, Anja M F Liljegren⁴, Vegard Strøm^{1

5}, Truls Raastad¹, Kristin L Jonvik⁶

Affiliations

¹ Department of Physical Performance, Norwegian School of Sport Sciences, Postboks 4014, Oslo, 0806, Norway.
² Institute for Sports and Exercise Studies, HAN university of Applied Sciences, Nijmegen, The Netherlands.
³ Department of Neuromedicine and Movement Science, Norwegian University of Technology and Science, Trondheim, Norway.
⁴ SimArena, Department of Health and Functioning, Western Norway University of Applied Science, Bergen, Norway.
⁵ Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
⁶ Department of Physical Performance, Norwegian School of Sport Sciences, Postboks 4014, Oslo, 0806, Norway. kristinlj@nih.no.

Abstract

PURPOSE: Wheelchair users are at increased risk of low bone mineral density (BMD). While BMD varies by sport among Paralympic athletes, it remains unclear whether sports participation protects against low BMD in the impaired population. This study compared BMD at several skeletal sites between sports-active and non-sports-active wheelchair users. METHODS: This study presents cross-sectional analyses of adult (18–60 years) wheelchair users with non-progressive impairments recruited for a subsequent multi-site intervention study. BMD and body composition were measured with dual-energy X-ray absorptiometry. Low BMD was defined as Z-score <–1.0. Multiple linear regression models assessed differences between sports-active (≥ 1 year organised; ≥3 training hours per week) and non-sports-active participants, and associations with impairment and exercise characteristics, and body composition. RESULTS: Sixty-three wheelchair users (age 37 ± 11 years; 41% female; 48% sports-active; 49% with acquired impairments) were included. Low BMD was prevalent in 33%, 81% and 77% at the spine, hip and femoral neck, respectively. Low BMD at the hip was less prevalent in sports-active compared to non-sports-active (p = 0.013), without differences in any BMD Z-score models (all p > 0.05). Acquired impairments was positively associated with lumbar spine BMD (p = 0.034), while full-time wheelchair use was negatively associated with femoral neck BMD (p = 0.036). Impairments and SCIM scores were associated with hip BMD (both p < 0.05). CONCLUSION: Notably high prevalences of low BMD was found in this study, particularly at the hip and regardless of sports participation. Impairments and ambulatory ability appear the most influential on BMD. Targeted exercise interventions for bone health are warranted in this population. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (NCT05615402) on Nov 14, 2022, as well as Open Science Framework ( https://doi.org/10.17605/OSF.IO/SE2TB ) on Jan 04, 2023.

Keywords: Bone health; Cerebral palsy; Lean body mass; Para sports; Paraplegia; Spina bifida; Spinal cord injury.

Associated data

ClinicalTrials.gov/NCT05615402