Bone mineral density in female runners, swimmers, and water polo athletes Comparisons across sports with different impacts
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Abstract
Bone mineral density (BMD) is a measure of bone health which reflects risk for osteoporosis. Different types of exercise induce divergent impact on the skeleton influencing accrual of BMD. Previous research reported that female collegiate athletes in aquatic sports had lower BMD than other athletes and controls. PURPOSE: The goal of this study was to conduct a modern comparison of BMD of athletes in weight-bearing and non-weight-bearing sports with normally active controls. METHODS: Height, weight, and calcium intake was assessed in collegiate females (20.0 ± 1.3 years); 39 runners, 9 swimmers, 16 water polo players, and 24 controls. BMD and bone free lean mass were measured via dual-energy x-ray absorptiometry (DXA) at baseline and 5 months later. RESULTS: When controlling for calcium intake and lean mass, there were no statistical differences between groups in BMD at the anterior-posterior (AP) spine, lateral spine, trochanter, total hip, and whole body. At the femoral neck (FN), water polo players had greater BMD than swimmers (0.922 ± 0.030 vs. 0.790 ± 0.033 g/cm2, p = .005). Longitudinally, increases in BMD between visits occurred for swimmers at the AP spine (p = .028), lateral spine (p = .049), FN (p = .049), and trochanter (p = .018) and for controls at whole body (p = .008). CONCLUSION: Bone health in female aquatic athletes was similar to controls and runners, except at the FN where BMD of swimmers was less than water polo players. Some females may continue to accrue BMD in college years. Modern training methods among female college athletes may lead to similar bone health even in sports with different skeletal impact.
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Loyola Marymount University
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References
Barrack, M. T., Rauh, M. J., Nichols, J. F. 2008. Prevalence of and traits associated with low bmd among female adolescent runners. Med Sci Sports Exerc. 40(12), 2015-2021. https://doi.org/10.1249/MSS.0b013e3181822ea0
Bell, R. C. 2007. A history of women in sport prior to title ix. The Sport Journal. 10(2).
Cohen, J. 1988. Statistical power for the behavioral sciences. Routledge.
Fredericson, M., Chew, K., Ngo, J., Cleek, T., Kiratli, J., Cobb, K. 2007. Regional bone mineral density in male athletes: A comparison of soccer players, runners and controls. Br J Sports Med. 41(10), 664-668. https://doi.org/10.1136/bjsm.2006.030783
Greene, D. A., Naughton, G. A., Bradshaw, E., Moresi, M., Ducher, G. 2012. Mechanical loading with or without weight-bearing activity: Influence on bone strength index in elite female adolescent athletes engaged in water polo, gymnastics, and track-and-field. J Bone Miner Metab. 30(5), 580-587. https://doi.org/10.1007/s00774-012-0360-6
Gunter, K. B., Almstedt, H. C., Baptista, F., Janz, K. F. 2011. The importance of childhood physical activity for optimal lifelong bone health. Research Digest for the President's Council on Fitness, Sports, and Nutrition. 12(4), 1-8.
Haff, G., Triplett, N. 2015. Essentials of strength training and conditioning. Human Kinetics.
Henry, M. B., Almstedt, H. C. 2009. Validity of a dietary calcium questionnaire modified to include supplement use in athletes. J Sports Sci Med. 8(2), 225-229.
Ho-Pham, L. T., Nguyen, U. D., Nguyen, T. V. 2014. Association between lean mass, fat mass, and bone mineral density: A meta-analysis. J Clin Endocrinol Metab. 99(1), 30-38. https://doi.org/10.1210/jc.2013-3190
Infantino, N. A., McCormack, W. P., Almstedt, H. C. 2021. Bone mineral density and hip structure changes over one-year in collegiate distance runners and non-athlete controls. Bone Rep. 14, 101056. https://doi.org/10.1016/j.bonr.2021.101056
IOM. 2011. Dietary reference intakes for calcium and vitamin d. Washington, DC: The National Academies Press.
Johnell, O., Kanis, J. A., Oden, A., Johansson, H., De Laet, C., Delmas, P., Eisman, J. A., Fujiwara, S., Kroger, H., Mellstrom, D. et al. 2005. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 20(7), 1185-1194. https://doi.org/10.1359/JBMR.050304
Kavouras, S. A., Magkos, F., Yannakoulia, M., Perraki, M., Karipidou, M., Sidossis, L. S. 2006. Water polo is associated with an apparent redistribution of bone mass and density from the lower to the upper limbs. Eur J Appl Physiol. 97(3), 316-321. https://doi.org/10.1007/s00421-006-0201-1
Kohrt, W. M., Bloomfield, S. A., Little, K. D., Nelson, M. E., Yingling, V. R. 2004. Physical activity and bone health. American College of Sports Medicine. https://doi.org/10.1249/01.MSS.0000142662.21767.58
Leslie, W. D., Lix, L. M., Manitoba Bone Density, P. 2011. Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: Derivation and validation of a hybrid system. J Bone Miner Res. 26(3), 460-467. https://doi.org/10.1002/jbmr.248
McCormack, W. P., Shoepe, T. C., LaBrie, J., Almstedt, H. C. 2019. Bone mineral density, energy availability, and dietary restraint in collegiate cross-country runners and non-running controls. Eur J Appl Physiol. 119(8), 1747-1756. https://doi.org/10.1007/s00421-019-04164-z
McGuire, C. Celebrating progress: Women's representation in NCAA sports, leadership roles. 2025. NCAA. Retrieved from [Accessed 2025, 30 May]: https://www.ncaa.org/news/2025/3/1/media-center-celebrating-progress-womens-representation-in-ncaa-sports-leadership-roles.aspx#:~:text=1.,Sports%20on%20the%20rise
Pereira, M. A., FitzerGerald, S. J., Gregg, E. W., Joswiak, M. L., Ryan, W. J., Suminski, R. R., Utter, A. C., Zmuda, J. M. 1997. A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc. 29(6 Suppl), S1-205.
Sale, C., Elliott-Sale, K. J. 2019. Nutrition and athlete bone health. Sports Med. 49(Suppl 2), 139-151. https://doi.org/10.1007/s40279-019-01161-2
Sarafrazi, N., Wambogo, E. A., Shepherd, J. A. 2021. Osteoporosis or low bone mass in older adults: United states, 2017-2018. NCHS Data Brief. (405), 1-8. https://doi.org/10.15620/cdc:103477
Taaffe, D. R., Robinson, T. L., Snow, C. M., Marcus, R. 1997. High-impact exercise promotes bone gain in well-trained female athletes. J Bone Miner Res. 12(2), 255-260. https://doi.org/10.1359/jbmr.1997.12.2.255
Taaffe, D. R., Snow-Harter, C., Connolly, D. A., Robinson, T. L., Brown, M. D., Marcus, R. 1995. Differential effects of swimming versus weight-bearing activity on bone mineral status of eumenorrheic athletes. J Bone Miner Res. 10(4), 586-593. https://doi.org/10.1002/jbmr.5650100411
Tam, N., Santos-Concejero, J., Tucker, R., Lamberts, R. P., Micklesfield, L. K. 2018. Bone health in elite kenyan runners. J Sports Sci. 36(4), 456-461.
Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J. H., Golden, N. H., Fredericson, M. 2018. Sport and triad risk factors influence bone mineral density in collegiate athletes. Med Sci Sports Exerc. 50(12), 2536-2543. https://doi.org/10.1249/MSS.0000000000001711
Tenforde, A. S., Fredericson, M., Sayres, L. C., Cutti, P., Sainani, K. L. 2015. Identifying sex-specific risk factors for low bone mineral density in adolescent runners. Am J Sports Med. 43(6), 1494-1504. https://doi.org/10.1177/0363546515572142
Wasnich, R. D., Miller, P. D. 2000. Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab. 85(1), 231-236. https://doi.org/10.1210/jcem.85.1.6267
Weaver, C. M., Gordon, C. M., Janz, K. F., Kalkwarf, H. J., Lappe, J. M., Lewis, R., O'Karma, M., Wallace, T. C., Zemel, B. S. 2016. Erratum to: The national osteoporosis foundation's position statement on peak bone mass development and lifestyle factors: A systematic review and implementation recommendations. Osteoporos Int. 27(4), 1387. https://doi.org/10.1007/s00198-016-3551-5
Weinstein, R. S. 2000. True strength. J Bone Miner Res. 15(4), 621-625. https://doi.org/10.1359/jbmr.2000.15.4.621
Welch, J. M., Turner, C. H., Devareddy, L., Arjmandi, B. H., Weaver, C. M. 2008. High impact exercise is more beneficial than dietary calcium for building bone strength in the growing rat skeleton. Bone. 42(4), 660-668. https://doi.org/10.1016/j.bone.2007.12.220
Whitaker, J. Looking back at the first women's champions in NCAA history. 2023. NCAA. Retrieved from [Accessed 2025, 30 May]: https://www.ncaa.org/news/2023/3/10/media-center-looking-back-at-the-first-womens-champions-in-ncaa-history.aspx
Winters-Stone, K. M., Snow, C. M. 2003. Musculoskeletal response to exercise is greatest in women with low initial values. Med Sci Sports Exerc. 35(10), 1691-1696. https://doi.org/10.1249/01.MSS.0000089338.66054.A5
Wright, N. C., Looker, A. C., Saag, K. G., Curtis, J. R., Delzell, E. S., Randall, S., Dawson-Hughes, B. 2014. The recent prevalence of osteoporosis and low bone mass in the united states based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 29(11), 2520-2526. https://doi.org/10.1002/jbmr.2269