Top

Published in:

01-12-2021 | Nutrition | Original Article

Associations between nutrition, energy expenditure and energy availability with bone mass acquisition in dance students: a 3-year longitudinal study

Authors: Tânia Amorim, Laura Freitas, George S. Metsios, Thayse Natacha Gomes, Matthew Wyon, Andreas D. Flouris, José Maia, Franklim Marques, Luísa Nogueira, Nuno Adubeiro, Yiannis Koutedakis

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

Three years of study showed that female and male vocational dancers displayed lower bone mass compared to controls, at forearm, lumbar spine and femoral neck. Energy intake was found to positively predict bone mass accruals only in female dancers at femoral neck. Vocational dancers can be a risk population to develop osteoporosis.

Purpose

To determine whether risk factors normally associated with low bone mass in athletic populations (i.e. nutrition intake, energy expenditure and energy availability) are significant predictors of bone mass changes in vocational dance students.

Methods

The total of 101 vocational dancers (63 females, 12.8 ± 2.2 years; 38 males, 12.7 ± 2.2 years) and 115 age-matched controls (68 females, 13.0 ± 2.1 years; 47 males, 13.0 ± 1.8 years) were monitored for 3 consecutive years. Bone mass parameters were measured annually at impact sites (femoral neck, FN; lumber spine, LS) and non-impact site (forearm) using DXA. Nutrition (3-day record), energy expenditure (accelerometer), energy availability and IGF-1 serum concentration (immunoradiometric assays) were also assessed.

Results

Female and male vocational dancers had consistently reduced bone mass at all anatomical sites (p < 0.001) than controls. IGF-1 did not differ between male vocational dancers and controls, but female dancers showed it higher than controls. At baseline, calcium intake was significantly greater in female vocational dancers than controls (p < 0.05). Male vocational dancers’ fat and carbohydrate intakes were significantly lower than matched controls (p < 0.001 and p < 0.05, respectively). Energy availability of both female and male vocational dancers was within the normal range. A significant group effect was found at the FN regarding energy intake (p < 0.05) in female dancers. No significant predictors were found to explain bone mass differences in males.

Conclusion

Our 3-year study revealed that both female and male vocational dancers displayed lower bone mass compared to controls, at both impact and non-impact sites. The aetiology of these findings may be grounded on factors different than those usually considered in athletic populations.

Feng X, McDonald JM (2011) Disorders of bone remodeling. Annu Rev Pathol 6:121–145. https://doi.org/10.1146/annurev-pathol-011110-130203CrossRefPubMedPubMedCentral

Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. Lancet 341(8837):72–75. https://doi.org/10.1016/0140-6736(93)92555-8CrossRef

Melton LJ, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL (1993) Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 8(10):1227–1233. https://doi.org/10.1002/jbmr.5650081010CrossRefPubMed

Holroyd C, Cooper C, Dennison E (2008) Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab 22(5):671–685. https://doi.org/10.1016/j.beem.2008.06.001CrossRefPubMed

Myszkewycz L, Koutedakis Y (1998) Injuries, amenorrhea, and osteoporosis in active females: an overview. J Dance Med Sci 2:88–94

Robson B, Chertoff A (2010) Bone health and female dancers:physical and nutritional guidelines. Int Assoc Dance Med Sci: 1–4. Available from: https://fusionartsphysicaltherapy.com/bone-health-and-female-dancers-physical-nutritional-guidelines/

Doyle-Lucas AF, Akers JD, Davy BM (2010) Energetic efficiency, menstrual irregularity, and bone mineral density in elite professional female ballet dancers. J Dance Med Sci 14(4):146–154PubMed

Burckhardt P, Wynn E, Krieg MA, Bagutti C, Faouzi M (2011) The effects of nutrition, puberty and dancing on bone density in adolescent ballet dancers. J Dance Med Sci 15(2):51–60PubMed

Valentino R, Savastano S, Tommaselli AP, D’Amore G, Dorato M, Lombardi G (2001) The influence of intense ballet training on trabecular bone mass, hormone status, and gonadotropin structure in young women. J Clin Endocrinol Metab 86(10):4674–4678. https://doi.org/10.1210/jcem.86.10.7908CrossRefPubMed

10.

Keay N, Fogelman I, Blake G (1997) Bone mineral density in professional female dancers. Br J Sports Med 31(2):143–147. https://doi.org/10.1136/bjsm.31.2.143CrossRefPubMedPubMedCentral

11.

Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP (2007) American College of Sports Medicine position stand: the female athlete triad. Med Sci Sports Exerc 39(10):1867–1882. https://doi.org/10.1249/mss.0b013e318149f111CrossRefPubMed

12.

Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A (2014) The IOC consensus statement: beyond the female athlete triad: relative energy deficiency in sport (RED-S). Br J Sports Med 48(7):491–497. https://doi.org/10.1136/bjsports-2014-093502CrossRefPubMed

13.

Koutedakis Y, Jamurtas A (2004) The dancer as a performing athlete: physiological considerations. Sports Med 34(10):651–661. https://doi.org/10.2165/00007256-200434100-00003CrossRefPubMed

14.

Locatelli V, Bianchi VE (2014) Effect of GH/IGF-1 on bone metabolism and osteoporsosis. Int J Endocrinol 2014:1–25. https://doi.org/10.1155/2014/235060CrossRef

15.

Amorim T, Wyon M, Maia J, Machado JC, Marques F, Metsios GS, Flouris AD, Koutedakis Y (2015) Prevalence of low bone mineral density in female dancers. Sports Med 45(2):257–268. https://doi.org/10.1007/s40279-014-0268-5CrossRefPubMed

16.

Amorim T, Metsios GS, Flouris AD, Nevill A, Gomes TN, Wyon M, Marques F, Nogueira L, Adubeiro N, Jamurtas AZ, Maia J, Koutedakis Y (2019) Endocrine parameters in association with bone mineral accrual in young female vocational ballet dancers. Arch Osteoporos 14(46):1–9. https://doi.org/10.1007/s11657-019-0596-zCrossRef

17.

Mirwald RL, Baxter-Jones AD, Bailey DA, Beunen GP (2002) An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc 34(4):689–694. https://doi.org/10.1097/00005768-200204000-00020CrossRef

18.

Crawford PB, Obarzanek E, Morrison J, Sabry ZI (1994) Comparative advantage of 3-day food records over 24-hour recall and 5-day food frequency validated by observation of 9- and 10-year-old girls. J Am Diet Assoc 94(6):626–630. https://doi.org/10.1016/0002-8223(94)90158-9CrossRefPubMed

19.

Brazeau AS, Beaudoin N, Bélisle V, Messier V, Karelis AD, Rabasa-Lhoret R (2016) Validation and reliability of two activity monitors for energy expenditure assessment. J Sci Med Sport 19(1):46–50. https://doi.org/10.1016/j.jsams.2014.11.001CrossRefPubMed

20.

Weeks BK, Beck BR (2008) The BPAQ: a bone-specific physical activity assessment instrument. Osteoporos Int 19(11):1567–1577. https://doi.org/10.1007/s00198-008-0606-2CrossRefPubMed

21.

Cardadeiro G, Baptista F, Rosati N, Zymbal V, Janz KF, Sardinha LB (2014) Influence of physical activity and skeleton geometry on bone mass at the proximal femur in 10- to 12-year-old children: a longitudinal study. Osteoporos Int 25(8):2035–2045. https://doi.org/10.1007/s00198-014-2729-yCrossRefPubMed

22.

Farr JN, Lee VR, Blew RM, Lohman TG, Going SB (2011) Quantifying bone-relevant activity and its relation to bone strength in girls. Med Sci Sports Exerc 43(3):476–483. https://doi.org/10.1249/MSS.0b013e3181eeb2f2CrossRefPubMedPubMedCentral

23.

Kindler JM, Ross HL, Laing EM, Modlesky CM, Pollock NK, Baile CA, Lewis RD (2015) Load-specific physical activity scores are related to tibia bone architecture. Int J Sport Nutr Exerc Metab 25(2):136–144. https://doi.org/10.1123/ijsnem.2013-0258CrossRefPubMed

24.

Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado JC, Marques F, Metsios GS, Flouris AD, Adubeiro N, Nogueira L, Dimitriou L (2017) Bone mineral density in vocational and professional ballet dancers. Osteoporos Int 28(10):2903–2912. https://doi.org/10.1007/s00198-017-4130-0CrossRefPubMed

25.

Amorim T, Metsios GS, Wyon M, Nevill AM, Flouris AD, Maia J, Teixeira E, Machado JC, Marques F, Koutedakis Y (2017) Bone mass of female dance students prior to professional dance training: a cross-sectional study. PLoS ONE 12(7):1–11. https://doi.org/10.1371/journal.pone.0180639CrossRef

26.

Warren MP, Brooks-Gunn J, Fox RP, Lancelot C, Newman D, Hamilton WG (1991) Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones. J Clin Endocrinol Metab 72(4):847–853. https://doi.org/10.1210/jcem-72-4-847CrossRefPubMed

27.

Armann S, Wells C, Cheung S (1986) Bone mass, menstrual abnormalities, dietary intake, and body composition in classical ballerinas. Kinesiol Med Dance 13(1):1–15

28.

Pearce G, Bass S, Young N, Formica C, Seeman E (1990) Does weight-bearing exercise protect against the effects of exercise-induced oligomenorrhea on bone density? Osteoporos Int 6:448–452CrossRef

29.

Russell JA, Kruse DW, Koutedakis Y, McEwan IM, Wyon MA (2010) Pathoanatomy of posterior ankle impingement in ballet dancers. Clin Anat 23(6):613–621. https://doi.org/10.1002/ca.20991CrossRefPubMed

30.

Angioi M, Metsios GS, Koutedakis Y, Twitchett E, Wyon MA (2009) Physical fitness and severity of injuries in contemporary dance. Med Probl Perform Art 24(1):26–29CrossRef

31.

Fortes CM, Goldberg TB, Kurokawa CS, Silva CC, Moretto MR, Biason TP, Teixeira AS, Nunes HR (2014) Relationship between chronological and bone ages and pubertal stage of breasts with bone biomarkers and bone mineral density in adolescents. J Pediatr (Rio J) 90(6):624–631. https://doi.org/10.1016/j.jped.2014.04.008CrossRef

32.

Rantalainen T, Weeks BK, Nogueira RC, Beck BR (2015) Effects of bone-specific physical activity, gender and maturity on tibial cross-sectional bone material distribution: a cross-sectional pQCT comparison of children and young adults aged 5–29 years. Bone 72:101–108. https://doi.org/10.1016/j.bone.2014.11.015CrossRefPubMed

33.

Oral A, Tarakçi D, Disci R (2006) Calcaneal quantitative ultrasound measurements in young male and female professional dancers. J Strength Cond Res 20(3):572–578. https://doi.org/10.1519/r-17915.1CrossRefPubMed

34.

Cuesta A, Revilla M, Villa LF, Hernández ER, Rico H (1996) Total and regional bone mineral content in spanish professional ballet dancers. Calcif Tissue Int 58(3):150–154. https://doi.org/10.1007/bf02526880CrossRefPubMed

35.

Bonewald LF (2011) The amazing osteocyte. J Bone Miner Res 26(2):229–238. https://doi.org/10.1002/jbmr.320CrossRefPubMed

36.

Amorim T, Durães C, Machado JC, Metsios GS, Wyon M, Maia J, Flouris AD, Marques F, Nogueira L, Adubeiro N, Koutedakis Y (2018) Genetic variation in Wnt/β-catenin and ER signalling pathways in female and male elite dancers and its associations with low bone mineral density: a cross-section and longitudinal study. Osteoporos Int 29(10):2261–2274. https://doi.org/10.1007/s00198-018-4610-xCrossRefPubMed

37.

Jepsen KJ (2009) Systems analysis of bone. WIREs Syst Biol Med 1(1):73–88. https://doi.org/10.1002/wsbm.15CrossRef

38.

Xing W, Baylink D, Kesavan C, Hu Y, Kapoor S, Chadwick RB, Mohan S (2005) Global gene expression analysis in the bones reveals involvement of several novel genes and pathways in mediating an anabolic response of mechanical loading in mice. J Cell Biochem 96(5):1049–1060. https://doi.org/10.1002/jcb.20606CrossRefPubMed

39.

Suuriniemi M, Mahonen A, Kovanen V, Alén M, Lyytikainen A, Wang Q, Kroger H, Cheng S (2004) Association between exercise and pubertal BMD is modulated by estrogen receptor alpha genotype. J Bone Miner Res 19(11):1758–1765. https://doi.org/10.1359/jbmr.040918CrossRefPubMed

40.

Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hajj Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM (2014) Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD pediatric official positions. J Clin Densitom 17(2):225–242. https://doi.org/10.1016/j.jocd.2014.01.003CrossRefPubMed

Title: Associations between nutrition, energy expenditure and energy availability with bone mass acquisition in dance students: a 3-year longitudinal study
Authors: Tânia Amorim
Laura Freitas
George S. Metsios
Thayse Natacha Gomes
Matthew Wyon
Andreas D. Flouris
José Maia
Franklim Marques
Luísa Nogueira
Nuno Adubeiro
Yiannis Koutedakis
Publication date: 01-12-2021
Publisher: Springer London
Keyword: Nutrition
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-01005-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Associations between nutrition, energy expenditure and energy availability with bone mass acquisition in dance students: a 3-year longitudinal study

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

SCOPE 2021: a new scorecard for osteoporosis in Europe

The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults

Bone mineral density in spanish children at the diagnosis of inflammatory bowel disease

The associations of statin intake and the trabecular bone score and bone mineral density status in elderly Iranian individuals: a cross-sectional analysis of the Bushehr Elderly Health (BEH) program

Incidence of and risk factors for hip fracture in Nagasaki, Japan from 2005 to 2014

New technology REMS for bone evaluation compared to DXA in adult women for the osteoporosis diagnosis: a real-life experience