Factors influencing bone health in elite female athletes: A study of aesthetic and non-aesthetic sports

Abstract

Introduction: Bone mineral density (BMD) and bone metabolism are crucial for athlete health but remain unexplored among aesthetic athletes. This study aimed to compare BMD and bone metabolism markers between aesthetic and non-aesthetic athletes and to identify factors influencing bone health. Materials and Methods: Female collegiate and high school athletes ( n = 172) from aesthetic ( n = 113) and non-aesthetic ( n = 59) sports competing at a national level were enrolled. Total body BMD was measured using dual-energy X-ray absorptiometry, and bone biomarkers were assessed. Maturation status was calculated as chronological age minus age at menarche. Multiple regression analyses examined the effects of sport type and maturation on BMD and bone biomarkers. Results: Aesthetic athletes exhibited significantly lower total body BMD (Z-score: 1.03 ± 1.16) compared to non-aesthetic athletes (Z-score: 1.71 ± 1.25, p < 0.01). Vitamin D levels were also significantly lower in aesthetic athletes (15.7 ± 5.6 ng/mL) compared to non-aesthetic athletes (28.1 ± 8.9 ng/mL, p < 0.01). However, in adjusted models, aesthetic sport participation was not associated with BMD, whereas greater maturation was a significant positive predictor (β = 0.18, 95% CI: 0.08–0.27, p < 0.001). Aesthetic sport participation was associated with altered bone resorption markers, including lower tartrate-resistant acid phosphatase type 5b and higher Type I collagen cross-linked N-telopeptide. Bone formation markers were not associated with sport type but showed significant negative associations with maturation. Conclusion: Maturation—reflecting age and earlier menarche—was the strongest predictor of BMD and bone metabolism, exerting greater influence than sport type. These findings highlight the importance of developmental stage in evaluating bone health among female athletes.