The Relationship Between Non-elite Sporting Activity and Calcaneal Bone Density in Adolescents and Young Adults: A Narrative Systematic Review

Abstract

Introduction: Osteoporotic fractures represent a major public health burden. The risk of fragility fractures in late adulthood is strongly impacted by peak bone mass acquisition by the third decade. Weight-bearing sporting activity may be beneficial to peak bone mass accrual, but previous studies have focused on elite sporting activity and have used dual energy X-ray absorptiometry as a measure of bone density. The authors performed a narrative systematic review of individual sports (performed non-competitively or at local level) and calcaneal quantitative ultrasound (cQUS) bone measures in young people. Methods: Multiple databases were systematically searched up until the 31st of March 2019. The authors included studies of participants' mean age (11-35 years), reporting any level of recreational sporting activity and cQUS measures as well as excluding elite/professional sporting physical activity. Studies (title and abstract) were screened independently by two reviewers, and a third reviewer resolved any discrepancies. STROBE guidelines were used to check the reporting of observational studies. The Newcastle-Ottawa Scale was used to assess the risk of bias of the studies included in the review. The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Results: A search yielded 29,512 articles that considered relationships between bone density assessed by any technique and sporting activity. Duplicate and out of scope abstracts were removed. This left 424 papers that were screened by two reviewers; of these, six met the inclusion criteria, including assessment by cQUS. The authors identified papers where sports were considered, included soccer (football), swimming, cycling, gymnastics, dancing, badminton, basketball, fencing, wrestling, and judokas. Although study heterogeneity prohibited meta-analysis, all six included studies reported significant benefits of weight-bearing non-elite sports on cQUS outcomes. Conclusion: Our study found beneficial effects of non-elite sports participation on cQUS in adolescence and young adulthood, although further work is now indicated.

Impact of physical activity on incidence of osteoporotic fractures - a review

“…The small size of study group has limited the possibility to verify if the relation is equally strong in men and women. Weight bearing sports had a higher impact on bone density [18]. Similar results were obtained in group of men from South Dakota in age ranging from 20 to 66 years.…”

Do we need to change the guideline values for determining low bone mineral density in athletes?

“…Participation in high-impact sports with bone-specific loading activities increases BMD, both throughout adolescence ( 17 ) and adulthood ( 18 ). Such sports have weight-bearing endurance activities (e.g., tennis and running), activities that involve jumping (e.g., volleyball and basketball), and resistance exercise (e.g., weightlifting) ( 19 ).…”

Relative Energy Deficiency in Sport (RED-S) in Adolescents – A Practical Review

“…Genetics remain the largest predictor of PBM, but LEA, hypoestrogenism, menstrual dysfunction, poor calcium intake, significant weight loss, subclinical eating disorders and depot-medroxyprogesterone acetate (DMPA) contraception use can prevent an individual from reaching this genetically determined PBM [51][52][53][54]. Physical activity that involves high impact activity in adolescence is well recognised as having positive effects on BMD [55] but only in the presence of energy balance. Young wrestling/judo participants and sprinters have been identified as having higher BMD than endurance athletes and swimmers, and those who are inactive [56][57][58].…”