Regional Bone Mineral Density in Male Athletes: A Comparison of Soccer Players, Runners, and Controls

Michael Fredericson ^1*, Kelvin Chew ², Jessica Ngo ³, Tammy Cleek ⁴, Jenny Kiratli ⁵ and Kristin Cobb ⁶

¹ Department of Orthopaedic Surgery, Division of Sports Medicine, Stanford University, United States
² Department of Orthopaedic Surgery, Sports Medicine Center, Alexandra Hospital, Singapore
³ Stanford University, United States
⁴ School of Informatics & Engineering, Flinders University, Australia
⁵ Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, United States
⁶ ||Health Research & Policy - Epidemiology, Stanford University, United States

^* To whom correspondence should be addressed. E-mail: mfred2{at}stanford.edu.

Accepted 27 March 2007

Abstract

Objectives: To investigate the association between soccer playing and long-distance running on total and regional bone mineral density (BMD).

Design: Cross-sectional study.

Setting: Academic medical center.

Participants: Elite male soccer players (n = 15), elite male long-distance runners (n = 15), and sedentary male controls (n = 15) aged between 20 and 30 years.

Main Outcome Measurements: BMD (g/cm2) of the lumbar spine (L1-L4), right hip, right leg and total body were assessed by dual-energy x-ray absorptiometry and a scan of the right calcaneus was taken with a peripheral instantaneous x-ray imaging bone densitometer.

Results: After adjusting for age, weight, and percent body fat, soccer players had significantly higher whole body, spine, right hip, right leg and calcaneal BMD values compared with controls (P = .008; P = .041; P < .001; P = .019; P < .001) and significantly higher right hip and spine BMD values compared with runners (P = .012; P = .009). Runners had higher calcaneal BMD values compared with controls (P = .002). Forty percent of the runners had T-scores of the lumbar spine between -1 and -2.5. But controls were similar: 34% had T-scores below -1 (including 7% with T-scores lower than -2.5).

Conclusions: Playing soccer is associated with higher BMD of the skeleton at all sites measured. Running is associated with higher BMD at directly loaded sites (ie, calcaneus) but not at relatively unloaded sites (ie, spine). Specific loading conditions, seen in ball sports or in running, play a pivotal role in skeletal adaptation. We underscore the importance of including an appropriate control group in clinical studies.

Key Words: athletes, bone density, male, runners, soccer

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