Skip to main content
Log in

Dancing for bone health: a 3-year longitudinal study of bone mineral accrual across puberty in female non-elite dancers and controls

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Introduction

Weight-bearing exercise during growth enhances peak bone mass. However, the window of opportunity for optimizing positive effects of exercise on peak bone mass remains to be fully defined. Ballet dancing provides a model of mechanical loading patterns required to site-specifically modulate bone.

Methods

We assessed the effects of ballet dancing on bone mineral accrual in female non-elite dancers and normally active controls for 3 years across puberty. We recruited 82 ballet dancers and 61 controls age 8–11 years at baseline. Participants were measured over 3 consecutive years; however, the overlap in ages allowed analysis of the groups across 8–14 years of age. We annually assessed bone mineral content (BMC) at the total body (TB), including upper and lower limb regions, and biannually assessed BMC at the proximal femur and lumbar spine (LS) using dual x-ray absorptiometry (DXA). We derived TB lean mass and fat mass from DXA TB scans. Anthropometry, exercise levels, and calcium intake were also measured biannually. Maturational age was determined by age at peak height velocity (PHV). A multilevel regression model was used to determine the independent effects of body size, body composition, maturation, exercise levels, and calcium intake at each measurement occasion.

Results

When adjusted for growth and maturation, dancers had significantly greater BMC at the TB, lower limbs, femoral neck (FN), and LS than controls. Excepting the FN region, these differences became apparent at 1 year post-PHV, or the peripubertal years, and by 2 years post-PHV the differences represented a cumulative advantage in dancers of 0.6–1.3% (p<0.05) greater BMC than controls. At the FN, dancers had 4% (p<0.05) greater BMC than controls in prepuberty and maintained this advantage throughout the pubertal years.

Conclusions

Results from this novel population provide evidence for modest site-specific and maturity-specific effects of mechanical loading on bone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 14:1672–1679

    Article  PubMed  CAS  Google Scholar 

  2. Arlot ME, Sornay-Rendu E, Garnero P, Vey-Marty B, Delmas PD (1997) Apparent pre- and postmenopausal bone loss evaluated by DXA at different skeletal sites in women: the OFELY cohort. J Bone Miner Res 12:683–690

    Article  PubMed  CAS  Google Scholar 

  3. Heinonen A, Sievanen H, Kannus P, Oja P, Pasanen M, Vuori I (2000) High-impact exercise and bones of growing girls: a 9-month controlled trial. Osteoporos Int 11:1010–1017

    Article  PubMed  CAS  Google Scholar 

  4. MacKelvie KJ, McKay HA, Khan KM, Crocker PR (2001) A school-based exercise intervention augments bone mineral accrual in early pubertal girls. J Pediatr 139:501–508

    Article  PubMed  CAS  Google Scholar 

  5. Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, Seeman E (1998) Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 13:500–507

    Article  PubMed  CAS  Google Scholar 

  6. Nickols-Richardson SM, O’Connor PJ, Shapses SA, Lewis RD (1999) Longitudinal bone mineral density changes in female child artistic gymnasts. J Bone Miner Res 14:994–1002

    Article  PubMed  CAS  Google Scholar 

  7. Lehtonen-Veromaa M, Mottonen T, Irjala K, Nuotio I, Leino A, Viikari J (2000) A 1-year prospective study on the relationship between physical activity, markers of bone metabolism, and bone acquisition in peripubertal girls. J Clin Endocrinol Metab 85:3726–3732

    Article  PubMed  CAS  Google Scholar 

  8. Khan KM, Bennell KL, Hopper JL, Flicker L, Nowson CA, Sherwin AJ, Crichton KJ, Harcourt PR, Wark JD (1998) Self-reported ballet classes undertaken at age 10–12 years and hip bone mineral density in later life. Osteoporos Int 8:165–173

    Article  PubMed  CAS  Google Scholar 

  9. Ross W, Marfell-Jones M (1991) Kinanthropometry. In: MacDougall J, Wenger H, Green H (eds) Physiological testing of the high-performance athlete. Human Kinetic Books, Champaign Illinois pp 223–308

    Google Scholar 

  10. Mirwald RL, Bailey DA (1997) Seasonal height velocity in boys and girls 8–18 years. Am J Human Biol 9:709–715

    Article  Google Scholar 

  11. Mirwald RL, Baxter-Jones AD, Bailey DA, Beunen GP (2002) An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc 34:689–694

    Article  PubMed  Google Scholar 

  12. Morris N, Udry J (1980) Validation of a self-administered instrument to assess stage of adolescent development. J Youth Adolesc 9:271–280

    Article  Google Scholar 

  13. Bennell K, Khan K, Matthews B, De Gruyter M, Cook E, Holzer K, Wark J (1999) Hip and ankle range of motion and hip muscle strength in young novice female ballet dancers and controls. Br J Sports Med 33:340–346

    Article  PubMed  CAS  Google Scholar 

  14. Angus RM, Sambrook PN, Pocock NA (1988) Dietary intake and bone mineral density. Bone Miner 4:265–277

    PubMed  CAS  Google Scholar 

  15. Young D, Hopper J, Nowson C, Green R, Sherwin A, Kaymakci B, Smid M, Guest C, Larkins R, Wark J (1995) Determinants of bone mass in 10-to 26-year-old females: A twin study. J Bone Miner Res 4:558–567

    Google Scholar 

  16. James WP, Bingham SA, Cole TJ (1981) Epidemiological assessment of dietary intake. Nutr Cancer 2:203–212

    Article  PubMed  CAS  Google Scholar 

  17. Strain JJ, Robson PJ, Livingstone MBE, Savage JM, Cran GW (1994) Estimates of food and macro-nutrient intake in a random sample of Northern Ireland adolescents. Br J Nutr 72:343–352

    Article  PubMed  CAS  Google Scholar 

  18. Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Human Nutrition Clin Nutr 39C(Suppl 1):5–41

    Google Scholar 

  19. Baxter-Jones AD, Mirwald RL, McKay HA, Bailey DA (2003) A longitudinal analysis of sex differences in bone mineral accrual in healthy 8-19-year-old boys and girls. Ann Hum Biol 30:160–175

    Article  PubMed  CAS  Google Scholar 

  20. Baxter-Jones AD, Mirwald R (2004) Multilevel modeling. In: Hauspie R, Cameron N, Molinari L (eds) Methods in human growth research. Cambridge University Press, Cambridge, UK pp 306–330

    Google Scholar 

  21. Goldstein H, Rasbash J, Plewis I, Draper D, Browne W, Yang M, Woodhouse G, Healy MJR (1998) A user’s guide to MLwiN. Multilevel Models Project, Institute of Education, University of London, London

    Google Scholar 

  22. Fuchs RK, Bauer JJ, Snow CM (2001) Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res 16:148–156

    Article  PubMed  CAS  Google Scholar 

  23. Courteix D, Jaffrè C, Obert P, Benhamou L (2001) Bone mass and somatic development in young female gymnasts: a longitudinal study. Pediatr Exerc Sci 13:422–434

    Google Scholar 

  24. Laing EM, Massoni JA, Nickols-Richardson SM, Modlesky CM, O’Connor PJ, Lewis RD (2002) A prospective study of bone mass and body composition in female adolescent gymnasts. J Pediatr 141:211–216

    Article  PubMed  Google Scholar 

  25. Nurmi-Lawton JA, Baxter-Jones AD, Mirwald RL, Bishop JA, Taylor P, Cooper C, New SA (2004) Evidence of sustained skeletal benefits from impact-loading exercise in young females: a 3-year longitudinal study. J Bone Miner Res 19:314–322

    Article  PubMed  Google Scholar 

  26. McKay HA, Petit MA, Schutz RW, Prior JC, Barr SI, Khan KM (2000) Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr 136:156–162

    Article  PubMed  CAS  Google Scholar 

  27. Hodges PW, Richardson CA (1997) Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther 77:132–142

    PubMed  CAS  Google Scholar 

  28. Skyrme AD, Cahill DJ, Marsh HP, Ellis H (1999) Psoas major and its controversial rotational action. Clin Anat 12:264–265

    Article  PubMed  CAS  Google Scholar 

  29. Revel M, Mayoux-Benhamou MA, Rabourdin JP, Bagheri F, Roux C (1993) One-year psoas training can prevent lumbar bone loss in postmenopausal women: a randomized controlled trial. Calcif Tissue Int 53:307–311

    Article  PubMed  CAS  Google Scholar 

  30. Lee PA, Xenakis T, Winer J, Matsenbaugh S (1976) Puberty in girls: correlation of serum levels of gonadotropins, prolactin, androgens, estrogens, and progestins with physical changes. J Clin Endocrinol Metab 43:775–784

    Article  PubMed  CAS  Google Scholar 

  31. Juul A, Dalgaard P, Blum WF, Bang P, Hall K, Michaelsen KF, Muller J, Skakkebaek NE (1995) Serum levels of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) in healthy infants, children, and adolescents: the relation to IGF-I, IGF-II, IGFBP-1, IGFBP-2, age, sex, body mass index, and pubertal maturation. J Clin Endocrinol Metab 80:2534–2542

    Article  PubMed  CAS  Google Scholar 

  32. Laaneots L, Karelson K, Smirnova T, Viru A (1998) Hormonal responses to exercise in girls during sexual maturation. J Physiol Pharmacol 49:121–133

    PubMed  CAS  Google Scholar 

  33. Libanati C, Baylink DJ, Lois-Wenzel E, Srinvasan N, Mohan S (1999) Studies on the potential mediators of skeletal changes occurring during puberty in girls. J Clin Endocrinol Metab 84:2807–2814

    Article  PubMed  CAS  Google Scholar 

  34. Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD (1997) Prospective ten-month exercise intervention in premenarcheal girls - positive effects on bone and lean mass. J Bone Miner Res 12:1453–1462

    Article  PubMed  CAS  Google Scholar 

  35. Sabatier JP, Guaydier-Souquieres G, Benmalek A, Marcelli C (1999) Evolution of lumbar bone mineral content during adolescence and adulthood: a longitudinal study in 395 healthy females 10–24 years of age and 206 premenopausal women. Osteoporos Int 9:476–482

    Article  PubMed  CAS  Google Scholar 

  36. Malina RM, Bouchard C, Bar-Or O (2004) Growth, maturation, and physical activity. Human Kinetics, Champaign Ill

    Google Scholar 

  37. McKay HA, Bailey DA, Mirwald RL, Davison KS, Faulkner RA (1998) Peak bone mineral accrual and age at menarche in adolescent girls - a 6-year longitudinal study. J Pediatr 133:682–687

    Article  PubMed  CAS  Google Scholar 

  38. Lindgren G (1978) Growth of schoolchildren with early, average and late ages of peak height velocity. Ann Hum Biol 5:253–267

    Article  PubMed  CAS  Google Scholar 

  39. Forwood MR (2001) Mechanical effects on the skeleton: are there clinical implications? Osteoporos Int 12:77–83

    Article  PubMed  CAS  Google Scholar 

  40. Snow-Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R (1990) Muscle strength as a predictor of bone mineral density in young women. J Bone Miner Res 5:589–595

    Article  PubMed  CAS  Google Scholar 

  41. Soderman K, Bergstrom E, Lorentzon R, Alfredson H (2000) Bone mass and muscle strength in young female soccer players. Calcif Tissue Int 67:297–303

    Article  PubMed  CAS  Google Scholar 

  42. Duncan CS, Blimkie CJ, Cowell CT, Burke ST, Briody JN, Howman-Giles R (2002) Bone mineral density in adolescent female athletes: relationship to exercise type and muscle strength. Med Sci Sports Exerc 34:286–294

    Article  PubMed  Google Scholar 

  43. Faulkner RA, Forwood MR, Beck TJ, Mafukidze JC, Russell K, Wallace W (2003) Strength indices of the proximal femur and shaft in prepubertal female gymnasts. Med Sci Sports Exerc 35:513–518

    Article  PubMed  Google Scholar 

  44. Goldstein H (1995) Multilevel statistical models. E. Arnold, London

    Google Scholar 

  45. Nelson DA, Koo WWK (1999) Interpretation of absorptiometric bone mass measurements in the growing skeleton: Issues and limitations. Calcif Tissue Int 65:1–3

    Article  PubMed  CAS  Google Scholar 

  46. 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. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75

    Article  PubMed  CAS  Google Scholar 

  47. Melton LJ 3rd (1996) Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18:121S–125S

    Article  PubMed  Google Scholar 

  48. Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25:613–619

    Article  PubMed  CAS  Google Scholar 

  49. Kontulainen S, Kannus P, Haapasalo H, Sievanen H, Pasanen M, Heinonen A, Oja P, Vuori I (2001) Good maintenance of exercise-induced bone gain with decreased training of female tennis and squash players: a prospective 5-year follow-up study of young and old starters and controls. J Bone Miner Res 16:195–201

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This project was funded by grants from the National Health and Medical Research Council (project grant number 980662), the University of Melbourne, the H&L Hecht Trust, the Medical Advances Without Animals Trust, Australia and New Zealand Charitable Trusts, and the Estate of Daniel Scott. We are most grateful to the dance schools and primary schools for recruitment assistance, and we thank the girls who participated in the study and their parents. Our thanks also go to Sue Kantor, Bahtiyar Kaymacki, and Lee Bell for their assistance with data collection.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. L. Matthews.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matthews, B.L., Bennell, K.L., McKay, H.A. et al. Dancing for bone health: a 3-year longitudinal study of bone mineral accrual across puberty in female non-elite dancers and controls. Osteoporos Int 17, 1043–1054 (2006). https://doi.org/10.1007/s00198-006-0093-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-006-0093-2

Keywords

Navigation