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Low Bone Mineral Density in Underweight Adolescents
Pane, Hillary BA, MLA, CPH-S, MS-IV, Texas Tech Health Sciences Center, School of Medicine, El Paso, TX, United States
The 2005 death of Joffrey ballerina Erika Goodman from an osteoporotic fracture brought attention to the community that dancers are not adequately screened, educated, and/or treated for low bone mineral density (BMD). This may be a significant health problem for dancers, but its symptom-free course often goes undiagnosed for years.
Children accumulate bone mass throughout childhood, with bone building slowing around 16-19 years. The lifetime peak of bone mass is attained by late adolescence and adequate BMD may not be attainable if it is not reached by young adulthood. Additionally, dancers have significant physical and lifestyle risk factors for low BMD, including low body mass, hypoestrinemia (low serum estrogen), inadequate micronutrient intake, smoking, and low exposure to sunlight. Likewise, dancers have multiple risk factors for stress fractures, such as repetitive uniplanar stress and high impact exercise without proper impact-absorbing support. Dancers may therefore be at increased risk for both low BMD and the associated morbidities/mortalities such as fractures. Because of the importance of building and maintaining bone at an early age, education and screening should be implemented as an essential element in pre-season physicals.
Extensive research has been conducted on post-menopausal women, but little is known about the prevalence, pathophysiology, and treatment options for young women with low BMD. Recent research indicates bone metabolism is constitutionally different in underweight women, demonstrating significant physiological and endocrinological differences in young, undernourished women compared with healthy controls. Disparities persist after weight and nutrition are normalized, suggesting that periods of undernutrition in adolescent dancers may have long-term or irreversible impacts on health.
In this presentation, I will review the pathophysiology of low BMD within the context of undernourished adolescents, present a case study of vertebral avulsion fractures in a dancer with spinal osteopenia (low BMD), and make recommendations for future research.