Physiological Parameters of Bone Health in Elite Ballet Dancers

Bradley S. Lambert, Michael T. Cain, Tyler Heimdal, Joshua D. Harris, Vijay Jotwani, Steven Petak, Patrick McCulloch

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Stress fractures are common among elite ballet dancers whereby musculoskeletal health may be affected by energy balance and overtraining. Purpose This study aimed to characterize bone health in relation to stress fracture history, body composition, eating disorder risk, and blood biomarkers in professional male and female ballet dancers. Methods A single cohort of 112 dancers (male: 55, 25 ± 6 yr; female: 57, 24 ± 6 yr) was recruited. All participants underwent bone and body composition measures using dual-energy x-ray absorptiometry. In a subset of our cohort (male: 30, 24 ± 6 yr; female, 29, 23 ± 5 yr), a blood panel, disordered eating screen, menstrual history, and stress fracture history were also collected. Age-matched Z scores and young-adult T scores were calculated for bone mineral density (BMD) and body composition. Independent-samples t-tests and Fisher's exact tests were used to compare BMD, Z-scores, T scores, and those with and without history of stress fractures. A 1 × 3 ANOVA was used to compare BMD for those scoring 0-1, 2-6, and 7+ using the EAT26 questionnaire for eating disorder risk. Regression was used to predict BMD from demographic and body composition measures. Results Female dancers demonstrated reduced spinal (42nd percentile, 10%T <-1) and pelvic (16th percentile, 76%T <-1) BMD. Several anthropometric measures were predictive of BMD (P < 0.05, r2 = 0.65-0.81, standard error of estimate = 0.08-0.10 g·cm-2, percent error = 6.3-8.5). Those scoring >1 on EAT26 had lower BMD than did those with a score of 0-1 (P < 0.05). Conclusions Professional female ballet dancers exhibit reduced BMD, fat mass, and lean mass compared with the general population whereby low BMD and stress fractures tend to be more prevalent in those with a higher risk of disordered eating. Anthropometric and demographic measures are predictive of BMD in this population.

Original languageEnglish (US)
Pages (from-to)1668-1678
Number of pages11
JournalMedicine and science in sports and exercise
Issue number8
StatePublished - Aug 1 2020


  • Ballet
  • body composition
  • bone
  • bone mineral density
  • nutrition
  • stress fractures

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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