Summary-Development of optimal skeletal strength should decrease adult bone fragility. Nongymnasts (NON) were compared with girls exposed to gymnastics during growth (EX/GYM), using peripheral quantitative computed tomography (pQCT) to evaluate postmenarcheal bone geometry, density, and strength. Pre-and perimenarcheal gymnastic loading yields advantages in indices of postmenarcheal bone geometry and skeletal strength.

Impact activity is an important contributor to bone accrual. Children engaging in such activity have been shown to have greater bone mineral density (BMD) than their peers. This cross-sectional study was designed to quantify the association between BMD and impact activity in pre-pubescent girls, specifically examining for a dose-dependent relationship. Fifty 7-11-year-old Caucasian female gymnasts were grouped by hours of gymnastics participation during a 6-month period: LOW, 1-8 hours/week (hrs/wk); HIGH, >8 hrs/wk. They were compared with 20 controls, with height, weight, age, and Tanner stage averages matched to the gymnasts. Total body, forearm, hip, lumbar spine BMD, and body composition were measured by dual energy X-ray absorptiometry (DXA). Strength was measured by one repetition maximum testing, calcium intake was quantified by questionnaire, and physical activity was measured by questionnaire and activity monitors. Total and regional BMD were greater in the HIGH group than the controls (P<0.05). Furthermore, both total and forearm BMD were greater in the HIGH group than in the LOW group, and greater in the LOW group than in the controls (P<0.05). Simple regression analysis between hrs/wk of gymnastics activity versus total and regional BMD (using maturation-adjusted Z scores) yielded a positive slope for each site. R2 was greatest for hip BMD (R2 = 0.25), and least for lumbar spine (R2 = 0.10) (P<0.0001). In conclusion, in this group of pre-pubescent girls, we observed a dose-dependent relationship between BMD and hrs/wk of impact activity; even moderate doses of impact activity were associated with increased BMD.

Summary Preliminary prospective, longitudinal results suggest that pre-menarcheal exposure to artistic gymnastics is associated with greater radius BMC, aBMD, and projected area throughout growth and into early adulthood, more than 4 years after activity cessation. Any loss of benefit associated with de-training appears to be temporary. Introduction Mechanical loading may enhance bone accrual during growth, but prospective evidence of benefit retention is limited. This prospective, longitudinal cohort study tests whether gymnastics is linked to distal radius advantages during growth and four or more years post-training cessation. Methods Semi-annually, female ex/gymnasts and non-gymnasts underwent height and weight measurements; questionnaires assessed calcium intake, physical activity, and maturation. Annual dual energy X-ray absorptiometry scans (Hologic QDR 4500W) measured total body fat-free mass, skull areal density (aBMD), and bone mineral content (BMC); forearm scans measured ultradistal and 1/3 radius area, BMC, and aBMD. Analysis inclusion criteria were: (1) achievement of gynecological age >4 years and (2) for gymnasts, >2 years of pre-menarcheal training (>6 h/week), ceasing between 0.5 year pre-menarche and 1 year post-menarche. Hierarchical linear modeling (HLM v6.0) evaluated outcomes for ex/gymnasts versus non-gymnasts; a slope/intercept discontinuity evaluated de-training effects. Results Data from 14 non-gymnasts and six ex/gymnasts represented outcomes from 4 years pre-menarche to 9 years post-menarche. All adjusted distal radius parameters were higher in ex/gymnasts than non-gymnasts (p<0.02). Ultradistal BMC, ultradistal aBMD, and 1/3 aBMD temporarily decreased with gymnastic cessation (p<0.04); ultradistal area, 1/3 area, and 1/3 BMC did not change significantly. Skull outcomes did not differ between groups or change with activity cessation. Conclusion Gymnastic exposure during childhood and early puberty is associated with greater radius bone mass, size, and aBMD. Despite brief de-training losses in density and mass, significant skeletal benefits are manifested throughout growth and at least 4 years beyond activity cessation into early adulthood.

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The distal radius bears unique forces during gymnastic activity. Its relatively simple anatomy, minimal soft tissue envelope and varied composition make the distal radius ideal for evaluating the effects of loading on bone properties. For 56 premenarcheal gymnasts and non-gymnasts, ultradistal and 1/3 distal radius DXA scans measured bone mineral content (BMC), areal bone mineral density and projected area. Simplified geometric models were used to generate bone mineral apparent density (BMAD), geometric indices, strength indices and fall strength ratios. Ratios of regional BMC vs. total body fat free mass (FFM) were calculated. Separate Tanner I and II analyses of covariance adjusted bone parameters for age and height. Ratios were compared using maturity-matched analyses of variance. At the 1/3 region, periosteal width, BMC, cortical cross-sectional area, and section modulus were greater in gymnasts than non-gymnasts (p<0.05); 1/3 BMAD means were equivalent. Ultradistal BMAD, BMC and index for structural strength in axial compression were higher in gymnasts than non-gymnasts; ultradistal periosteal width was only larger in Tanner I gymnasts. Fall strength ratios and BMC/FFM ratios were greater in gymnasts (p<0.05). Geometric and volumetric responses to mechanical loading are site-specific during late childhood and early adolescence.The distal radius bears unique forces during gymnastic activity, and fan beam magnification error is negligible at this site, making it ideal for DXA evaluation of associated bone properties. For 56 premenarcheal gymnasts and non-gymnasts, ultradistal and 1/3 distal radius DXA scans measured bone mineral content, areal bone mineral density and projected area. Simplified geometric models were used to generate bone mineral apparent density, geometric indices, strength indices and fall strength ratios. Ratios of regional bone mineral content vs. total body fat free mass were calculated. Separate Tanner I and II analyses of covariance adjusted bone parameters for age and height. Ratios were compared using maturity-matched analyses of variance. At the 1/3 region, periosteal width, bone mineral content, cortical cross-sectional area, and section modulus were greater in gymnasts than non-gymnasts (p<0.05); 1/3 bone mineral apparent densities were equivalent. Gymnasts' ultradistal bone mineral apparent density, bone mineral content and index for structural strength in axial compression were higher; ultradistal periosteal width was only larger in Tanner I gymnasts. Fall strength ratios and bone mineral content vs. fat-free mass were greater in gymnasts (p<0.05). Gymnasts' geometric and volumetric responses to mechanical loading are site-specific during late childhood and early adolescence.