Scoliosis and Fractures in Young Ballet Dancers

Abstract

In a survey of 75 dancers (mean age, 24.3 years) in four professional ballet companies, we found that the prevalence of scoliosis was 24 percent and that it rose with increases in age at menarche. Fifteen of 18 dancers (83 percent) with scoliosis had had a delayed menarche (14 years or older), as compared with 31 of 57 dancers (54 percent) without scoliosis (P less than 0.04). The dancers with scoliosis had a slightly higher prevalence of secondary amenorrhea (44 percent vs. 31 percent), the mean (+/- SD) duration of their amenorrhea was longer (11.4 +/- 18.3 vs. 4.1 +/- 7.4 months; P less than 0.05), and they scored higher on a questionnaire that assessed anorectic behavior. The incidence of fractures was 61 percent (46 of 75 dancers), and it rose with increasing age at menarche. Sixty-nine percent of the fractures that were described were stress fractures (mostly in the metatarsals), and their occurrence had an even stronger correlation with increased age at menarche. The incidence of secondary amenorrhea was twice as high among the dancers with stress fractures (P less than 0.01), and its duration was longer (P less than 0.05). In 7 of 10 dancers in whom endocrine studies were performed, the amenorrheic intervals were marked by prolonged hypoestrogenism. These data suggest that a delay in menarche and prolonged intervals of amenorrhea that reflect prolonged hypoestrogenism may predispose ballet dancers to scoliosis and stress fractures.

A tríade da atleta: posicionamento oficial

“…O seu estado esquelético depende da duração e da gravidade da sua irregularidade menstrual, bem como de fatores que influenciem a sua DMO antes do início da amenorréia: o tipo de carga esquelética durante a atividade, o seu estado nutricional e o componente genético 123 . Uma questão importante para atletas com baixa DMO devido a hipoestrogenemia é relativa ao risco de fraturas durante os seus anos de competições e o risco futuro de fraturas prematuras por osteoporose 124 . As fraturas de colo de fêmur e fraturas múltiplas de compressão nas vértebras, comuns entre mulheres idosas, foram documentadas em mulheres jovens com anorexia nervosa 30,125 .…”

“…Enquanto que atletas de baixo peso podem não satisfazer todos os critérios para anorexia nervosa ou bulimia nervosa, uma ingestão calórica inadequada ou uma má nutrição com o objetivo de atingir um peso irrealmente baixo pode colocar essas mulheres em risco para fraturas importantes 111,126 . Estudos relatam uma maior incidência de lesões e fraturas de estresse entre mulheres amenorréicas e oligomenorréicas do que em mulheres eumenorréicas 79,124,126,127 . Um estudo 38 relata uma DMO mais baixa em atletas mulheres que tiveram fraturas de estresse do que entre indivíduos controle sem lesões.…”

Effects of Aging on Bone Mineral Content and Bone Biomarkers in Female Cynomolgus Monkeys.

“…An extensive loss of bone with a disruption of trabecular architecture results in osteoporosis [2,13]. Severe osteopenia may also occur as early as adolescence in patients who have estrogen or androgen deficiency from various causes [4,8,21,32]. Similar phenomena are also apparent in nonhuman primates.…”

Research on Developmental Psychology

“…The work included measurement of hormones to better understand pubertal changes and possible emotional reactions. The investigations followed girls who were likely to have delayed puberty because of exercise and food restriction (dancers training in national ballet companies as well as elite swimmers and gymnasts) and girls attending private schools-many of the girls were followed from middle school through college Warren 1985, 1988a, b;Warren et al 1986Warren et al , 1991.…”