Archives of Osteoporosis

, 14:46 | Cite as

Endocrine parameters in association with bone mineral accrual in young female vocational ballet dancers

  • Tânia AmorimEmail author
  • George S. Metsios
  • Andreas D. Flouris
  • Alan Nevill
  • Thayse N. Gomes
  • Matthew Wyon
  • Franklim Marques
  • Luísa Nogueira
  • Nuno Adubeiro
  • Athanasios Z. Jamurtas
  • José Maia
  • Yiannis Koutedakis
Original Article



Less is known on bone mass gains in dancers involved in vocational dance training. The present study found that, as young vocational dancers progress on their professional training, their bone health remains consistently lower compared to non-exercising controls. Endocrine mechanisms do not seem to explain these findings.


Little is known on bone mass development in dancers involved in vocational training. The aim of the present study was to model bone mineral content (BMC) accruals and to determine whether circulating levels of oestrogens, growth hormone (GH), and insulin-like growth factor I (IGF-1) explain differences in bone mass gains between vocational dance students and matched controls.


The total of 67 vocational female dancers (VFDs) and 68 aged-matched controls (12.1 ± 1.9 years and 12.7 ± 2.0 years at baseline, respectively) were followed for two consecutive years (34 VFD and 31 controls remained in the study for the full duration). BMC was evaluated annually at impact [femoral neck (FN); lumbar spine (LS)] and non-impact sites (forearm) using DXA. Anthropometry, age at menarche (questionnaire), and hormone serum concentrations (immunoradiometric assays) were also assessed for the same period.


VFD demonstrated consistently reduced body weight (p < 0.001) and BMC at all three anatomical sites (p < 0.001) compared to controls throughout the study period. Menarche, body weight, GH, and IGF-1 were significantly associated with bone mass changes over time (p < 0.05) but did not explain group differences in BMC gains at impact sites (p > 0.05). However, body weight did explain the differences between groups in terms of BMC gains at the forearm (non-impact site).


Two consecutive years of vocational dance training revealed that young female dancers demonstrate consistently lower bone mass compared to controls at both impact and non-impact sites. The studied endocrine parameters do not seem to explain group differences in terms of bone mass gains at impact sites.


Bone health Children Endocrinology Performance Training BMC 


Compliance with ethical standards

All participants provided signed informed consent according to the Declaration of Helsinki. The study was approved by the ethics committee of the Regional Administration of Health of Lisbon, Portugal (Proc.063/CES/INV/201).

Conflicts of interest



  1. 1.
    Jay FXMM (2011) Disorders of bone remodeling. Annu Rev Pathol 6:121–145CrossRefGoogle Scholar
  2. 2.
    Sharan K, Yadav VK (2014) Hypothalamic control of bone metabolism. Best Pract Res Clin Endocrinol Metab. Elsevier Ltd;28:713–23. Available from: CrossRefGoogle Scholar
  3. 3.
    Locatelli V, Bianchi VE (2014) Effect of GH/IGF-1 on bone metabolism and osteoporsosis. Int J Endocrinol 2014:1–25 Available from: CrossRefGoogle Scholar
  4. 4.
    Ueland T (2004) Bone metabolism in relation to alterations in systemic growth hormone. Growth Hormon IGF Res 14:404–417CrossRefGoogle Scholar
  5. 5.
    Canalis E, Agnusdei D (1996) Insulin-like growth factors and their role in osteoporosis. Calcif Tissue Int 58:133–134 Available from: CrossRefGoogle Scholar
  6. 6.
    Bonjour JP, Chevalley T (2014) Pubertal timing, bone acquisition, and risk of fracture throughout life. Endocr Rev 35:820–847CrossRefGoogle Scholar
  7. 7.
    Perrini S, Laviola L, Carreira MC, Cignarelli A, Natalicchio A, Giorgino F (2010) The GH/IGF1 axis and signaling pathways in the muscle and bone: mechanisms underlying age-related skeletal muscle wasting and osteoporosis. J Endocrinol 205:201–210CrossRefGoogle Scholar
  8. 8.
    Murray PG, Clayton PE (2013) Endocrine control of growth. Am J Med Genet C Semin Med Genet 163:76–85CrossRefGoogle Scholar
  9. 9.
    Robson H, Siebler T, Shalet SM, Williams GR (2002) Interactions between GH, IGF-I, glucocorticoids, and thyroid hormones during skeletal growth. Pediatr Res 52:137–147CrossRefGoogle Scholar
  10. 10.
    Pigeon P, Oliver I, Charlet JP, Rochiccioli P (1997) Intensive dance practice repercussions growth and puberty. Am J Sports Med 25:243–247CrossRefGoogle Scholar
  11. 11.
    Georgopoulos NA, Theodoropoulou A, Leglise M, Vagenakis AG, Markou KB (2004) Growth and skeletal maturation in male and female artistic gymnasts. J Clin Endocrinol Metab 89:4377–4382CrossRefGoogle Scholar
  12. 12.
    Burckhardt P, Wynn E, Krieg M-A, Bagutti C, Faouzi M (2011) The effects of nutrition, puberty and dancing on bone density in adolescent ballet dancers. J Dance Med Sci 15:51–60PubMedGoogle Scholar
  13. 13.
    Scofield KL, Hecht S (2012) Bone health in endurance athletes. Curr Sports Med Rep 11:328–334CrossRefGoogle Scholar
  14. 14.
    Warren MP, Perlroth NE (2001) The effects of intense exercise on the female reproductive system. J Endocrinol 170:3–11CrossRefGoogle Scholar
  15. 15.
    Koutedakis Y, Jamurtas AZ (2004) The dancer as a performing athlete. Sport Med 34:651–661CrossRefGoogle Scholar
  16. 16.
    Twitchett EA, Koutedakis Y, Wyon MA (2009) Physiological fitness and professional classical ballet performance: a brief review. J Strength Cond Res 23:2732–2740CrossRefGoogle Scholar
  17. 17.
    Koutedakis Y (2000) “Burnout” in dance—the physiological viewpoint. J Danc Med Sci 4:122–127 Available from: Google Scholar
  18. 18.
    Koutedakis Y, Frischknecht GV, Sharp NC, Budgett R (1995) Maximal voluntary quadriceps strength patterns in Olympic overtrained athletes. Med Sci Sports Exerc 27:566–572CrossRefGoogle Scholar
  19. 19.
    Loenneke JP, Abe T, Wilson J, Thiebaud RS, Fahs CA, Rossow L (2012) Blood flow restriction: an evidence based progressive model (Review). Acta Physiol Hung. J. Loenneke, University of Oklahoma, Department of Health and Exercise Science, 1401 Asp Avenue, Norman, OK 73019–0615, United States. E-mail: Akademiai Kiado Rt. (Prielle Kornelia u. 19/d, Budapest H-1117, Hungary) 99:235–50. Available from:
  20. 20.
    Amorim T, Koutedakis Y, Nevill A, Wyon M, Maia J, Machado JC, Marques F, Metsios GS, Flouris AD, Adubeiro N, Nogueira L, Dimitriou L (2017) Bone mineral density in vocational and professional ballet dancers. Osteoporos Int 28:2903–2912CrossRefGoogle Scholar
  21. 21.
    Amorim T (2017) Bone mass of female dance students prior to professional dance training: a cross-sectional study. PLoS One 12:1–11Google Scholar
  22. 22.
    Amorim T, Wyon M, Machado JC, Metsios GS, Flouris D, Koutedakis Y (2015) Prevalence of low bone mineral density in female dancers. Sport Med 45:257–268CrossRefGoogle Scholar
  23. 23.
    The Section on Endocrinology (2011) Bone densitometry in children and adolescents. Pediatrics 127:189–194 Available from: CrossRefGoogle Scholar
  24. 24.
    Mirwald RL, Baxter-Jones ADG, Bailey DA, Beunen GP (2002) An assessment of maturity from anthropometric measurements. Med Sci Sports Exerc 34:689–694 Available from: PubMedGoogle Scholar
  25. 25.
    Pearson D, Horton B, Green DJ (2006) Cross calibration of DXA as part of an equipment replacement program. J Clin Densitom 9:287–294CrossRefGoogle Scholar
  26. 26.
    Hagiwara S, Yang KES, Dhillon MS, Guglielmi G, Nelson DL, Genant HK (2000) Dual X-ray absorptiometry forearm software : accuracy and intermachine relationship. J Bone Miner Res 9:1425–1427CrossRefGoogle Scholar
  27. 27.
    Robson B, Chertoff A (2010) Bone health and female dancers: physical and nutritional guidelines. Int Assoc Danc Med Sci:1–4 Available from:
  28. 28.
    Mughal MZ, Khadilkar AV (2011) The accrual of bone mass during childhood and puberty. Curr Opin Endocrinol Diabetes Obes 18:28–32 Available from: CrossRefGoogle Scholar
  29. 29.
    Markou KB, Theodoropoulou A, Tsekouras A, Vagenakis AG, Georgopoulos NA (2010) Bone acquisition during adolescence in athletes. Ann N Y Acad Sci 1205:12–16CrossRefGoogle Scholar
  30. 30.
    Mohan S, Richman C, Guo R, Amaar Y, Donahue LR, Wergedal J, Baylink DJ (2003) Insulin-like growth factor regulates peak bone mineral density in mice by both growth hormone-dependent and -independent mechanisms. Endocrinology. 144:929–936CrossRefGoogle Scholar
  31. 31.
    Bonewald LF (2011) The amazing osteocyte. J Bone Miner Res 26:229–238CrossRefGoogle Scholar
  32. 32.
    Bonewald LF, Johnson ML (2008) Osteocytes, mechanosensing and Wnt signaling. Bone. 42:606–615CrossRefGoogle Scholar
  33. 33.
    Crockett JC, Rogers MJ, Coxon FP, Hocking LJ, Helfrich MH (2011) Bone remodelling at a glance. J Cell Sci 124:991–998CrossRefGoogle Scholar
  34. 34.
    Delgado-Calle J (2012) Do epigenetic marks govern bone mass and homeostasis? Curr Genomics 13:252–263CrossRefGoogle Scholar
  35. 35.
    Jepsen KJ (2009) Systems analysis of bone. Syst Biol Med:73–88PubMedGoogle Scholar
  36. 36.
    Xing W, Baylink D, Kesavan C, Hu Y, Kapoor S, Chadwick RB, Mohan S (2005) Global gene expression analysis in the bones reveals involvement of several novel genes and pathways in mediating an anabolic response of mechanical loading in mice. J Cell Biochem 96:1049–1060CrossRefGoogle Scholar
  37. 37.
    Ducher G, Prouteau S, Courteix D, Benhamou C-L (2004) Cortical and trabecular bone at the forearm show different adaptation patterns in response to tennis playing. J Clin Densitom 7:399–405 Available from: CrossRefGoogle Scholar
  38. 38.
    Barrack MT, Van Loan MD, Rauh MJ, Nichols JF (2011) Body mass, training, menses, and bone in adolescent runners: a 3-yr follow-up. Med Sci Sports Exerc 43:959–966CrossRefGoogle Scholar
  39. 39.
    Allen N, Nevill A, Brooks J, Koutedakis Y, Wyon M (2012) Ballet injuries: injury incidence and severity over 1 year. J Orthop Sports Phys Ther 42:781–790CrossRefGoogle Scholar
  40. 40.
    Ekegrena C, Questedb R, Brodrick A (2014) Incidence in pre-professional ballet dancers: incidence, characteristics and consequences. J Sci Med Sport 17:271–275CrossRefGoogle Scholar
  41. 41.
    Baxter-Jones ADG, Burrows M, Bachrach LK, Lloyd T, Petit M, Macdonald H, et al (2010) International longitudinal pediatric reference standards for bone mineral content. Bone. Elsevier Inc. 46:208–16. Available from: CrossRefGoogle Scholar
  42. 42.
    Darelid A, Ohlsson C, Nilsson M, Kindblom JM, Mellström D, Lorentzon M (2012) Catch up in bone acquisition in young adult men with late normal puberty. J Bone Miner Res 27:2198–2207CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Tânia Amorim
    • 1
    • 2
    • 3
    Email author
  • George S. Metsios
    • 1
    • 4
  • Andreas D. Flouris
    • 3
    • 4
  • Alan Nevill
    • 1
  • Thayse N. Gomes
    • 2
    • 5
  • Matthew Wyon
    • 1
    • 6
  • Franklim Marques
    • 7
  • Luísa Nogueira
    • 8
  • Nuno Adubeiro
    • 8
  • Athanasios Z. Jamurtas
    • 4
  • José Maia
    • 2
  • Yiannis Koutedakis
    • 1
    • 4
  1. 1.Research Centre for Sport, Exercise and Performance, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWalsallUK
  2. 2.Centre of Research, Education, Innovation and Intervention in Sport, Faculty of SportsUniversity of PortoPortoPortugal
  3. 3.FAME Laboratory, Department of Exercise ScienceUniversity of ThessalyTrikalaGreece
  4. 4.School of Sports and Exercise SciencesUniversity of ThessalyTrikalaGreece
  5. 5.Department of Physical EducationFederal University of SergipeAracajuBrazil
  6. 6.National Institute of Dance Medicine and ScienceBirminghamUK
  7. 7.Faculty of PharmacyUniversity of PortoPortoPortugal
  8. 8.School of Health Technology of PortoPolytechnic Institute of PortoPortoPortugal

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