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High bone mineral density in lifelong trained female team handball players and young elite football players



Low bone mineral density (BMD) and fractures are a major concern in the female population and preventative strategies are needed. Whether team sports participation may reduce age-related bone loss in elderly women is still uncertain.


One hundred and thirty healthy, non-smoking women participated in this cross-sectional study, i.e., elderly (60–80 years) team handball players (EH, n = 35), elderly untrained controls (EC, n = 35), young (18–30 years) elite football players (YF, n = 30) and young untrained controls (YC, n = 30). A whole-body and two regional dual-energy X-ray absorptiometry (DXA) scans were performed to evaluate BMD and a blood sample was collected for measurement of bone turnover markers (BTMs).


EH had higher BMD in all regions of the lumbar spine, except for L1, compared to EC (8–10%), and higher BMD in the femoral Ward’s triangle (9%) and trochanter (7%) of the left leg. Furthermore, EH had higher mean leg BMD (8%) and whole-body BMD (5%) than EC. EH and YC had similar BMD in femoral trochanter, L1–L4 and mean leg despite an age difference of ~ 40 years. YF had higher BMD in all regions of the proximal femur (18–29%) and lumbar spine (12–16%) compared to YC, as well as higher mean leg BMD (20%) and whole-body BMD (13%). Sclerostin was 14% lower in EH compared to EC. YF showed higher PINP (98%), osteocalcin (57%), and CTX (83%) compared to YC.


Lifelong team handball training and elite football training are associated with superior bone mineralization and changed bone turnover in elderly and young women.

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Fig. 1
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Fig. 3



Analysis of variance


Bone mass content


Bone mineral density


Bone turnover markers


Carboxy-terminal type-1 collagen crosslinks


Dual-energy X-ray absorptiometry


Elderly controls


Elderly team handball players


Lumbar spinal vertebra 1–4


Peak bone mass


Procollagen type-1 N-terminal propeptide


Young controls


Young football players


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The study was funded by the Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Denmark, and the Danish Ministry of Culture’s Research Committee (Kulturministeriets Forskningsudvalg, KFU, FPK.2016-0039). Plasma analyses were conducted by the Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark. The authors would like to thank all participants for their dedicated participation, and all football coaches who helped with the recruitment of elite football players. Special thanks go to Jon Egelund, Thomas Morville, Thomas Beck, Jesper Løvind Andersen, Nadia Quardon, and Johan Wikman for their crucial technical and scientific collaboration. Finally, we would like to thank the Danish Handball Federation (Dansk Håndbold Forbund, DHF) for their assistance with recruiting elderly team handball players.

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Correspondence to Peter Krustrup.

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Hagman, M., Helge, E.W., Fristrup, B. et al. High bone mineral density in lifelong trained female team handball players and young elite football players. Eur J Appl Physiol 121, 2825–2836 (2021).

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  • Lifelong exercise training
  • Master athletes
  • Soccer
  • Bone health
  • Bone turnover markers
  • Static postural balance