This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kaufman, B. A. Articles by Pierson, R. N. Search for Related Content PubMed PubMed Citation Articles by Kaufman, B. A. Articles by Pierson, R. N.

Bone Density and Amenorrhea in Ballet Dancers Are Related to a Decreased Resting Metabolic Rate and Lower Leptin Levels

Department of Medicine and Obstetrics and Gynecology, Columbia College of Physicians and Surgeons, New York, New York 10032; and Nutrition Research Center, St. Luke’s-Roosevelt Hospital Center, New York, New York 10025

Address all correspondence and requests for reprints to: Michelle P. Warren, M.D., PH 16-127, Department of Obstetrics and Gynecology, Columbia University, 622 West 168th Street, New York, New York 10032. E-mail: . mpw1{at}columbia.edu

Abstract

Osteopenia, which is correlated with amenorrhea and poor nutritional habits, has been well documented in elite ballet dancers. Estrogen replacement therapy and recovery from amenorrhea have not been associated with normalization of bone density. Thus, the osteopenia may be related to changes brought about by chronic dieting or other factors, such as a hypometabolic state induced by poor nutrition. The purpose of this study was to investigate the relationship of chronic dieting and resting metabolic rate (RMR) to amenorrhea and bone density.

RMR, bone density, eating disorder assessments, leptin levels, and complete menstrual and medical histories were determined in 21 elite ballet dancers and in 27 nondancers (age, 20–30 yr). No significant correlations were found between high EAT26 scores, a measure of disordered eating, and RMR, bone densities, body weight, body fat, or fat-free mass. However, when RMR was adjusted for fat-free mass (FFM), a significant positive correlation was found between RMR/FFM and bone density in both the arms (P < 0.001) and spine (P < 0.05) in ballet dancers, but not in the normal controls. The dancers also demonstrated significantly higher EAT scores (22.9 ± 10.3 vs. 4.1 ± 2.4; P < 0.001) and lower RMR/FFM ratios (30.0 ± 2.2 vs. 32.05 ± 2.8; P < 0.01). The only variable to predict lower RMR/FFM in the entire sample was ever having had amenorrhea; this group had significantly higher EAT scores (18.0 ± 13.5 vs. 10.3 ± 10.2; P < 0.05), lower leptin levels (4.03 ± 0.625 vs. 7.10 ± 4.052; P < 0.05), and lower bone mineral density in the spine (0.984 ± 0.11 vs. 1.10 ± 0.13; P < 0.05) and arm (0.773 ± 0.99 vs. 0.818 ± 0.01; P < 0.05).

We hypothesize that the correlation between low RMR and lower leptin levels and bone density may be more strongly related to nutritional habits in ballet dancers, causing significant depression of RMR, particularly for those with a history of amenorrhea.

This article has been cited by other articles:

				J. Dominguez, L. Goodman, S. Sen Gupta, L. Mayer, S. F. Etu, B T. Walsh, J. Wang, R. Pierson, and M. P Warren Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses Am. J. Clinical Nutrition, July 1, 2007; 86(1): 92 - 99. [Abstract] [Full Text] [PDF]

				M. W. Hamrick Leptin and Bone: A Consensus Emerging? IBMS BoneKEy, March 1, 2007; 4(3): 99 - 107. [Abstract] [Full Text] [PDF]

				C. Ruggiero and L. Ferrucci The endeavor of high maintenance homeostasis: resting metabolic rate and the legacy of longevity. J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2006; 61(5): 466 - 473. [Abstract] [Full Text] [PDF]

				M. J. De Souza and N. I. Williams Physiological aspects and clinical sequelae of energy deficiency and hypoestrogenism in exercising women Hum. Reprod. Update, September 1, 2004; 10(5): 433 - 448. [Abstract] [Full Text] [PDF]