Relative Energy Deficiency in Sport (REDs) and site-specific bone mineral density in female adolescent artistic athletes

Relative Energy Deficiency in Sport (REDs) negatively impacts bone mineral density (BMD), menstruation, growth, and maturation. The prevalence of REDs indicators in artistic adolescent athletes is unknown. The primary objective of this study was to examine the prevalence and factors associated with REDs in female adolescent artistic athletes. The secondary objective was to assess BMD and associated factors. Twenty artistic swimmers, 20 recreational/competitive dancers, 20 vocational dancers, and 14 figure skaters, 9–19 years old (mean 15.3 ± 2.6), participated in this cross-sectional study. Participants completed demographic/medical/menstrual history questionnaires, and the Eating Disorder Examination Questionnaire. Dual X-ray absorptiometry was completed at the total body less head, 33% distal radius, lumbar spine, and femoral neck. Firth’s penalized logistic regression examined odds of REDs risk (demonstrated ≥ 1 indicator, yes/no), and multivariable modelling examined areal BMD (aBMD) differences between cohorts. 34/74 athletes (45.9%) demonstrated ≥ 1 primary REDs indicator. Age, height, lean body mass, weekly training hours, sport specialization status, injury history, or sport were not associated with REDs risk. Relative to artistic swimmers, REDs risk odds ratios were 0.33 (95% CI: 0.08–1.46) for recreational/competitive dancers, 1.15 (95% CI: 0.33–4.05) for vocational dancers, and 0.73 (95% CI: 0.15–3.44) for figure skaters. Relative to artistic swimmers, marginal-mean aBMD was greater by 0.066 g/cm 2 (95% CI: 0.026–0.105) in recreational/completive dancers, 0.070 g/cm 2 (95% CI: 0.026–0.113) in vocational dancers, and 0.081 g/cm 2 (95% CI: 0.035–0.127) in figure skaters relative to artistic swimmers. Marginal-mean femoral neck aBMD was 0.104 g/cm 2 (95% CI: 0.022–0.186) greater in recreational/competitive dancers and 0.118 g/cm 2 (95% CI: 0.035–0.178) greater in vocational dancers compared to artistic swimmers. High prevalence of REDs indicators emphasizes the need for REDs screening and prevention in artistic sports.