Bone density and health outcomes

Bone Loss

Dancers depend on their bones and skeletal system. Bones in turn depend on key nutrients and micronutrients to maintain their density and their ability to carry out the dancers' often extreme demands. Because bone is living tissue, a thorough understanding of how bone density is created and maintained is essential for all dancers. Female dancers need to be especially aware of the impact of diet, lifestyle, and hormones on their bones. A clinically defined syndrome known as Female Athlete Triad refers to the three main variables that impact female bone mineral densities including disordered eating, irregular menstrual cycles, and osteoporosis. The triad itself also refers to energy availability, menstrual function, and bone health (Mountjoy et al., 2014). Bone health can be easily conceptualized as the balance between dietary energy intakes and energy expenditures. Maintaining balance and biological equilibrium can promote maximum health in professional dancers. Because the triad can affect male professional dancers as well as females, the IOC has recently recommended a shift in terminology away from the Female Athlete Triad, to include references to male dancers. The recommended new term is Relative Energy Deficiency in Sport (RED-S) (Mountjoy, et al., 2014). Framed as RED-S, it becomes easier to conceptualize bone health in terms of nutritional variables that impact both genders.

Nutrition is closely linked to good bone health among all populations, and nutrition can be especially relevant to populations that place inordinate stress on bone systems. The estimated 38,000 professional dancers (and "countless" amateurs) in the United States therefore stand to benefit from education and awareness related to nutrition and hormonal balance related to bone density and bone health (Hoch, et al., 2011, p. 2). Dancers have lower body fat relative to the general population and subsequently a decreased risk for cardiovascular and metabolic diseases (Friesen, et al., 2011). However, dancers also have a higher than average incidence rate of eating disorders (Friesen et al., 2011). Female dancers also have a higher rate of menstrual dysfunction, related to dietary and exercise habits, versus the general female population (Friesen, et al., 2011). Disordered eating and amenorrhea also combine to create "synergistic effects in decreasing bone mineral density," (Friesen, et al., 2011, p. 31). Low bone mineral density increases the risk of bone fractures in both sexes, making dietary health and nutrition awareness particularly important to professionals hoping to maintain a long and successful career. It is worth noting that Caucasian women are at a greater risk for low bone density and other RED-S factors vs. African-American women. Still, all dancers should be made aware of the consequences of disordered eating on their health and their career.