Bone Mineral Density in Physique-Focused and Non-Physique-Focused Female Collegiate Athletes: Associations With Relative Energy Deficiency in Sport Risk Factors.
Kolb DE, Cipriano NL, Moody RA, Stephens JA, Caldwell LK, Lindley MR et al. · Journal of strength and conditioning research · 2026
Abstract Kolb, DE, Cipriano, NL, Moody, RA, Stephens, JA, Caldwell, LK, Lindley, MR, Ware, ME, and Deemer, SE. Bone mineral density in physique-focused and non-physique-focused female collegiate athletes: Associations with relative energy deficiency in sport risk factors. J Strength Cond Res XX(X): 000-000, 2026-Bone mineral density (BMD) is a critical indicator of skeletal health and long-term injury risk in athletic populations. Female athletes are susceptible to changes in BMD because of sport-specific training demands, hormonal dysregulation, and energy availability. The present study aimed to compare BMD between physique-focused (PF; endurance, aesthetic, and weight-dependent sports) and non-physique-focused (NPF; ball, power, and skill-based sports) female collegiate athletes and assess risk factors associated with relative energy deficiency in sport (REDs) across both groups. Thirty-three female athletes were evaluated for BMD by dual-energy X-ray absorptiometry (DXA), REDs risk using the Clinical Assessment Tool 2 (CAT2), anthropometric measurements, blood biomarkers, the Eating Disorder Examination Questionnaire (EDE-Q), and the Low Energy Availability in Females Questionnaire (LEAF-Q). Group differences were assessed using independent t-tests with
Significance: set at p < 0.05. Physique-focused athletes demonstrated significantly lower DXA-derived z-scores at anteroposterior spine, right and left femur, and total body sites than NPF athletes (p < 0.001). There were no differences in leptin (p = 0.35), cortisol (p = 0.16), vitamin D (p = 0.29), LEAF-Q total score (p = 0.72), or global EDE-Q score (p = 0.10). No group differences in CAT2 REDs risk were observed; thus, subjects were combined: 19 athletes were classified as "green;" 12 were "yellow;" and 2 were "orange." Lower BMD in PF athletes supports the importance of early screening and targeted interventions to support bone health. These
Findings: suggest sport type may influence skeletal outcomes independent of traditional REDs indicators, emphasizing the need for sport-specific assessment strategies.