# Bone Health in Former Artistic Gymnasts Aged 45 Years and Over: Case–Control Comparison with Controls and Reference Populations

## TL;DR

Former artistic gymnasts over 45 have better bone health and lower osteoporosis risk compared to age-matched adults due to early-life high-impact exercise.

## Contribution

Shows long-term skeletal benefits of childhood osteogenic exercise in a rarely studied population of older former gymnasts.

## Key findings

- Former gymnasts had 4–6 times higher femoral Z-scores and lower osteopenia/osteoporosis prevalence than controls.
- No osteoporosis cases were found among gymnasts compared to 6–12% in reference populations.
- Protective effects were reduced in older females due to postmenopausal bone loss.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Identifies how early-life participation in an osteogenic sport like artistic gymnastics can influence bone health decades later, a key factor in preventing osteoporosis;Addresses the burden of age-related bone loss by examining a population rarely studied: former gymnasts aged 45 years and over.

Identifies how early-life participation in an osteogenic sport like artistic gymnastics can influence bone health decades later, a key factor in preventing osteoporosis;

Addresses the burden of age-related bone loss by examining a population rarely studied: former gymnasts aged 45 years and over.

Public health significance—Why is this work of significance to public health?
Demonstrates that former gymnasts have higher bone density and lower prevalence of osteopenia/osteoporosis than age-matched middle-aged and older adults;Supports the idea that maximizing bone accrual during growth can provide lasting protection and help preserve bone health in later in life.

Demonstrates that former gymnasts have higher bone density and lower prevalence of osteopenia/osteoporosis than age-matched middle-aged and older adults;

Supports the idea that maximizing bone accrual during growth can provide lasting protection and help preserve bone health in later in life.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Encouraging high-impact, weight-bearing exercise in childhood and adolescence may help establish a lifelong “bone reserve” and lower future osteoporosis risk;Highlights the need for lifespan-oriented bone health strategies that combine early mechanical loading benefits with targeted support in older adulthood, especially for postmenopausal females, who face accelerated bone loss despite earlier advantages.

Encouraging high-impact, weight-bearing exercise in childhood and adolescence may help establish a lifelong “bone reserve” and lower future osteoporosis risk;

Highlights the need for lifespan-oriented bone health strategies that combine early mechanical loading benefits with targeted support in older adulthood, especially for postmenopausal females, who face accelerated bone loss despite earlier advantages.

Peak bone mass gained in youth is crucial for preventing osteoporosis. Artistic gymnastics (AG) is highly osteogenic, yet its long-term effects on adults ≥ 45 years are not well documented. This case–control study compared bone mineral density (BMD) and the prevalence of osteopenia/osteoporosis in former gymnasts, age-matched controls, and reference populations from Brazil and Portugal. Participants included 65 former gymnasts (32 males, 33 females; 45–84 years), who trained for 12.6 ± 4.3 years and included 41 international competitors, and 91 controls (37 males; 45–87 years). Whole-body and femoral BMD were assessed by DXA. Physical activity during youth (10–20 years) (PA-Youth) and the past decade (PA-10) was recorded. Reference data were drawn from large cohorts in Brazil (FIBRA, n = 828) and Portugal (CIAFEL, n = 1089). Former gymnasts had substantially higher PA-Youth than controls, while PA-10 was similar. Gymnasts displayed 4–6 times higher femoral Z-scores (neck and total) and a markedly lower prevalence of osteopenia/osteoporosis (males: 3% vs. 16%; females: 36% vs. 52%, p < 0.05). These benefits remained after adjustment for age, PA-10, and hormonal/calcium therapy. Relative to reference populations, gymnasts showed greater whole-body and femoral mineralization, with no osteoporosis cases (vs. 6–12% overall; 9–13% among those ≥60 years). Age-stratified analysis (45–59 and ≥60 years) revealed a consistently lower osteopenia prevalence across age groups, except in females ≥ 60 years. In conclusion, early-life AG participation is associated with enduring skeletal benefits, including higher bone mineralization and reduced osteopenia/osteoporosis in adults ≥ 45 years. The protective effect appears diminished in older females, likely reflecting prolonged postmenopausal bone loss.