Menstrual status and bone health in athletes from different sports - a retrospective analysis

Gina F Øistuen; John O Osborne; Jorunn Sundgot-Borgen; Dionne A Noordhof; Madison Y Taylor; Ida Heikura; Trent Stellingwerff; Sara A Solheim; Helge E Lundberg; Therese F Mathisen; Mette Hansen; Mikkel Oxfeldt; Line B Dalgaard; Erik P Andersson; Klavs Madsen; Kristin L Jonvik

doi:10.1186/s13102-026-01781-y

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Menstrual status and bone health in athletes from different sports - a retrospective analysis

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Menstrual status and bone health in athletes from different sports - a retrospective analysis

Gina F Øistuen, John O Osborne, Jorunn Sundgot-Borgen, Dionne A Noordhof, Madison Y Taylor, Ida Heikura, Trent Stellingwerff, Sara A Solheim, Helge E Lundberg, Therese F Mathisen, …

BMC Sports Science, Medicine and Rehabilitation, Vol.Advanced access(1)

09-Jun-2026

DOI: https://doi.org/10.1186/s13102-026-01781-y

PMCID: PMC13474736

PMID: 42265735

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Abstract

Impact Sport

Hormonal contraceptives

Menstrual cycle

Menstrual disturbances

Relative Energy Deficiency in Sports

Bone Mass

Background Relative energy deficiency in sport (REDs) is linked to low energy availability, menstrual disturbances (MD) and low bone mineral density (BMD; Z-score < -1.0). The prevalence of these symptoms across sports and their interrelationships requires further investigation. This study aimed to 1) investigate the prevalence of severe MD and low BMD among athletes from different sports, 2) compare BMD Z-scores at lumbar spine, total hip and whole-body between regularly menstruating (RM), severe MD and hormonal contraceptive (HC) users, and 3) examine factors related to BMD among endurance athletes, including menstrual status, athletic caliber and sport-specific loading characteristics. Methods Retrospective analysis of cross-sectional data from seven projects included 411 women from 34 sports (endurance: n = 257; non-endurance: n = 154). BMD was assessed using dual-energy X-ray absorptiometry. Menstrual status was defined by the three-step method, cycle tracking or questionnaire, and categorized as RM, severe MD or HC. Endurance sports were further grouped by loading characteristics (very low, low and medium). Results Among non-HC users (51%), the prevalence of severe MD was 37% in endurance, 34% in ball sport and 36% in power- and technical- sports. BMD was not different between menstrual status groups at either lumbar spine (P = 0.334), total hip (P = 0.079) or whole-body (P = 0.164). Endurance athletes had lower lumbar spine BMD Z-scores than non-endurance athletes (-0.0 ± 1.0 vs 1.2 ± 1.2, P < 0.0001), with a higher prevalence of low BMD (17% vs 2%, P = 0.015). Total hip BMD Z-scores were lower in endurance than non-endurance athletes (0.6 ± 0.9 vs 1.4 ± 1.2, P < 0.05 for age < 27). Among endurance athletes, neither loading characteristics nor athletic caliber were associated with BMD. However, endurance athletes with severe MD had lower total hip BMD Z-scores compared to RM athletes (P = 0.008) and HC users (P = 0.021). Conclusions The prevalence of severe MD did not differ between sport types. Overall, BMD Z-scores did not differ across menstrual status categories. However, endurance athletes had lower BMD, with total hip BMD being lower in those with severe MD. Heterogenous menstrual assessment methods across the projects included in this study may have impacted the results. Future research should integrate comprehensive REDs assessments including detailed data on menstrual status, training history, bone-loading impact and injuries in female athletes from different sports.

Details

Title: Menstrual status and bone health in athletes from different sports - a retrospective analysis
Authors: Gina F Øistuen - Norwegian School of Sport Sciences
John O Osborne - University of the Sunshine Coast
Jorunn Sundgot-Borgen - Norwegian School of Sport Sciences
Dionne A Noordhof - Norwegian University of Science and Technology
Madison Y Taylor - UiT The Arctic University of Norway
Ida Heikura - University of Victoria
Trent Stellingwerff - University of Victoria
Sara A Solheim - Oslo University Hospital
Helge E Lundberg - Norwegian School of Sport Sciences
Therese F Mathisen - Østfold University of Applied Sciences
Mette Hansen - Aarhus University
Mikkel Oxfeldt - Aarhus University
Line B Dalgaard - Aarhus University
Erik P Andersson - Mid Sweden University
Klavs Madsen - Norwegian School of Sport Sciences
Kristin L Jonvik (Corresponding Author) - Norwegian School of Sport Sciences
Publication details: BMC Sports Science, Medicine and Rehabilitation, Vol.Advanced access(1)
Publisher: BioMed Central Ltd.
DOI: 10.1186/s13102-026-01781-y
ISSN: 2052-1847
PMID: 42265735; PMC13474736
Copyright note: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Grant note: This research was funded by Foundation Dam (Norway), grant number SDAM_HEL525787.
Organisation Unit: School of Health
Language: English
Record Identifier: 991246170202621
Output Type: Journal article

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