Using High Resolution Peripheral Quantitative Computed Tomography to Evaluate Bone Health and Relative Energy Deficiency in Sport Risk in Elite Winter Sport Athletes

Relative Energy Deficiency in Sport (REDs) is a syndrome resulting from problematic low energy availability (LEA). Low areal bone mineral density (aBMD) is a primary indicator of LEA and is measured at the hip or spine by dual X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) measures volumetric BMD (vBMD), microarchitecture, geometry, and estimated strength reported as failure load. The objective of this study was to assess the differences in bone parameters using HR-pQCT in elite winter sport athletes identified as at-risk or not at-risk of REDs using the Clinical Assessment Tool (CAT2). Participants included 101 athletes (24.1±4.4 SD years; 53% female). HR-pQCT scans of the nondominant radius and left tibia were analyzed and compared to DXA results. Seventeen athletes (17%; 71% female) were at-risk of REDs based on the CAT2. Bland-Altman plots suggested that compared to aBMD, Z-scores were more like failure load (ICC=0.42±0.10) than vBMD (ICC=0.25±0.07). After covarying for lean mass, odds ratios (OR) suggested increased likelihood of REDs risk classification for those with low cortical thickness (radius: OR=2.14, p=0.021; tibia: OR=1.89, p=0.037), and area (radius: OR=3.04, p=0.007; tibia: OR=2.74, p=0.006), total vBMD (tibia: OR=2.06, p=0.030), and failure load (tibia: OR=2.17, p=0.033). ROC-AUC analysis showed very poor to poor (0.50

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Year

Entry

1985

Hvid I, Hansen SL. Trabecular bone strength patterns at the proximal tibial epiphysis. J Orthop Res. 1985;3(4):464-472.

2018

Whittier DE, Manske SL, Kiel DP, Bouxsein M, Boyd SK. Harmonizing finite element modelling for non-invasive strength estimation by high-resolution peripheral quantitative computed tomography. J Biomech. October 26, 2018;80:63-71.

2008

MacNeil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. June 2008;42(6):1203-1213.

2010

Burghardt AJ, Kazakia GJ, Sode M, de Papp AE, Link TM, Majumdar S. A longitudinal HR-pQCT study of alendronate treatment in postmenopausal women with low bone density: relations among density, cortical and trabecular microarchitecture, biomechanics, and bone turnover. J Bone Miner Res. December 2010;25(12):2558-2571.

2002

Pistoia W, van Rietbergen B, Lochmüller E-M, Lill CA, Eckstein F, Rüegsegger P. Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone. June 2002;30(6):842-848.