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

Former artistic gymnasts displayed 4-6 times higher femoral Z-scores compared to age-matched controls.

• Femoral Z-scores (neck and total) were 4-6 times higher in former gymnasts than controls.
• The study included 65 former gymnasts (32 males, 33 females; aged 45-84 years) and 91 controls (37 males; aged 45-87 years).
• Gymnasts had trained for an average of 12.6 ± 4.3 years, with 41 being international competitors.
• Whole-body and femoral BMD were assessed by DXA.

Former gymnasts had a markedly lower prevalence of osteopenia/osteoporosis compared to age-matched controls.

• Male gymnasts had an osteopenia/osteoporosis prevalence of 3% versus 16% in male controls (p < 0.05).
• Female gymnasts had a prevalence of 36% versus 52% in female controls (p < 0.05).
• These benefits remained after adjustment for age, physical activity in the past decade (PA-10), and hormonal/calcium therapy.

Former gymnasts showed greater whole-body and femoral mineralization relative to reference populations, with no osteoporosis cases observed.

• Reference data were drawn from large cohorts in Brazil (FIBRA, n = 828) and Portugal (CIAFEL, n = 1089).
• Osteoporosis prevalence in reference populations was 6-12% overall and 9-13% among those aged ≥60 years.
• No osteoporosis cases were found among former gymnasts.
• Former gymnasts had substantially higher physical activity during youth (ages 10-20 years; PA-Youth) than controls, while PA in the past decade (PA-10) was similar between groups.

Age-stratified analysis revealed that the protective effect of former gymnastics participation on osteopenia prevalence was diminished in females aged 60 years and over.

• Age-stratified analysis compared two groups: 45-59 years and ≥60 years.
• A consistently lower osteopenia prevalence was observed across age groups in gymnasts, except in females aged ≥60 years.
• The diminished protective effect in older females was attributed to prolonged postmenopausal bone loss.
• The overall female gymnast osteopenia/osteoporosis prevalence was still lower than controls (36% vs. 52%).

Former artistic gymnasts had substantially higher physical activity during youth compared to controls, while recent physical activity levels were similar between groups.

• Physical activity during youth (PA-Youth, ages 10-20 years) was substantially higher in former gymnasts than controls.
• Physical activity over the past decade (PA-10) was similar between former gymnasts and controls.
• The skeletal benefits in former gymnasts persisted after statistical adjustment for PA-10, suggesting the effects were attributable to early-life gymnastics exposure rather than recent physical activity.