Using High Resolution Peripheral Quantitative Computed Tomography to Evaluate Bone Health and Relative Energy Deficiency in Sport Risk in Elite Winter Sport Athletes
Date
2024-08-27
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Abstract
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 (24.14.4 SD years; 53% female). HR-pQCT scans of the non-dominant 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=0.420.10) than vBMD (ICC=0.250.07). 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<AUC<0.69) discriminatory abilities at both the radius and tibia in identifying REDs risk based on the current threshold of Z-score <-1.0 standard deviations (SD). Bone parameters were lower in athletes at-risk of REDs and results agree with the new consensus statement that HR-pQCT may identify impaired bone health in athletes at-risk of REDs. These findings are novel in approaching REDs using HR-pQCT and in the population of elite winter sport athletes. Future directions should explore longitudinal studies utilizing bone change over time as this may provide greater insight into REDs risk.
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Keywords
HR-pQCT, Medical Imaging, Elite Athletes, REDs, Bone Health
Citation
Smith, E. M. (2024). Using high resolution peripheral quantitative computed tomography to evaluate bone health and relative energy deficiency in sport risk in elite winter sport athletes (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.