Site-specific, adult bone benefits attributed to loading during youth: A preliminary longitudinal analysis

• Distal radius and femoral neck strength increase with peri-menarcheal loading.
• Narrow endosteal diameter, greater cortical thickness produce femoral neck strength.
• Lumbar spine and sub-head BMC are greater with peri-menarcheal loading.
• When loading ceases, cortical bone may improve, corticocancellous bone may diminish.

We examined site-specific bone development in relation to childhood and adolescent artistic gymnastics exposure, comparing up to 10 years of prospectively acquired longitudinal data in 44 subjects, including 31 non-gymnasts (NON) and 13 gymnasts (GYM) who participated in gymnastics from pre-menarche to ≥ 1.9 years post-menarche. Subjects underwent annual regional and whole-body DXA scans; indices of bone geometry and strength were calculated. Anthropometrics, physical activity, and maturity were assessed annually, coincident with DXA scans. Non-linear mixed effect models centered growth in bone outcomes at menarche and adjusted for menarcheal age, height, and non-bone fat-free mass to evaluate GYM-NON differences. A POST-QUIT variable assessed the withdrawal effect of quitting gymnastics. Curves for bone area, mass (BMC), and strength indices were higher in GYM than NON at both distal radius metaphysis and diaphysis (p < 0.0001). At the femoral neck, greater GYM BMC (p < 0.01), narrower GYM endosteal diameter (p < 0.02), and similar periosteal width (p = 0.09) yielded GYM advantages in narrow neck cortical thickness and buckling ratio (both p < 0.001; lower BR indicates lower fracture risk). Lumbar spine and sub-head BMC were greater in GYM than NON (p < 0.036). Following gymnastics cessation, GYM slopes increased for distal radius diaphysis parameters (p ≤ 0.01) and for narrow neck BR (p = 0.02). At the distal radius metaphysis, GYM BMC and compressive strength slopes decreased, as did slopes for lumbar spine BMC, femoral neck BMC, and narrow neck cortical thickness (p < 0.02). In conclusion, advantages in bone mass, geometry, and strength at multiple skeletal sites were noted across growth and into young adulthood in girls who participated in gymnastics loading to at least 1.9 years post-menarche. Following gymnastics cessation, advantages at cortical bone sites improved or stabilized, while advantages at corticocancellous sites stabilized or diminished. Additional longitudinal observation is necessary to determine whether residual loading benefits enhance lifelong skeletal strength.