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

Peak bone mass gained in youth is crucial for preventing osteoporosis. Artistic gymnastics (AG) is highly osteogenic, yet its long-term effects on adults ≥ 45 years are not well documented. This case-control study compared bone mineral density (BMD) and the prevalence of osteopenia/osteoporosis in former gymnasts, age-matched controls, and reference populations from Brazil and Portugal. Participants included 65 former gymnasts (32 males, 33 females; 45-84 years), who trained for 12.6 ± 4.3 years and included 41 international competitors, and 91 controls (37 males; 45-87 years). Whole-body and femoral BMD were assessed by DXA. Physical activity during youth (10-20 years) (PA-Youth) and the past decade (PA-10) was recorded. Reference data were drawn from large cohorts in Brazil (FIBRA, n = 828) and Portugal (CIAFEL, n = 1089). Former gymnasts had substantially higher PA-Youth than controls, while PA-10 was similar. Gymnasts displayed 4-6 times higher femoral Z-scores (neck and total) and a markedly lower prevalence of osteopenia/osteoporosis (males: 3% vs. 16%; females: 36% vs. 52%, p < 0.05). These benefits remained after adjustment for age, PA-10, and hormonal/calcium therapy. Relative to reference populations, gymnasts showed greater whole-body and femoral mineralization, with no osteoporosis cases (vs. 6-12% overall; 9-13% among those ≥60 years). Age-stratified analysis (45-59 and ≥60 years) revealed a consistently lower osteopenia prevalence across age groups, except in females ≥ 60 years. In conclusion, early-life AG participation is associated with enduring skeletal benefits, including higher bone mineralization and reduced osteopenia/osteoporosis in adults ≥ 45 years. The protective effect appears diminished in older females, likely reflecting prolonged postmenopausal bone loss.