In this prospective, cross-sectional study male adolescent tennis players (44) and nonathletic controls (32) were evaluated to determine the effects of physical activity, dietary nutrient intakes, sexual maturation, and body composition on bone-mineral density (BMD). Dietary nutrient intakes and physical activity expenditure were estimated by 4-d diaries. Total body composition, bone-mineral content (BMC), and BMD (L1–L4, femur, and nondominant forearm) were assessed by dual-energy X-ray absorptiometry. Tennis players had significantly greater lean body mass (mean [SEM] 50.6 [1.6] kg vs. 45.1 [1.7] kg, p = .022), trochanter BMD (1.0 [0.02] g/cm2 vs. 0.9 [0.03] g/cm2, p = .032), and dominant forearm BMC (173.7 [7.4] g vs. 146.5 [9.3] g) but lower BMD in the nondominant forearm (0.7 [0.02] g/cm2 vs. 0.8 [0.03] g/cm2, p = .028). Daily average calcium intake was below the recommendation in both groups. No correlation was found between BMD and calcium intake and exercise. Lean body mass was the best predictor of BMD and BMC for both tennis players and controls (R2 = .825, .628, and .693 for L1–L4, total femur, and nondominant forearm, respectively). Based on these results the authors conclude that lean body mass is the best predictor of BMD and BMC for both tennis players and others. Tennis exerts a site-specific effect, and training should focus on ways minimize this effect. Although calcium intake showed no effect on BMD, nutrition education for young athletes should focus on promoting a balanced diet, providing energy and nutrients in adequate amounts.
Juzwiak, Amancio, and Vitalle are with the Pediatric Dept., and Szejnfeld and Pinheiro, the Rheumatology Division, Federal University of São Paulo, São Paulo, Brazil.