Development and validation of a pre-screening tool for early detection of low bone mineral density in female athletes (PreST-LBMD)

The prevalence of low bone mineral density (BMD) among female athletes is higher than that among their male counterparts up to 40%. Low BMD increases the risk of stress fractures. To examine factors associated with low BMD in female athletes, and to develop, test, and evaluate a Pre-screening Tool for Early Detection of Low BMD in Female Athletes (PreST-LBMD). The development and validation groups (381 and 233 subjects, respectively) underwent a medical interview and a BMD test at the lumbar spine using dual-energy X-ray absorptiometry (DXA). A Z-score Factors associated with low BMD included age at menarche, amenorrhea for more than 1 year during the teenage years, current duration of amenorrhea, body mass index, history of stress fractures, and exercise load. The calculated cutoff value for a high likelihood of low BMD was 3 points, with a sensitivity of 0.83 (0.79–0.88), a negative predictive value of 0.85 (0.81–0.90), and an area under the curve of 0.74 (0.67–0.81). We successfully developed the PreST-LBMD, which showed promising results identifying female athletes with low BMD. Those scoring ≥3 should be assessed by DXA and evaluated for the likelihood of low BMD by the athlete’s health and performance team.