Objectives 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, measured by dual X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) is an advanced imaging device that provides measures of volumetric BMD (vBMD), bone microarchitecture, geometry, and strength. The objective of this study was to assess prevalence of REDs in elite winter sport athletes and to observe the associations in bone parameters using HR-pQCT in athletes identified as at-risk or not at-risk of REDs.

Methods Participants included 101 elite athletes (24.1±4.4 SD years; 52% female). The REDs Clinical Assessment Tool (CAT2) was used to determine REDs risk. HR- pQCT scans of the non-dominant radius and left tibia were analyzed upon REDs risk grouping.

Results Seventeen athletes (17%; 71% female) were at-risk based on the REDs CAT2. After covarying for lean mass, odds ratios (OR) suggested higher likelihood of REDs risk classification for athletes with low cortical thickness, cortical area, total vBMD, and bone strength.

Conclusions Impaired total vBMD, bone strength and cortical bone parameters were approximately twice as likely (OR: 1.9-3.0) in athletes at-risk of REDs. Results agree with the consensus statement that HR-pQCT may identify impaired bone health in athletes at-risk of REDs. Future directions should use HR-pQCT to explore REDs risk longitudinally, utilizing bone change over time as this may provide greater insight. Using advanced imaging to explore REDs risk in a population of winter high-performance athletes is novel.

The authors have declared no competing interest.

This study did not receive any funding

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This cross-sectional study obtained ethics approval from the Conjoint Health Research and Ethics Board at the University of Calgary (REB19-1078)

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