What are the consequences of misuse of Dual-Energy X-ray Absorptiometry (DEXA) scans in female athletes?

From the Guidelines

Healthcare providers should avoid using DEXA scans solely for body composition assessment in female athletes, as this practice can lead to potential harm, including restrictive eating behaviors, psychological distress, and components of Relative Energy Deficiency in Sport (RED-S) 1. The misuse of DEXA scans in female athlete populations stems from the flawed assumption that lower body fat percentages universally improve performance, when in reality, adequate energy availability is crucial for both health and optimal athletic performance.

Key Considerations

• DEXA scans are valuable for bone density assessment, but should not be used to set arbitrary body fat percentage targets 1.
• Female athletes subjected to regular DEXA monitoring often develop disordered eating patterns and menstrual dysfunction, highlighting the need for comprehensive health assessments that prioritize energy availability, menstrual function, bone health, metabolic markers, and psychological well-being 1.
• The International Olympic Committee (IOC) recommends a broader, more comprehensive approach to addressing the health concerns of female athletes, recognizing that male athletes can also be affected by Relative Energy Deficiency in Sport (RED-S) 1.

Recommendations for Practice

• Instead of relying on DEXA-based body composition targets, healthcare providers should focus on comprehensive health assessments that support sustainable athletic performance and overall well-being 1.
• Athletes with a history of traumatic fractures, medications that impact bone health, or other risk factors should be considered for DXA testing, but this should be done in the context of a broader health assessment 1.
• Healthcare providers should prioritize energy availability, menstrual function, bone health, metabolic markers, and psychological well-being in their assessments and interventions, rather than relying solely on body fat percentage or other arbitrary metrics 1.

From the Research

Consequences of Misuse of DEXA Scans in Female Athletes

• Misuse of DEXA scans can lead to inaccurate diagnosis and treatment of osteoporosis and other bone-related conditions in female athletes 2, 3, 4.
• The consequences of misuse can include delayed or inappropriate treatment, which can exacerbate bone health problems and increase the risk of fractures and other complications 3, 4.
• In female athletes with the Female Athlete Triad, misuse of DEXA scans can lead to underestimation or overestimation of bone mineral density (BMD), which can impact treatment decisions and athlete health 2.

Specific Consequences of DEXA Scan Misuse

• Failure to detect low BMD, which can increase the risk of osteoporosis and fractures 3, 4.
• Inaccurate diagnosis of osteoporosis or osteopenia, which can lead to unnecessary or inappropriate treatment 4.
• Delayed or missed diagnosis of other bone-related conditions, such as stress fractures or osteonecrosis 5, 6.

Factors Contributing to DEXA Scan Misuse

• Limited understanding of DEXA scan results and their implications for athlete health 5, 6.
• Inadequate training or experience in interpreting DEXA scan results 3, 4.
• Failure to consider individual athlete factors, such as age, sex, and athletic history, when interpreting DEXA scan results 2, 3, 4.