Anthropometric Measures Associated with Orthopedic Injuries in Professional Ballet Performers: New DEXA Screening Criteria?

<b>Introduction:</b> Musculoskeletal injuries are common among professional ballet performers due to the discipline's high physical demands and aesthetic pressures. Although dual-energy X-ray absorptiometry (DEXA) is widely used to assess bone mineral density (BMD) and body composition in athletes, no ballet-specific injury risk thresholds currently exist. This investigation aimed to identify population-specific DEXA thresholds associated with musculoskeletal injury risk in professional ballet performers. We hypothesized that dancers who sustained injuries during a performance season would exhibit reduced lean mass, body mass index (BMI), and BMD compared to uninjured counterparts. <b>Methods:</b> This retrospective cohort study included 199 professional ballet dancers (96 females, 102 males) from a single company who underwent DEXA scans during annual physicals between 2017 and 2022 to assess total and regional lean mass, body fat percentage, and BMD. Injury status in the year following each scan was classified into four levels: 0 = no injury, 1 = complaint with full participation, 2 = modified participation, and 3 = time-loss injury. Independent samples <i>t</i>-tests compared DEXA measures between injury groups within each sex. Significance was set at <i>P</i> < .05. <b>Results:</b> Among females, those with higher-level injuries (Levels 2-3) had significantly lower total lean mass index (LMI: 13.83 ± 0.19 vs 14.41 ± 0.31 kg/m², <i>P</i> = .006), BMI (18.44 ± 0.42 vs 19.24 ± 0.28 kg/m², <i>P</i> = .008), and total BMD (1.12 ± 0.03 vs 1.16 ± 0.02 g/cm², <i>P</i> = .037). Among males, those with injuries (Levels 1-3) had significantly lower total LMI (18.57 ± 0.37 vs 19.22 ± 0.29 kg/m², <i>P</i> = .031) and legs LMI (6.45 ± 0.15 vs 6.74 ± 0.12 kg/m², <i>P</i> = .020). <b>Conclusion:</b> Reduced lean mass and BMD are associated with increased injury risk in professional ballet dancers. Sex- and sport-specific DEXA thresholds may improve injury screening and prevention strategies.