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Female athletes now compete in virtually all the main sporting arenas of the world in which the physical differences between the sexes are largely irrelevant because women only compete against [...]

To investigate whether stress fractures occurring in elite femaleathletes are related to reductions in bone mineral density (BMD), we measured BMD in nine athletes with such fractures and nine athletes without fractures who were matched for age, weight, height and sport. BMD was measured in three regions: upper limbs (distal radius), axial skeleton (lumbar spine) and lower limbs (femoralneck)by photon absorptiometry.The number of mensesper year was significantly less (P<0.04) and the age of menarche was significantly delayed(mean ± SD; 16.1 ± 0.4 v. 14.4 ± 1.5 years. P<0.02) in the fracture group comparedwith the non‐fracture group. There was no significant difference in BMD between the two groups at any of the measurement sites. Moreover although the fractures occurred mainly in lower limb bones. at sites characterised by predominantly cortical bone. all athletes had femoral neck BMD values within the 95% confidence limits for normal non‐athletic women.Weconclude that stress fractures in elite female athletes are largely independent of BMD.