Bone mineral density, rib pain and other features of the female athlete triad in elite lightweight rowers

Abstract

ObjectiveTo determine bone mineral density (BMD) and the associations among BMD, menstrual history, disordered eating (DE), training history, intentional weight loss (IWL) and rib pain for the first time in female lightweight rowers.Setting9 lightweight rowing clubs, UK.Participants29 Caucasian female lightweight rowers volunteered. 21 (12 active, 9 retired) completed the study. Inclusion criteria: female lightweight rowers aged over 18 years. Exclusion criteria: participants with a history of bone disease, used medications known to influence BMD or if they were pregnant, lactating or postmenopausal.Main outcome measuresDual-energy X-ray absorptiometry measured total body (TB) composition and BMD at the spine, femoral neck (FN), radius and TB. DE, oligomenorrhoea/amenorrhoea years; rib pain and training history.ResultsDE was reported in six of the rowers. The active with DE started rowing younger (p<0.05) than those without, and their amount of IWL was associated with Eating Attitudes Test-26 score (p<0.05). Some participants reported a history of oligomenorrhoea/amenorrhoea 17 (76%) and/or rib pain 7 (32%) with those with rib pain having lower spine and TB Z-scores (p<0.05) than those without. Those with oligomenorrhoea/amenorrhoea had lower spine Z-scores (p<0.01) than those without. Twelve participants had low BMD; three at spine; one at FN; and eight at radius. Thirteen per cent of mean total training hours (18.6±9.1 h/week) were spent strength training (2.4±2.2 h/week).ConclusionsUpper body exercises incorporating multidimensional high peak bone strain were not reported and may need to be considered in their strength training to improve radial BMD. Results suggest IWL and high-level training at a young age increases the likelihood of DE and there may be a lack of quality nutritional support for these athletes. Thus, multidisciplinary sport science support should be offered at a young age and perhaps also to consider changing the weight rules to prevent the development of the Triad.

Current and past menstrual status is an important determinant of femoral neck geometry in exercising women

“…On the other hand, contrary to our hypotheses, the BMD of the C/P-RIR group was not significantly different from the BMD of both the C + P-IR and the C + P-R group at all sites. These results largely support the findings of other investigators, which demonstrated that female athletes with a history of menstrual irregularity had lower BMD [7] or Z-scores [28] at the lumbar spine but not at the femoral neck when compared with eumenorrheic athletes. Using a study design similar to that in the current study, Drinkwater et al [3] also demonstrated that athletes with current and past menstrual irregularity and athletes with episodes of menstrual irregularity interspersed with periods of menstrual regularity had lower lumbar spine BMD than athletes who had consistently regular menstrual cycles.…”

“…Using a study design similar to that in the current study, Drinkwater et al [3] also demonstrated that athletes with current and past menstrual irregularity and athletes with episodes of menstrual irregularity interspersed with periods of menstrual regularity had lower lumbar spine BMD than athletes who had consistently regular menstrual cycles. However, contrary to our findings and those of other investigators [7,28], Drinkwater et al [3] reported that BMD at a weight-bearing site, the femoral shaft, was lower among athletes with current and past menstrual irregularity compared with athletes who had always had regular menstrual cycles (and compared with those who had episodes of amenorrhea/oligomenorrhea interspersed with period of eumenorrhea).…”

“…Investigators of these studies reported that, in female athletes, self-reported history of irregular menstrual cycles since menarche was associated with low BMD (Z-score ≤ −1) [29] or with lower BMD compared with a history of regular menses [7,28,31,32] and was also associated with history of stress fracture [8]; however, geometric measures of the femoral neck were similar between those with a history of regular vs. irregular menses since menarche [7]. Results from Ducher et al [27], who used peripheral quantitative computed tomography (pQCT) to assess bone health, revealed that retired gymnasts with a history of amenorrhea had significantly lower trabecular volumetric BMD and estimated bone strength but greater total bone area at the distal radius when compared with retired gymnasts with a history of regular menses.…”

“…Several contemporary studies [7,8,[27][28][29][30] and classic studies [31,32] have explored the impact of past menstrual status, i.e., menstrual history, on bone health. Investigators of these studies reported that, in female athletes, self-reported history of irregular menstrual cycles since menarche was associated with low BMD (Z-score ≤ −1) [29] or with lower BMD compared with a history of regular menses [7,28,31,32] and was also associated with history of stress fracture [8]; however, geometric measures of the femoral neck were similar between those with a history of regular vs. irregular menses since menarche [7].…”

Bone mineral density in elite rowers

“…High impact sports increases BMD at loaded sites with low impact sports having largely neutral findings [1]. The influence of high level rowing training has not been well explored with relatively small samples within a single category or discipline [2–5]. …”