<i>Exercise‐Induced Amenorrhea and Bone Health in the Adolescent Athlete</i>

Warren, Michelle P.; Chua, Abigail

doi:10.1196/annals.1429.025

Cited by 52 publications

(33 citation statements)

References 100 publications

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“…Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad, suggesting that the risk of stress fractures was increased in cases with the female athlete triad. There is a potential link between body mass index, energy deficit, and hypothalamic dysfunction, and the pathophysiology underlying low BMD in hypothalamic amenorrhea is directly related to nutritional issues [20][21][22] . There may be both a nutritional component affecting formation and an estrogen-related component affecting resorption (uncoupling of bone formation and resorption).…”

Section: Discussionmentioning

confidence: 99%

“…There may be both a nutritional component affecting formation and an estrogen-related component affecting resorption (uncoupling of bone formation and resorption). The first aim is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure; weight gain and an increase in energy availability (> 30 kcal/kg of fat-free mass per day) in those young women are clinical priorities to facilitate resumption of their menses [20][21][22] . Adequate amounts of bone-building nutrients such as calcium (1000-1300 mg/d), vitamin D (400-800 IU/d), and vitamin K (60-90 µg/d) are also needed to maintain bone health [20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

“…The first aim is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure; weight gain and an increase in energy availability (> 30 kcal/kg of fat-free mass per day) in those young women are clinical priorities to facilitate resumption of their menses [20][21][22] . Adequate amounts of bone-building nutrients such as calcium (1000-1300 mg/d), vitamin D (400-800 IU/d), and vitamin K (60-90 µg/d) are also needed to maintain bone health [20][21][22] . Leptin administration for relative leptin deficiency in women with hypothalamic amenorrhea was reported to improve reproductive, thyroid, and growth hormone axes and markers of bone formation, suggesting that leptin, a peripheral signal reflecting the adequacy of energy stores, is required for normal reproductive and neuroendocrine function [23] .…”

Section: Discussionmentioning

confidence: 99%

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Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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AIM:To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS:We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS:During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION:The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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“…However, one or more main signals that centrally indicates the availability of energy is still unknown ( 4 ). Since physical activity may reduce leptin mRNA expression ( 5 , 6 ) and athletes that train intensively, under restricted calorie intake, present a higher percentage of amenorrhea than sedentary women ( 7 ), it may be speculated that leptin is involved in the transduction of the energy availability signals.…”

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confidence: 99%

Effect of Food Restriction and Intense Physical Training on Estrous Cyclicity and Plasma Leptin Concentrations in Rats

Santos

Silva

Bacurau

et al. 2011

J Nutr Sci Vitaminol

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SummaryIntense physical training and dietary energy restriction have been associated with consequences such as nutritional amenorrhea. We investigated the effects of intense physical training, food restriction or the combination of both strategies on estrous cyclicity in female rats, and the relationship between leptin ad these effects. Twenty-seven female Wistar rats were distributed into four groups: SF: sedentary, fed ad libitum; SR: sedentary subjected to 50% food restriction (based on the food intake of their fed counterparts); TF: trained (physical training on a motor treadmill with a gradual increase in speed and time), fed ad libitum; TR: trained with 50% food restriction. We analysed estrous cyclicity, plasma leptin and estradiol as well as chemical composition of the carcass, body weight variation, and weight of ovaries and perirenal adipose tissue. Data demonstrate that physical training alone was not responsible for significant modifications in either carcass chemical composition or reproductive function. Food restriction reduced leptin levels in all animals and interrupted the estrous cyclicity in some animals, but only the combination of food restriction and physical training was capable of interrupting the estrous cyclicity in all animals. Leptin was not directly related to estrous cyclicity. From our findings, it may be concluded that there is an additive or synergistic effect of energy intake restriction and energy expenditure by intense physical training on estrous cyclicity. Leptin appears to be one among others factors related to estrous cycle, but it probably acts indirectly. Key Words energy intake, body composition, estrous cycle, leptin, physical exercise Some female athletes are constantly under pressure to achieve and/or to maintain low body weight, leading to potentially harmful patterns of restricted dieting and over exercising. Some of the health consequences of long-term energy restriction include poor nutritional status and risk of exercise-induced amenorrhea ( 1 , 2 ). In humans, this condition is characterized by the absence of menstruation for 90 d or more.Based on epidemiological data, Frisch ( 3 ) reported that, in women and girls, body fat content and ovulatory cyclicity were positively associated. However, one or more main signals that centrally indicates the availability of energy is still unknown ( 4 ). Since physical activity may reduce leptin mRNA expression ( 5 , 6 ) and athletes that train intensively, under restricted calorie intake, present a higher percentage of amenorrhea than sedentary women ( 7 ), it may be speculated that leptin is involved in the transduction of the energy availability signals.Studies on the effects of exercise, reproductive function and leptin response have been hindered by the inability to disassociate the effects of exercise itself from other confusing factors. These factors could be related to energy intake below the requirements or different hormones involved ( 8 , 9 ). It is not clear whether the reproductive functions are interrupted due...

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“…Adequate reproductive hormones, especially estrogen, are needed for bone mineralization during adolescence and for continued bone maintenance thereafter. Up to 66% of female competitive endurance runners exhibit menstrual irregularities, and 40% have low bone mass (Barrack et al 2008;Cobb et al 2003;Gibson et al 2004;Warren and Chua 2008). These rates are about three to five times higher than reported estimates of these same conditions in healthy young women and girls who do not run competitively (van Hooff et al 1998).…”

Section: Female Athlete Health Issuesmentioning

confidence: 46%

Proper nutrition can prevent negative health outcomes in young female athletes

Barrack¹,

Loan²

2011

Cal Ag

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female athletes, largely to their benefit. However, some negative health outcomes such as disordered eating, chronic menstrual disturbances and low bone mass have been associated with high-level competition among some female athletes, particularly in sports such as gymnastics and cross-country running, where a slender physique or lean body build is important. Adolescent female athletes, in a rapid growth and development phase, may be at greatest risk. We sought to identify athletes at risk, understand the origin of possible negative outcomes and recommend behavioral modifications that promote participation in competitive sports while supporting lifetime health. This review discusses the development and impact of disordered eating and menstrual dysfunction on bone mass in young, competitive, female athletes and provides nutrition recommendations for their energy, carbohydrate, protein, vitamin and mineral intake.

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Exercise‐Induced Amenorrhea and Bone Health in the Adolescent Athlete

Cited by 52 publications

References 100 publications

Analysis of stress fractures in athletes based on our clinical experience

Analysis of stress fractures in athletes based on our clinical experience

Effect of Food Restriction and Intense Physical Training on Estrous Cyclicity and Plasma Leptin Concentrations in Rats

Proper nutrition can prevent negative health outcomes in young female athletes

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