Menstrual Function, Eating Disorders, Low Energy Availability, and Musculoskeletal Injuries in British Servicewomen

Abstract

Purpose: This study aimed to investigate associations between menstrual function, eating disorders, and risk of low energy availability with musculoskeletal injuries in British servicewomen. Methods: All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about menstrual function, eating behaviors, exercise behaviors, and injury history. Results: A total of 3022 women participated; 2% had a bone stress injury in the last 12 months, 20% had ever had a bone stress injury, 40% had a time-loss musculoskeletal injury in the last 12 months, and 11% were medically downgraded for a musculoskeletal injury. Menstrual disturbances (oligomenorrhea/amenorrhea, history of amenorrhea, and delayed menarche) were not associated with injury. Women at high risk of disordered eating (Female Athlete Screening Tool score >94) were at higher risk of history of a bone stress injury (odds ratio (OR; 95% confidence interval (CI)), 2.29 (1.67-3.14); P < 0.001) and time-loss injury in the last 12 months (OR (95% CI), 1.56 (1.21-2.03); P < 0.001) than women at low risk of disordered eating. Women at high risk of low energy availability (Low Energy Availability in Females Questionnaire score ≥8) were at higher risk of bone stress injury in the last 12 months (OR (95% CI), 3.62 (2.07-6.49); P < 0.001), history of a bone stress injury (OR (95% CI), 2.08 (1.66-2.59); P < 0.001), a time-loss injury in the last 12 months (OR (95% CI), 9.69 (7.90-11.9); P < 0.001), and being medically downgraded with an injury (OR (95% CI), 3.78 (2.84-5.04); P < 0.001) than women at low risk of low energy availability. Conclusions: Eating disorders and risk of low energy availability provide targets for protecting against musculoskeletal injuries in servicewomen.

Eating Disorder Risk and Common Mental Disorders in British Servicewomen: A Cross-Sectional Observational Study

“…Eating disorders and/or disordered eating are risk factors for impaired health and performance described in the Triad (1) and RED-S (2) frameworks. We have previously shown that risks of eating disorders—and anxiety and depression—were associated with an increased risk of menstrual disturbances (15) and musculoskeletal injuries (16) in this cohort of servicewomen.…”

“…The direction of this relationship is not clear, and shorter sleep duration could contribute to, or be the result of, eating disorders and common mental disorders. Nevertheless, protecting sleep is likely an important intervention to protect mental health, and shorter sleep duration was also associated with increased risk of menstrual disturbances (15) and musculoskeletal injuries (16) in this population. Some military environments can decrease sleep duration (e.g., field exercises and basic training), which may contribute to the upregulation of the hypothalamic–pituitary–adrenal axis and depressive symptoms (21).…”

“…Demographics, job role, exercise behaviors, risk of eating disorders, anxiety, depression, stress, and resilience are presented in this article. Data on menstrual disturbances (15) and musculoskeletal injuries (16) have been previously published. All participants provided informed consent.…”

“…Common mental disorders were assessed using the 7-item Generalized Anxiety Disorder Assessment (GAD-7) (38), the 9-item Patient Health Questionnaire (PHQ-9) (39), the Perceived Stress Scale (40), and 10-item Connor-Davidson Resilience Scale (CD-RISC-10) (41). Anxiety and depression were scored according to severity using the respective GAD-7 (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21)) and PHQ-9 scores (minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), severe (20)(21)(22)(23)(24)(25)(26)(27)). A participant was defined as having symptoms of anxiety if they scored ≥10 on the GAD-7 (38) and depression if they scored ≥10 on the PHQ-9 (39).…”

Editorial on: Association between Combat‐Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates with Altered Loading in Amputees: The ADVANCE Study

“…Similar results were reported in other studies, with as many as half of the amputees being diagnosed with osteoporosis or osteopenia after 5 years or more following lower limb amputation. ( 1‐3 ) As pointed out by the authors, the young adult age of the injured service personnel (mean 22 years of age) is a time when osteoporosis is uncommon, although other groups, such as premenopausal amenorrheic soldiers ( 4 ) and athletes ( 5 ) or those with underlying hormonal, inflammatory, or digestive diseases, ( 6 ) may also experience low bone mass at an early age. Early bone loss at the femoral neck in amputees is a concern given the decades‐long intermission between amputation and the typical onset of bone fragility later in life.…”