Women athletes with menstrual irregularity have increased musculoskeletal injuries

Lloyd, Tom; Triantafyllou, Steven J.; Baker, Elizabeth R.; Houts, Peter S.; Whiteside, James A.; Kalenak, Alexander; Stumpf, Paul G.

doi:10.1249/00005768-198608000-00002

Cited by 177 publications

(66 citation statements)

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“…The increased odds of stress fracture with running in this study were consistent with the results of other reports that showed high incidence rates for stress fractures among collegiate female runners. 30 Sample sizes for gymnastics in other studies were too small to allow comparisons. It is biologically plausible that these activities are most strongly associated with stress fractures, because the load applied to bone can equal 2 to 5 times body weight for jogging or running 36 and up to 12 times body weight for jumping and landing, 37 which are repetitive maneuvers in cheerleading and gymnastics.…”

Section: Discussionmentioning

confidence: 97%

“…Studies of collegiate athletes estimated that the annual incidence of stress fractures among late adolescent and young adult female athletes is between 2.7% and 6.9%. [30][31][32] The largest cohort studies of stress fracture have been among women in the US military and observed incidence rates among adult female recruits during basic training to be between 1.1% and 3.4%. 33,34 Although the mothers of the GUTS participants were registered nurses and thereby potentially more accurate than lay persons in providing information regarding medical conditions, relying on maternal recollections of stress fracture diagnoses still might have resulted in an underestimate of the true prevalence of stress fractures in our sample.…”

Section: Discussionmentioning

confidence: 99%

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Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

Gordon²,

et al. 2005

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ABSTRACT. Objective. Although stress fractures are a source of significant morbidity in active populations, particularly among young female athletes, the causes of stress fractures have not been explored among females <17 years of age or in the general population. The purpose of this study was to examine correlates of stress fractures in a large, population-based, national, cohort study of preadolescent and adolescent girls.Methods. A cross-sectional analysis of data from 5461 girls, 11 to 17 years of age, in the Growing Up Today Study, an ongoing longitudinal study of the children of registered female nurses participating in Nurses' Health Study II, was performed. Mothers self-reported information regarding their children's histories of stress fractures on their 1998 annual questionnaire. Growing Up Today Study participants self-reported their weight and height, menarcheal status, physical activity, dietary intake, and disordered eating habits on annual surveys.Results. In 1998, the mean age of the participants was 13.9 years. Approximately 2.7% of the girls had a history of stress fracture, 3% engaged in disordered eating (using fasting, diet pills, laxatives, or vomiting to control weight), and 16% participated in >16 hours per week of moderate to vigorous activity. Age at menarche, z score of BMI in 1998, calcium intake, vitamin D intake, and daily dairy intake were all unrelated to stress fractures after controlling for age. Independent of age and BMI, girls who participated in >16 hours per week of activity in 1998 had 1.88 greater odds of a history of stress fracture than did girls who participated in <4 hours per week (95% confidence interval [CI]: 1.18 -3.30). Girls who participated in >16 hours per week of activity were also more likely than their peers to engage in disordered eating (4.6% vs 2.8%); however, disordered eating did not have an independent association with stress fractures (odds ratio Conclusions. These findings suggest that, although activity can be beneficial for bone health, there is a threshold over which the risk of stress fracture increases significantly among adolescent girls. High-impact activities, particularly running, cheerleading, and gymnastics, appear to be higher risk than other activities. Prospective studies are needed to explore the directionality of these relationships, as well as the role of menstrual history. In the meantime, clinicians should remain vigilant in identifying and treating disordered eating and menstrual irregularities among their highly active, young, female patients. Pediatrics 2005; 115:e399-e406. URL: www.pediatrics.org/cgi[

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

Gordon²,

et al. 2005

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“…Enquanto que atletas de baixo peso podem não satisfazer todos os critérios para anorexia nervosa ou bulimia nervosa, uma ingestão calórica inadequada ou uma má nutrição com o objetivo de atingir um peso irrealmente baixo pode colocar essas mulheres em risco para fraturas importantes 111,126 . Estudos relatam uma maior incidência de lesões e fraturas de estresse entre mulheres amenorréicas e oligomenorréicas do que em mulheres eumenorréicas 79,124,126,127 . Um estudo 38 relata uma DMO mais baixa em atletas mulheres que tiveram fraturas de estresse do que entre indivíduos controle sem lesões.…”

Section: Osteoporoseunclassified

A tríade da atleta: posicionamento oficial

Otis¹,

Drinkwater²,

Johnson³

et al. 1999

Rev Bras Med Esporte

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o desempenho, provocar amenorréia e até mesmo aumentar a mortalidade [11][12][13][14] . Amenorréia.A amenorréia primária (retardo da menarca) é a ausência de menstruação em uma menina de 16 anos com caracteres sexuais secundários 15 . A amenorréia secundá-ria é a ausência de três ou mais ciclos menstruais consecutivos após a menarca [15][16][17][18][19] . A amenorréia associada com o exercício ou com anorexia nervosa é de origem hipotalâmica [20][21][22] . A amenorréia hipotalâ-mica resulta em uma produção reduzida de hormônios ovarianos e hipoestrogenemia semelhantes à menopausa. Tanto a amenorréia hipotalâmica quanto a menopausa estão associadas com uma redução densidade mineral óssea 3,[23][24][25][26][27][28][29][30] . 3. Osteoporose. A osteoporose é uma doença caracterizada por uma massa óssea reduzida e uma deterioração da microarquitetura do tecido ósseo, o que leva a uma maior fragilidade esquelética e um maior risco de fraturas 24 . Um painel de especialistas promovido pela Organização Mundial da Saú-de estabeleceu os seguintes critérios diagnósticos 31 : a. Normal: densidade mineral óssea (DMO) que não esteja mais do que um Desvio Padrão (DP) abaixo da média de adultos jovens.b. Osteopenia: DMO entre 1 e 2,5 DP abaixo da média de adultos jovens. c. Osteoporose: DMO mais de 2,5 DP abaixo da média de adultos jovens.d. Osteoporose grave: DMO mais de 2,5 DP abaixo da mé-dia de adultos jovens mais uma ou mais fraturas.A principal causa de osteoporose pré-menopausa em mulheres ativas é uma redução da produção de hormônios ovarianos e hipoestrogenemia em conseqüência de uma amenorréia hipotalâmica 23,[26][27][28][29][30]32,33 . POSICIONAMENTO OFICIALCom base em uma abrangente revisão da literatura, em estudos de pesquisa, relatos de casos e no consenso de especialistas 4 , é posição oficial do Colégio Americano de Medicina do Esporte que:1. A Tríade da Atleta é uma síndrome importante que consiste de distúrbios alimentares, amenorréia e osteoporose. Os RESUMO A tríade da atleta é uma síndrome que ocorre em adolescentes e mulheres fisicamente ativas. Os seus componentes inter-relacionados são distúrbios alimentares, amenorréia e osteoporose. A pressão à qual adolescentes e mulheres jovens são submetidas para atingir ou manter um peso corporal irrealmente baixo está por trás dessa síndrome. Possuem maior risco as adolescentes e mulheres que praticam esportes nos quais um baixo peso corporal é importante para o desempenho ou por razões estéticas. As jovens e mulheres com um dos componentes dessa tríade devem ser investigadas para os outros. INTRODUÇÃOA maioria das adolescentes e mulheres podem obter benefícios importantes em termos de saúde advindos de uma práti-ca regular de exercícios sem estar submetidas a riscos para a saúde 1-3 . Elas devem ser estimuladas a serem fisicamente ativas em todas as fases de suas vidas. Se ocorrerem lesões ou problemas clínicos, estes devem ser rapidamente identificados e tratados por profissionais especialistas e com experiên-cia com mulheres fisicamente ativas.Em 1992 a Tríade...

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“…In contrast to the above studies, Lloyd et a1 (31) concluded that dura-tion and frequency of training did not cause menstrual irregularities, as both eumenorrheic and oligomenorrheic athletes who completed the study's questionnaire were running similar distances and numbers of sessions per week. The use of oral contraceptives by many of the subjects, however, may have confounded their data.…”

Section: Training Parametersmentioning

confidence: 91%

Factors Associated With Menstrual Irregularities and Decreased Bone Mineral Density in Female Athletes

Fruth¹,

Worrell²

1995

J Orthop Sports Phys Ther

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n intense preoccupation with leanness and low body weight exists in the athletic population. This is especially apparent in young female athletes. M'ith strong intrinsic and extrinsic pressure to perform and the need to appear lean and fit, training is often taken to extremes. Whether the athlete's goal is to improve performance, become "ultra fit," o r lose weight, the results are often similar in the female population: menstrual irregularity, namely amenorrhea. While the absence of menses may be a pleasant convenience for the female athlete, she may be completely unaware that her skeleton could suffer irreversible consequences, such as decreased peak bone mass and eventual osteoporosis (7,38). Athletic amenorrhea, also termed hypothalamic hypogonadism (23), has been shown to cause substantial decreases in bone mineral density (BMD) at various sites in the body, especially in areas of high trabecular content (10,13,14, 29,32,38,44). Unfortunately, the loss of BMD is a silent process, and the athlete is usually unaware that a problem exists until a related injury, such as a stress fracture, occurs.Numerous variables are thought to be associated with athletic amenorrhea: training intensity, hours spent training, diet, body weight, body composition, age of menarche, type of sport, and psychological stress (8, l2,29). While many authors have sought to determine the specific cause of menstrual irregularities in female athletes, n o evidence exists demonstrating that a single risk factor is responsible (32). Therefore, it is likely that all (or at least several) of these factors are working in concert and contribute to menstrual disturbance (7,12,32,40).Regardless of the cause, menstrual irregularities are common among female athletes ( 1 2-15,23). As many as 51 % of endurance runners (1 1 ), 44% of ballet dancers (5), and 12% of swimmers and cyclist3 (45) have reported menstrual disturbances during periods of training. Rutherford (44), who studied female triathletes, found that 50% of the subjects experienced menstrual disturbances. Furthermore, these women reported that "[menstrual irregularities] were representative of the general incidence among good triathletes." Although resumption of menses usually occurs following a reduction o r cessation of training (13,15,41), it is not known if the decrease in BMD is permanent and will predispose the women to stress fractures or osteope rosis (1 3,15,32,4O).In addition to the large number of variables involved in these studies, interpretation of the results is made difficult by the lack of standard definitions of menstrual categories. Criteria for amenorrhea have ranged from

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Women athletes with menstrual irregularity have increased musculoskeletal injuries

Cited by 177 publications

References 0 publications

Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

A tríade da atleta: posicionamento oficial

Factors Associated With Menstrual Irregularities and Decreased Bone Mineral Density in Female Athletes

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