Energy deficiency, menstrual disorders, and low bone mineral density in female athletes: a systematic review

Role of Chlorhexidine and Herbal Oral Rinses in Managing Periodontitis

OBJECTIVE

The aim of this research was to assess the effect of 0.12% chlorhexidine (CHX) and a Salvadora persica-based mouthwash on whole salivary tumour necrosis factor-alpha (TNF-α) levels and periodontal inflammation in patients with type 2 diabetes mellitus (T2DM).

METHODS

Patients with and without medically diagnosed T2DM were included. Patients' medical records were evaluated to confirm the diagnosis of T2DM. All patients underwent nonsurgical periodontal therapy (NSPT). Patients were divided into 2 subgroups. In the test and control group, patients were advised to rinse with an S persica-based mouthwash and a non-alcoholic 0.12% CHX after NSPT twice daily for 2 weeks, respectively. Demographic data were collected. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were measured, and whole salivary TNF-α levels were gauged at baseline and at 3-month follow-up. Haemoglobin A1c (HbA1c) levels were measured in all patients at baseline and at 3-month follow-up. Sample size estimation was done, and group comparison was performed. Level of significance was set at P < .01.

RESULTS

Twenty-one nondiabetic individuals and 21 patients with T2DM were included. At baseline, there was no significant difference in clinical and radiographic periodontal parameters amongst in patients with and without T2DM. At 3-month follow-up, HbA1c, TNF-α, PI, PD, and clinical AL were comparable with their respective baseline values in the test and control groups amongst patients with T2DM. In nondiabetic individuals, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01), and TNF-α (P < .01) at 3-month follow-up in the test and control groups compared with their respective baseline scores.

CONCLUSIONS

In the short term, NSPT with 0.12% CHX or S persica-based mouthwashes is more effective in reducing periodontal inflammation and whole salivary TNF-α levels in nondiabetic individuals than in patients with T2DM with periodontal inflammation.

Association Between Reproductive Health Factors and Musculoskeletal Injuries in Female Canadian Armed Forces Members

Background: Musculoskeletal injuries (MSKi) play a role in member retention in the military. In general, female military members have higher rates of MSKi than males and female reproductive health characteristics may be contributing to these disparities. This study seeks to characterize reproductive health factors in female Canadian Armed Forces (CAF) members and their relationship with MSKi. Materials and Methods: An electronic survey (SurveyMonkey^®) was made available to present and former CAF members 18-65 years of age. Responses were collected between September 2020 and February 2021. Seven female reproductive characteristics were assessed: age of menarche, menstrual cycle regularity, birth control use, having given birth while serving, endometriosis, early menopause, and secondary oligomenorrhea/amenorrhea. Binary logistic regressions were used to analyze associations between reproductive characteristics with repetitive strain (RSI) and acute injuries. Results: A total of 2,001 participants consented to the survey with 855 respondents being female. Females reporting menstrual cycles as never regular, irregular for a few months, who never had a period, and whose periods stopped while serving presented a greater likelihood of reporting RSI compared to their peers who reported regular menstrual cycles (adjusted odds ratio [aOR]: 1.898, confidence interval [CI]: 1.138-3.166). Participants who have experienced endometriosis presented a higher likelihood of reporting acute injuries than those who did not (aOR: 2.426, CI: 1.030-5.709). Conclusion: This examination of females within the CAF suggests that irregular menstrual cycles or absent periods increase the likelihood of experiencing MSKi, namely those categorized as RSI injuries and reporting endometriosis were associated with greater rates of acute injuries.

Female Hyperandrogenism in Elite Sports and the Athletic Triad

Essential hyperandrogenism seems to be overrepresented in female elite athletes. This applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders of sex development (DSD). The reason is likely a selection bias since there is increasing evidence that androgens are beneficial for athletic performance by potent anabolic effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may cause a greatly increased production of testosterone in the male range, that is, 10 to 20 times higher than the normal female range. The established regulations concerning the eligibility of female athletes with severe hyperandrogenism to compete in the female classification remain controversial. The most common cause of menstrual disorders in female athletes, however, is probably an acquired functional hypothalamic disturbance due to energy deficiency in relation to energy expenditure, which could lead to low bone mineral density and increased risk of injury. This condition is particularly common in endurance and esthetic sports, where a lean body composition is considered an advantage for physical performance. It is important to carefully evaluate endocrine disturbances and menstrual disorders in athletes since the management should be specific according to the underlying cause.