Influence of sports participation and menarche on bone mineral density of female high school athletes

Somatic Structure and Ultrasound Parameters of the Calcaneus Bone in Combat Sports Athletes in Relation to Vitamin D3 Levels

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the type, intensity, duration, and frequency of the most effective physical activities. This study focuses on combat sports athletes and examines the relationship between their somatic build and heel bone parameters using ultrasound (USG) and their vitamin D3 levels. Methods: The study included 40 male athletes specializing in various combat sports. The measurements of body height, body mass, skinfold thickness, and bone widths at multiple sites were performed to estimate the somatic build. The USG parameters of the heel bone and the blood levels of vitamin D3 were also recorded. Statistical significance was determined using one-way ANOVA, with differences among sports disciplines also examined. Results: The study found significant differences in the body composition and USG bone parameters among athletes from different combat sports (p ≤ 0.05). The calcaneus stiffness index (SI) and speed of sound (SOS) were significantly higher in athletes with normal vitamin D3 levels compared to those with below-normal levels (p = 0.0015 and p = 0.001, respectively). These findings suggest that vitamin D3 may influence bone stiffness and density. Conclusions: The study underscores the importance of maintaining adequate vitamin D3 levels to support bone mineralization in athletes, particularly those training indoors with limited exposure to sunlight. It also highlights the potential of using USG as a non-invasive method to assess bone health, aiding in the optimization of training programs to prevent injuries and improve performance.

Moving from ethnic exclusions to cultural safety: how is athlete ethnicity discussed in research on menstrual health in sports? A scoping review

OBJECTIVE

This study aims to investigate how athlete ethnicity is discussed in the inclusion and exclusion criteria, methodology, findings, and conclusions of research focused on menstrual health in sports science and medicine.

DESIGN

A scoping review of sports-based research conducted on athletes related to (1) menstrual health and ethnicity, (2) how researchers include/exclude participants based on ethnicity and (3) how ethnicity is discussed.

DATA SOURCES

Electronic search of PubMed and ProQuest.

ELIGIBILITY CRITERIA

Articles were included if they met the following criteria: (1) published before September 2023, (2) published in peer-reviewed journals, (3) participants were women athletes, (4) published in English and (5) relating to menstrual health. Articles were assessed as good, fair or poor quality using the Inclusion of Participant Ethnicity Quality Assessment Criteria.

RESULTS

From the 1089 studies available from the initial database search, 55 studies considered ethnicity. Nine studies met the inclusion criteria and were assessed as either good (22%), fair (44%) or poor (33%) in quality in their consideration of athlete ethnicity. 81% of research articles on menstrual health in sports do not consider athlete ethnicity, and when ethnicity is discussed, it rarely meets the criteria for cultural safety in the research process. Most studies did not factor ethnicity into the analysis and lacked cultural considerations in the research design and interventions.

CONCLUSION

More careful inclusion of ethnicity in sports menstrual health-related research and recognition of social and cultural influences on health and research outcomes for indigenous and other ethnic minority groups is needed. Such research is required to support coaches, medical personnel and support staff in designing culturally safe environments for sportswomen from diverse cultural and ethnic backgrounds.

Puberty timing and relative age as predictors of physical activity discontinuation during adolescence

Among same-age adolescents, those who enter puberty relatively later and those who are relatively younger (e.g., born later in the year) might be at greater risk of physical activity discontinuation. This study aimed to (1) describe gender-specific discontinuation, re-engagement, and uptake rates in various types of physical activities from the age of 11 to 17 years, and (2) assess puberty timing and relative age as predictors of discontinuation from organized, unorganized, individual, and group-based physical activities. Longitudinal data from 781 (56% girls, age 10-13 years at study baseline) Canadian participants who self-reported puberty status, birthdate, and involvement in 36 physical activities every four months from 2011 to 2018 was analyzed. The incidence of discontinuation, re-engagement, and uptake in organized/unorganized and individual/group activities from grade 6 until grade 12 was described and Cox proportional hazard models were used to estimate associations of puberty timing and relative age with organized/unorganized and individual/group activity discontinuation. Results demonstrate that individual and unorganized activities are maintained longer than group-based and organized activities. Girls who started puberty earlier were more likely to discontinue organized activities than girls with average-puberty timing [Hazard ratio (HR) (95% confidence interval (CI)) 1.68 (1.05-2.69)]. Compared to boys born in the 4th quarter of the year, boys born in the 2nd quarter of the year were less likely to discontinue organized [HR (95% CI) 0.41 (0.23-0.74)], unorganized [HR (95% CI) 0.33 (0.16-0.70)], group [HR (95% CI) 0.58 (0.34-0.98)], and individual activities[HR (95% CI) 0.46 (0.23-0.91)], and boys born in the 3rd quarter were less likely to discontinue unorganized activities[HR (95% CI) 0.41 (0.19-0.88)]. This study illustrates the patterns of physical activity participation throughout adolescence. However, the generalizability of findings may be limited due to participant representation.

The Limited Impact of Low-Volume Recreational Dance on Three-Compartment Body Composition and Apparent Bone Mineral Density in Young Girls

Recreational dance is practiced worldwide as a multidimensional physical activity with a potential for prevention of a sedentary lifestyle and overweight/obesity. This study explored in young (7−15 year; n = 21) girls the effect of long-term (>1 year) exposure to recreational (2 h/w) dancing on three-compartment body composition. Recreational dancers (RD) were compared with recreational (≤4 h/w) artistic gymnasts (RG, n = 22) and physically active young girls not involved in structured extracurricular physical activity (control; C, n = 22), adjusting for confounding variables (age, body mass, menarche). We hypothesized for RD an intermediate body composition between RG and C. The three groups had similar age and body mass index. Body composition indices in RD were intermediate between that of C and RG, but RD values were not statistically significantly different vs. C. This agreed with the not statistically significant higher energy expenditure (MET-min/w) in RD vs. C (1357.7 ± 805.32 and 1090.9 ± 596.63, p = 0.172). In conclusion, long-term recreational dance exposure at low volume had limited positive effect on body composition of young girls vs. unstructured extracurricular physical activity. Future work will explore the potential of recreational dance at higher volume (3−4 h/w) to improve body composition in young girls.

Exploring the relationship between adolescent biological maturation, physical activity, and sedentary behaviour: a systematic review and narrative synthesis

CONTEXT

Across adolescence, there is a notable decline in physical activity in boys and girls. Maturational timing may be a risk factor for disengagement from physical activity and increased sedentary behaviours during adolescence.

OBJECTIVE

This systematic review aimed to summarise literature that examined the relationship between maturational timing, physical activity and sedentary behaviour in adolescents.

METHODS

Six electronic databases were searched for articles that assessed biological maturation and physical activity (including sports participation and active transportation) or sedentary behaviours in adolescents. Two reviewers conducted title, abstract, and full-text screening, reference and forward citation searches. Included articles were evaluated for quality using a standardised tool. A narrative synthesis was used to analyse the findings due to the heterogeneity of the studies.

RESULTS

Searches yielded 78 articles (64 unique studies) that met the inclusion criteria, representing 242,316 participants (153,179 unique). Studies ranged from 30.0% (low) to 91.7% (high) in quality. An inverse relationship between maturational timing and physical activity (in 50 and 60% of studies in boys and girls, respectively) and a positive relationship between maturational timing and sedentary behaviour (in 100% and 53% of studies in boys and girls, respectively) was most commonly reported. Evidence supporting an association between maturational timing, sports participation, and active transportation was inconsistent.

CONCLUSIONS

While this review demonstrates some evidence for early maturational timing as a risk factor for disengagement from physical activity and increase in sedentary behaviours, the reviewed literature also demonstrates that this relationship is complex. Future research that tracks maturity-related variations in physical activity and sedentary behaviours over adolescence is warranted.

Low bone density risk is higher in exercising women with multiple triad risk factors

The cumulative effect of the female athlete triad (Triad) risk factors on the likelihood of low bone mineral density (BMD) in exercising women is unclear.

PURPOSE

This study aimed to determine the risk of low BMD in exercising women with multiple Triad risk factors.

METHODS

We retrospectively examined cross-sectional data from 437 exercising women (mean ± SD age of 18.0 ± 3.5 yr, weighed 57.5 ± 7.1 kg with 24.5% ± 6.1% body fat) obtained at baseline from 4 prospective cohort studies examining Triad risk factors. Questionnaires were completed to obtain information on demographic characteristics, self-reported eating attitudes/behaviors, menstrual function, sport/activity participation, and medication use. Height and body weight were measured. BMD was measured using dual energy x-ray absorptiometry. Low BMD was defined as z-scores of <-1 and ≤-2. Chi-square tests were performed to determine the percentage of women with low BMD who met the criteria for individual (current oligo/amenorrhea, late menarche, low body mass index (BMI), elevated dietary restraint, lean sport/activity participation) or multiple (2, 3, 4, or 5) Triad risk factors.

RESULTS

Late menarche and low BMI were associated with the highest percentage of low BMD (z-score < -1), 55% and 54%, respectively, and low BMD (z-score ≤-2), 14% and 16%, respectively. The percentage of participants with low BMD (z-score < -1 and ≤-2) increased from 10% to 62% and from 2% to 18%, respectively, as women met the criteria for an increasing number of Triad risk factors.

CONCLUSIONS

A cumulative number of Triad risk factors were associated with an increased risk of low BMD, suggesting a dose-response association between the number of Triad risk factors and BMD in exercising women. Further research should be conducted to develop a user-friendly algorithm integrating these indicators of risk for low BMD in exercising women (particularly factors associated with low BMI/body weight, menstrual dysfunction, lean sport/activity participation, and elevated dietary restraint).

Risk factors of low vitamin D status in adolescent females in Kuwait: implications for high peak bone mass attainment

Risks of low vitamin D status in Kuwaiti adolescent girls are high parathyroid hormone (PTH), high waist/hip ratio, veiling and not having a private room. Low vitamin D status is likely to have a negative impact on their bone mass and accrual.

INTRODUCTION

Low serum 25-hydroxyvitamin D (25OHD) levels are repeatedly found in females in the Middle East, which is a cause for concern particularly for adolescent females. This is because vitamin D has been shown to promote bone mineral accrual in adolescence.

PURPOSE

The aim of this study was to assess the risk factors of low vitamin D status in adolescent females and to assess its impact on their bone mass.

METHODS

Serum 25OHD and PTH were measured in 232 females. Anthropometric measurements and skin colour were obtained. Bone measurements at the lumbar spine were performed using dual-energy x-ray absorptiometry (DXA). Data on food intake, physical activity (PA) and sun exposure were taken. Binary logistic regression was used to assess the risk factors of serum 25OHD levels <25 nmol/L and multiple linear regression was used to assess the predictors of bone mineral variables.

RESULTS

Median 25OHD was 19.4 nmol/L (IQR 16.4-23.68), among which 98.7 % obtained <50 nmol/L. PTH >7 pmol/L (odds ratio (OR) 4.3; 95 % CI 1.8, 10.2), not having a private room (OR 3.7; 95 % CI 1.4, 9.8), veiling (OR 2.4; 95 % CI 1.1, 5.5) and waist/hip ratio >0.75 (OR 2.1; 95 % CI 1.0, 4.3) were risk factors of low vitamin D status, whereas, height, weight, month since menarche, PTH, animal protein intake and PA were independent predictors of bone mineral content (p < 0.05).

CONCLUSION

Low vitamin D status is prevalent in Kuwaiti adolescent females, which may have a negative impact on their bone mineralization and accrual. Further investigation is needed to reveal the underlying causes.

Female athlete triad syndrome in the high school athlete

Female sports participation at the high school level has significantly increased since the 1970s. Physical activity in females has numerous positive benefits, including improved body image and overall health. Unfortunately, a select population of exercising females may experience symptoms related to the "female athlete triad," which refers to the interrelationships among energy availability, menstrual function, and bone mineral density. Clinically, these conditions can manifest as disordered eating behaviors, menstrual irregularity, and stress fractures. Athletes with conditions related to the triad are distributed along a spectrum between optimal health and disease and may not experience all conditions simultaneously. Previous research related to the triad has primarily focused on collegiate and elite athletes. However, mounting evidence demonstrates that the triad is present in the high school population. High school athletes should be assessed for triad components at preparticipation physicals. In addition, parents, coaches, and health care professionals should be educated and informed about the female athlete triad syndrome. In the presence of triad symptoms, further evaluation and treatment by a multidisciplinary team is strongly recommended for the athlete.

A Systematic Review of Bone Health in Cyclists

Context:

Low bone mineral density (BMD) is a serious public health problem. Osteoporotic fractures are associated with low bone mass, occurring frequently in the hip and spine. Previous studies have demonstrated a positive relationship between BMD and weightbearing exercise but not a similar positive relationship with nonweightbearing exercise. There is concern that cycling, a weight-supported sport, does not benefit bone health.

Objective:

To systematically review the evidence suggesting that cyclists have impaired bone health at the femoral neck and lumbar spine.

Data Sources:

Articles in PubMed, Cochrane Library, and CINAHL were identified in December 2009 What is the start date for the search?based on the following terms and combinations: bicycling, bone density, cyclist.

Study Selection:

Thirteen studies satisfied inclusion criteria: 2 prospective studies (level of evidence 2b) and 11 cross-sectional studies (level of evidence 2c).

Data Extraction:

Data included sample size, demographics, description of cycling and control criteria, and BMD (g/cm²) at the lumbar spine, femoral neck, and hip.

Results:

Two prospective studies showed a decrease in femoral neck, total hip, or lumbar spine BMD in cyclists over the study period. Four cross-sectional studies compared cyclists with sedentary controls, and 3 found cyclists’ lumbar spine and femoral neck BMD similar to that of controls, whereas 1 found cyclists’ BMD to be lower than that of controls. Seven cross-sectional studies compared cyclists with active controls: 2 found no differences in femoral neck and lumbar spine BMD between cyclists and controls; 4 found that cyclists had lower lumbar spine BMD than did active controls, including runners; and 1 reported a trend toward lower lumbar spine BMD in cyclists versus controls.

Conclusions:

There is concerning but inconsistent, limited-quality disease-oriented evidence—primarily from cross-sectional data—indicating that cyclists may be at risk for low bone mass, particularly at the lumbar spine. Additional longitudinal controlled intervention trials are needed.

Body Composition of Young Athletes

Absolute and relative components of body mass are a primary focus in studies of body composition. Components change with growth and maturation, requiring care in selecting methods of assessment in children and adolescents. Although sex differences are apparent in fat-free mass (FFM), fat mass (FM), and relative fatness (% Fat) during childhood, they are more clearly defined during adolescence and adulthood. Body composition is one of many determinants of sport performance, but % Fat tends to be the primary focus of discussion in young athletes. The influence of training for sport on bone mineral has received more attention in recent years because of methodological advances in assessment and concern for potential negative effects of altered menstrual function on bone. Relative fatness of young athletes in several sports is summarized, and issues related to sport training and body composition in young athletes are considered. Suggestions for dealing with body composition in young athletes are provided.

Prevalence of and traits associated with low BMD among female adolescent runners

PURPOSE

Identify the prevalence of and traits that may increase the risk of low bone mineral density (BMD) among 93 female adolescent competitive endurance runners.

METHODS

Participants were 93 high school runners, ages 13-18 yr, from southern California. Eating attitudes and behaviors were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Menstrual and sports participation history were evaluated using an interviewer-assisted, self-report questionnaire. Bone mineral density (BMD) of the spine (L1-L4), total hip, and total body were measured by dual-energy x-ray absorptiometry. The -2 and -1 BMD age-matched, gender-specific z-score cutoffs were used to categorize girls as having low bone mass for age.

RESULTS

Among the female runners, 11.8% and 28% met the -2 and -1 BMD z-score cutoffs, respectively, whereas 25.8% reported menstrual irregularity (MI). Total hip BMD, lumbar spine BMD, and lumbar spine BMD z-score were significantly lower in runners with MI after adjusting for body mass index (BMI) and lean tissue mass. Runners that participated in five or more compared with three seasons of endurance running exhibited a significantly lower total body and lumbar spine BMD z-score after adjusting for BMI, lean tissue mass, and number of menstrual cycles in the past year. Multiple regression analysis indicated that MI, participation in five or more seasons of endurance running, BMI, and lean tissue mass were independent predictors of low BMD.

CONCLUSION

Female adolescent endurance runners may represent a population with an increased risk of low bone mass. Future studies are necessary to further understand the factors contributing to low bone mass in young runners and to identify behavioral strategies that will promote optimal bone mineral accumulation during the adolescent years.

Bone density in the adolescent athlete

Adolescence is a critical time for bone mass accrual, and increases in bone mass through puberty are dependent on rising levels of gonadal steroids, growth hormone and insulin like growth factor-1. Many high school girls are involved in athletic activities, and as many as 23.5% of adolescent athletes have been reported to develop amenorrhea. This review focuses on (1) factors that determine which athletes are likely to develop amenorrhea, such as a negative energy balance state, low levels of leptin and high levels of ghrelin, and (2) the impact of hypogonadism in athletes on bone metabolism. Beneficial effects of increased mechanical loading from athletic activity do not appear to protect against the deleterious effects of hypogonadism in adolescent athletes.