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Liu S, Wu S, Qi J, Wang L. Effect of traditional Chinese fitness exercises on bone mineral density in postmenopausal women: a network meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne) 2024; 15:1323595. [PMID: 38390196 PMCID: PMC10882717 DOI: 10.3389/fendo.2024.1323595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
We aimed to evaluate the clinical efficacy of five traditional Chinese fitness exercises (Baduanjin, Taijiquan, Wuqinxi, Yijinjing, and Liuzijue), as well as their efficacy when combined with drug therapy, in the treatment of decreased bone mineral density in postmenopausal women. Methods This study strictly followed the evaluation guidelines of PRISMA and followed the "PICOS" principle outlined in the Cochrane Handbook. We performed a systematic search on Web of Science, Springer Link, Scopus, EMBASE, EBSCO, PubMed, the Cochrane Library, CNKI, Wanfang, CBMdisc, and the VIP Database, and we targeted RCTs studying the effect of TCE on BMD in postmenopausal women published prior to September 2023. The quality of the literature and the risk of bias of the included studies were assessed according to ROB2 and GRADE criteria, and data analysis was performed using Stata 14. Results A total of 33 RCTs (3658 post-menopausal women) were included. Network meta-analysis showed that Taiji (SMD=0.72, 95% CI: 0.22, 1.21, P<0.01) and Yijinjing (SMD=0.51, 95% CI: 0.03, 0.99, P<0.05) were significantly superior to conventional rehabilitation in lumbar BMD. In terms of improvement of femoral neck BMD, Baduanjin (SMD=1.63, 95% CI: -3.58, 6.85, P<0.001) and Taiji (SMD=0.46, 95% CI: 0.14, 0.79, P<0.05) had statistically different outcomes to conventional rehabilitation. Regarding Ward's triangle BMD, Taiji (SMD= 0.32, 95% CI: 0.14, 0.50, P< 0.05) had statistically different outcomes to conventional rehabilitation. The results of the SUCRA probability ranking showed that Baduanjin + drug interventions achieved the most significant improvement in lumbar BMD (SUCRA=83.6%) and femoral neck BMD (SUCRA=90.2%). Taiji + drug interventions most effectively improved Ward's triangle BMD (SUCRA=86.0%). In terms of traditional Chinese fitness exercises alone, Taiji was the most effective in improving lumbar BMD (SUCRA=64.4%) and Ward's triangle BMD (SUCRA=46.8%), and Baduanjin was the most effective in treating femoral neck BMD (SUCRA=89.9%). Conclusion Traditional Chinese fitness exercises can significantly improve the BMD levels of postmenopausal women. Taiji, Yijinjing, and Baduanjin combined with medication showed better intervention effects overall. However, due to the limitations of the number of studies and sample sizes of individual interventions, definitive conclusions need to be verified by more high-quality studies.
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Affiliation(s)
| | | | | | - Lin Wang
- School of Physical Education, Wuhan University of Technology, Wuhan, China
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Nose-Ogura S, Yoshino O, Kinoshita S, Nakamura H, Harada M, Hiraike O, Osuga Y, Dohi M, Nakajima K, Kawahara T. Differences of Bone Mineral Density by Characteristics of Sports in Amenorrheic Athletes. Int J Sports Med 2024; 45:55-62. [PMID: 37813353 DOI: 10.1055/a-2161-5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Hypothalamic amenorrhea leads to a hypoestrogenic state, causing decreased bone mineral density (BMD), while strong impact loading on bone has been shown to increase BMD. The purpose of this study is to compare BMD in female athletes based on menstrual status and their sports/events by impact loading characteristics. BMD at the lumbar spine was measured by dual-energy X-ray absorptiometry and hormone level. The subjects were classified into four groups and BMD and hormone levels were compared among the four groups, which were divided into amenorrheic athletes (AAs) and eumenorrheic athletes (EAs). This study recruited 410 female athletes (164 in the AAs and 246 in the EAs), 55 athletes in non-impact sports, 123 in low-impact sports, 141 in multidirectional sports, and 91 in high-impact sports. In the AAs group, BMD Z-score was lowest in low-impact sports (Z-score: -1.53 [-1.76, -1.30]), and was highest in high-impact sports (Z-score: 0.02 [-0.34, 0.38]). In multidirectional and high-impact sports, BMD Z-score in the AAs group did not show results lower than the average for non-athletes. When screening female athletes for low BMD, it is important to evaluate the risk of low BMD based on the impact loading characteristics of their sports/events, in addition to the menstrual state.
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Affiliation(s)
- Sayaka Nose-Ogura
- Department of Sports Medicine and Research, JAPAN High Performance Sport Center, Japan Institute of Sports Sciences, Kita-ku, Japan
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, The University of Yamanashi, Yamanashi, Japan
| | - Sakiko Kinoshita
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroe Nakamura
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Japan
| | - Michiko Dohi
- Department of Sports Medicine and Research, JAPAN High Performance Sport Center, Japan Institute of Sports Sciences, Kita-ku, Japan
| | - Kohei Nakajima
- Department of Sports Medicine and Research, JAPAN High Performance Sport Center, Japan Institute of Sports Sciences, Kita-ku, Japan
| | - Takashi Kawahara
- Department of Sports Medicine and Research, JAPAN High Performance Sport Center, Japan Institute of Sports Sciences, Kita-ku, Japan
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Skarakis NS, Mastorakos G, Georgopoulos N, Goulis DG. Energy deficiency, menstrual disorders, and low bone mineral density in female athletes: a systematic review. Hormones (Athens) 2021; 20:439-448. [PMID: 33884586 DOI: 10.1007/s42000-021-00288-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad. The primary aim of the present review was to systematically investigate the impact of chronic strenuous exercise on the energy status of professional female athletes compared to sedentary, recreationally active controls as concerns their menstrual status and bone mineral density (BMD). A secondary aim was evaluation of the combined prevalence of the components of the female athlete triad in athletes as compared to non-athletes. METHODS A systematic review was conducted from 2007 to February 2018. The inclusion and exclusion criteria of the studies were established in advance of the literature search according to the clinical inquiry and the study design. RESULTS Four studies were included in this systematic review. The female athlete triad was more prevalent in professional athletes compared to non-athletes. The same results were obtained for both LEA and menstrual disorders. However, BMD and Z-scores showed high heterogeneity among the studies. CONCLUSION Both female athletes and non-athletes are prone to LEA and subsequent menstrual disorders and low BMD or osteoporosis. Future studies are needed to examine energy availability in elite female athletes as well as in non-athletes.
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Affiliation(s)
- Nikitas S Skarakis
- Peripheral General Hospital Athens Giorgos Gennimatas Geniko Nosokomeio Athenon Giorgos Gennematas, Athens, Greece.
- Third Department of Pediatrics, Endocrinology Unit, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Mastorakos
- Department of Endocrinology, Metabolism and Diabetes, School of Medicine, Aretaeio Hospital, National and Kapodistrian University Athens, 76 Vas. Sofias, 11528, Athens, Greece
| | - Neoklis Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Medical School, University of Patras, Patras, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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4
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Aalberg K, Stavem K, Norheim F, Russell MB, Chaibi A. Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2021; 7:e001112. [PMID: 34306727 PMCID: PMC8264872 DOI: 10.1136/bmjsem-2021-001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/03/2022] Open
Abstract
Background Female athletes might develop reduced bone mineral density (BMD) and amenorrhoea due to low energy intake. Objective To systematically review the literature of randomised controlled trials (RCTs) assessing the effect of oestrogen oral contraceptives (OCP), conjugated oestrogens (CE) and transdermal estradiol (TE) on BMD in premenopausal women with functional hypothalamic amenorrhoea (FHA) due to weight loss, vigorous exercise and/or stress. Methods A comprehensive literature search in PubMed, MEDLINE, Cochrane Library, Ovid and CINAHL from inception to 1 October 2020. Data extraction and synthesis Two authors independently extracted data. When possible, the data were pooled in a random-effects meta-analysis. Main outcomes Difference in BMD (g/cm2) at the lumbar spine. Results Nine RCTs comprising 770 participants met the inclusion criteria; five studies applied OCP, two CE and two TE. Four RCTs (two OCP, two TE) found an increased BMD in premenopausal women with FHA, and five (three OCP, two CE) found a decreased BMD compared with controls. A meta-analysis showed no difference in BMD between the treatment and control groups, (standardised mean difference (SMD) 0.30, 95% CI -0.12 to 0.73). A secondary analysis for change scores from baseline to first assessment point, showed a similar overall result (SMD 0.17, 95% CI -0.16 to 0.51). No serious adverse events were reported. Conclusion The literature suggests that TE might increase lumbar BMD in premenopausal women with FHA, but pooled results revealed no effect of the intervention. The findings do not support oestrogen therapy to improve BMD in these patient groups.
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Affiliation(s)
| | - Knut Stavem
- Institute of Clinical Medicine, Akershus University Hospital, Lorenskog, Norway.,Department of Pulmonary Medicine, University of Oslo, Akershus University Hospital, Lorenskog, Norway
| | - Frode Norheim
- Department of Nutrition, University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway
| | - Michael Bjørn Russell
- Institute of Clinical Medicine, Akershus University Hospital, Lorenskog, Norway.,Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, Lorenskog, Norway
| | - Aleksander Chaibi
- Head and Neck Research Group, Division for Research and Innovation, Akershus University Hospital, Lorenskog, Norway.,Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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5
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Xiao CM, Kang Y, Zhuang YC. Effects of Elastic Resistance Band Exercise on Postural Balance, Estrogen, Bone Metabolism Index, and Muscle Strength of Perimenopausal Period Women. J Am Geriatr Soc 2018; 64:1368-70. [PMID: 27321627 DOI: 10.1111/jgs.14172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chun-Mei Xiao
- Department of Health Promotion and Physical Education, Beijing Institute of Graphic Communication, Beijing, China
| | - Yong Kang
- Department of Health Promotion and Physical Education, Beijing University of Chemical Technology, Beijing, China
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Kandemir N, Slattery M, Ackerman KE, Tulsiani S, Bose A, Singhal V, Baskaran C, Ebrahimi S, Goldstein M, Eddy K, Klibanski A, Misra M. Bone Parameters in Anorexia Nervosa and Athletic Amenorrhea: Comparison of Two Hypothalamic Amenorrhea States. J Clin Endocrinol Metab 2018; 103:2392-2402. [PMID: 29659886 PMCID: PMC6456997 DOI: 10.1210/jc.2018-00338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We have reported low bone mineral density (BMD), impaired bone structure, and increased fracture risk in participants with anorexia nervosa (AN) and normal-weight oligoamenorrheic athletes (OAs). However, data directly comparing compartment-specific bone parameters in participants with AN, OAs, and controls are lacking. DESIGN A total of 468 female participants 14 to 21.9 years old were included: 269 with AN, 104 OAs, and 95 normal-weight eumenorrheic controls. Dual-energy x-ray absorptiometry was used to assess areal BMD (aBMD) of the whole body less head (WBLH), spine, and hip. High-resolution peripheral quantitative computed tomography was used to assess volumetric BMD (vBMD), bone geometry, and structure at the non-weight-bearing distal radius and weight-bearing distal tibia. RESULTS Participants with AN had lower WBLH and hip aBMD z scores than OAs and controls (P < 0.0001). Participants with AN and OAs had lower spine aBMD z scores than controls (P < 0.01). At the radius, total and cortical vBMD, percentage cortical area, and thickness were lower in the AN and OA groups than in controls (P ≤ 0.04); trabecular vBMD was lower in participants with AN than controls. At the tibia, participants with AN had lower measures for most parameters compared with OAs and controls (P < 0.05); OAs had lower cortical vBMD than controls (P = 0.002). Participants with AN and OAs had higher fracture rates than controls. Stress fracture prevalence was highest in OAs (P < 0.0001); nonstress fracture prevalence was highest in participants with AN (P < 0.05). CONCLUSION AN is deleterious to bone at all sites and both bone compartments. A high stress fracture rate in OAs, who have comparable WBLH and hip aBMD measures to controls, indicates that BMD in these women may need to be even higher to avoid fractures.
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Affiliation(s)
- Nurgun Kandemir
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Divisions of Sports Medicine and Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Shreya Tulsiani
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charumathi Baskaran
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Seda Ebrahimi
- Center of Eating Disorders Management, Cambridge, Massachusetts
| | - Mark Goldstein
- Division of Adolescent Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kamryn Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Madhusmita Misra, MD, MPH, Massachusetts General Hospital, BUL 457 B, 55 Fruit Street, Boston, Massachusetts 02114. E-mail:
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7
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Xiao C, Yu D, Kang Y, Zhuang Y. Effect of Playing Kick Shuttlecock on the Estrogen Levels, Bone Mineral Density, and Postural Balance of Postmenopausal Women. J Am Geriatr Soc 2016; 64:e35-6. [PMID: 27562953 DOI: 10.1111/jgs.14340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chunmei Xiao
- Department of Health Promotion and Physical Education, Beijing Institute of Graphic Communication, Beijing, China
| | - Dong Yu
- Department of Health Promotion and Physical Education, Beijing Institute of Petrochemical Technology, Beijing, China
| | - Yong Kang
- Department of Health Promotion and Physical Education, Beijing University of Chemical Technology, Beijing, China
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8
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Swanenburg J, de Bruin ED, Stauffacher M, Mulder T, Uebelhart D. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study. Clin Rehabil 2016; 21:523-34. [PMID: 17613583 DOI: 10.1177/0269215507075206] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance. Design : Randomized clinical trial. Setting : University hospital physiotherapy department. Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of —1.8 (0.8). Interventions : A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period. Outcome measures : Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health. Results : Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls). Conclusion : This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.
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Affiliation(s)
- Jaap Swanenburg
- University Hospital Zurich, Department of Rheumatology and Institute of Physical Medicine, Zurich.
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Muia EN, Wright HH, Onywera VO, Kuria EN. Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating. J Sports Sci 2015; 34:598-606. [DOI: 10.1080/02640414.2015.1065340] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Ackerman KE, Putman M, Guereca G, Taylor AP, Pierce L, Herzog DB, Klibanski A, Bouxsein M, Misra M. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. Bone 2012; 51:680-7. [PMID: 22878154 PMCID: PMC3482939 DOI: 10.1016/j.bone.2012.07.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 02/05/2023]
Abstract
CONTEXT Lower bone density in young amenorrheic athletes (AA) compared to eumenorrheic athletes (EA) and non-athletes may increase fracture risk during a critical time of bone accrual. Finite element analysis (FEA) is a unique tool to estimate bone strength in vivo, and the contribution of cortical microstructure to bone strength in young athletes is not well understood. OBJECTIVE We hypothesized that FEA-estimated stiffness and failure load are impaired in AA at the distal radius and tibia compared to EA and non-athletes despite weight-bearing exercise. DESIGN AND SETTING Cross-sectional study; Clinical Research Center SUBJECTS 34 female endurance athletes involved in weight-bearing sports (17 AA, 17 EA) and 16 non-athletes (14-21 years) of comparable age, maturity and BMI OUTCOME MEASURES: We used HR-pQCT images to assess cortical microarchitecture and FEA to estimate bone stiffness and failure load. RESULTS Cortical perimeter, porosity and trabecular area at the weight-bearing tibia were greater in both groups of athletes than non-athletes, whereas the ratio (%) of cortical to total area was lowest in AA. Despite greater cortical porosity in EA, estimated tibial stiffness and failure load was higher than in non-athletes. However, this advantage was lost in AA. At the non-weight-bearing radius, failure load and stiffness were lower in AA than non-athletes. After controlling for lean mass and menarchal age, athletic status accounted for 5-9% of the variability in stiffness and failure load, menarchal age for 8-23%, and lean mass for 12-37%. CONCLUSION AA have lower FEA-estimated bone strength at the distal radius than non-athletes, and lose the advantage of weight-bearing exercise seen in EA at the distal tibia.
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Affiliation(s)
- Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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11
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Banu J, Varela E, Fernandes G. Alternative therapies for the prevention and treatment of osteoporosis. Nutr Rev 2012; 70:22-40. [PMID: 22221214 DOI: 10.1111/j.1753-4887.2011.00451.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis is a medical condition that affects millions of men and women. People with this condition have low bone mass, which places them at increased risk for bone fracture after minor trauma. The surgeries and treatments required to repair and heal bone fractures involve long recovery periods and can be expensive. Because osteoporosis occurs frequently in the elderly, the financial burden it places on society is likely to be large. In the United States, the Food and Drug Administration has approved several drugs for use in the prevention and treatment of osteoporosis. However, all of the currently available agents have severe side effects that limit their efficacy and underscore the urgent need for new treatment options. One promising approach is the development of alternative (nonpharmaceutical) strategies for bone maintenance, as well as for the prevention and treatment of osteoporosis. This review examines the currently available nonpharmaceutical alternatives that have been evaluated in in vitro and in vivo studies. Certain plants from the following families have shown the greatest benefits on bone: Alliceae, Asteraceae, Thecaceae, Fabaceae, Oleaceae, Rosaceae, Ranunculaceae, Vitaceae, Zingiberaceae. The present review discusses the most promising findings from studies of these plant families.
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Affiliation(s)
- Jameela Banu
- Division of Clinical Immunology and Rheumatology, Department of Medicine, San Antonio, Texas, USA.
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Abstract
Peak bone mass (PBM) is a negative predictor of osteoporosis and lifelong fracture risk. Because osteoporosis is such a prevalent disease with life-threatening consequences, it is important to try to maximize PBM. Adolescence is a critical period for bone acquisition. This article discusses some of the differences in male and female skeletal development and modifiable factors that enhance bone accrual in this age group, particularly in athletes. Hormonal influences, effects of physical activity, and nutritional contributions are included, with a focus on the adolescent athlete. Emphasis is placed on the importance of appropriate energy availability in this age group. We also review prevention and treatment strategies for the female athlete triad (ie, the inter-relationship of decreased energy availability, menstrual irregularity, and low bone density) in adolescents and athletic women. Recommendations for maximizing bone density in both male and female adolescents are discussed.
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Affiliation(s)
- Kathryn E. Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114,Department of Sports Medicine, Children’s Hospital, Boston, MA 02115
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114,Pediatric Endocrine Unit, MassGeneral Hospital for Children and Harvard Medical School, Boston, MA 02114
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Abstract
Bone Metabolism Markers in Sportswomen with Menstrual Cycle DysfunctionsIt is a well known fact that sportswomen with irregular menstrual cycle are exposed to the risk of diminished bone mineral density, and consequentially osteoporosis may appear. Monitoring of the levels of biochemical markers of bone metabolism enables understanding of the dynamic changes during the bone remodeling process. The objectives of the conducted research were to determine the prevalence of menstrual dysfunctions in a sports-women sample and a control group, and also to determine the levels of bone metabolism markers in groups of women with menstrual dysfunctions. The women (n=117) were separated into two groups, the experimental group (S) (n=84) comprised of three subgroups of sports women (34 women who play ball game sports, 27 athletes and 23 sport dancers) and the control group (C) (n=34). To establish the menstrual profile and dysfunction of the menstrual cycle, we used a very detailed questionnaire. The level of mid-fragment osteocalcin (N-MID osteocalcin) as a marker of bone formation was deter mined, as well as β-Cross Laps (β-CTx-bone resorption marker) via the electro luminescent immunochemistry method on an Elecsys 1010 automated machine. Primary amenorrhea was found in 7 (8.33%) and oligomenorrhea in 11 (13.09%) sportswomen, which was statistically a much higher incidence (p<0.05) than in the control group (0/34). Values of bone metabolism markers showed a statistically significant difference in the level of the bone resorption marker β-CrossLaps between the groups of amenorrheic and oligomenorrheic sportswomen in comparison to the eumenorrheic women, both sportswomen and those in the control group. Accelerated resorption was accompanied with accelerated bone formation. Menstrual dysfunctions were statistically more present in the sports-women group than in the control group and were accompanied with accelerated bone metabolism from the point of view of the increase of bone metabolism markers level.
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14
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Abstract
High-school girls and collegiate women have tremendous opportunities to participate in athletic teams. Young girls are also playing in club and select teams at an early age and often, year-round. There are many benefits for participating in sport and physical activity on both the physical and mental health of girls and women. Decreased risk for heart disease and diabetes mellitus, along with improved self-esteem and body-image, were among the first reported benefits of regular physical activity. In addition, sport participation and physical activity is also associated with bone health. Athletes have a greater bone mineral density compared with non-active and physically active females. The increase in bone mass should reduce the risk of fragility fractures in later life. There appears to be a window of opportunity during the development of peak bone mass in which the bone is especially responsive to weight-bearing physical activity. Impact loading sports such as gymnastics, rugby or volleyball tend to produce a better overall osteogenic response than sports without impact loading such as cycling, rowing and swimming. Relatively little is known about the impact of retiring from athletics on bone density. It appears that former athletes continue to have a higher bone density than non-athletes; however, the rate of bone loss appears to be similar in the femoral neck. The positive impact of sports participation on bone mass can be tempered by nutritional and hormonal status. It is not known whether female athletes need additional calcium compared with the general female population. Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight, some female athletes may develop low energy availability or an eating disorder and subsequently amenorrhoea and a loss of bone mineral density. The three inter-related clinical disorders are referred to as the 'female athlete triad'. This article presents a review of the relationship between sports training and bone health, specifically bone mineral density, in young athletic women.
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Affiliation(s)
- David L Nichols
- Department of Kinesiology, Texas Woman's University, Denton, Texas 76204, USA.
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15
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Affiliation(s)
- Holly J Benjamin
- Pediatric Sports Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Evaluation of trabecular mechanical and microstructural properties in human calcaneal bone of advanced age using mechanical testing, microCT, and DXA. J Biomech 2007; 41:368-75. [PMID: 17953972 DOI: 10.1016/j.jbiomech.2007.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 08/28/2007] [Accepted: 09/01/2007] [Indexed: 11/23/2022]
Abstract
Early detection of fracture risk is important for initiating treatment and improving outcomes from both physiologic and pathologic causes of bone loss. While bone mineral density (a quantity measure) has traditionally been used for this purpose, alternative structural imaging parameters (quality measures) are proposed to better predict bone's true mechanical properties. To further elucidate this, trabecular bone from cadaveric human calcanei were used to evaluate the interrelationship of mechanical and structural parameters using mechanical testing, dual energy X-ray absorptiometry (DXA) scanning, and micro computed tomography (microCT) imaging. Directional specific structural properties were assessed in three-dimensional (3-D) and correlated to mechanical testing and DXA. The results demonstrated that microCT-derived indices of bone quality (i.e., volume fraction and structural model index) are better than DXA-derived bone mineral density for the prediction of the mechanical parameters of bone (i.e., elastic modulus, yield stress, and ultimate stress). Diagnostically, this implies that future work on the early prediction of fracture risk should focus as much on bone quality as on quantity. Furthermore, the results of this study show that a loss of bone primarily affects the connectedness and overall number of trabeculae. Ultimate stress, however, is better correlated with trabecular number than thickness. As such, primary prevention of osteoporosis may be more important than later countermeasures for bone loss.
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Hoch AZ, Lal S, Jurva JW, Gutterman DD. The Female Athlete Triad and Cardiovascular Dysfunction. Phys Med Rehabil Clin N Am 2007; 18:385-400, vii-viii. [PMID: 17678758 DOI: 10.1016/j.pmr.2007.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the past 35 years, a significant increase has occurred in sports participation by women. An estimated 3 million girls and young women compete in American high school sports. Women who participate in sports and fitness programs are generally healthier and have higher self-esteem. However, an increase has also been seen in gender-specific injuries and medical problems. The female athlete triad is a syndrome of separate but interrelated conditions of disordered eating, amenorrhea, and osteoporosis. Athletic amenorrhea is known to have a hormonal profile similar to menopause characterized by decreased circulating estrogens. Menopause is known to be associated with osteoporosis and accelerated cardiovascular disease. Although enhanced risk for cardiovascular disease is theoretically possible, it has not been explored in the young athletic population. Premature cardiovascular disease first manifests as endothelial dysfunction, which can be examined noninvasively with ultrasound. This article discusses disordered eating, amenorrhea, osteoporosis, and the potential for heightened cardiovascular risk in young athletic women.
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Affiliation(s)
- Anne Z Hoch
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Banu J, Bhattacharya A, Rahman M, O'Shea M, Fernandes G. Effects of conjugated linoleic acid and exercise on bone mass in young male Balb/C mice. Lipids Health Dis 2006; 5:7. [PMID: 16556311 PMCID: PMC1440862 DOI: 10.1186/1476-511x-5-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 03/23/2006] [Indexed: 11/10/2022] Open
Abstract
There is an increase in obesity among the population of industrialized countries, and dietary supplementation with Conjugated Linoleic Acid (CLA) has been reported to lower body fat mass. However, weight loss is generally associated with negative effects on bone mass, but CLA is reported to have beneficial effects on bone. Furthermore, another factor that is well established to have a beneficial effect on bone is exercise (EX). However, a combination therapy of CLA and EX on bone health has not been studied. In this paper, we report the beneficial effects of CLA and EX on bone, in four different groups of Balb-C young, male mice. There were 4 groups in our study: 1. Safflower oil (SFO) sedentary (SED); 2. SFO EX; 3. CLA SED; 4. CLA EX. Two months old mice, under their respective treatment regimens were followed for 14 weeks. Mice were scanned in vivo using a DEXA scanner before and after treatment. At the end of the treatment period, the animals were sacrificed, the left tibia was removed and scanned using peripheral quantitative computerized tomography (pQCT). The results showed that although CLA decreased gain in body weight by 35%, it however increased bone mass by both reducing bone resorption and increasing bone formation. EX also decreased gain in body weight by 21% and increased bone mass; but a combination of CLA and EX, however, did not show any further increase in bone mass. In conclusion, CLA increases bone mass in both cancellous and cortical bones, and the effects of CLA on bone is not further improved by EX in pure cortical bone of young male mice.
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Affiliation(s)
- Jameela Banu
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio, 7703, Floyd Curl Dr, San Antonio, 78229-3900, USA
| | - Arunabh Bhattacharya
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio, 7703, Floyd Curl Dr, San Antonio, 78229-3900, USA
| | - Mizanur Rahman
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio, 7703, Floyd Curl Dr, San Antonio, 78229-3900, USA
| | | | - Gabriel Fernandes
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio, 7703, Floyd Curl Dr, San Antonio, 78229-3900, USA
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Punpilai S, Sujitra T, Ouyporn T, Teraporn V, Sombut B. Menstrual status and bone mineral density among female athletes. Nurs Health Sci 2005; 7:259-65. [PMID: 16271132 DOI: 10.1111/j.1442-2018.2005.00245.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study investigated the relationship between menstrual status and bone mineral density (BMD). Sixty-three elite female athletes competing at the regional level participated. Self-reported menstrual status, stress during the past 6 months, dietary intake of calcium, blood samples for hormonal study, mid-thigh skinfold thickness, triceps, iliac crest, spine and femoral neck BMD were determined. It was found that more than half of the athletes were eumenorrheic while almost half were menstrually dysfunctional. The bone mineral density at the lumbar spine and the femoral neck were within normal ranges. Menstrual dysfunction in female athletes was related to a low BMD at the lumbar spine but not at the femoral neck. Delayed menarche and menstrual dysfunction during the first 2 years after menarche were related to current menstrual dysfunction, but low percent body fat was not related to menstrual dysfunction. This study suggests that exercise in elite female athletes might be an underlying cause of menstrual dysfunction and that there is a relationship between lumbar spine BMD and menstrual dysfunction. The assessment of menstrual history and percent body fat could be used as a screening tool for menstrual dysfunction.
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Affiliation(s)
- Sriareporn Punpilai
- Department of Obstetrics and Gynecologic Nursing, Chiang Mai University, Chiang Mai, Thailand.
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Mittra E, Rubin C, Qin YX. Interrelationship of trabecular mechanical and microstructural properties in sheep trabecular bone. J Biomech 2005; 38:1229-37. [PMID: 15863107 DOI: 10.1016/j.jbiomech.2004.06.007] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
The ability to evaluate fracture risk at an early time point is essential for improved prognostics as well as enhanced treatment in cases of bone loss such as from osteoporosis. Improving the diagnostic ability is inherent upon both high-resolution non-invasive imaging, and a thorough understanding of how the derived indices of structure and density relate to its true mechanical behavior. Using sheep femoral trabecular bone with a range of strength, the interrelationship of mechanical and microstructural parameters was analyzed using multi-directional mechanical testing and micro-computed tomography. Forty-five cubic trabecular bone samples were harvested from 23 adult female sheep, some of whom had received hind-limb vibratory stimuli over the course of 2 years with consequently enhanced mechanical properties. These samples were pooled into a low, medium, or high strength group for further analysis. The findings show that microCT indices that are structural in nature, e.g., structural model index (SMI) (r2=0.85, p<0.0001) is as good as more density oriented indices like bone volume/total volume (BV/TV) (r2=0.81, p<0.0001) in predicting the ultimate strength of a region of trabecular bone. Additionally, those indices more related to global changes in trabecular structure such as connectivity density (ConnD) or degree of anisotropy (DA) are less able to predict the mechanical properties of bone. Interrelationships of trabecular indices such as trabecular number (TbN), thickness (TbTh), and spacing (TbSp) provide clues as to how the trabecular bone will remodel to ultimately achieve differences in the apparent mechanical properties. For instance, the analysis showed that a loss of bone primarily affects the connectedness and overall number of trabeculae, while increased strength results in an increase of the overall thickness of trabeculae while not improving the connectedness. Certainly, the microCT indices studied are able to predict the bulk mechanical properties of a trabecular ROI well, leaving unaccounted only about 15-20% of its inherent variability. Diagnostically, this implies that future work on the early prediction of fracture risk should continue to explore the role of bone quality as the key factors or as an adjuvant to bone quantity (e.g., apparent density).
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Affiliation(s)
- Erik Mittra
- Department of Biomedical Engineering, Stony Brook University, Psychology-A Building, 3rd Floor, Stony Brook, NY 11794-2580, USA
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Abstract
High-intensity training can alter the normal pattern of pubertal development in elite gymnasts. We investigated sex hormones, the ob gene product leptin, body composition, nutrition, and eating habits in female and male elite gymnasts from national cadres to elucidate gender-related differences. Serum leptin levels were decreased, particularly in pubertal girls, and did not show the normal developmental pattern. After leptin levels were transformed into standard deviation scores, mainly pubertal female gymnasts had significantly lower values than normal controls of the same gender, pubertal stage, and body mass index. The percentage of body fat was reduced compared with a normal age-matched population in both genders but to a higher degree in female gymnasts. When leptin standard deviation scores were based on percent body fat instead of body mass index, mean values were still significantly decreased compared with those of normal controls: -1.05 in girls (P < 0.001) and -0.60 in boys (P = 0.025). In both genders, total energy consumption and nutritional intake were insufficient, although to a lesser extent in male gymnasts. Pubertal development is influenced to a different degree in female and male elite gymnasts. In contrast to their male counterparts, high-intensity training takes place during the sensitive phase of pubertal maturation in female gymnasts. Whereas the girls displayed low estrogen levels, hypoleptinemia, reduced body fat mass, insufficient caloric intake, and retarded menarche, the pubertal development of male gymnasts remained almost unaltered.
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Affiliation(s)
- Edda Weimann
- Medical Centre for Child Heath, Clinic for Pediatric Endocrinology and Metabolism, Johann Wolfgang Goethe University, D-60590 Frankfurt, Germany.
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Lange-Collett J. Promoting health among perimenopausal women through diet and exercise. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 2002; 14:172-7; quiz 178-9. [PMID: 12001748 DOI: 10.1111/j.1745-7599.2002.tb00109.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the literature related to health promotion during the perimenopausal years and suggest methods for integrating those changes into the lifestyles of women in primary care. DATA SOURCES Selected scientific literature and guidelines for exercise programs. CONCLUSIONS The transition into perimenopause presents an opportunity for addressing health promotion issues, such as diet and exercise. As a woman senses perimenopausal changes, health awareness emerges. Such personal insight motivates the woman to implement lifestyle changes. IMPLICATIONS FOR PRACTICE Considering the average women will spend approximately one third of her life past menopause, a concerted effort is needed to ensure her well-being. Diet and exercise represent two modifiable areas of concern for perimenopausal women. Dietary selections of phytoestrogens, calcium, fiber and fat along with exercises plans are relatively simple interventions to begin the process of change.
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Abstract
Clinical or biochemical abnormalities of gonadal function, consisting of delayed puberty, luteal phase deficiency, oligo-amenorrhea or anovulation, occur in girls and women participating in strenuous sports. The evidence of a causal relationship between athletic activity and menstrual dysfunction has led to increased interest, also because the number of women who practice sports has increased rapidly. The pathogenesis of exercise-related female reproductive dysfunction (ERFRD) is not completely clarified. The heterogeneity of sports practice, the role of overtraining and other factors, as adequate calorie balance or the assumption of exogenous steroids, could play a primary role in the comprehension of the pathogenic mechanisms of reproductive dysfunction. The interest of physicians about ERFRD is also due to the consequences of reduced gonadal function on women's health. Apart from some short-term transient effects (i.e. on muscle, genito-urinary tract or behavior), hypoestrogenemia can induce long-term deleterious effects, as premature osteoporosis and lifelong impairment of skeletal structure. In view of the possible short-term (infertility) and long-term (osteoporosis) consequences of ERFRD, correct physical training and adequate diet approach are mandatory to prevent or to revert neuroendocrine abnormalities so frequently reported in girls and women participating in recreational or competitive athletic activities.
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Affiliation(s)
- S Cannavò
- Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, Italy.
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Flaws JA, Langenberg P, Babus JK, Hirshfield AN, Sharara FI. Ovarian volume and antral follicle counts as indicators of menopausal status. Menopause 2001; 8:175-80. [PMID: 11355039 DOI: 10.1097/00042192-200105000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies suggest that ovarian volume and antral follicle numbers may be sensitive, specific, and early indicators of menopausal status. The accuracy of these markers, however, has not been compared directly to more traditional markers [age and follicle-stimulating hormone (FSH) levels]. Thus, the purpose of this study was to test whether ovarian volume and antral follicle counts are more sensitive and specific markers of menopausal status than age or FSH levels. DESIGN Premenopausal (n = 34) and postmenopausal (n = 25) women between 40 and 54 years old received a transvaginal ultrasound for determination of ovarian volume and antral follicle numbers, provided blood for measurement of FSH levels, and completed a questionnaire. FSH levels, age, ovarian volume, and antral follicle numbers were compared using t tests. Receiver operating characteristic curves were generated to evaluate the sensitivity and specificity of each marker. RESULTS Postmenopausal women had significantly higher FSH levels (p < or = 0.0001), smaller ovarian volumes (p < or = 0.002), and fewer antral follicles (p < or = 0.002) than premenopausal women. Ovarian volume and antral follicle numbers had similar sensitivity (27.3-100%) and specificity (3.4-92.9%) in indicating postmenopausal status as FSH levels and age. CONCLUSION These data suggest that ovarian volume and antral follicle numbers may be useful indicators of menopausal status.
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Affiliation(s)
- J A Flaws
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA
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