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Zamboni F, Ferrari P, Cazzoletti L, Setti A, Bertoldo F, Dalle Carbonare LG, Danese E, Tardivo S, Crisafulli E, Ferrari M. Bone Mineral Density in Mountain, Road Cyclists and Untrained Controls: Exercise, Diet and Hormones. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:423-430. [PMID: 37540285 DOI: 10.1080/02701367.2023.2242417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/12/2023] [Indexed: 08/05/2023]
Abstract
Purpose: The aim of the study was to compare bone mineral density (BMD) in the lumbar spine (LSBMD) and the femoral neck (FBMD) in male road cyclists (RC n = 39), mountain cyclists (MC n = 30) and controls (C n = 27) and to determine the factors associated with BMD in the same group of participants. Methods: BMD, fat mass (FM) and fat-free mass (FFM) were measured using DXA. Calcium intake (Cal), exercise energy expenditure (EEE) and energy availability (EA) were assessed using self-reported questionnaires. Samples for circulating hormones were also obtained. VO2max was estimated by a cycloergometric test. Results: After adjustment for body mass, in cyclists LSBMD (RC 0.98 ± 0.12; MC 0.98 ± 0.10 g/cm2) was significantly lower than in C (1.11 ± 0.10; p < .001), while FBMD resulted in no significant difference in cyclists compared to C (p = 0.213). EA (kcal/FFM/day) was different in cyclists and in C (p < .05). In C, EEE and EA were positively associated with LSBMD (R = 0.561, R = 0.656, respectively, p < .01), whereas only EA was associated with FBMD (R = 0.554, p < .05); a positive association between EA and FBMD was found in MC (R = 0.464, p < .05). A negative relationship between VO2max and LSBMD in RC (R = -0.418, p < .05) and a positive one between EEE and LSBMD in MC were found (R = 0.605, p < .001). CaI, free testosterone and cortisol were unrelated to BMD. Conclusion: Both the RC and MC had lower LSBMD than C, whereas no difference was found between the two groups of cyclists. The factors associated with BMD are manifold, vary in relation to the measurement site and are likely different in RC, MC and C.
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Stenner E, Giovannella L, Raffaelli G, Delbello G, Ruscio M, Verna R. Laboratory Investigation of the 900-km Lapland Extreme Challenge. Ann Lab Med 2020; 40:92-94. [PMID: 31432648 PMCID: PMC6713650 DOI: 10.3343/alm.2020.40.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/25/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Elisabetta Stenner
- SC Laboratorio Unico di ASUITs, Burlo, Gorizia e Monfalcone, Dipartimento di Medicina dei Servizi, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
| | - Luca Giovannella
- Centro Malattie Tiroidee, Clinica di Medicina Nucleare e Imaging Molecolare, Istituto di Imaging della Svizzera Italiana, Bellinzona, Switzerland
| | - Giorgia Raffaelli
- U.O.C. Medicina Trasfusionale e Patologia Clinica, Repubblica di San Marino - Istituto per la Sicurezza Sociale, San Marino, Republic of San Marino
| | - Giorgio Delbello
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Maurizio Ruscio
- SC Laboratorio Unico di ASUITs, Burlo, Gorizia e Monfalcone, Dipartimento di Medicina dei Servizi, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
| | - Roberto Verna
- World Association of Societies of Pathology and Laboratory Medicine, Milan, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Williams NI, Mallinson RJ, De Souza MJ. Rationale and study design of an intervention of increased energy intake in women with exercise-associated menstrual disturbances to improve menstrual function and bone health: The REFUEL study. Contemp Clin Trials Commun 2019; 14:100325. [PMID: 30723840 PMCID: PMC6353734 DOI: 10.1016/j.conctc.2019.100325] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Exercising women who consume inadequate energy relative to expenditure are at risk for downstream health consequences, such as menstrual cycle disturbances and poor bone health. Collectively, these conditions are known as the Female Athlete Triad (Triad). Clinicians often prescribe hormonal contraceptives to address this issue; however, the recommended treatment is reversal of the energy deficit. This paper describes the design of the REFUEL study, a randomized controlled trial (RCT) that explored the effectiveness of a 12-month intervention of increased energy intake on the reversal of an unhealthy energetic status and menstrual dysfunction and subsequent improvements in bone health in exercising women with severe menstrual cycle disturbances. Methods Women between the ages of 18–35 years and participating in at least 2 h/week of purposeful exercise were recruited. Those who reported irregular or absent menstrual cycles and were determined to have an exercise-associated menstrual disturbance (EAMD) were randomized into either the treatment group (EAMD + Cal), which was instructed to increase caloric intake throughout the intervention, or a control group (EAMD Control). Women who reported eumenorrhea were eligible for the ovulatory (OV) Control group. Repeated measures of energetic and metabolic status, reproductive status, and skeletal health were obtained. Discussion The REFUEL study is the first RCT to explore a non-pharmacological treatment approach among exercising women with the Triad. 118 women were randomized, and 55 women completed the entire study. The findings of this study have the potential to inform and alter clinical practice for exercising young women who present with this condition.
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Affiliation(s)
- Nancy I Williams
- Pennsylvania State University, Department of Kinesiology, Noll Laboratory, Women's Health and Exercise Laboratory, University Park, PA, 16802, USA
| | - Rebecca J Mallinson
- Pennsylvania State University, Department of Kinesiology, Noll Laboratory, Women's Health and Exercise Laboratory, University Park, PA, 16802, USA
| | - Mary Jane De Souza
- Pennsylvania State University, Department of Kinesiology, Noll Laboratory, Women's Health and Exercise Laboratory, University Park, PA, 16802, USA
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Tam N, Santos-Concejero J, Tucker R, Lamberts RP, Micklesfield LK. Bone health in elite Kenyan runners. J Sports Sci 2017; 36:456-461. [PMID: 28406358 DOI: 10.1080/02640414.2017.1313998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impact loading in athletes participating in various sports has been positively associated with increased bone mineral density (BMD), but this has not been investigated in elite Kenyan runners. Body composition and site-specific BMD measures quantified with dual x-ray absorptiometry were measured in 15 elite male Kenyan runners and 23 apparently healthy South African males of different ethnicities. Training load and biomechanical variables associated with impact loading, such as joint stiffness, were determined in the elite Kenyan runners. Greater proximal femur (PF) BMD (g · cm-2) was higher (P = 0.001, ES = 1.24) in the elite Kenyan runners compared with the controls. Six of the 15 (40%) Kenyan runners exhibited lumbar spine (LS) Z-Scores below -2.0 SD, whereas this was not found in the apparently healthy controls. PFBMD was associated with training load (r = 0.560, P = 0.003) and ankle (r = 0.710, P = 0.004) and knee (r = 0.546, P = 0.043) joint stiffness. Elite Kenyan runners exhibit greater PFBMD than healthy controls, which is associated with higher training load and higher joint stiffness. Our results reaffirm the benefits of impact loading on BMD at a weight-bearing site, while a high prevalence of low LSBMD in the elite Kenyan runners is hypothesised to be the result of a mismatch between energy intake and high training load. Future research investigating energy availability in Kenyan runners and the possible association with musculoskeletal injury should be investigated.
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Affiliation(s)
- Nicholas Tam
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa
| | - Jordan Santos-Concejero
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa.,b Department of Physical Education and Sport , University of the Basque Country, UPV/EHU , Vitoria-Gasteiz , Spain
| | - Ross Tucker
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa.,c School of Medicine , University of the Free State , Bloemfontein , South Africa
| | - Robert P Lamberts
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa.,d Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences , Stellenbosch University , Western Cape , South Africa
| | - Lisa K Micklesfield
- a Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Science , University of Cape Town , Cape Town , South Africa.,e MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Robbeson J, Havemann-Nel L, Wright H. The female athlete triad in student track and field athletes. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2013.11734446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bone formation is suppressed with multi-stressor military training. Eur J Appl Physiol 2014; 114:2251-9. [PMID: 25027064 DOI: 10.1007/s00421-014-2950-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the effects of US Army Ranger Training, an 8-week, physically demanding program (energy expenditure of 2,500-4,500 kcal/day) with energy restriction (deficit of 1,000-4,000 kcal/day) and sleep deprivation (<4 h sleep/night) on bone metabolism. METHODS Blood was collected from 22 men (age 24 ± 4 years) before and after training. Follow-up measurements were made in a subset of 8 subjects between 2 and 6 weeks after training. Serum was analyzed for bone formation biomarkers [bone alkaline phosphatase (BAP) and osteocalcin (OCN)], bone resorption biomarkers [C-telopeptide cross-links of type I collagen (CTX) and tartrate-resistant acid phosphatase (TRAP5b)], calcium, parathyroid hormone (PTH), and vitamin D 25(OH)D increased significantly by 37.3 ± 45.2 % with training [corrected]. A repeated-measures ANOVA with time as the only factor was used to analyze data on the subset of 8 subjects who completed follow-up data collection. RESULTS BAP and OCN significantly decreased by 22.8 ± 15.5% (pre 41.9 ± 10.1; post 31.7 ± 7.8 ng/ml) and 21.0 ± 23.3% (pre 15.0 ± 3.5; post 11.3 ± 2.1 ng/ml), respectively, with training, suggesting suppressed bone formation. OCN returned to baseline, while BAP remained suppressed 2-6 weeks post-training. TRAP5b significantly increased by 57.5 ± 51.6% (pre 3.0 ± 0.9; post 4.6 ± 1.4 ng/ml) from pre- to post-training, suggesting increased bone resorption, and returned to baseline 2-6 weeks post-training. PTH Increased significantly by 37.3 ± 45.2% with training. No changes in CTX, calcium, or PTH were detected. CONCLUSIONS These data indicate that multi-stressor military training results in increased bone resorption and suppressed bone formation, with recovery of bone metabolism 2-6 weeks after completion of training.
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Watanabe K, Wang Y. Influence of Backpack Load and Gait Speed on Plantar Forces During Walking. Res Sports Med 2013; 21:395-401. [DOI: 10.1080/15438627.2013.825802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Yun Wang
- b Department of Health and Exercise Science , Tianjin University of Sport , Tianjin , China
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Dolan E, Crabtree N, McGoldrick A, Ashley DT, McCaffrey N, Warrington GD. Weight regulation and bone mass: a comparison between professional jockeys, elite amateur boxers, and age, gender and BMI matched controls. J Bone Miner Metab 2012; 30:164-70. [PMID: 21773703 DOI: 10.1007/s00774-011-0297-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 06/20/2011] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare bone mass between two groups of jockeys (flat: n = 14; national hunt: n = 16); boxers (n = 14) and age, gender and BMI matched controls (n = 14). All subjects underwent dual energy X-ray absorptiometry (DXA) scanning for assessment of bone mass, with measurements made of the total body, vertebra L2-4 and femoral neck. Body composition and the relative contribution of fat and lean mass were extrapolated from the results. Data were analysed in accordance with differences in body composition, in particular, height, lean mass, fat mass and age. Both jockey groups were shown to display lower bone mass than either the boxers or control group at a number of sites including total body bone mineral density (BMD) (1.019 ± 0.06 and 1.17 ± 1.05 vs. 1.26 ± 0.01 and 1.26 ± 0.06 g cm(-2) for flat, national hunt, boxer and control, respectively), total body bone mineral content (BMC) less head, L2-4 BMD and femoral neck BMD and BMC (p < 0.05). Regression analysis revealed that lean mass and height were the primary predictors of total body BMC, although additional group-specific influences were present which reduced bone mass in the flat jockey group and enhanced it in the boxers (R (2) = 0.814). Reduced bone mass in jockeys may be a consequence of reduced energy availability in response to chronic weight restriction and could have particular implications for these athletes in light of the high risk nature of the sport. In contrast, the high intensity, high impact training associated with boxing may have conveyed an osteogenic stimulus on these athletes.
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Affiliation(s)
- Eimear Dolan
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland.
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Abstract
To investigate current theories of the contributing factors to osteopenia/osteoporosis in competitive cyclists, we present a narrative review of published cross-sectional studies investigating plausible etiologies of decreased bone density in competitive cyclists. Aggregate from multiple published studies as cited. Bone mineral density in cyclists appears to be correlated positively to the cumulative amount of bone loading forces experienced over a lifetime. However, decreases in bone mineral density are noted over the short term if bone loading forces are removed, despite previous gains. There also appears to be a negative correlation between bone mineral density and dermal calcium losses during exercise. Data are mixed on whether calcium supplementation improves bone mineral density in this setting. No correlation was found between sex hormones and bone mineral density in the competitive cyclists studied. Knowledge of the underlying contributors to reduced bone mineral density in cyclists can aid in making preventative and therapeutic recommendations that potentially could decrease the morbidity and mortality related to osteoporosis.
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Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, Goemaere S, Kaufman J, Reginster JY, Rozenberg S. Loading and skeletal development and maintenance. J Osteoporos 2010; 2011:786752. [PMID: 21209784 PMCID: PMC3010667 DOI: 10.4061/2011/786752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/06/2010] [Indexed: 12/12/2022] Open
Abstract
Mechanical loading is a major regulator of bone mass and geometry. The osteocytes network is considered the main sensor of loads, through the shear stress generated by strain induced fluid flow in the lacuno-canalicular system. Intracellular transduction implies several kinases and phosphorylation of the estrogen receptor. Several extra-cellular mediators, among which NO and prostaglandins are transducing the signal to the effector cells. Disuse results in osteocytes apoptosis and rapid imbalanced bone resorption, leading to severe osteoporosis. Exercising during growth increases peak bone mass, and could be beneficial with regards to osteoporosis later in life, but the gain could be lost if training is abandoned. Exercise programs in adults and seniors have barely significant effects on bone mass and geometry at least at short term. There are few data on a possible additive effect of exercise and drugs in osteoporosis treatment, but disuse could decrease drugs action. Exercise programs proposed for bone health are tedious and compliance is usually low. The most practical advice for patients is to walk a minimum of 30 to 60 minutes per day. Other exercises like swimming or cycling have less effect on bone, but could reduce fracture risk indirectly by maintaining muscle mass and force.
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Affiliation(s)
- P. Bergmann
- Department of Nuclear Medicine, Laboratory of Clinical Chemistry and Experimental Medicine, CHU Brugmann, Université Libre de Bruxelles, 4 Pl. Van Gehuchten, 1020 Brussels, Belgium,*P. Bergmann:
| | - J. J. Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium
| | - S. Boonen
- Division of Gerontology and Geriatrics, Center for Musculoskeletal Research, Department of Experimental Medicine, Catholic Leuven University, 3000 Leuven, Belgium
| | - Y. Boutsen
- Department of Rheumatology, Mont-Godinne University Hospital, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - J. P. Devogelaer
- Rheumatology Unit, Saint-Luc University Hospital, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - S. Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9000 Ghent, Belgium
| | - J. Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9000 Ghent, Belgium
| | - J. Y. Reginster
- Department of Public Health Sciences, University of Liège, 4000 Liège, Belgium
| | - S. Rozenberg
- Department of Gynaecology-Obstetrics, Free University of Brussels, 1090 Brussels, Belgium
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Smathers AM, Bemben MG, Bemben DA. Bone density comparisons in male competitive road cyclists and untrained controls. Med Sci Sports Exerc 2009; 41:290-6. [PMID: 19127198 DOI: 10.1249/mss.0b013e318185493e] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Low bone mineral density (BMD) has been documented in endurance-trained runners; however, the bone status of cyclists is unclear. PURPOSE The purpose of this study was to compare total body, lumbar spine, and dual proximal femur BMD in male competitive road cyclists (n = 32) and in age- and body mass-matched controls (n = 30). METHODS The cyclists had an average of 9.4 yr of racing experience and trained 7-22 h wk(-1). BMD was measured using dual energy x-ray absorptiometry (DXA; GE Lunar Prodigy, v. 6.70.021). Calcium intake was estimated from a food frequency questionnaire. Resting serum total and free testosterone levels were measured by RIA (Diagnostic Systems Laboratory). RESULTS There were no significant differences (P > 0.050) between the cyclists (CYC) and the controls (CON) for age, height, body mass, or testosterone levels. CYC had significantly (P < 0.050) lower percent body fat and higher bone-free lean body mass than the CON. Calcium intake for CYC was significantly higher (P < 0.050) than for the CON group (1557 +/- 132 vs 1098 +/- 69 mg d(-1)). Anterior-posterior spine (L2-L4) and lateral spine (LS) BMD (g cm(-2)) were significantly lower (P < 0.050) for CYC (L2-L4 = 1.165 +/- 0.023 g cm(-2); LS = 0.781 +/- 0.025 g cm(-2)) than for CON (L2-L4 = 1.246 +/- 0.028 g cm(-2); LS = 0.911 +/- 0.027 g cm(-2)). Based on t-scores (SD from the young adult reference population mean), 9% of CYC and 3% of CON were classified as osteoporotic, whereas 25% and 10% of CYC and CON, respectively, were osteopenic. CONCLUSIONS Our findings indicated that male cyclists had lower spine BMD than controls, which was not associated with group differences in testosterone. Future studies are needed to elucidate the underlying mechanisms for low bone mass in cyclists.
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Affiliation(s)
- Aaron M Smathers
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73109, USA
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Warrington G, Dolan E, McGoldrick A, McEvoy J, MacManus C, Griffin M, Lyons D. Chronic weight control impacts on physiological function and bone health in elite jockeys. J Sports Sci 2009; 27:543-50. [DOI: 10.1080/02640410802702863] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Trutschnigg B, Chong C, Habermayerova L, Karelis AD, Komorowski J. Female boxers have high bone mineral density despite low body fat mass, high energy expenditure, and a high incidence of oligomenorrhea. Appl Physiol Nutr Metab 2008; 33:863-9. [PMID: 18923560 DOI: 10.1139/h08-071] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Low body fat mass and menstrual irregularities have been associated with low bone mineral density (BMD). The aim of this study was to compare the relation between BMD, lean body mass, fat mass, physical activity energy expenditure (PAEE), and menstrual status in female boxers and in physically active females with low (C1) or average (C2) fat mass. Boxers (n = 11) and controls (C1, n = 16; C2, n = 17), aged 18-38 years, were assessed for BMD and body composition with dual-energy X-ray absorptiometry. Menstrual status and PAEE were determined from questionnaires. There was no difference in anthropometric measurements between boxers and C1 subjects, except that boxers had higher arm lean mass. However, both boxers and C1 subjects had a lower percentage of fat (p < 0.001) than C2 subjects (boxers, 14.6% +/- 2.0; C1, 15.5% +/- 4.2; C2, 25.8% +/- 3.4%), and boxers had a higher (p = 0.002) lean body mass index (lean body mass/height2, where lean body mass is measured in kilograms and height is measured in metres) than C2 subjects. The PAEE of boxers was higher (p < 0.007) than that of controls (boxers, 5748 +/- 2284 ; C1, 2966 +/- 2258 ; C2, 2714 +/- 1722 kcal.week-1). Oligomenorrhea was more common in boxers than in C1 and C2 subjects (boxers, 54.6%; C1, 18.8%; C2, 35.3%). Arm, leg, and spine BMD were higher (p < 0.008) in boxers than in C1 subjects, and arm BMD was higher in boxers than in C2 subjects. BMD Z scores were also higher (p < 0.05) in boxers (boxers, 1.1+/- 0.8, C1, 0.1 +/- 0.7; C2: 0.3 +/- 1.1). High BMD in boxers, despite low fat mass, high PAEE, and an increased incidence of oligomenorrhea suggest that boxing has a positive effect on BMD.
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Affiliation(s)
- Barbara Trutschnigg
- Department of Exercise Science, Concordia University, The Richard J. Renault Science Pavilion, Montreal, QC H4B1R6, Canada
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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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Klentrou P, Slack J, Roy B, Ladouceur M. Effects of exercise training with weighted vests on bone turnover and isokinetic strength in postmenopausal women. J Aging Phys Act 2007; 15:287-99. [PMID: 17724395 DOI: 10.1123/japa.15.3.287] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effects of 12 wk of exercise training using weighted vests on bone turnover and isokinetic strength were evaluated in postmenopausal women randomly assigned as exercisers (EX; n = 9) or controls (CON; n = 7). Training included 3 multimodal exercise sessions per wk wearing weighted vests. The vest load was progressively increased each wk to a maximum of 15% of body weight. Bone turnover was determined from resting levels of serum osteocalcin and NTx. Knee and ankle strength were measured at 60 degrees/s and 180 degrees/s using an isokinetic dynamometer. After 12 wk, NTx decreased by 14.5% (P <or= .05) in EX, with no significant changes in osteocalcin. EX also showed a 40% (P <or= .05) improvement in ankle plantar-flexion strength at 60 degrees/s. Relative body fat significantly decreased and fat-free mass increased in EX. Exercise compliance was 80%. These findings support the use of progressive exercise training using weighted vests in postmenopausal women.
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Affiliation(s)
- Panagiota Klentrou
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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De Souza MJ, Hontscharuk R, Olmsted M, Kerr G, Williams NI. Drive for thinness score is a proxy indicator of energy deficiency in exercising women. Appetite 2007; 48:359-67. [PMID: 17184880 DOI: 10.1016/j.appet.2006.10.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to determine the association between drive for thinness (DT) and adaptations to energy deficiency in exercising women. This observational study evaluated psychometric and metabolic factors in sedentary (n=9, 27.9+/-2.0 yr) and exercising women (n=43, 24.0+/-1.1 yr). Volunteers were retrospectively grouped according to exercise status (sedentary or exercising) and a DT score of normal (sedentary or exercising) or high (exercising only). Resting energy expenditure (REE) and metabolic hormones (triiodothyronine, (TT3), ghrelin, leptin, insulin) were measured repeatedly over a 2-3 month period. The DT subscale successfully discriminated the groups based on energy status. Although the groups did not differ in body weight, the high DT group exhibited adaptations to chronic energy deficiency, including a REE below 90% of their predicted REE (86+/-3.0%), significantly lower TT3 levels and significantly higher ghrelin levels than the normal DT groups. Since energy deficiency plays a causal role in the Female Athlete Triad, DT may serve as a proxy indicator of underlying energy deficiency and may be useful for identifying individuals at risk for Triad disorders prior to the development of serious clinical sequelae.
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Affiliation(s)
- Mary Jane De Souza
- Women's Exercise and Bone Health Laboratory, Faculty of Physical Education and Health, University of Toronto, Toronto, Ont., Canada.
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Courteix D, Rieth N, Thomas T, Van Praagh E, Benhamou CL, Collomp K, Lespessailles E, Jaffré C. Preserved Bone Health in Adolescent Elite Rhythmic Gymnasts despite Hypoleptinemia. Horm Res Paediatr 2007; 68:20-7. [PMID: 17220634 DOI: 10.1159/000098546] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 09/28/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Leptin is linked to hormonal disturbances occurring in anorexia and positively linked with bone mineral density. The aim of this study was to determine whether hypoleptinemia occurring in rhythmic gymnasts may affect bone health. METHOD Leptin, insulin, cortisol, IGF1 levels and bone markers were determined in 36 rhythmic gymnasts (EG) and 20 controls (C). Body composition, BMD at the whole body (WBBMD), lumbar spine (LSBMD) and bone ultrasound properties (SOS, BUA) were measured. RESULTS The rhythmic gymnasts had lower fat mass and leptin level than the controls. There was no difference for IGF1, cortisol and insulin levels. Bone turnover rate was higher in elite gymnasts. The uncoupling index showed that remodeling favored the bone formation. LSBMD, WBBMD, SOS and BUA were higher in elite gymnasts after adjustment for fat mass. Leptin correlated positively with fat mass and negatively with physical activity. CONCLUSION High impact training is able to counterbalance bone effects usually encountered in hormonally disturbed subjects. Our results suggest that hypoleptinaemia might be related to direct osteogenic effects and indirect hormonal mechanisms including preservation of IGF and cortisol levels.
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Affiliation(s)
- D Courteix
- Laboratory of Bone Architecture and Physical Exercise (ATOSEP EA 3895), University of Orleans, Orleans, France.
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Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone 2007; 40:14-27. [PMID: 16956802 DOI: 10.1016/j.bone.2006.07.006] [Citation(s) in RCA: 285] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 07/06/2006] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Osteoporosis is a serious skeletal disease and as there is currently no cure, there is a large emphasis on its prevention, including the optimisation of peak bone mass. There is increasing evidence that regular weight-bearing exercise is an effective strategy for enhancing bone status during growth. This systematic review evaluates randomised and non-randomised controlled trials to date, on the effects of exercise on bone mineral accrual in children and adolescents. METHODS An online search of Medline and the Cochrane database enabled the identification of studies. Those that met the inclusion criteria were included in the review and graded according to risk for bias. RESULTS Twenty-two trials were reviewed. Nine were conducted in prepubertal children (Tanner I), 8 in early pubertal (Tanner II-III) and 5 in pubertal (Tanner IV-V). Sample sizes ranged from n=10 to 65 per group. Exercise interventions included games, dance, resistance training and jumping exercises, ranging in duration from 3 to 48 months. Approximately half of the trials (n=10) included ground reaction force (GRF) data (2 to 9 times body weight). All trials in early pubertal children, 6 in pre pubertal and 2 in pubertal children, reported positive effects of exercise on bone (P<0.05). Mean increases in bone parameters over 6 months were 0.9-4.9% in prepubertal, 1.1-5.5% in early pubertal and 0.3-1.9% in pubertal exercisers compared to controls (P<0.05). CONCLUSIONS Although weight-bearing exercise appears to enhance bone mineral accrual in children, particularly during early puberty; it remains unclear as to what constitutes the optimal exercise programme. Many studies to date have a high risk for bias and only a few have a low risk. Major limitations concerned selection procedures, compliance rates and control of variables. More well designed and controlled investigations are needed. Furthermore, the specific exercise intervention that will provide the optimal stimulus for peak bone mineral accretion is unclear. Future quantitative, dose-response studies using larger sample sizes and interventions that vary in GRF and frequency may characterise the most and least effective exercise programmes for bone mineral accrual in this population. In addition, the measurement of bone quality parameters and volumetric BMD would provide a greater insight into the mechanisms implicated in the adaptation of bone to exercise.
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Affiliation(s)
- K Hind
- University of Leeds, Centre for Bone and Body Composition Research, Ground Floor, Wellcome Wing, The General Infirmary, Leeds, LS1 3EX, UK.
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Zanker C. Nutrition et sport au cours de l’enfance et de l’adolescence: satisfaire les demandes métaboliques liées à la croissance et à l’exercice physique. ACTA ACUST UNITED AC 2006. [DOI: 10.1159/000095889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rosenthal MD, Moore JH, DeBerardino TM. Diagnosis of medial knee pain: atypical stress fracture about the knee joint. J Orthop Sports Phys Ther 2006; 36:526-34. [PMID: 16881469 DOI: 10.2519/jospt.2006.2125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Resident's case problem. BACKGROUND A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. DIAGNOSIS Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. DISCUSSION Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.
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Zanker CL. Regulation of reproductive function in athletic women: an investigation of the roles of energy availability and body composition. Br J Sports Med 2006; 40:489-90; discussion 490. [PMID: 16720883 PMCID: PMC2465098 DOI: 10.1136/bjsm.2004.016758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- C L Zanker
- Carnegie Research Institute, Faculty of Sport and Education, Leeds Metropolitan University, Headingley Campus, Leeds LS6 3QS, UK.
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Low lumbar spine bone mineral density in both male and female endurance runners. Bone 2006; 39:880-5. [PMID: 16682267 DOI: 10.1016/j.bone.2006.03.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 03/22/2006] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
There have been many reports of low bone mineral density (BMD) in female endurance runners. Although there have been several reports of low BMD in male runners, it is unclear how comparable the problem is to that in females. We compared BMD between male and female endurance runners and with a reference population. One hundred and nine endurance runners (65 females, 44 males) aged 19-50 years participated and had been training regularly for at least 3 years (32-187.2 km week(-1)) in events from 3 km to the marathon. BMD was measured at the lumbar spine (L2-L4) and hip by DXA. A questionnaire assessed training and menstrual status. Lumbar spine T scores were similar in male and female runners (-0.8 (0.8) versus -0.8 (0.7); f = 0.015; P = 0.904) as were total hip T scores (0.6 (7.9) versus 0.5 (9.2); f = 0.192; P = 0.662). The proportion of male runners with low lumbar spine BMD (<-1.0) (n = 16 from 44) compared to that of females (n = 27 from 65) (P = 0.675). Males had lower spine T scores than eumenorrhoeic females (-0.8 (0.7) versus -0.4 (0.7); f = 5.169; P = 0.03). There were moderate negative correlations between weekly running distance and lumbar spine BMD in males and females (r(2) = 0.267; 0.189; P < 0.001), independent of menstrual status in females (r(2) = 0.192; P < 0.001). Lumbar spine but not hip T scores were greater in runners who participated in resistance training at least twice-a-week (male: -0.4 versus -1.1; female: -0.5 versus -1.1; P < 0.01). Using multiple regression, running distance (-) and BMI (+) together best predicted lumbar spine T scores (r(2) = 0.402; P < 0.01) in females. Although weak, BMI (+) best predicted hip T scores (r(2) = 0.167; P < 0.05). In males, running distance and training years (-) together best predicted lumbar spine T scores (r(2) = 0.400; P < 0.01). Training years (-) best predicted hip T scores (r(2) = 0.361; P < 0.01). To conclude, our findings suggest that male runners face the same bone threat at the spine, as female runners. Further research in male athletes is required. Incorporation of regular resistance training into an athlete's training programme may be a useful preventative strategy.
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Jürimäe J, Purge P, Jürimäe T, von Duvillard SP. Bone metabolism in elite male rowers: adaptation to volume-extended training. Eur J Appl Physiol 2006; 97:127-32. [PMID: 16583234 DOI: 10.1007/s00421-006-0158-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2006] [Indexed: 10/24/2022]
Abstract
We examined the effect of 6-month volume-extended training on bone metabolism in elite male rowers. Twelve elite male rowers (20.8+/-3.0 years; 192.9+/-4.7 cm; 91.9+/-5.3 kg; body fat 10.1+/-2.3%; VO2max 6.2+/-0.5 l min(-1)) participated in this study. Bone biochemical markers, hormones, bone mineral content (BMC), and bone mineral density (BMD) were assessed before and after training. Average weekly training volume was significantly higher (P<0.05) during the 6 months of heavy training compared to relative rest (11.6+/-0.4 h week(-1) vs. 16.8+/-0.6 h week(-1)), while intensity remained the same. At the end of training, only arm BMD was significantly increased by 5.7%. Osteocalcin (16.6%), insulin-like growth factor-1 (IGF-1) (20.2%) and the bioavailability IGF-1 index (17.9%) were significantly increased. Before heavy training, relationships were observed between the whole body BMD and growth hormone (r=0.64; P< or =0.02), lumbar spine BMD and 1.25(OH)2 vitamin D (r=0.69; P< or =0.04), arm BMD and testosterone (r=0.59; P< or =0.05), and arm BMD and adiponectin (r=0.59; P< or =0.05). No relationship was found between BMC or BMD and blood biochemical measures 6 months later (r=0.56; P> or =0.05). In addition, osteocalcin was related to IGF-1 (r>0.58; P<0.048) and bioavailability IGF-1 index (r>0.59; P< or =0.055) before and after training. In summary, heavy training had a moderately favorable effect on BMD. Bone tissue at specific skeleton sites is sensitive to changes in training volume even in athletes with already high BMD values. Changes in BMD and bone formation may be caused by changes in specific hormones such as IGF-1 and adiponectin in male athletes.
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Affiliation(s)
- Jaak Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, University of Tartu, Tartu, Estonia
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Håglin L. The consequences of negative energy balance in anorexia syndrome. J Pediatr Adolesc Gynecol 2005; 18:319-25. [PMID: 16202935 DOI: 10.1016/j.jpag.2005.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Using four cases, this study describes common etiological factors and clinical sequelae in anorexia nervosa and athletic anorexia to present a biological explanation for interactions. DESIGN Four anorectic girls were interviewed regarding their training programs and dietary intake. Bone mineral content, hormonal status, and energy intake were assessed during follow-ups. RESULTS All the girls began training before puberty and had a low energy intake for age and height. Amenorrhea, low bone mineral content with stress fractures in three cases, and growth retardation in one case, were present at the follow-up after 6 years. Low amount of body fat and high serum cortisol is indicated and included in the discussion. The etiology is presented in an integrated model in addition to a biological explanation based on a negative energy balance, an acidic condition. CONCLUSION Energy deficits during puberty can result in the clinical sequela of the anorexia syndrome.
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Affiliation(s)
- Lena Håglin
- Department of Social Medicine, University Hospital, SE-901 85 Umeå, Sweden.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000185331.32574.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW In the past year, there have been remarkable advancements in the understanding of the female athlete's pathology and in recognizing the specific needs of women participating in both recreational and competitive sports. The purpose of this review is to highlight the recent developments in the field of female athletes and menstrual function. RECENT FINDINGS Although the female athletic triad, consisting of disordered eating, amenorrhea and osteoporosis, has been clinically recognized, there have been few studies quantifying the long-term effects. This review summarizes recently explored topics, including: disordered eating as a main culprit of menstrual irregularities, long-term longitudinal studies following female athletes through to retirement, and current treatment options. SUMMARY Understanding the causes, profiles and the prevention of menstrual irregularities in the female athlete should help decrease its prevalence among women involved in athletics. The literature reviewed in this article stresses the importance of early detection, as well as the consequences of eating disorders, menstrual disturbances and bone loss left untreated.
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