Factors associated with menstrual irregularities and decreased bone mineral density in female athletes

Eating Disorders in Adolescent Athletes

Adolescent athletes are especially vulnerable to developing disordered eating behaviors. Risk factors include participation in sports where weight and lean body type are important, high-intensity training, pressure from coaches, and training and dieting beginning at an early age. Medical complications associated with these unhealthy dietary and weight-control practices and eating disorders can be potentially dangerous. Prevention strategies include minimizing the importance of weight, increased sensitivity on the part of those working with athletes for issues around weight and dieting, and appropriate education on proper weight-control methods and nutrition. The long-term prognosis is not known.

Gender differences in high school coaches' knowledge, attitudes, and communication about the female athlete triad

The objective of this study was to assess high school coaches' knowledge, attitudes, communication, and management decisions with respect to the Female Athlete Triad and to determine whether results are patterned by coach gender. Data were obtained through an online survey of high school coaches (n = 227). Significant differences were found between male and female coaches in certain attitudes and communication behaviors related to eating and menstrual irregularity. School or district level policies may help reduce these differences and may help mitigate the health consequences for athletes related to possible differential prevention and detection of the comorbidities of the Female Athlete Triad.

The adolescent female athlete: current concepts and conundrums

The adolescent female athlete has become a common part of the sports environment at all levels from childhood play to professional adult sports. This article considers various issues common to this athlete to help clinicians care for their patients. Basic sports physiology is reviewed and then specific conditions are considered, including iron deficiency anemia, stress urinary incontinence, breast issues (ie, pain, asymmetry, galactorrhea, injury), the female athlete triad (ie, menstrual dysfunction, abnormal eating patterns, and osteopenia or osteoporosis), and injuries. Clinical conundrums are considered including the difficulty in caring for a dedicated athlete whose intense love of her sport may lead to menstrual and bone loss complications. The knowledgeable clinician in the twenty-first century can be of considerable help to the female athlete who is at and beyond puberty.

Amenorréia e osteoporose em adolescentes atletas

A participação feminina no esporte foi crescendo ao longo dos anos. Trabalhos científicos têm mostrado os benefícios trazidos por esta prática para a saúde da mulher, mas quando se trata de esporte competitivo podem surgir problemas. A complicação mais comum descrita pela literatura é a "tríade da atleta", a qual envolve três processos: o distúrbio alimentar, a amenorréia e a osteoporose. A amenorréia atinge, nos Estados Unidos, até 66% das atletas de competição, e algumas de suas possíveis causas são: perda de peso, excesso de treino, quantidade insuficiente de gordura corporal, perda de estoques específicos de gordura corporal e dieta inadequada. Como conseqüência da amenorréia, a esportista pode desenvolver osteoporose precoce. Não se sabe ao certo a porcentagem de atletas com osteopenia, mas há indícios de que a falta de estrógeno, a dieta inadequada e o consumo insuficiente de cálcio serem fatores que as predispõem a desenvolver a doença.

The female athlete. Before and beyond puberty

As the twentieth century progressed, the female athlete became an accepted participant of sports at all levels. This article reviews various aspects of female sports participation. After an historical perspective, selected comments are provided on psychologic and physiologic aspects. Concepts of adolescent gynecology are reviewed, including breast and menstrual problems and pregnancy. Other areas reviewed include iron deficiency anemia, stress urinary incontinence, and sports injuries in female athletes.

Development of a medical nutrition therapy protocol for female collegiate athletes

Nutrition intervention can improve athletic performance and reduce the risk of nutrition related problems in women athletes. The current healthcare environment demands that dietitians document the outcomes of the medical nutrition therapy (MNT) they provide. This requires the development and validation of MNT protocols so that outcomes can be documented and compared in similar populations across multiple settings. The purpose of this project was to develop a sports nutrition management MNT protocol for collegiate women athletes. A registered dietitian currently working with collegiate women athletes collaborated with four dietitians from the community to develop an MNT protocol. Further testing and validation using this MNT protocol will help dietitians document the outcomes of their interventions in this population.

Effects of nandrolone decanoate therapy in borderline hypogonadal men with HIV-associated weight loss

Serum testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to androgen treatment has not been determined, however. Eighteen men with AWS (mean +/- standard error [SE]: 87% +/- 1% usual body weight; CD4 count 90 +/- 24) and borderline low serum testosterone concentrations (382 +/- 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (i.m.) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7) nandrolone decanoate, a testosterone analogue. Nitrogen balance, stable isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and gonadal hormone levels were measured. Both low-dose and high-dose nandrolone resulted in significant nitrogen retention (33-52 g nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase, body weight increased by 4.9 +/- 1.2 kg, including 3.1 +/- 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary, nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo, similar in extent to the nitrogen retention previously achieved with recombinant growth hormone. It is reasonable to expand the criteria for androgen treatment in AWS to include at least patients in the lowest quartile of serum testosterone.

The preparticipation sports examination for high school and college athletes

The PSE can be used as a tool to allow athletes to participate safely in sports. The goal of the PSE is not to disqualify athletes but to ensure that their participation in sports does not unnecessarily increase their risk of injury. The PSE is most effectively conducted by the station method with multiple examiners, one of whom should have specialty training in musculoskeletal disorders. The examination should be conducted 6 weeks prior to the beginning of the season and at the beginning of each new level of competition, unless directed differently by local laws. The correct use of the PSE should screen for signs and symptoms of pathological states that may lead to a nontraumatic death while participating in sports. An effective musculoskeletal examination should detect any postinjury deficits that may lead to subsequent reinjury later in the season. It is our hope that a PSE, based on the literature, can be used to prevent some of the nontraumatic deaths and musculoskeletal injury associated with sports participation.

How do we manage specific types of osteoporosis?

Osteoporosis in children, adolescents and corticosteroid-treated patients represent a particular problem for clinicians. In children and adolescents, the main management question is whether any specific interventions can influence attainment of peak bone mass and so decrease the chance of osteoporosis in later adult life. The role of physical activity and calcium in particular are reviewed. In adolescence, osteoporosis is usually due to idiopathic juvenile osteoporosis or secondary to amenorrhoea or anorexia nervosa. These entities, as well as the management of corticosteroid-induced osteoporosis at all ages, are discussed.