Skip to main content
SpringerLink
Log in

Irreversible bone loss in former amenorrheic athletes

  • Editorial
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Small gains in bone mineral density (BMD) have been reported in the first year following resumption of menses in amenorrheic athletes but there have been no long-term outcome studies. The purpose of this study was to determine whether the BMD of former oligomenorrheic or amenorrheic athletes normalizes following several years of normal menses or use of oral contraceptives. Twenty-nine athletes first studied in this laboratory 8.1 years (range 6–10 years) ago were available for follow-up. At recruitment (time 1) 29 athletes, mean age of 30.6 years, were non-smokers, exercised 4 or more days/week for at least 45 min, had not used oral contraceptives, and had no medical conditions affecting bone metabolism. At time 1, 9 women (R/R) had always menstruated regularly, 9 (R/O/A) had experienced intermittent oligo/amenorrhea as well as regular menses, and 11 (O/A) had never menstruated regularly. At follow-up (time 2) mean age of the women was 38.2 years and there were no significant changes in height, weight or activity patterns. BMD (g/cm2) was measured at the lumbar vertebrae (L1–4 and femoral neck by dual-energy X-ray absorptiometry and expressed as a percentage of R/R values. Vertebral BMD was significantly lower in the O/A group compared with the R/R group at both time 1 and time 2 (p<0.05). The R/O/A group had intermediate values and did not differ significantly from R/R or O/A at either time. Differences in technique between machines for determining femoral neck BMD made it difficult to detect the longitudinal effect of menstrual status at that site. Despite several years of normal menses or use of oral contraceptives, the mean vertebral BMD of former oligo-amenorrheic athletes remained low, being 84.4% of the R/R value compared to 84.8% at time 1. Those experiencing menstrual regularity with intermittent oligo/amenorrhea remained at an intermediate position of 94.7% of the R/R mean. Our results suggest early intervention is necessary to prevent irreversible vertebral bone loss in oligo/amenorrheic athletes

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Cann CE, Martin MC, Genant HK, Jaffe RB Decreased spinal mineral content in amenorrheic women. JAMA 1984;251:626–9.

    Google Scholar 

  2. Drinkwater BL, Nilson K, Chesnut C, Bremner WJ, Shainholtz S, Southworth MB. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984;311:277–81.

    Google Scholar 

  3. Lindberg JS, Fears WB, Hunt MM, Powell MR, Boll D, Wade CE. Exercise-induced amenorrhea and bone density. Ann Intern Med 1984;101:647–8.

    Google Scholar 

  4. Marcus R, Cann C, Madvig P, et al. Menstrual function and bone mass in elite women distance runners: endocrine and metabolic features. Ann Intern Med 1985;102:158–163.

    Google Scholar 

  5. Micklesfield LK, Lambert EV, Fataar AB, Noakes TD, Myburgh KH. bone mineral density in mature, premenopausal ultramarathon runners. Med Sci Sports Exerc 1995;27:688–96.

    Google Scholar 

  6. Myburgh KH, Bachrach LK, Lewis B, Kent K, Marcus R. Low bone mineral density at axial and appendicular sites in amenorrheic athletes. Med Sci Sports Exerc 1993;25:1197–1202.

    Google Scholar 

  7. Rencken ML, Chesnut CH III, Drinkwater BL. Bone density at multiple skeletal sites in amenorrheic athletes. JAMA 1996;276:238–240.

    Google Scholar 

  8. Lloyd T, Triantafyllou SJ, Baker ER, et al. Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc 1986;18:374–9.

    Google Scholar 

  9. Myburgh KH, Hutchins J, Fataar AB, Hough SF, Noakes TD. Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med 1990;113:754–9.

    Google Scholar 

  10. Wilson JH, Wolman RL. Osteoporosis and fracture complications in an amenorrheic athlete: case study. Br J Rheumatol 1994;33:480–1.

    Google Scholar 

  11. Drinkwater BL, Nilson K, Ott S, Chesnut CH. Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 1986;256:380–2.

    Google Scholar 

  12. Lindberg JS, Powell MR, Hunt MM, Ducey DE, Wade CE. Increased vertebral bone mineral in response to reduced exercise in amenorrheic runners. West J Med 1987;146:39–42.

    Google Scholar 

  13. Drinkwater BL, Bruemner B, Chesnut CH. Menstrual history as a determinant of current bone density in young athletes. JAMA 1990;263:545–8.

    Google Scholar 

  14. Rencken ML, Murano R, Drinkwater BL, Chesnut CH. In vitro comparability of dual energy X-ray absorptiometry (DEKA) bone densitometers. Calcif Tissue Int 1991:48:245–8.

    Google Scholar 

  15. Recker RR, Davies KM. Hinders SM, Heaney RP, Stegman MR, Kimmel DB. Bone gain in young adult women. JAMA 1992;268:2403–8.

    Google Scholar 

  16. Jonnavithula S, Warren MP, Fox RP, Lazaro MI. Bone density is compromised in amenorrheic women despite return of menses: a 2-year study. Obstet Gynecol 1993;81:669–74.

    Google Scholar 

  17. Bachrach LK, Katzman DK, Litt IF, Guido D, Marcus R. Recovery from osteopenia in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 1991;72:602–6.

    Google Scholar 

  18. Iketani T, Kiriike N, Nakanishi S, Nakasuji T. Effects of weight gain and resumption of menses on reduced bone density in patients with anorexia nervosa. Biol Psychiatri 1995;37:521–7.

    Google Scholar 

  19. Herzog W, Minne H, Deter C, et al. Outcome of bone mineral density in anorexia nervosa patients 11. 7 years after first admission. J Bone Miner Res 1993; 8:597–605.

    Google Scholar 

  20. Yeager KK, Agostini R, Nattiv A, Drinkwater BL. The Female Athlete Triad: disordered eating, amenorrhea, osteoporosis. Med Sci Sports Exerc 1993;25:775–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Sport, Exercise and Health Sciences, University of Bristol, Bristol, UK

    A. D. Keen

  2. Department of Medicine, Pacific Medical Center, 1200 12th Ave. S., 98144, Seattle, WA, USA

    B. L. Drinkwater PhD

Authors
  1. A. D. Keen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. L. Drinkwater PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. L. Drinkwater PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keen, A.D., Drinkwater, B.L. Irreversible bone loss in former amenorrheic athletes. Osteoporosis Int 7, 311–315 (1997). https://doi.org/10.1007/BF01623770

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01623770

Keywords

Search

Navigation