Physical Activity, Menstrual History, and Bone Microarchitecture in Female Athletes with Multiple Bone Stress Injuries.
Absorptiometry, Photon
Adolescent
Adult
Amenorrhea
/ physiopathology
Bone Density
Cross-Sectional Studies
Exercise
/ physiology
Female
Fractures, Stress
/ physiopathology
Humans
Menstruation
/ physiology
Military Personnel
Physical Conditioning, Human
/ physiology
Recurrence
Risk Factors
Tibia
/ anatomy & histology
Tomography, X-Ray Computed
Young Adult
Journal
Medicine and science in sports and exercise
ISSN: 1530-0315
Titre abrégé: Med Sci Sports Exerc
Pays: United States
ID NLM: 8005433
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
pubmed:
9
4
2021
medline:
12
11
2021
entrez:
8
4
2021
Statut:
ppublish
Résumé
To determine differences in health and physical activity history, bone density, microarchitecture, and strength among female athletes with a history of multiple BSI, athletes with ≤1 BSI, and nonathletes. We enrolled 101 women (age, 18-32 yr) for this cross-sectional study: nonathlete controls (n = 17) and athletes with a history of ≥3 BSIs (n = 21) or ≤1 BSI (n = 63). We collected subjects' health and training history and measured bone microarchitecture of the distal tibia via high-resolution peripheral quantitative computed tomography (HR-pQCT) and areal bone mineral density of the hip and spine by dual-energy X-ray absorptiometry. Groups did not differ according to age, body mass index, age at menarche, areal bone mineral density, or tibial bone microarchitecture. Women with multiple BSI had a higher prevalence of primary and secondary amenorrhea (P < 0.01) compared with other groups. Total hours of physical activity in middle school were similar across groups; however, women with multiple BSI performed more total hours of physical activity in high school (P = 0.05), more hours of uniaxial loading in both middle school and high school (P = 0.004, P = 0.02), and a smaller proportion of multiaxial loading activity compared with other groups. These observations suggest that participation in sports with multiaxial loading and maintaining normal menstrual status during adolescence and young adulthood may reduce the risk of multiple bone stress injuries.
Identifiants
pubmed: 33831898
doi: 10.1249/MSS.0000000000002676
pii: 00005768-202110000-00017
pmc: PMC8440446
mid: NIHMS1689268
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2182-2189Subventions
Organisme : NCRR NIH HHS
ID : S10 RR017868
Pays : United States
Informations de copyright
Copyright © 2021 by the American College of Sports Medicine.
Références
Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study. Am J Sports Med . 1996;24(2):211–7.
Cosman F, Ruffing J, Zion M, et al. Determinants of stress fracture risk in United States Military Academy cadets. Bone . 2013;55(2):359–66.
Wright AA, Taylor JB, Ford KR, Siska L, Smoliga JM. Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med . 2015;49(23):1517–23.
Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The epidemiology of stress fractures in collegiate student-athletes, 2004–2005 through 2013–2014 academic years. J Athl Train . 2017;52(10):966–75.
Giladi M, Milgrom C, Kashtan H, Stein M, Chisin R, Dizian R. Recurrent stress fractures in military recruits. One-year follow-up of 66 recruits. J Bone Joint Surg (Br) . 1986;68(3):439–41.
Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther . 2014;44(10):749–65.
De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med . 2014;48(4):289.
Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med . 2014;48(7):491–7.
Daily JP, Stumbo JR. Female athlete triad. Prim Care . 2018;45(4):615–24.
Beck BR, Rudolph K, Matheson GO, Bergman AG, Norling TL. Risk factors for tibial stress injuries: a case-control study. Clin J Sport Med . 2015;25(3):230–6.
Beck TJ, Ruff CB, Shaffer RA, Betsinger K, Trone DW, Brodine SK. Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors. Bone . 2000;27(3):437–44.
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(10):754–9.
Schnackenburg KE, Macdonald HM, Ferber R, Wiley JP, Boyd SK. Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc . 2011;43(11):2110–9.
Carbon R, Sambrook PN, Deakin V, et al. Bone density of elite female athletes with stress fractures. Med J Aust . 1990;153(7):373–6.
Armstrong DW 3rd, Rue JP, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone . 2004;35(3):806–16.
Petit MA, Beck TJ, Kontulainen SA. Examining the developing bone: What do we measure and how do we do it? J Musculoskelet Neuronal Interact . 2005;5(3):213–24.
Mallinson RJ, Southmayd EA, De Souza MJ. Geometric and “true” densitometric characteristics of bones in athletes with stress fracture and menstrual disturbances: a systematic review. Sports Med . 2019;49(7):1059–78.
Troy KL, Mancuso ME, Butler TA, Johnson JE. Exercise early and often: effects of physical activity and exercise on women’s bone health. Int J Environ Res Public Health . 2018;15(5).
Xu J, Lombardi G, Jiao W, Banfi G. Effects of exercise on bone status in female subjects, from young girls to postmenopausal women: an overview of systematic reviews and meta-analyses. Sports Med . 2016;46(8):1165–82.
MacKelvie KJ, Khan KM, McKay HA. Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med . 2002;36(4):250–7; discussion 7.
Tan VP, Macdonald HM, Kim S, et al. Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis. J Bone Miner Res . 2014;29(10):2161–81.
Janz KF, Letuchy EM, Burns TL, Eichenberger Gilmore JM, Torner JC, Levy SM. Objectively measured physical activity trajectories predict adolescent bone strength: Iowa Bone Development Study. Br J Sports Med . 2014;48(13):1032–6.
Gunter K, Baxter-Jones AD, Mirwald RL, et al. Jump starting skeletal health: a 4-year longitudinal study assessing the effects of jumping on skeletal development in pre and circum pubertal children. Bone . 2008;42(4):710–8.
Warden SJ, Mantila Roosa SM, Kersh ME, et al. Physical activity when young provides lifelong benefits to cortical bone size and strength in men. Proc Natl Acad Sci U S A . 2014;111(14):5337–42.
Milgrom C, Simkin A, Eldad A, Nyska M, Finestone A. Using bone’s adaptation ability to lower the incidence of stress fractures. Am J Sports Med . 2000;28(2):245–51.
Tenforde AS, Parziale AL, Popp KL, Ackerman KE. Low bone mineral density in male athletes is associated with bone stress injuries at anatomic sites with greater trabecular composition. Am J Sports Med . 2018;46(1):30–6.
Tenforde AS, Fredericson M. Influence of sports participation on bone health in the young athlete: a review of the literature. PM R . 2011;3(9):861–7.
Popp KL, Turkington V, Hughes JM, et al. Skeletal loading score is associated with bone microarchitecture in young adults. Bone . 2019;127:360–6.
Nattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc . 2007;39(10):1867–82.
Jepsen KJ, Evans R, Negus CH, et al. Variation in tibial functionality and fracture susceptibility among healthy, young adults arises from the acquisition of biologically distinct sets of traits. J Bone Miner Res . 2013;28(6):1290–300.
Schlecht SH, Jepsen KJ. Functional integration of skeletal traits: an intraskeletal assessment of bone size, mineralization, and volume covariance. Bone . 2013;56(1):127–38.
Pistoia W, van Rietbergen B, Lochmüller EM, Lill CA, Eckstein F, Rüegsegger P. Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone . 2002;30(6):842–8.
Popp KL, Hughes JM, Martinez-Betancourt A, et al. Bone mass, microarchitecture and strength are influenced by race/ethnicity in young adult men and women. Bone . 2017;103:200–8.
Bennell K, Crossley K, Jayarajan J, et al. Ground reaction forces and bone parameters in females with tibial stress fracture. Med Sci Sports Exerc . 2004;36(3):397–404.
Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med . 1995;5(4):229–35.
Duarte Sosa D, Fink Eriksen E. Women with previous stress fractures show reduced bone material strength. Acta Orthop . 2016;87(6):626–31.
Weidauer LA, Binkley T, Vukovich M, Specker B. Greater polar moment of inertia at the tibia in athletes who develop stress fractures. Orthop J Sports Med . 2014;2(7):2325967114541411.
Ackerman KE, Cano Sokoloff N, DE Nardo Maffazioli G, Clarke HM, Lee H, Misra M. Fractures in relation to menstrual status and bone parameters in young athletes. Med Sci Sports Exerc . 2015;47(8):1577–86.
Mitchell DM, Tuck P, Ackerman KE, et al. Altered trabecular bone morphology in adolescent and young adult athletes with menstrual dysfunction. Bone . 2015;81:24–30.
Popp KL, Hughes JM, Smock AJ, et al. Bone geometry, strength, and muscle size in runners with a history of stress fracture. Med Sci Sports Exerc . 2009;41(12):2145–50.
Popp KL, McDermott W, Hughes JM, Baxter SA, Stovitz SD, Petit MA. Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history. Bone . 2016;94:22–8.
Loucks AB, Laughlin GA, Mortola JF, Girton L, Nelson JC, Yen SS. Hypothalamic-pituitary-thyroidal function in eumenorrheic and amenorrheic athletes. J Clin Endocrinol Metab . 1992;75(2):514–8.
Schorr M, Miller KK. The endocrine manifestations of anorexia nervosa: mechanisms and management. Nat Rev Endocrinol . 2017;13(3):174–86.
Duckham RL, Peirce N, Meyer C, Summers GD, Cameron N, Brooke-Wavell K. Risk factors for stress fracture in female endurance athletes: a cross-sectional study. BMJ Open . 2012;2(6).
Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med . 2018;52(11):687–97.
Turner CH, Robling AG. Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev . 2003;31(1):45–50.
Yang PF, Brüggemann GP, Rittweger J. What do we currently know from in vivo bone strain measurements in humans? J Musculoskelet Neuronal Interact . 2011;11(1):8–20.
Hughes JM, Dickin DC, Wang H. The relationships between multiaxial loading history and tibial strains during load carriage. J Sci Med Sport . 2019;22(1):48–53.
Wang H, Kia M, Dickin DC. Influences of load carriage and physical activity history on tibia bone strain. J Sport Health Sci . 2019;8(5):478–85.
Rauh MJ, Tenforde AS, Barrack MT, M R, Nichols JF. High school sports specialization is associated with low bone mineral density in female high school distance runners. J Athl Train . 2020;55(12):1239–46.
Rauh MJ, Tenforde AS, Barrack MT, Rosenthal MD, Nichols JF. Associations between sport specialization, running-related injury, and menstrual dysfunction among high school distance runners. Athletic Training Sports Health Care . 2018;10(6):260–9.
Loucks AB. Low energy availability in the marathon and other endurance sports. Sports Med . 2007;37(4–5):348–52.