Menstrual dysfunction and bone health in female athletes

Female athletes are generally considered to be at Iow risk of osteoporosis because of the skeletal loading associated with sports participation. Sites that are exposed to long-term high-impact loading are consistently reported to be higher than the same sites in their sedentary peers. However, weight-bearing exercise does not always ensure that athletes will have high bone-mineral density, as the hormonal environment, dietary factors, and loading history all influence bone-mineral density, In particular, menstrual dysfunction, which can occur with intense training or disordered eating, is a significant risk factor for Iow bone-mineral density. Exercise history before menstrual dysfunction is likely to offer some protection for Iow bone-mineral density, particularly at the hip, Resumption of menses is unlikely to restore bone-mineral density to levels reported in eumenorrheic athletes or even sedentary peers, Athletes at risk of amenorrhea should be identified and their training loads and energy intakes monitored to ensure normal menstrual function, Athletes who remain amenorrheic should be counseled about the possible negative effects of amenorrhea and monitored for bone loss. Early intervention is recommended for amenorrheic athletes with Iow bone-mineral density.

Prescribing exercise for Osteoporosis

Osteoporosis is a major public health problem because of the morbidity and mortality associated with fracture. Minimizing the risk of fracture is the primary objective of osteoporosis management. The role of exercise in osteoporosis management is to increase and maintain peak bone density and reduce the rate of bone loss and the risk of falling. This article provides recommendations focusing on a life-span approach to minimizing the risk of fracture associated with osteoporosis. Osteoporosis prevention begins in childhood, when exercise can increase peak bone strength. In young adults, it can maintain peak bone mineral density. In elderly individuals, physical activity can slow bone loss and improve fitness and muscle strength, helping prevent falls and lower the risk of fracture. Exercise goals for individuals with osteoporosis should include reducing pain, increasing mobility, and improving muscle endurance, balance, and stability in order to improve the quality of life and reduce the risk of falling. Thus, exercise plays a significant part in reducing fractures in later life.

Thermoregulation in young athletes exercising in hot environments.

Children are less efficient thermoregulators than are adults. During exercise, sweat evaporation is the most important physiological means of cooling the body. The sweat response in children, however, is less efficient than in adults, so children dissipate less heat though evaporative sweating and more through convection (the loss of heat through the skin) plus radiation. Children and adolescents with high levels of body fat and heavy builds are more susceptible to heat stress because they dissipate body heat less efficiently. Maintaining adequate hydration is crucial for preventing heat stress, Although water is often described as the best choice of fluid, studies on voluntary drinking habits and flavor preferences in children and adolescents suggest that greater consumption occurs when sports drinks are offered instead of water. Although a child's sweat contains less sodium and chloride than an adult's does, there appears to be no evidence that a child's performance improves when given beverages more diluted than those currently recommended for adults, More information is necessary to identify the optimal electrolyte and carbohydrate content of sports drinks for young athletes.

The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: a study in tennis players

Exercise during growth results in biologically important increases in bone mineral content (BMC). The aim of this study was to determine whether the effects of loading were site specific and depended on the maturational stage of the region. BMC and humeral dimensions were determined using DXA and magnetic resonance imaging (MRI) of the loaded and nonloaded arms in 47 competitive female tennis players aged 8-17 years. Periosteal (external) cross-sectional area (CSA), cortical area, medullary area, and the polar second moments of area (I_p, mm⁴) were calculated at the mid and distal sites in the loaded and nonloaded arms. BMC and I _p of the humerus were 11-14% greater in the loaded arm than in the nonloaded arm in prepubertal players and did not increase further in peri- or postpubertal players despite longer duration of loading (both, _p < 0.01). The higher BMC was the result of a 7-11% greater cortical area in the prepubertal players due to greater periosteal than medullary expansion at the midhumerus and a greater periosteal expansion alone at the distal humerus. Loading late in puberty resulted in medullary contraction. Growth and the effects of loading are region and surface specific, with periosteal apposition before puberty accounting for the increase in the bone's resistance to torsion and endocortical contraction contributing late in puberty conferring little increase in resistance to torsion. Increasing the bone's rt.osistance to torsion is achieved hy modifying bone shape and mass, not necessarily bone density.

Does training affect growth? - answers to common questions

Adolescent athletes may be at risk of restricted growth and delayed maturation when intense training is combined with insufficient energy intake. Because catch-up growth commonly occurs when training is reduced or ceases, final adult stature is unlikely to be compromised. However, in athletes who have long-term, clinically delayed maturation, catch-up growth may be incomplete. By charting individual growth patterns, physicians, coaches, and athletic trainers can detect vulnerable periods when the training intensity should be reduced and energy intake may need to be increased.

Long-term trends in the Australaian gannet (Morus serrator) population in Australia: the effect of climate change and commercial fisheries

The Australasian gannet (Morus serrator) population has increased considerably over the past century, both in New Zealand and Australia. Since 1980, the population in Australian waters has increased threefold, from 6,600 breeding pairs to approximately 20,000 pairs in 1999-2000, a rate of 6% per year. Reasons for the increase in the Australasian gannet population are poorly understood; here we consider the possible effects of recent fluctuations in climatic and oceanographic conditions, and changes in major local commercial fisheries. A significant trend towards more frequent, and stronger, El Niño Southern Oscillation events, warmer summer sea surface temperatures in Bass Strait, increased annual catches and catch per unit effort in the Victorian pilchard (Sardinops sagax) fishery and potential increased discarding of fisheries bycatch may account for at least some of the observed increase in the Australasian gannet population. The potential interactive effects of these factors on prey distribution and abundance and consequently on gannet numbers are discussed.

The relationship between muscle size and bone geometry during growth and in response to exercise

As muscles become larger and stronger during growth and in response to increased loading, bones should adapt by adding mass, size, and strength. In this unilateral model, we tested the hypothesis that (1) the relationship between muscle size and bone mass and geometry (nonplaying arm) would not change during different stages of puberty and (2) exercise would not alter the relationship between muscle and bone, that is, additional loading would result in a similar unit increment in both muscle and bone mass, bone size, and bending strength during growth. We studied 47 competitive female tennis players aged 8–17 years. Total, cortical, and medullary cross-sectional areas, muscle area, and the polar second moment of area (Ip) were calculated in the playing and nonplaying arms using magnetic resonance imaging (MRI); BMC was assessed by DXA. Growth effects: In the nonplaying arm in pre-, peri- and post-pubertal players, muscle area was linearly associated BMC, total and cortical area, and Ip (r = 0.56–0.81, P < 0.09 to < 0.001), independent of age. No detectable differences were found between pubertal groups for the slope of the relationship between muscle and bone traits. Post-pubertal players, however, had a higher BMC and cortical area relative to muscle area (i.e., higher intercept) than pre- and peri-pubertal players (P < 0.05 to < 0.01), independent of age; pre- and peri-pubertal players had a greater medullary area relative to muscle area than post-pubertal players (P < 0.05 to < 0.01). Exercise effects: Comparison of the side-to-side differences revealed that muscle and bone traits were 6–13% greater in the playing arm in pre-pubertal players, and did not increase with advancing maturation. In all players, the percent (and absolute) side-to-side differences in muscle area were positively correlated with the percent (and absolute) differences in BMC, total and cortical area, and Ip (r = 0.36–0.40, P < 0.05 to < 0.001). However, the side-to-side differences in muscle area only accounted for 11.8–15.9% of the variance of the differences in bone mass, bone size, and bending strength. This suggests that other factors associated with loading distinct from muscle size itself contributed to the bones adaptive response during growth. Therefore, the unifying hypothesis that larger muscles induced by exercise led to a proportional increase in bone mass, bone size, and bending strength appears to be simplistic and denies the influence of other factors in the development of bone mass and bone shape.

Microsatellite DNA analysis of southeast Australian Haliotis laevigata (Donovan) populations - implications for ranching in Port Phillip Bay

The genetic composition of greenlip abalone (Haliotis laevigata) from Point Cook in Port Phillip Bay was examined prior to the aggregation of individuals from this site for ranching. The very thinly distributed natural population at Point Cook was believed to be of low genetic diversity, because the animals all originated from a single spawning event 5 y previously. Animals from Point Cook were compared with other H. laevigata from two sampling sites within Port Phillip Bay, and two sites outside the Bay in Bass Strait, to examine their genetic diversity and origin. Variation was assessed at five microsatellite loci. Deviations from Hardy-Weinberg equilibrium (HWE) were observed at some loci in various populations, but the Point Cook population was in HWE at all five loci. Mean heterozygosity and number of alleles was similar in all populations. Hierarchical analysis of molecular variance indicated significant genetic variation among populations, but did not differentiate Port Phillip Bay from Bass Strait populations. Pairwise comparisons of multilocus F_STand R_ST indicated significant genetic differences between Point Cook and some populations, as well as between other populations, but no consistent spatial pattern of differentiation was observed. There was no significant correlation between genetic and geographic distance. The level of genetic variation observed in the Point Cook individuals was similar to that in individuals from the other four sites, and sufficient to support a ranching program. However, this variation should be monitored to maximize genetic potential, and avoid commercially undesirable effects of inbreeding. Implications of this study in relation to the management of a ranching population in Port Phillip Bay are discussed.

The global mio-pliocene climatic equability and coastal ostracod faunas of southeast Australia

This study on the Mio–Pliocene ostracod successions of southeast Australia outlines several faunal events indicative of climate warming and/or increased rainfall events. Ostracod faunas associated with a late Late Miocene sea level rise event suggest that the climate of this time in southeast Australia was similar to, or slightly warmer than that of present day southeast Australia. However, it was probably wetter and significantly warmer than immediately preceding (mid Late Miocene) palaeoclimatic conditions within the region. Evidence for a change to wetter and warmer conditions during the late Late Miocene is seen in the appearance of various extant euryhaline and semi-thermophilic ostracod species in coastal ostracod faunas. The appearance of euryhaline species, which are mostly absent from older shallow marine Cenozoic strata of the Bass Strait hinterland, suggests a major influx of fresh water into coastal marine settings, which contributed to the initial phase of development of the southeast Australian late Neogene barrier coastline and associated marginal marine palaeoenvironments.

During the time interval latest Miocene to earliest Pliocene, and during the early Late Pliocene, two subsequent global sea level rise events are also preserved in the southeast Australian coastal plain. Many of the species present in ostracod faunas associated with these two events are the same as in older local late Late Miocene faunas. In earliest (?) Pliocene faunas, there is minor evidence for the reappearance of semi-thermophilic ostracods. Faunas of early Late Pliocene age often exhibit a conspicuous faunal dominance by, or large abundance of euryhaline species, indicating the particularly strong influence of fresh water influxes into coastal marine palaeoenvironments. This may reflect the presence of especially wet local temperate palaeoclimatic conditions during a time of equable global climates.

Succeeding estuarine, lagoonal and coastal embayment ostracod faunas of late Late Pliocene age are associated with marginal marine sediments that are interbedded with coastal dune aeolianites. This suggests an overall seaward retreat of marginal marine environments that was initiated by a major global sea level fall linked to the onset of cooler Late Pliocene and Quaternary global climates.

Growth of highly versus moderately trained competitive female artistic gymnasts

Purpose: To investigate whether growth was adversely affected in 137 young competitive female artistic gymnasts involved in different training volumes.

Methods: This was a 2-yr prospective cohort study in which height, sitting height, leg length, weight, skinfolds, and pubertal status were measured in competitive advanced (20–27 h·wk-1) and intermediate (7.5–22 h·wk-1) training level female gymnasts every 6–12 months. Biological parameters of the adolescent growth curve were estimated using the Preece–Baines growth model. Growth rates were estimated for both groups from the mixed-longitudinal data.

Results: Estimated ages at peak height velocity (PHV) (13–13.5 yr) and mean PHV (6.2–6.4 cm·yr-1) for the advanced- and intermediate-level gymnasts suggest that these gymnasts were later maturing and experienced a blunting of the growth spurt relative to reference values for U.S. youth. Comparison of growth velocities by pubertal status revealed that height velocity was lower in the advanced- versus the intermediate-level peripubertal gymnasts, which was due to a significant reduction in sitting height velocity (2.3 vs 3.1 cm·yr-1, P. < 0.05). No marked acceleration in height or sitting height velocity was detected in the advanced-level gymnasts from pre- to peripuberty. Inspection of individual growth rates revealed that over 35% of the pre- and peripubertal gymnasts experienced growth faltering (height velocity less than 4.5 cm·yr-1) during follow-up.

Conclusion: Advanced–and intermediate–training level competitive female gymnasts tend to exhibit an adolescent growth spurt that is similar in timing and tempo to short, normal, slowly maturing girls, but the high frequency of growth faltering suggests that training may alter the tempo of growth and maturation in some, but not all, female gymnasts.

Near normalisation of lumbar spine bone density in young women with osteopenia recovered from adolescent onset anorexia nervosa: a longitudinal study

To investigate the effect of the progression of adolescent onset anorexia nervosa (AN) on bone parameters we followed two cohorts (Disease cohort and recovered cohort) of adolescents for a total of 5.2 years. In the 'Disease' cohort (n = 18), lumbar spine bone density (BMD) was reduced by 0.6 SD after 0.8 years of disease and was reduced a further 1.0 SD after a total 2.5 years of disease (p < 0.001). At the third lumbar vertebra there was bone loss (-3.7%, p < 0.05) resulting in reduced volumetric BMD (-5.1%, p < 0.08). In the 'recovered' cohort, lumbar spine BMD was reduced by 1.9 SD after 1.7 years of disease, and increased by 1.5 SD after 2.7 years of recovery (p < 0.001). At the third lumbar vertebra there was an increase in bone mass (20.5%, p < 0.001) and bone volume (14.1%, p < 0.001), resulting in increased volumetric BMD (6.3%, p < 0.08). Normalisation of lumbar spine BMD may be achieved in patients with adolescent onset AN when the successful recovery of body weight is combined with the return of regular menses.

The effect of exercise and nutrition on the mechanostat

In this review, we discuss the effect of increased and decreased loading and nutrition deficiency on muscle and bone mass and strength (and bone length and architecture) independently and combined. Both exercise and nutrition are integral components of the mechanostat model but both have distinctly different roles. Mechanical strain imparted by muscle action is responsible for the development of the external size and shape of the bone and subsequently the bone strength. In contrast, immobilization during growth results in reduced growth in bone length and a loss of bone strength due to large losses in bone mass (a result of endosteal resorption in cortical bone and trabecular thinning) and changes in geometry (bone shafts do not develop their characteristic shape but rather develop a rounded default shape). The use of surrogate measures for peak muscle forces acting on bone (muscle strength, size, or mass) limits our ability to confirm a cause-and-effect relationship between peak muscle force acting on bone and changes in bone strength. However, the examples presented in this review support the notion that under adequate nutrition, exercise has the potential to increase peak muscle forces acting on bone and thus can lead to a proportional increase in bone strength. In contrast, nutrition alone does not influence muscle or bone in a dose-dependent manner. Muscle and bone are only influenced when there is nutritional deficiency – and in this case the effect is profound. Similar to immobilization, the immediate effect of malnutrition is a reduction in longitudinal growth. More specifically, protein and energy malnutrition results in massive bone loss due to endosteal resorption in cortical bone and trabecular thinning. Unlike loading however, there is indirect evidence that severe malnutrition when associated with menstrual dysfunction can shift the mechanostat set point upward, thus leading to less bone accrual for a given amount of bone strain.

Lifetime sport and leisure activity participation is associated with greater bone size, quality and strength in older men

Introduction: It remains uncertain whether long-term participation in regular weight-bearing exercise confers an advantage to bone structure and strength in old age. The aim of this study was to investigate the relationship between lifetime sport and leisure activity participation on bone material and structural properties at the axial and appendicular skeleton in older men (>50 years).

Methods: We used dual-energy X-ray absorptiometry (DXA) to assess hip, spine and ultradistal (UD) radius areal bone mineral density (aBMD) (n=161), quantitative ultrasound (QUS) to measure heel bone quality (n=161), and quantitative computed tomography (QCT) to assess volumetric BMD, bone geometry and strength at the spine (L₁–L₃) and mid-femur (n=111). Current (>50+ years) and past hours of sport and leisure activity participation during adolescence (13–18 years) and adulthood (19–50 years) were assessed by questionnaire. This information was used to calculate the total time (min) spent participating in sport and leisure activities and an osteogenic index (OI) score for each participant, which provides a measure of participation in weight-bearing activities.

Results: Regression analysis revealed that a greater lifetime (13–50+ years) and mid-adulthood (19–50 years) OI, but not total time (min), was associated with a greater mid-femur total and cortical area, cortical bone mineral content (BMC), and the polar moment of inertia (I _p) and heel VOS (p ranging from <0.05 to <0.01). These results were independent of age, height (or femoral length) and weight (or muscle cross-sectional area). Adolescent OI scores were not found to be significant predictors of bone structure or strength. Furthermore, no significant relationships were detected with areal or volumetric BMD at any site. Subjects were then categorized into either a high (H) or low/non-impact (L) group during adolescence (13–18 years) and adulthood (19–50+ years) according to their OI scores during each of these periods. Three groups were subsequently formed to reflect weight-bearing impact categories during adolescence and then adulthood: LL, HL and HH. Compared to the LL group, mid-femur total and cortical area, cortical BMC and I _p were 6.5–14.2% higher in the HH group. No differences were detected between the LL and HL groups.

Conclusions: In conclusion, these findings indicate that long-term regular participation in sport and leisure activities categorized according to an osteogenic index [but not the total time (min) spent participating in all sport and leisure activities] was an important determinant of bone size, quality and strength, but not BMD, at loaded sites in older men. Furthermore, continued participation in weight-bearing exercise in early to mid-adulthood appears to be important for reducing the risk of low bone strength in old age.

Calcium- and vitamin D3 - fortified milk reduces bone loss at clinically relevant skeletal sites on llder men: a 2-year randomised controlled trial

In this 2-year randomized controlled study of 167 men >50 years of age, supplementation with calcium-vitamin D3-fortified milk providing an additional 1000 mg of calcium and 800 IU of vitamin D3 per day was effective for suppressing PTH and stopping or slowing bone loss at several clinically important skeletal sites at risk for fracture.

Introduction: Low dietary calcium and inadequate vitamin D stores have long been implicated in age-related bone loss and osteoporosis. The aim of this study was to assess the effects of calcium and vitamin D3 fortified milk on BMD in community living men >50 years of age.

Materials and Methods: This was a 2-year randomized controlled study in which 167 men (mean age ± SD, 61.9 ± 7.7 years) were assigned to receive either 400 ml/day of reduced fat (1%) ultra-high temperature (UHT) milk containing 1000 mg of calcium plus 800 IU of vitamin D3 or to a control group receiving no additional milk. Primary endpoints were changes in BMD, serum 25(OH)D, and PTH.

Results: One hundred forty-nine men completed the study. Baseline characteristics between the groups were not different; mean dietary calcium and serum 25(OH)D levels were 941 ± 387 mg/day and 77 ± 23 nM, respectively. After 2 years, the mean percent change in BMD was 0.9-1.6% less in the milk supplementation compared with control group at the femoral neck, total hip, and ultradistal radius (range, p < 0.08 to p < 0.001 after adjusting for covariates). There was a greater increase in lumbar spine BMD in the milk supplementation group after 12 and 18 months (0.8-1.0%, p ≤ 0.05), but the between-group difference was not significant after 2 years (0.7%; 95% CI, −0.3, 1.7). Serum 25(OH)D increased and PTH decreased in the milk supplementation relative to control group after the first year (31% and −18%, respectively; both p < 0.001), and these differences remained after 2 years. Body weight remained unchanged in both groups at the completion of the study.

Conclusions: Supplementing the diet of men >50 years of age with reduced-fat calcium- and vitamin D3-enriched milk may represent a simple, nutritionally sound and cost-effective strategy to reduce age-related bone loss at several skeletal sites at risk for fracture in the elderly.