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Osteopenia in Exercise-Associated Amenorrhea Using Ballet Dancers as a Model: A Longitudinal Study

Osteopenia in Exercise-Associated Amenorrhea Using Ballet Dancers as a Model: A Longitudinal Study,MICHELLE P. WARREN,JEANNE BROOKS-GUNN,RICHARD P. FO

Osteopenia in Exercise-Associated Amenorrhea Using Ballet Dancers as a Model: A Longitudinal Study   (Citations: 22)
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Few longitudinal studies have investigated the effects of amenorrhea and amenorrhea plus exercise on bone mineral density (BMD) of young women. We carried out a 2-yr com- parison of dancers and nondancers, both amenorrheic and normal, that investigated the role of hypothalamic amen- orrhea on bone in this context. We studied 111 subjects (mean age, 22.4 4.6 yr; age of menarche, 14.1 2.2 yr), including 54 dancers, 22 with hypothalamic amenorrhea, and 57 nondancers, 22 with hypothalamic amenorrhea. De- tailed hormonal and nutritional data were obtained in all groups to determine possible causal relationship to osteo- porosis. The amenorrheic groups, dancers and nondancers, both showed reduced BMD in the spine, wrist, and foot, which remained below controls throughout the 2 yr. Only amenorrheic dancers showed significant changes in spine BMD (12.1%; P < 0.05) but still remained below controls, and within this subgroup, only those with delayed menarche showed a significant increase. The seven amenorrheic sub- jects (three dancers and four nondancers) who resumed menses during the study showed an increase in spine and wrist BMD (17%; P < 0.001) without achieving normaliza- tion. Delayed menarche was the only variable that pre- dicted stress fractures (P < 0.005), which we used as a mea- sure of bone functional strength. Analysis of dieting and nutritional patterns showed higher incidence of dieting be- havior in this group, as manifested by higher Eating Atti- tudes Test scores (16.3 2.00 vs. 11.5 1.45; P < 0.05) and higher fiber intakes (30.7 3.00 vs. 17.5 2.01 g/24 h; P < 0.001). We concluded that low bone mass occurs in young women with amenorrhea and delayed menarche, both ex- ercisers and nonexercisers. Crucial bone mass accretion may be compromised by their reproductive and nutritional health. (J Clin Endocrinol Metab 87: 3162-3168, 2002)
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