Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes.
Influence of ghrelin and adipocytokines on bone mineral density in adolescent female athletes with amenorrhea and eumenorrheic athletes.
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生长素释放肽和脂肪细胞因子对闭经和正常月经的青少年女运动员骨密度的影响。
DOI：
10.1159/000321975
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Misra,Madhusmita
中科院分区：
文献类型：
--
作者：
Russell,Melissa;Misra,Madhusmita
青少年女运动员继发于运动引起的性腺功能减退的低骨密度（BMD）风险增加。特别值得关注的是，青少年时期也是骨骼积累的关键时期，在这一时期发生的缺陷可能导致未达到最佳的骨量峰值，并在以后的生活中导致骨折风险。虽然负重运动通常与骨密度增加有关，但闭经运动员的骨密度低于痛经运动员和非运动对照组，这是由于能量利用率低和随后的性腺功能减退所致。重要的是要认识到，当能量摄入跟不上消耗时，净能量可用性和下丘脑-垂体-性腺（hp -g）轴之间存在关键的相互作用，这是性腺功能低下状态发展的关键。虽然能量可用性和促性腺激素搏动模式之间的联系已经确立，但将两者联系起来的实际代谢信号却不太清楚。运动员能量利用率的降低与脂肪量的减少、脂肪因子（如瘦素和脂联素）和脂肪调节激素（如胃饥饿素和肽YY）的改变有关。在动物模型中，这些激素影响hp - g轴，在运动员中，脂肪相关激素的改变可能会向下丘脑发出能量可用状态的信号，并有助于抑制促性腺激素的搏动，导致下丘脑闭经，从而降低骨密度。更好地了解低能量可用性与功能性下丘脑闭经和低骨密度之间的联系途径，对于发展针对闭经运动员这些问题的未来治疗策略至关重要。
Adolescent female athletes are at increased risk for low bone mineral density (BMD) secondary to exercise-induced hypogonadism. Of particular concern is that the adolescent years are also a critical time for bone accrual, and deficits incurred during this period could lead to suboptimal peak bone mass acquisition and subsequent fracture risk in later life. Although weight bearing exercise is typically associated with an increase in BMD, amenorrheic athletes have lower BMD than eumenorrheic athletes and non-athletic controls as a consequence of low energy availability and subsequent hypogonadism. It is important to recognize that critical interactions exist between net energy availability and the hypothalamo-pituitary-gonadal (H-P-G) axis that are key to the development of a hypogonadal state when energy intake cannot keep pace with expenditure. While the link between energy availability and gonadtotropin pulsatility patterns is well established, the actual metabolic signals that link the two are less clear. Decreased energy availability in athletes is associated with decreases in fat mass, and alterations in adipokines (such as leptin and adiponectin) and fat-regulated hormones (such as ghrelin and peptide YY). These hormones impact the H-P-G axis in animal models, and it is possible that in athletes alterations in fat-related hormones signal the state of energy availability to the hypothalamus and contribute to suppression of gonadotrophin pulsatility, hypothalamic amenorrhea and consequent decreased BMD. A better understanding of pathways linking low energy availability with functional hypothalamic amenorrhea and low BMD is critical for the development of future therapeutic strategies addressing these issues in amenorrheic athletes.