Low bone mass density at multiple skeletal sites, including the appendicular skeleton in amenorrheic runners
Low bone mass density at multiple skeletal sites, including the appendicular skeleton in amenorrheic runners
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DOI：
10.1007/s002239900589
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发表时间：
1999-02-01
影响因子：
4.2
通讯作者：
Lorentzon, R
中科院分区：
文献类型：
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作者：
Pettersson, U;Stålnacke, BM;Lorentzon, R
本研究旨在探讨女性长跑运动员闭经与正常月经者不同部位骨量的差异。我们比较了10名闭经和10名月经来潮的运动员，以确定闭经的运动员是否在多个骨骼区域（包括负重下肢）具有较低的BMD。闭经组月经失调3 ~ 43个月。另取16名患风湿性关节炎的足球运动员作为对照组，与前两组运动员进行骨密度测量比较。两组在年龄、身高和训练量方面相匹配。测量了区域骨矿物质密度（BMD），并发现在全身、肱骨、脊柱、腰椎、骨盆、股骨颈、转子、全股骨、股骨干、胫骨干和非承重股骨头中，amorpheic组的BMD显著较低。体重、BMI、脂肪量和体脂百分比在闭经组中显著较低。调整体重后，头部、肱骨、股骨颈、全股骨、股骨干和胫骨干的BMD差异消失。与足球组相比，除了头部、沃德三角和股骨干外，其他部位的骨密度值均显著降低。在两个运行组中获得血液样本用于骨钙素、羧基末端肽（ICTP）、前胶原I（PICP）和雌二醇的分析。各组之间无显着差异，但停经组中雌二醇水平较低、骨钙素水平较高的趋势很强。游离雌二醇指数（FE 2）是由雌二醇与性激素结合球蛋白（SHBG）的比值得出的，在闭经组中显著较低。观察到他们每日总能量、蛋白质、碳水化合物、纤维、钙和维生素D的摄入量没有差异。然而，两组都显示出与他们的训练方案有关的惊人的低能量摄入。逐步回归分析显示，体重是两组脊柱骨密度的最佳预测因素。E2和FE 2是骨质疏松组股骨近端BMD的显著预测因子，但不能预测骨质疏松组的任何BMD部位。总之，运动员女性的闭经影响了中轴骨和外展骨的骨小梁和骨皮质。然而，一些差异可以用较低的体重来解释。即使在下肢和脊柱的承重骨中，体力负重活动似乎也不能完全补偿雌激素水平降低的副作用。
The aim of this study was to investigate any difference in bone mass at different sites between female long-distance runners with amenorrhea and those with eumenorrhea. We compared 10 amenorrheic and 10 eumenorrheic athletes to determine whether athletes with amenorrhea have lower BMD in multiple skeletal regions, including weight-bearing lower limbs. The amenorrheic group had experienced menstrual dysfunction ranging from 3 to 43 months. As a further control group, 16 eumenorrheic soccer players were compared with the former two running groups regarding their BMD measurements. The two groups were matched for age, height, and amount of training. Areal bone mineral density (BMD) was measured and was found to be significantly lower in the total body, humerus, spine, lumbar spine, pelvis, femoral neck, trochanter, total femur, femur diaphysis, tibia diaphysis and in the nonweight-bearing head of the femur in the amenorrheic group. Body weight, BMI, fat mass, and body fat percent were significantly lower in the amenorrheic group. The differences in the BMD of the head, humerus, femoral neck, total femur, femur diaphysis, and tibia diaphysis disappeared when adjusted for body weight. Compared with the soccer group, the amenorrheic subjects had significantly lower BMD values at all sites except for the head, Ward's triangle, and femur diaphysis. Blood samples were obtained in the two running groups for analysis of osteocalcin, carboxy terminal telopeptide (ICTP), procollagen I (PICP), and estradiol. There were no significant differences between the groups but there was a strong tendency towards a lower estradiol level and a higher osteocalcin level in the amenorrheic group. A free estradiol index (FE2) was derived as the ratio of estradiol to sex hormone binding globulin (SHBG) and was significantly lower in the amenorrheic group. No difference in their daily intake of total energy, protein, carbohydrates, fiber, calcium, and vitamin D was observed. However, both groups showed a surprisingly low energy intake in relation to their training regimens. Stepwise regression analyses revealed that weight was the best predictor of spine BMD in both groups. Estradiol and FE2 were significant predictors of the BMD of the proximal femur in the eumenorrheic group, but did not predict any BMD site in the amenorrheic group. In conclusion, amenorrhea in athletic women affects trabecular and cortical bone in both axial and appendicular skeleton. However, some of the discrepancy can be explained by a lower body weight. Physical weightbearing activity does not seem to completely compensate for the side effects of reduced estrogen levels even in weight-bearing bones in the lower extremity and spine.