Menstrual Status and Fracture Risk in Young Athletes

Alain Joffe, MD, MPH, FAAP

Lifetime fracture risk was higher in oligo-amenorrheic athletes than in eumenorrheic athletes or nonathletes.

Weight-bearing activities increase bone mineral density (BMD), but menstrual status may also play a role. Investigators in Boston studied the relations among menstrual status, bone density, and fracture risk in 175 teens and young women (mean age, 20). The study population included 100 oligo-amenorrheic athletes (AA), 35 eumenorrheic athletes (EA), and 40 nonathletes (NA). Oligo-amenorrhea was defined as no menarche by age ≥15 or absence of menses for ≥3 months during a 6-month period where cycle length exceeded 6 weeks. Eumenorrhea was defined as ≥9 menses yearly with no oral contraceptive use during the 3 months before enrollment. Dual-energy x-ray absorptiometry scans were used to assess bone mineral density (BMD).

AA experienced menarche significantly later than did EA or NA (14 vs. 12 years) and had lower body-mass index (20 vs. 22 kg/m2) and lower fat mass. Vitamin D levels were higher in AA (38 ng/mL) than in EA (30 ng/mL) and NA (25 ng/mL). Twenty-six percent of AA had histories of eating disorders. EA had significantly higher BMD Z-scores than did AA; however, AA and NA did not differ. Lifetime fracture risk was 47% in AA, 26% in EA, and 12% in NA. Differences in lifetime fracture risk were mostly accounted for by stress fractures (AA, 32%; EA, 6%; NA, 0%). Fracture differences among groups persisted after controlling for age at menarche and histories of eating disorders.

Citation(s):

Ackerman KE et al. Fractures in relation to menstrual status and bone parameters in young athletes. Med Sci Sports Exerc 2014 Nov 13; [e-pub ahead of print].