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The influence of the female athlete triad on bone quality in endurance athletes

Coulson, Jessica (2014) The influence of the female athlete triad on bone quality in endurance athletes. Masters thesis (MSc), Manchester Metropolitan University.

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Abstract

The female athlete triad was defined in 1997 by the American College of Sports Medicine (ACSM) consisting of three components: Disordered Eating, Amenorrhea and Osteoporosis (Waldrop, 2005). Previous literature has identified a reduced bone health in athletes with altered menstrual cycles and/or those with eating disorders. For this masters, athletes were recruited from elite athletic databases then grouped according to their menstrual cycle irregularities and physical activity levels identified from a questionnaire completed prior to participation. The three groups identified were controls, eumonrrheic athletes or amenorrheic athletes. Each participant was subject to dual energy X-ray absorptiometry (DEXA), peripheral quantitative computed tomography (pQCT) scanning, a blood test, if willing, to assess hormonal status. A three day food diary was completed prior to testing. Significant differences between both eumenorrehic and amenorheic athletes and controls were identified for total calorie, proteins, carbohydrate, potassium and phosphorous intake per day. pQCT scanning showed significantly lower cortical thickness in the amenorrheic athletes compared with eumenorrheic athletes (P=0.025). The amenorrehic athletes had a greater endochondrol circumference than both control and eumenorrheic athletes, indicating that the amenorrehic athletes had a diaphysis much wider and thinner than the control and eumenorrheic athletes (P=0.011). There was a significant difference at the tibia cortical area of the diaphysis between the control and amenorrheic athletes (P=0.017). DEXA results highlighted significant differences between control and amenorrheic athletes, with controls having a greater bone mineral density, at non weight bearing sites of the head (P=0.038), trunk (p=0.004), ribs (p=0.027), pelvis (p=0.015), spine (p=0.008) and L1-L4 (p=0.025). With further significant differences found between the amenorrehic and eumenorrheic group of athletes at the trunk (p=0.020) and pelvis (p=0.016), in this case the bone mineral density of the eumenorrheic athletes was higher than the amenorrheic athletes. Blood tests demonstrated a significantly higher level of the bone resoprtion marker Tartrate resistant- acid phosphatase (TRAP) in amenorrheic athletes than in the eumenorrheic and control groups (p=0.026). Overall results demonstrate that elite level endurance athletes with amenorrhea have lower bone mineral density in the radius and tibia compared with other eumenorrheic athletes and controls which was associated with increased circulating levels of TRAP.

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