Osteoporosis is a disease characterized by low bone mass and structural deterioration
of bone tissue, leading to fragile bones and an increased susceptibility to
fractures of the hip, spine, and wrist. This disease can be prevented and
treated. If not prevented or not treated, it can progress until a bone breaks.
How common is osteoporosis?
1 out of every 2 women over the age of 50 has some form of osteoporosis.
Millions of Americans are at risk.
Females are four times more likely than males to develop the disease;
however, men also suffer from osteoporosis.
When is most bone built?
Most bone is built between the ages of 10 - 20. A small amount is added
between the ages of 20 - 30 years.
Recent research suggests that the plateau for bone growth may be reached
as early as age 14 - 16 years or two years post menarche in young women.
What are the risk factors for osteoporosis in females?
Being female.
Family history of osteoporosis.
Thin and/or small frame.
Menstrual dysfunction.
Eating disorders (anorexia or bulimia).
Excessive use of alcohol.
Smoking.
Caucasians and Asians are at higher risk than African Americans and Hispanics.
Use of steroid drugs. These are often prescribed for arthritis, asthma,
Crohn’s disease, and lupus. Bone loss occurs within six months of
taking steroids in as many as 50% of adult patients.
How can young females prevent osteoporosis?
Get moderate, but not excessive physical activity. Include weight bearing
exercise three to five times a week.
Monitor menstrual cycle for irregularities and reduce exercise if these
begin.
Avoid complete immobilization.
Eat a well balanced diet with adequate calcium (1300 - 1500 mg./day for
female athletes who are 9 - 18 years of age) and vitamin D (400 IU/day).
Drink less soft drinks. They are highly acidic, contain caffeine, and
the high phosphorous content may accelerate calcium excretion.
Avoid cigarettes. Nicotine and other substances are antiestrogenic and
may interfere with attainment of bone mass.
Limit alcohol to minimum. Excessive consumption can lead to a lower bone
mass.
Avoid disordered eating patterns as these are destructive to the skeleton.
What is the Female Athlete Triad and how does it relate to
osteoporosis?
The female athlete triad consists of amenorrhea (
the absence of menstruation), and eating disorders (anorexia
nervosa, bulimia, and/or bingeing/purging), which often affect bone density,
thus causing osteoporosis. A focus on achieving or maintaining
an ideal body weight or optimal percentage body fat is a common theme
of those with the triad.
Young amenorrheic female athletes in their early 20's who have consumed
poor diets and produced inadequate amounts of estrogen may have thin, fragile
bones resembling women in their 70's.
In general, women lose about 1% of bone mineral content per year in their
early thirties and 5% per year after menopause. In amenorrheic athletes,
the loss of bone mass is equal to that of post-menopausal women.
Which female athletes are most likely to have the Female Athlete
Triad?
Females participating in sports or other activities that emphasize endurance
or a particular appearance in their clothing are particularly at risk, such
as the following sports:
1) Performance is subjectively scored (gymnastics, dance).
2) Low body weight is emphasized (cross country skiing, cycling).
3) Body contour revealing clothes are worn (volleyball, diving, cheerleading).
4) Weight categories for participation are required (martial arts,
wresting, rowing, horseback riding).
5) Sports emphasizing prepubertal body size for performance success
(figure skating, gymnastics, diving).
The athlete who perceives that she does not have control over her environment
will often compensate for this lack of control by controlling her food intake.
Many of these highly perfectionistic, competitive female athletes perceive
the need to have more control over their highly structured life. Excessive
exercise may be a method for weight control in these athletes.
Social isolation and a lack of a support system may be common in the athletes.
They may live for their sport.
Highly competitive elite athletes are particularly at risk.
Potentially, all female athletes are at risk for the Female Athlete Triad.
Researchers have found a higher frequency of menstrual disorders in athletes
(25%) than in the general population. For runners, menstrual irregularities
have been found to began at 43.2 miles per week.
How do you recognize the Female Athlete Triad?
Does the female athlete:
diet excessively or have yo-yo weight problems?
experience irregular or absent menstrual cycles?
have stress fractures?
seem to have mood and self-esteem determined by weight?
over exercise compulsively?
If she answers "yes" to one of the above, the athlete should see a health
care practitioner.
What is considered a disordered eating pattern?
Bingeing, purging or both.
Food restriction.
Prolonged fasting;
Use of diet pills, diuretics, laxatives.
Other abnormal eating behaviors.
Thought patterns which show preoccupation with food, dissatisfaction with
one's body, fear of becoming fat, and a distorted body image.
How common are disordered eating patterns in female athletes?
One study found 32% of female college athletes practiced at least one
pathogenic weight control practice, such as:
self-induced vomiting (14% of athletes);
laxative abuse (16%);
bingeing more than 2 times per week (20%);
diuretics or diet pills (25%).
The pathogenic weight control practices listed above were found in:
74% of gymnasts;
47% of runners
50% of field hockey players;
25% of softball, volleyball, track and tennis players.
70% of these athletes believed these practices were harmless.
From 15-65% of those in “thin build” sports where marking
is subjective and thus influenced by aesthetics or where a lean build is
considered ideal for optimum performance have pathogenic eating patterns.
Ballet dancers have been found to be the highest risk group.
Why are female athletes at increased risk for eating disorders?
Personality characteristics of athletes which are often required for success
may place them at risk for eating disorders:
Competitive athletic atmosphere.
Constant pressure to succeed.
Heightened body awareness.
Compulsiveness and perfectionism.
Fluctuation of self-esteem with fluctuation of performance.
Ability to block pain and hunger.
Willingness to take unnecessary risks to win.
Importance of aesthetics in sport or dance.
Belief that body leanness optimize performance.
Lack of identity beyond the sport or dance.
What is menstrual dysfunction?
The normal cycle is 23 - 25 days, with 10 - 13 cycles per year. This
is called eumenorrheic or regular.
Oligomenorrhea is 3 - 6 cycles per year at intervals greater than 36 days.
Amenorrhea is defined as the absence or cessation of menstruation and
is the clinical sign of a variety of disorders.
Reported percentages of females with menstrual irregularities:
General population: 2 - 5%.
Ballet: 6 - 79%.
Running 25%.
Cycling: 12%.
Swimming: 12%.
Many athletes view a lack of a menstrual period as adequate training.
This is to be discouraged.
How might the menstrual cycle be re-established?
If underweight, achieve a normal body weight.
Increase caloric intake by 250 - 350 calories per day.
Get adequate calcium (1,500 mg./day for those with irregular cycles),
as well as adequate iron and protein.
Reduce training by 10-20% for several months.
Estrogen therapy.
How might coaches help prevent the Female Athlete Triad?
Advocate health and well-being.
De-emphasize weight.
Discourage weighing.
Use normal weight models
Provide education about the Female Athlete Triad.
Refer those at risk for the Female Athlete Triad.
Dispel myths that thinner is better and amenorrhea is a normal sign of
training.
Osteoporosis Quiz
When is the most important time to make sure that you consume the recommended
amount of calcium?
A. 11-24 years old
B. 25-50 years old
C. 50 + years old
If you picked A, you are correct. The most important time to make sure
that you consume the daily recommended amount of calcium is between the ages
of 11 - 24. This is when you achieve your peak bone mass.
What role does calcium play in osteoporosis prevention?
Calcium alone cannot prevent or cure osteoporosis, but it is an important
part of an overall prevention or treatment program. National surveys have
shown that many Americans are not consuming enough calcium. Many women consume
less than half of the daily recommended amount of calcium.
What are the recommended calcium intakes for females?
Ages
Amount of Calcium in mg/day
Birth - 6 months
210
6 months - 1 year
270
1-3
500
4-8
800
9-13
1300
14-18
1300
19-30
1000
31-50
1000
51-70
1200
70 or older
1200
Most females do not get adequate calcium, as noted by the graph below:
How can you boost your calcium intake?
Top a baked potato with plain yogurt and chives.
Use milk instead of water to make oatmeal.
Sprinkle grated Parmesan or Romano cheese on your pasta dishes.
Replace regular orange juice with "calcium fortified" orange juice.
Add a serving of broccoli, cauliflower, spinach, or tofu to your meal.
Drink a calcium source at every meal and eat one calcium food as a snack
(ex. milk, low-fat yogurt, or string cheese).
How can you determine calcium intake from a food label?
Look for "Percent Daily Value" for calcium
Each day's calcium should add up to 120%
Other nutritional information for female athletes:
10% - 15% of calories should come from protein to help build
and repair muscle tissue (ex. fish, chicken, dried beans).
25% - 30% of calories should come from fat which you use while doing
low level exercise (ex. olive oil and any other unsaturated fats).
60% - 65% of calories should come from carbohydrates which are the
primary energy source when you perform hard, intense exercise (ex. fruits,
vegetables, breads).
Use the Food Guide Pyramid as a guide to healthy eating:
Osteoporosis, Female Athletes, & Calcium Resource Information
Dairy Council of California
National Osteoporosis Foundation
Osteoporosis and Related Bone Diseases ~National Resource Center 1-800-624-BONE
Women's Sports Foundation 1-212-972-9170
American College of Sports Medicine 1-614-637-9200
Eating Disorders Resource Information
Abilene Regional Medical Center
Academy for Eating Disorders
American Anorexia Bulimia Association, Inc.
The American Dietetic Association
Eating Disorders Awareness and Prevention
Harvard University Eating Disorders Center
Healing Connections, Inc.
International Association of Eating Disorders Professionals
International Food Information Council Foundation
Massachusetts Eating Disorders Association, Inc.
Overeaters Anonymous Headquarters
National Association of Anorexia Nervosa and Associated Disorders
National Association to Advance Fat Acceptance, Inc.
National Eating Disorders Screening Program
President's Council on Physical Fitness and Sports
Something Fishy Eating Disorder Information
We Insist on Natural Shape
Yourself
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This information made possible by a grant from the
South Carolina Department of Health and Environmental Control.
