Bone Metabolism in Young Female Athletes: a Review

It has been reported that the prevalence of amenorrhea in the general female population is 2-5% in young adult women, while this can be as high as 66% in certain sports events. Many investigations have found that prolonged amenorrhea in female athletes is associated with a reduction in bone mineral density (BMD). As exercise is an osteogenic stimulus in itself, it is possible that some bone loss due to amenorrhea may be offset in areas of high mechanical stimulus. However, BMD in female athletes is dependent on multiple factors and physical activity per se is not always protective for bone. Some of the factors that impact BMD include the nature of the sport discipline, the extent of energy deprivation, the changes in body composition and also various hormones. However, as the measurement of BMD represents only a static assessment of bone health, a more dynamic nature of the bone could be obtained by measuring the biochemical markers of bone formation and resorption. This review focuses on: 1) the impact of different mechanical loading on bone turnover markers in female athletes; and 2) the hormonal factors that influence these bone turnover markers. It has to be taken into account that the beneficial effects of increased mechanical loading from different athletic activities do not always appear to protect against the effects of possible amenorrhea on BMD in female athletes. Female athletes should be monitored at regular intervals to understand better the influence of a high training load on different hormonal markers that are responsive for the bone health in these athletes.