The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets
Tóm tắt
To determine the influence of menstrual irregularity, oral contraceptive use and other factors on bone mineral density (BMD) and bone size at different skeletal sites in 135 college-aged fit women. Menstrual history, oral contraceptive use, exercise history, and nutritional factors including calcium, caffeine, and alcohol intake as well as tobacco use were determined by written survey. Height, weight and fitness levels were measured. Spine and hip BMD were measured by dual x-ray absorptiometry (DXA), calcaneus BMD by peripheral DXA, and tibial bone mineral content (BMC) and size by peripheral Quantitative Computed Tomography (p QCT). The mean age was 18.4 ± 0.8 years. Weight and prior exercise were positively related to BMD at most skeletal sites and to tibial bone size. Milk intake was positively related to calcaneal BMD, tibial BMC and cortical thickness. Fracture history was an important predictor of spine, hip and heel BMD. Women who had ≥ 10 menstrual cycles in the year prior to BMD measurement had higher BMD at all sites as well as a greater tibial mineral content and cortical thickness than women who had oligomenorrhea/amenorrhea (≤ 9 cycles in the prior year; all p < 0.05). Oral Contraceptive (OC) users had significantly lower BMD in the spine (p < 0.02) and calcaneus (p = 0.04), smaller tibial periosteal circumference and lower tibial mineral content (p < 0.02) than non-OC users. In a population of fit, college-aged women, OC use and oligomenorrhea were associated with reduced BMD and bone size. Weight, as well as prior exercise and milk intake was positively related to bone density and size at some skeletal sites. Understanding these relationships would help improve skeletal health in young women.
Tài liệu tham khảo
Bone Health and Osteoporosis: A Report of the Surgeon General US Department of Health and Human Services, Office of the Surgeon General; 2004.
Medicine I (Ed): Reducing stress fracture in physically active military women Washington, D. C. , Academy Press; 1998.
Goulding A, Jones IE, Taylor RW, Manning PJ, Williams SM: More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 2000,15(10):2011-2018. 10.1359/jbmr.2000.15.10.2011
Melton LJ 3rd, Crowson CS, O'Fallon WM, Wahner HW, Riggs BL: Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bone Miner Res 2003,18(2):312-318. 10.1359/jbmr.2003.18.2.312
Szulc P, Beck TJ, Marchand F, Delmas PD: Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men--the MINOS study. J Bone Miner Res 2005,20(5):721-729. 10.1359/JBMR.041230
Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, Seeman E: Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 1998,13(3):500-507. 10.1359/jbmr.1998.13.3.500
McGuigan FE, Murray L, Gallagher A, Davey-Smith G, Neville CE, Van't Hof R, Boreham C, Ralston SH: Genetic and environmental determinants of peak bone mass in young men and women. J Bone Miner Res 2002,17(7):1273-1279. 10.1359/jbmr.2002.17.7.1273
Rubin LA, Hawker GA, Peltekova VD, Fielding LJ, Ridout R, Cole DE: Determinants of peak bone mass: clinical and genetic analyses in a young female Canadian cohort. J Bone Miner Res 1999,14(4):633-643. 10.1359/jbmr.1999.14.4.633
Cobb KL, Bachrach LK, Greendale G, Marcus R, Neer RM, Nieves J, Sowers MF, Brown BW Jr., Gopalakrishnan G, Luetters C, Tanner HK, Ward B, Kelsey JL: Disordered eating, menstrual irregularity, and bone mineral density in female runners. Med Sci Sports Exerc 2003,35(5):711-719. 10.1249/01.MSS.0000064935.68277.E7
Drinkwater BL, Nilson K, Chesnut CH 3rd, Bremner WJ, Shainholtz S, Southworth MB: Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984,311(5):277-281.
Soyka LA, Misra M, Frenchman A, Miller KK, Grinspoon S, Schoenfeld DA, Klibanski A: Abnormal bone mineral accrual in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 2002,87(9):4177-4185. 10.1210/jc.2001-011889
Burr DB, Yoshikawa T, Teegarden D, Lyle R, McCabe G, McCabe LD, Weaver CM: Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18-31 years of age. Bone 2000,27(6):855-863. 10.1016/S8756-3282(00)00403-8
Kleerekoper M, Brienza RS, Schultz LR, Johnson CC: Oral contraceptive use may protect against low bone mass. Henry Ford Hospital Osteoporosis Cooperative Research Group. Arch Intern Med 1991,151(10):1971-1976. 10.1001/archinte.151.10.1971
Lloyd T, Taylor DS, Lin HM, Matthews AE, Eggli DF, Legro RS: Oral contraceptive use by teenage women does not affect peak bone mass: a longitudinal study. Fertil Steril 2000,74(4):734-738. 10.1016/S0015-0282(00)00719-6
Weaver CM, Teegarden D, Lyle RM, McCabe GP, McCabe LD, Proulx W, Kern M, Sedlock D, Anderson DD, Hillberry BM, Peacock M, Johnston CC: Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc 2001,33(6):873-880. 10.1097/00005768-200106000-00004
Cromer BA: Bone mineral density in adolescent and young adult women on injectable or oral contraception. Curr Opin Obstet Gynecol 2003,15(5):353-357. 10.1097/00001703-200310000-00002
Hartard M, Kleinmond C, Kirchbichler A, Jeschke D, Wiseman M, Weissenbacher ER, Felsenberg D, Erben RG: Age at first oral contraceptive use as a major determinant of vertebral bone mass in female endurance athletes. Bone 2004,35(4):836-841. 10.1016/j.bone.2004.05.017
Wegienka G, Baird DD: Potential bias due to excluding oral contraceptive users when estimating menstrual cycle characteristics. Am J Epidemiol 2003,158(10):947-950. 10.1093/aje/kwg246
Cadogan J, Eastell R, Jones N, Barker ME: Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial. Bmj 1997,315(7118):1255-1260.
Chan GM, Hoffman K, McMurry M: Effects of dairy products on bone and body composition in pubertal girls. J Pediatr 1995,126(4):551-556. 10.1016/S0022-3476(95)70348-9
Headquarters DA: FM 21-20: Physical Fitness Training. Volume 14. Washington, D.C. ; 1998:1-20.
Munster K, Helm P, Schmidt L: Secondary amenorrhoea: prevalence and medical contact--a cross-sectional study from a Danish county. Br J Obstet Gynaecol 1992,99(5):430-433.
Magnusson PK, Rasmussen F: Familial resemblance of body mass index and familial risk of high and low body mass index. A study of young men in Sweden. Int J Obes Relat Metab Disord 2002,26(9):1225-1231. 10.1038/sj.ijo.0802041
Martin RB: Size, structure and gender: lessons about fracture risk. J Musculoskelet Neuronal Interact 2002,2(3):209-211.
van Langendonck L, Claessens AL, Lysens R, Koninckx PR, Beunen G: Association between bone, body composition and strength in premenarcheal girls and postmenopausal women. Ann Hum Biol 2004,31(2):228-244. 10.1080/03014460310001638929
van der Meulen MC, Ashford MW Jr., Kiratli BJ, Bachrach LK, Carter DR: Determinants of femoral geometry and structure during adolescent growth. J Orthop Res 1996,14(1):22-29. 10.1002/jor.1100140106
Suuriniemi M, Mahonen A, Kovanen V, Alen M, Lyytikainen A, Wang Q, Kroger H, Cheng S: Association between exercise and pubertal BMD is modulated by estrogen receptor alpha genotype. J Bone Miner Res 2004,19(11):1758-1765. 10.1359/JBMR.040918
Seeman E: Periosteal bone formation--a neglected determinant of bone strength. N Engl J Med 2003,349(4):320-323. 10.1056/NEJMp038101