The Cardiometabolic and Skeletal Profile of Female Endurance Athletes with Amenorrhea and Oligomenorrhea

Abstract

Background

Menstrual disturbances, namely amenorrhea and oligomenorrhea are relatively common disorders in female endurance athletes as a result of low energy availability (LEA). LEA is characterised by the perturbation of several hormones of which are involved in the regulation of bone (re)modelling and also those with cardio-protective properties. The impact on bone health is relatively well understood, but the extent of cardiometabolic risk factors ranging along a scale of both time and severity of menstrual disturbances is yet to be determined.

Methods

In this observational study, 4 amenorrheic athletes (AA), 3 oligomenorrheic athletes (OA) and 5 eumenorrheic athletes (EA) completed the LEAF-Q and received measurements of stature, mass, resting heart rate, resting blood pressure, waist circumference, body composition using bioelectrical impedance analysis and dual energy X-ray absorptiometry (DXA). Bone Mineral Density was measured by DXA at the total body, total hip, femoral neck, and anteriorposterior lumbar spine (L1-L4).

Results

There were statistically significant differences in the total body and lumbar spine BMD Zscores between amenorrheic and eumenorrheic athletes. Mean BMD Z-scores (-1.13 - 1.33)
for the amenorrheic group were not outside of the normal range (>-0.2). Total body water (TBW) was at the top end of the normal range for the amenorrheic group, but not statistically significant from the eumenorrheic group. TBW was, negatively associated with waist:height ratio (R=-.874, p=<.001). Waist:height ratio was positively associated with total body BMD Zscore (R=.741, P=.006). BMD total body (Z-score) was positively associated with percentage body fat (PBF) (R=.682, p=0.015).

Conclusions

This study confirms the findings of previous work, that exemplify the differences in bone density between amenorrheic and eumenorrheic endurance athletes. Further studies need to be undertaken to confirm bone loss and better understand the time-course for any bone loss from onset of menstrual disturbance. Due to COVID-19 restrictions, the study sample size was limited and biochemical markers of cardiometabolic status were possible.