Bone health and prevention of osteoporosis in active and athletic women.

Most studies have found lower bone mass among women with exercise-induced oligomenorrhea compared with eumenorrheic control women and athletes. These findings have important implications regarding increased risk of both stress fractures and premature osteoporosis. Active and athletic women should be encouraged to keep accurate records of their menstrual cycles. Any divergence from normal should be noted and carefully followed. Bone mass evaluation by bone densitometry for women with continued irregularities will allow assessment of skeletal status. Recommendations for treatment can be based, in part, upon these results, and follow-up scans will offer information on treatment efficacy. For athletes experiencing loss of periods accompanied by low bone mass, a decrease in training intensity and volume and an increase in total calories and calcium intake (1200 to 1500 mg/day) may be indicated. The dietary alterations could be accomplished by adding three glasses of skim milk per day to the diet. A program of resistance training designed to increase both muscle strength and mass may improve the skeletal profile of these athletes as well as protect against soft tissue injuries. Finally, estrogen replacement therapy (ERT) may be indicated for those women who are not willing to make changes in their exercise or dietary patterns. Although there are currently no controlled trials that examine the efficacy of ERT for treating these athletes, it is generally accepted that the doses prescribed to postmenopausal women are adequate for reducing bone loss among amenorrheic athletes. It is important that these women be followed with bone mass and serum measurements in order to evaluate the efficacy of the replacement therapy.