The Effects of Menstrual Irregularities on Bone Density in Elite Female Gymnasts

Background: Elite gymnastics is a popular sport with intense physical demands. Healthcare providers may be concerned that elite gymnasts often begin training at an early age, which places stress on young girls at a critical time in their development. Elite gymnasts are also thought to be at greater risk of developing components of the female athlete triad, including amenorrhea, due to the desire to maintain a thin and muscular physique. However, studies have shown that gymnasts tend to have higher bone mineral density despite having a higher incidence of menstrual irregularities. Methods: An exhaustive literature search of MedLine, CINAHL, Web of Science, CommonKnowledge and Google Scholar was conducted. Keywords were “Amenorrhea” and “Bone density” and “Female gymnasts”. Eligibility criteria were broad with no limitation of the age of the gymnasts. Male gymnasts were excluded. Data quality was assessed using the GRADE system. Results: Three studies were included in the systematic review. Wulff Helge and Kanstrop found more cases of menstrual irregularities but higher bone mineral density in gymnasts. Correlative statistics showed no correlation between the menstrual irregularities and BMD. Robinson et al reported greater BMD in gymnasts over runners regardless of menstrual status. Correlative statistics found no correlation between current menstrual status and history of menstrual irregularities, and BMD in gymnasts. Ducher et al found higher bone measurements in gymnasts with normal menses when compared to gymnasts with menstrual irregularities and controls. Conclusion: This review showed conflicting results with two studies showing a positive benefit of intense gymnastics on bone density. One study showed no benefit. Based on results, no definitive conclusion can be drawn and further studies are needed. Larger longitudinal studies with consistent bone density measurement methods would be beneficial and would increase the statistical power of results. Keywords: “Amenorrhea” and “Bone density” and Female gymnasts