Are high-performance young women athletes doomed to become low-performance old wives? : a reconsideration of the increased risk for osteoporosis in amenorrheic women

Osteoporosis and athletic amenorrhea are now well-established findings in top level women athletes. Specifically trabecular bone appears to be affected. Since these two phenomena seem to occur simultaneously, questions have been raised as to the underlying mechanisms and whether physical exercise, which had been proven to exert a positive beneficial effect under normal conditions, should be held responsible. Although hypo-estrogenic status, body composition, and nutritional deficiency have been offered as possible explanations, none of these can be solely regarded as completely satisfactory. As for athletic amenorrhea itself, low estrogens are probably secondary to other phenomena and may only be related indirectly to osteoporosis. Whether they interfere with nutritional uptake is obscure. Possibly, endogenous opioid peptides are involved as an unnegligible mediator. As an important practical consequence it should be pointed out that osteoporosis in women athletes will be only detected incidentally; a fact which could obstruct timely intervention, though whether therapy is necessary remains open to discussion. The discovery that amenorrheic athletes subject to more severe training have a higher bone density than less engaged amenorrheic colleagues, can only be in favor of physical exercise, even under these conditions