- Email: [email protected]
Areal bone density in female ballet dancers
114S
Abstracts
Conclusions. Regular weight bearing exercise (in the males), body mass and height (in the females) during the age of adolescence and young adulthood seem to be of more importance in reaching a high peak lumbar bone mass in normal healthy youngsters at the age of 27 years than a high calcium intake. During the growing years BMC as a measure of bone mass is a better parameter than BMD. Reference (1) Welten DC et al: Weight-bearingactivitiesduring youth is a more important factor for peak bone mass than calciumintake.J BoneMinerRes 9:1089-1096, 1994.
WHAT DO NORWEGIAN WOMEN AND MEN KNOW ABOUT O S T E O P O R O S I S ? RM Joakimsen 1, G Berntsen 1, JH Magnus 2, A Tollan 3, AJ Sogaard 1
1Institute of Community Medicine, 2Dept. of Obstetrics and Gynecology, 3 Dept. of Internal Medicine, University of Tromso, Norway Rationale and Objectives. A survey of an age- and genderstratified random sample of the Norwegian population was undertaken to investigate knowledge of osteoporosis and attitudes towards methods for preventing this disease among men and women. Materials and Methods. 1514 persons 16-79 years of age were interviewed by the Central Bureau of Statistics as part of their monthly national poll (OMNIBUS). The interviews were carried out by trained interviewers using a structured questionnaire, including questions regarding knowledge and prevention of osteoporosis. Results. Women know more about osteoporosis than men (p < 0.000001). Degree of knowledge about osteoporosis is correlated to level of education. Furthermore it is clearly demonstrated that to have or know someone with osteoporosis is correlated to more knowledge about the condition both for women and men. The multiple regression analysis confirmed the univariate analyses, and education is the strongest predicting factor for knowledge in the regression model (Sig T < 0.00001). Women were positive to physical activity as a mean to prevent osteoporosis. Older women preferred walking (p = 0.006), and younger women more organised athletic activity (p < 0.000001). Women who had much physical activity during leisure time knew more about osteoporosis than other women (p < 0.02). Conclusions. The general Norwegian population knows much about osteoporosis and its consequences. Women are positive to engage in physical activity in order to prevent osteoporosis, especially moderate physical activity as regular strolls. The best educated women are most negative to oestrogen substitution therapy and at the same time most positive to physical activity as a mean to prevent osteoporosis, and similar correlations are found between degree of knowledge about osteoporosis and attitude to oestrogen treatment and physical activity. P R E V A L E N C E O F M E N S T R U A L D Y S F U N C T I O N IN NORWEGIAN LONG DISTANCE RUNNERS PARTICIP A T I N G IN T H E O S L O M A R A T H O N C O N T E S T SE Tomten
The Norwegian University of Sport and Physical Education, Oslo, Norway Rationale and Objectives. The prevalence and possible trigger mechanics of menstrual disturbances among female athletes (ath-
Bone Vol. 18, No. 1, Supplement January 1996:103S-118S
letic amenorrhea-AA), has been debated for more than a decade. Now the issue has become increasingly important as athletic amenorrhea seems to be closely related to reduced bone mineral density in otherwise healthy young women. The objective of this study is to estimate the prevalence of AA in athletes on different performance levels, and evaluate a number of possible risk factors associated to AA. Materials and Methods. A questionnaire was sent to 288 performers (in all age groups) contesting in Oslo Marathon. 244 responded (85%). 187 of the responders were between 16 and 46 years of age, and included in the study of menstrual disorders. The mailed questionnaire consisted of 32 different entries, among them questions that concerned age, leanness, training history, menstrual history, performance level, stress and sociological and nutritional aspects. The data were analyzed using logistic regression. Results. 9 of the subjects in the study did not state their menstrual status. 135 (76%) runners had normal menstrual function, 17 (9.5%) had minor irregularities, and 26 (14.6%) were amenorrheic. Prevalence of menstrual disorders were significantly connected to 1) age at menarche (p = 0.029), 2) present age (p = 0.017), and 3) a feeling of conflict associated with food (p = 0.008). Some other factors were in the borderline of statistical significance: number of children, training volume, and everyday stress. Body composition did not seem to have any influence upon the prevalence of menstrual disorders in this group. There were also no evidence that age at menarche was associated with an early training debut per se--the frequency and intensity of prepubertal training was not taken into account. Conclusions. Not only among the national elite, but also among ordinary habitual and recreational runners, the prevalence of serious menstrual disorders (amenorrhea) supercedes what is previously found in young Norwegian controls. The prevalence is higher in the young runners, and amenorrhea seems to be strongly associated with the athlete's feeling of nutritional conflicts. Suspected factors like leanness, training debut, and performance level, did not seem to have any influence upon the prevalence of menstrual disorders in this study.
A R E A L B O N E DENSITY IN F E M A L E B A L L E T DANCERS M Fogelholm 1, W van Marken Lichtenbelt 2, R Ottenheym 2, K Westerterp 2
1The UKK Institute, Tampere, Finland, 2Dept. of Human Biology, Univ. of Limburg, The Netherlands Rationale and Objectives. Physical exercise is usually considered beneficial for bone status. Nevertheless, a few study groups have found low bone density in ballet dancers. Hormonal disturbances and/or very low calcium intake are postulated causes for the above finding. The aim of the present study was to compare site-specifc and total bone status in ballet dancers with and without menstrual disturbances. Moreover, factors associated with bone status were examined. Materials and Methods. Site-specific and total body bone areal mineral density (BMD) was measured in ballet dancers with menstrual disturbances (MD: < 4 yearly cycles, n = 7) and with regular menstruation (RM:9-14 yearly cycles, n = 17). The dancers were professionals (n = 14) or students (n = 10) in the Netherlands. BMD was measured by Lunar DPX total-body scanner (medium speed, 80 mm/s). Body composition was as-
Bone Vol. 18, No. 1, Supplement January 1996:103S-118S sessed by a four-compartment model (underwater weighing, deuterium dilution and DXA, in combination). Calcium intake was calculated from 7-day food records. Results. Percent body fat (MD: 17.8 (SD 4.1), RM: 18.5 (3.7) %) and dietary calcium intake (MD: 865 (330), RM: 691 (265) mg/day) was not different between the groups. Total body BMD was 1.123 (0.077) and 1.156 (0.065) g/cm2 in MD and RM groups, respectively (p = 0.36). The site-specific BMDs (arms, legs, trunk, pelvis, spine) in MD were not different (p = 0.340.87) from those in RM. BMD appeared to be highest in legs (113% of age-matched reference value), followed by pelvis (112%), trunk (108%), spine (101%) and arms (100%). Total body BMD could not be predicted by a stepwise regression including dancers' body mass index (BMI), age, age of menarche, weekly training hours (WTH), calcium intake and menstrual stares. BMD in legs was related to BMI and WTH: BMD (legs) = 0.121 + 0.069 BMI + 0.008 WTH (r2 = 0.40, p < 0.05). Condnsion. BMDs in these ballet dancers were at or above reference values regardless of menstrual status, body composition and dietary intake.
OSTEOPOROSIS AND REHABILITATION IN CHILDREN RS Lorenc, M Lebiedowski, M Olszaniecka, H Matusik, M Bartuszek
Child's Health Center, Warsaw, Poland Primary and secondary osteoporosis are common features in several metabolic bone diseases in children. The main symptoms are pain, myodystonia, postural pathology and decrease in general efficacy of the patient. Osteopenia taking advantage of densitometric means can also be diagnosed and monitored in early stage of the disease. Loss of bone quality and bone mass during disease is directing in final stage to fractures pointed on importance of rehabilitation in the prophylactic stage as well as the treatment of the disease. 105 cases of idiopathic juvenile osteoporosis and 64 cases of osteogenesis imperfecta were followed up during its diagnosis and treatment period. The complex proglmn of rehabilitation was instituted with the use of passive and active free exercises, active relaxation, active exercises in degravitation, isometric and isotonic exercises as well as hydrotherapy. The best rehabilitation results with respect to analgesia, improvement in gait and postural defects was obtained when active free exercises, especially with degravitation and hydrotherapy were used.
BONE MINERAL DENSITY OF A NATIVE POPULATION OF ARGENTINA WITH LOW CALCIUM INTAKE AND HEAVY PHYSICAL ACTIVITY A Spindler, E Lucero, A Berman, S Paz, E Vega, C Mautalen
Centro de Estudios de Osteoporosis, Facuhad de Medicina, Universidad de Tucurruin and S. de Osteopatids Mddicas, Buenos Aires, Argentina Rationale and Objectives. Since bone mass measurements of South American autochthonic mountaineer population have not been done, the aim of this study was to determine the bone mineral density (BMD) of a group of natives from the area of Taft del Valle, and to examine its possible differences compared to other populations. Materials and Methods. The BMD of lumbar spine and proximal femur was evaluated by dual x-ray absorptiometry (DXA),
Abstracts
115S
in volunteer natives of Taft del Valle (whose ancestors were Amaichas and Quilmes aborigens), placed 110 km from San Miguel de Tucumfin, 1300 km from Buenos Aires (Argentina, South America) and 2000 meters above the sea level. Forty seven women (21 pre- and 26 postmenopausal) and 31 men between 20----80 years old were assessed. The average daily ingestion of calcium, physical activity level, serum levels of vitamin D (25OHD), calcium, phosphorous and alkaline phosphatase were also determined. Results. Average calcium intake was 356 + 22.4 mg/day (+SD), the daily average sunlight exposure was 3.8 + 0.44 hours. The physical activity degree was moderate/hard (grade 4) to very hard (grade 6) before 60 years of age. Laboratory values were normal except for 25OHD levels which were significantly (p < 0.05) higher in Taft del Valle (26.8 ng/ml) as in Buenos Aires (20.7 ng/ml). BMD of proximal femur of both sexes was significantly greater compared to the reference groups: z-score of the female population was for femoral neck: + 0.64 (p < 0.05); Ward's triangle: + 0.64 (p < 0.001); trochanter: + 0.90 (p < 0.001), and among men, femoral neck: + 0.53 (p < 0.001); Ward's triangle: + 1.45 (p < 0.001); trochanter: + 0.95 (p < 0.001). No significant differences were observed in lumbar spine BMD. Conclusions. The high physical activity required by mountainous land of Taft del Valle may be the cause of increased BMD at the proximal femur among these people. High values of vitamin D produced by increase of sun exposure can lead to greater absorption of calcium despite of low calcium intake. The results obtained would indicate that a heavy physical activity, high level of vitamin D and perhaps, a racial factor of the native population could determine a greater BMD in proximal femur despite the low calcium intake.
EFFECT OF BONE LOADING EXERCISES PROGRAM ON GRIP STRENGTH IN POSTMENOPAUSAL WOMEN Y Alacamlioglu, E Preisinger, KL Resch, Th Bochdansky
Department of Physical Medicine and Rehabilitation, University of Vienna, Austria Rationale and Objectives. The efficiency of exercises in prevention of postmenopausal osteoporosis is being suggested by some studies, however there are unclarities about the type, intensity, and duration of exercise. The aim of this study was to examine an exercise program on grip strength, which has positively influenced bone mineral density of distal forearm. Materials and Methods. Thirty-seven postmenopausal healthy women were assigned into two groups. Group 1 took part at the exercise program for 6 months. Group 2 served as controls. Grip strength was measured with the Jamar dynamometer both on the dominant and nondominant side at the beginning, after 3 and 6 months. Total body exercises were designed mainly for posture correction and restoring motor function. The exercises were performed at least for 20 minutes, three times per week for six months. Mann-Whitney test was applied for statistical analysis. Results. There was a significant (p = 0.02) increase of grip strength at the dominant side and a slight increase at the nondominant side in group 1 when compared with group 2. Conclusions. In postmenopausal women loading therapeutic exercises performed regularly cause an increase in grip strength. In designing exercises for bone loading, improvement of the muscular strength seems to be an important part.
Abstracts
Conclusions. Regular weight bearing exercise (in the males), body mass and height (in the females) during the age of adolescence and young adulthood seem to be of more importance in reaching a high peak lumbar bone mass in normal healthy youngsters at the age of 27 years than a high calcium intake. During the growing years BMC as a measure of bone mass is a better parameter than BMD. Reference (1) Welten DC et al: Weight-bearingactivitiesduring youth is a more important factor for peak bone mass than calciumintake.J BoneMinerRes 9:1089-1096, 1994.
WHAT DO NORWEGIAN WOMEN AND MEN KNOW ABOUT O S T E O P O R O S I S ? RM Joakimsen 1, G Berntsen 1, JH Magnus 2, A Tollan 3, AJ Sogaard 1
1Institute of Community Medicine, 2Dept. of Obstetrics and Gynecology, 3 Dept. of Internal Medicine, University of Tromso, Norway Rationale and Objectives. A survey of an age- and genderstratified random sample of the Norwegian population was undertaken to investigate knowledge of osteoporosis and attitudes towards methods for preventing this disease among men and women. Materials and Methods. 1514 persons 16-79 years of age were interviewed by the Central Bureau of Statistics as part of their monthly national poll (OMNIBUS). The interviews were carried out by trained interviewers using a structured questionnaire, including questions regarding knowledge and prevention of osteoporosis. Results. Women know more about osteoporosis than men (p < 0.000001). Degree of knowledge about osteoporosis is correlated to level of education. Furthermore it is clearly demonstrated that to have or know someone with osteoporosis is correlated to more knowledge about the condition both for women and men. The multiple regression analysis confirmed the univariate analyses, and education is the strongest predicting factor for knowledge in the regression model (Sig T < 0.00001). Women were positive to physical activity as a mean to prevent osteoporosis. Older women preferred walking (p = 0.006), and younger women more organised athletic activity (p < 0.000001). Women who had much physical activity during leisure time knew more about osteoporosis than other women (p < 0.02). Conclusions. The general Norwegian population knows much about osteoporosis and its consequences. Women are positive to engage in physical activity in order to prevent osteoporosis, especially moderate physical activity as regular strolls. The best educated women are most negative to oestrogen substitution therapy and at the same time most positive to physical activity as a mean to prevent osteoporosis, and similar correlations are found between degree of knowledge about osteoporosis and attitude to oestrogen treatment and physical activity. P R E V A L E N C E O F M E N S T R U A L D Y S F U N C T I O N IN NORWEGIAN LONG DISTANCE RUNNERS PARTICIP A T I N G IN T H E O S L O M A R A T H O N C O N T E S T SE Tomten
The Norwegian University of Sport and Physical Education, Oslo, Norway Rationale and Objectives. The prevalence and possible trigger mechanics of menstrual disturbances among female athletes (ath-
Bone Vol. 18, No. 1, Supplement January 1996:103S-118S
letic amenorrhea-AA), has been debated for more than a decade. Now the issue has become increasingly important as athletic amenorrhea seems to be closely related to reduced bone mineral density in otherwise healthy young women. The objective of this study is to estimate the prevalence of AA in athletes on different performance levels, and evaluate a number of possible risk factors associated to AA. Materials and Methods. A questionnaire was sent to 288 performers (in all age groups) contesting in Oslo Marathon. 244 responded (85%). 187 of the responders were between 16 and 46 years of age, and included in the study of menstrual disorders. The mailed questionnaire consisted of 32 different entries, among them questions that concerned age, leanness, training history, menstrual history, performance level, stress and sociological and nutritional aspects. The data were analyzed using logistic regression. Results. 9 of the subjects in the study did not state their menstrual status. 135 (76%) runners had normal menstrual function, 17 (9.5%) had minor irregularities, and 26 (14.6%) were amenorrheic. Prevalence of menstrual disorders were significantly connected to 1) age at menarche (p = 0.029), 2) present age (p = 0.017), and 3) a feeling of conflict associated with food (p = 0.008). Some other factors were in the borderline of statistical significance: number of children, training volume, and everyday stress. Body composition did not seem to have any influence upon the prevalence of menstrual disorders in this group. There were also no evidence that age at menarche was associated with an early training debut per se--the frequency and intensity of prepubertal training was not taken into account. Conclusions. Not only among the national elite, but also among ordinary habitual and recreational runners, the prevalence of serious menstrual disorders (amenorrhea) supercedes what is previously found in young Norwegian controls. The prevalence is higher in the young runners, and amenorrhea seems to be strongly associated with the athlete's feeling of nutritional conflicts. Suspected factors like leanness, training debut, and performance level, did not seem to have any influence upon the prevalence of menstrual disorders in this study.
A R E A L B O N E DENSITY IN F E M A L E B A L L E T DANCERS M Fogelholm 1, W van Marken Lichtenbelt 2, R Ottenheym 2, K Westerterp 2
1The UKK Institute, Tampere, Finland, 2Dept. of Human Biology, Univ. of Limburg, The Netherlands Rationale and Objectives. Physical exercise is usually considered beneficial for bone status. Nevertheless, a few study groups have found low bone density in ballet dancers. Hormonal disturbances and/or very low calcium intake are postulated causes for the above finding. The aim of the present study was to compare site-specifc and total bone status in ballet dancers with and without menstrual disturbances. Moreover, factors associated with bone status were examined. Materials and Methods. Site-specific and total body bone areal mineral density (BMD) was measured in ballet dancers with menstrual disturbances (MD: < 4 yearly cycles, n = 7) and with regular menstruation (RM:9-14 yearly cycles, n = 17). The dancers were professionals (n = 14) or students (n = 10) in the Netherlands. BMD was measured by Lunar DPX total-body scanner (medium speed, 80 mm/s). Body composition was as-
Bone Vol. 18, No. 1, Supplement January 1996:103S-118S sessed by a four-compartment model (underwater weighing, deuterium dilution and DXA, in combination). Calcium intake was calculated from 7-day food records. Results. Percent body fat (MD: 17.8 (SD 4.1), RM: 18.5 (3.7) %) and dietary calcium intake (MD: 865 (330), RM: 691 (265) mg/day) was not different between the groups. Total body BMD was 1.123 (0.077) and 1.156 (0.065) g/cm2 in MD and RM groups, respectively (p = 0.36). The site-specific BMDs (arms, legs, trunk, pelvis, spine) in MD were not different (p = 0.340.87) from those in RM. BMD appeared to be highest in legs (113% of age-matched reference value), followed by pelvis (112%), trunk (108%), spine (101%) and arms (100%). Total body BMD could not be predicted by a stepwise regression including dancers' body mass index (BMI), age, age of menarche, weekly training hours (WTH), calcium intake and menstrual stares. BMD in legs was related to BMI and WTH: BMD (legs) = 0.121 + 0.069 BMI + 0.008 WTH (r2 = 0.40, p < 0.05). Condnsion. BMDs in these ballet dancers were at or above reference values regardless of menstrual status, body composition and dietary intake.
OSTEOPOROSIS AND REHABILITATION IN CHILDREN RS Lorenc, M Lebiedowski, M Olszaniecka, H Matusik, M Bartuszek
Child's Health Center, Warsaw, Poland Primary and secondary osteoporosis are common features in several metabolic bone diseases in children. The main symptoms are pain, myodystonia, postural pathology and decrease in general efficacy of the patient. Osteopenia taking advantage of densitometric means can also be diagnosed and monitored in early stage of the disease. Loss of bone quality and bone mass during disease is directing in final stage to fractures pointed on importance of rehabilitation in the prophylactic stage as well as the treatment of the disease. 105 cases of idiopathic juvenile osteoporosis and 64 cases of osteogenesis imperfecta were followed up during its diagnosis and treatment period. The complex proglmn of rehabilitation was instituted with the use of passive and active free exercises, active relaxation, active exercises in degravitation, isometric and isotonic exercises as well as hydrotherapy. The best rehabilitation results with respect to analgesia, improvement in gait and postural defects was obtained when active free exercises, especially with degravitation and hydrotherapy were used.
BONE MINERAL DENSITY OF A NATIVE POPULATION OF ARGENTINA WITH LOW CALCIUM INTAKE AND HEAVY PHYSICAL ACTIVITY A Spindler, E Lucero, A Berman, S Paz, E Vega, C Mautalen
Centro de Estudios de Osteoporosis, Facuhad de Medicina, Universidad de Tucurruin and S. de Osteopatids Mddicas, Buenos Aires, Argentina Rationale and Objectives. Since bone mass measurements of South American autochthonic mountaineer population have not been done, the aim of this study was to determine the bone mineral density (BMD) of a group of natives from the area of Taft del Valle, and to examine its possible differences compared to other populations. Materials and Methods. The BMD of lumbar spine and proximal femur was evaluated by dual x-ray absorptiometry (DXA),
Abstracts
115S
in volunteer natives of Taft del Valle (whose ancestors were Amaichas and Quilmes aborigens), placed 110 km from San Miguel de Tucumfin, 1300 km from Buenos Aires (Argentina, South America) and 2000 meters above the sea level. Forty seven women (21 pre- and 26 postmenopausal) and 31 men between 20----80 years old were assessed. The average daily ingestion of calcium, physical activity level, serum levels of vitamin D (25OHD), calcium, phosphorous and alkaline phosphatase were also determined. Results. Average calcium intake was 356 + 22.4 mg/day (+SD), the daily average sunlight exposure was 3.8 + 0.44 hours. The physical activity degree was moderate/hard (grade 4) to very hard (grade 6) before 60 years of age. Laboratory values were normal except for 25OHD levels which were significantly (p < 0.05) higher in Taft del Valle (26.8 ng/ml) as in Buenos Aires (20.7 ng/ml). BMD of proximal femur of both sexes was significantly greater compared to the reference groups: z-score of the female population was for femoral neck: + 0.64 (p < 0.05); Ward's triangle: + 0.64 (p < 0.001); trochanter: + 0.90 (p < 0.001), and among men, femoral neck: + 0.53 (p < 0.001); Ward's triangle: + 1.45 (p < 0.001); trochanter: + 0.95 (p < 0.001). No significant differences were observed in lumbar spine BMD. Conclusions. The high physical activity required by mountainous land of Taft del Valle may be the cause of increased BMD at the proximal femur among these people. High values of vitamin D produced by increase of sun exposure can lead to greater absorption of calcium despite of low calcium intake. The results obtained would indicate that a heavy physical activity, high level of vitamin D and perhaps, a racial factor of the native population could determine a greater BMD in proximal femur despite the low calcium intake.
EFFECT OF BONE LOADING EXERCISES PROGRAM ON GRIP STRENGTH IN POSTMENOPAUSAL WOMEN Y Alacamlioglu, E Preisinger, KL Resch, Th Bochdansky
Department of Physical Medicine and Rehabilitation, University of Vienna, Austria Rationale and Objectives. The efficiency of exercises in prevention of postmenopausal osteoporosis is being suggested by some studies, however there are unclarities about the type, intensity, and duration of exercise. The aim of this study was to examine an exercise program on grip strength, which has positively influenced bone mineral density of distal forearm. Materials and Methods. Thirty-seven postmenopausal healthy women were assigned into two groups. Group 1 took part at the exercise program for 6 months. Group 2 served as controls. Grip strength was measured with the Jamar dynamometer both on the dominant and nondominant side at the beginning, after 3 and 6 months. Total body exercises were designed mainly for posture correction and restoring motor function. The exercises were performed at least for 20 minutes, three times per week for six months. Mann-Whitney test was applied for statistical analysis. Results. There was a significant (p = 0.02) increase of grip strength at the dominant side and a slight increase at the nondominant side in group 1 when compared with group 2. Conclusions. In postmenopausal women loading therapeutic exercises performed regularly cause an increase in grip strength. In designing exercises for bone loading, improvement of the muscular strength seems to be an important part.