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The female The female athlete athlete Corso di Laurea in Scienze Motorie Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004 Prof G.Galanti A.A. 2003/2004

The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

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Page 1: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

The female The female athleteathleteThe female The female athleteathleteCorso di Laurea in Scienze Motorie Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004Prof G.Galanti A.A. 2003/2004

Page 2: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Until 1970 women were barred from officialUntil 1970 women were barred from official

partecipation in the marathon. partecipation in the marathon.

This restriction resulted from a This restriction resulted from a

misconception that women were physiologically misconception that women were physiologically

unsuited for endurance activity. unsuited for endurance activity.

Yet,at the 1984 Los Angeles Olympic Games ,Yet,at the 1984 Los Angeles Olympic Games ,

Joan Benoit won the gold medal in the Joan Benoit won the gold medal in the

first-ever Olympic marathon for women first-ever Olympic marathon for women

with a time of 02:24:52.with a time of 02:24:52.

Her time would have won 11 of the previous 20 Her time would have won 11 of the previous 20

men’s Olympic marathons!men’s Olympic marathons!

Page 3: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex-specific differencesSex-specific differencesBody compositionBody composition

Until puberty, boys and girls do not differUntil puberty, boys and girls do not differ

significantly in:significantly in:

•• heigth heigth •• weigth weigth•• girth girth •• bone with bone with•• fat-mass fat-mass •• fat-free mass fat-free mass

Sex-specific differences in body composition Sex-specific differences in body composition appeares at puberty and are due to theappeares at puberty and are due to the hormonal influences.hormonal influences.

Page 4: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex differences in FFM Sex differences in FFM changes with agechanges with age

Page 5: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Hormonal influences on body Hormonal influences on body compositioncomposition

TestosteroneTestosterone (men)(men) • • bone formationbone formation• • muscle massmuscle mass

EstrogensEstrogens (women)(women) • • growth rate of bonegrowth rate of bone• • broadening the pelvisbroadening the pelvis• • breast developmentbreast development• • fat deposition (thighs andfat deposition (thighs and hips)hips)

Page 6: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

0

10

20

30

40

50

60

70

weigth FFM FM

malefemale

Kg

Sex diffences in body composition Sex diffences in body composition at the end of puberty at the end of puberty (mean values)(mean values)

Page 7: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex diffences in body Sex diffences in body composition with agingcomposition with aging

Relative body fat values for average, Relative body fat values for average, untrained women and menuntrained women and men

Relative body fat (%)Relative body fat (%)Women MenWomen Men 20-24 13-1620-24 13-16 22-25 15-2022-25 15-20 24-30 18-2624-30 18-26 27-33 23-2927-33 23-29 30-36 26-3330-36 26-33 30-36 29-3330-36 29-33

Age groupAge group yearsyears 15-1915-19 20-2920-29 30-3930-39 40-4940-49 50-5950-59 60-6960-69

Page 8: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex differences in Sex differences in physiological responsesphysiological responses

to acute exercise to acute exercise

NeuromuscolarNeuromuscolar CardiovascularCardiovascular RespiratoryRespiratory MetabolicMetabolic

Page 9: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex differences Sex differences in physiological responses in physiological responses

to acute exerciseto acute exercise

NeuromuscolarNeuromuscolarCardiovascularCardiovascularRespiratoryRespiratoryMetabolicMetabolic

Page 10: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Differences in strengthDifferences in strength

In terms of absolute strength, women have been regarded as theIn terms of absolute strength, women have been regarded as the““weaker sex”, but when lower-body strength is expressed relativeweaker sex”, but when lower-body strength is expressed relativeto FFM, differences between women and men disappeares!to FFM, differences between women and men disappeares!

0

0,5

1

1,5

2

2,5

leg press benchpress

Arm curl

strengthstrengt/weigthstrength/FFM

Str

en

gth

ra

tio

(m

en

/wo

men

)S

tre

ng

th r

ati

o (

me

n/w

om

en)

Page 11: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

For the same amount of muscle, For the same amount of muscle, there are no differencesthere are no differences

in strength between sexes,in strength between sexes, though women possess smallerthough women possess smaller

muscle fiber cross-sectional areas and muscle fiber cross-sectional areas and less muscle mass than menless muscle mass than men

Differences in strengthDifferences in strength

Page 12: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex differences in Sex differences in physiological responsesphysiological responses

to acute exercise to acute exercise

NeuromuscolarNeuromuscolarCardiovascularCardiovascularRespiratoryRespiratoryMetabolicMetabolic

Page 13: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Cardiovascular responseto acute exercise

• women have higher submaximal HR than men

• maximum HR is the same in both sexes

• Cardiac Output (CO) for the same absolute rate of work is the same in both sexes• increase of CO in women is primarly due to an increase in HR, more than in stroke volume

Page 14: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Women’ lower stroke volume is related toWomen’ lower stroke volume is related to

smaller heart size related to their smaller body smaller heart size related to their smaller body

surface area (lower testosterone levels)surface area (lower testosterone levels)

Smaller blood volume, also related to smaller Smaller blood volume, also related to smaller

body sizebody size

Cardiovascular responseto acute exercise

Page 15: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Sex differences in Sex differences in physiological responsesphysiological responses

to acute exercise to acute exercise

NeuromuscolarNeuromuscolar CardiovascularCardiovascular RespiratoryRespiratory MetabolicMetabolic

Page 16: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Changes in aerobic capacity Changes in aerobic capacity

(VO2 max)(VO2 max)

Changes in aerobic capacity Changes in aerobic capacity

(VO2 max)(VO2 max)

VO2 max = CO x A-V diffVO2 max = CO x A-V diffVO2 max = CO x A-V diffVO2 max = CO x A-V diff

Page 17: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

VO2max in normal women

The average woman’s VO2max is only 70% The average woman’s VO2max is only 70% to 75% that of the average man. to 75% that of the average man.

The main causes of this differences are:The main causes of this differences are:

•• women’s greater fat masswomen’s greater fat mass

•• lower hemoglobin levelslower hemoglobin levels

•• lower maximal cardiac outputlower maximal cardiac output

Page 18: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

VO2 max in male and female VO2 max in male and female athletesathletes

The highest The highest VO2maxVO2max reported in literature reported in literature for a for a female athlete is 77ml/Kg/min,female athlete is 77ml/Kg/min, that of a that of a

Russian cross-country skier.Russian cross-country skier.

The highest value for a The highest value for a male athletemale athlete was was reported in Norwegian cross-country skier, reported in Norwegian cross-country skier,

who achieved a value of who achieved a value of 94 ml/Kg/min94 ml/Kg/min

Page 19: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Women Women respond respond

to physical to physical training training

in the same in the same manner manner

as men doas men do

Women’s adaptations to chronic exercise

Page 20: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Effect of training on body Effect of training on body composition in womencomposition in women

• • Fat-free mass (generally much less than man)Fat-free mass (generally much less than man)

• • Fat massFat mass

• • Relative fatRelative fat

• • Total body massTotal body mass

This changes are morerelated to total energy

expenditure than tosex differences.

Page 21: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Effect of resistence training on Effect of resistence training on women’s muscular strengthwomen’s muscular strength

Women can experience a relevant increase in strengthWomen can experience a relevant increase in strength

(20% to 40%) as a result of resistence training, (20% to 40%) as a result of resistence training,

and the magnitude of these changes is similar and the magnitude of these changes is similar

to that seen in men.to that seen in men.

These gains are due primarly to neural factors,These gains are due primarly to neural factors,

in fact women’s increase in muscle massin fact women’s increase in muscle mass

is generally small because of their is generally small because of their

low testosterone levels. low testosterone levels.

Page 22: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Cardiovascular effects of Cardiovascular effects of endurance trainingendurance training

Cardiovascular adaptations to endurance training are Cardiovascular adaptations to endurance training are

not sex specific. So, trained women have:not sex specific. So, trained women have:

•• lower rest and submaximal HRlower rest and submaximal HR

•• higher cardiac size (physiological hypertrophy)higher cardiac size (physiological hypertrophy)

•• higher stroke volume higher stroke volume

• • higher maximal cardiac outputhigher maximal cardiac output

•• largest blood volume largest blood volume

•• higher muscular capillary densityhigher muscular capillary density

………… …………than sedentary than sedentary

ones.ones.

Page 23: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Metabolic adaptationMetabolic adaptation

Women can improve their VO2max by 10% to 40% with endurance training (same % seen in men)

As in men, the magnitude of of change depends on:

• initial level of fitness

• intensity and duration of training session

• frequency of training

Page 24: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Medical problemsMedical problems in female athletein female athleteMedical problemsMedical problems in female athletein female athlete

Page 25: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Female athlete triadeFemale athlete triade

In 1992 the Task Force on Women’s Issues of the In 1992 the Task Force on Women’s Issues of the

American College of Sports Medicine describedAmerican College of Sports Medicine described

the “female athlete triade” as a syndrome of 3 medical,the “female athlete triade” as a syndrome of 3 medical,

often interrelated, entities that can occur inoften interrelated, entities that can occur in

female athlete :female athlete :

•Menstrual dysfunctions until Menstrual dysfunctions until amenorrheaamenorrhea•Eating disordersEating disorders•OsteoporosisOsteoporosis

Page 26: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Menstrual dysfunction

EumenorrheaEumenorrhea : normal menstrual function : normal menstrual function

OligomenorrheaOligomenorrhea : abnormally infrequent or : abnormally infrequent or scant menstruationscant menstruation

AmenorrheaAmenorrhea : absence of menstruation : absence of menstruation

Primary amenorrheaPrimary amenorrhea: absence of menarche in : absence of menarche in women 18 years of agewomen 18 years of age

Secondary amenorrheaSecondary amenorrhea : lack of menstruation in : lack of menstruation in women who previously had been eumenorrheicwomen who previously had been eumenorrheic

Page 27: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

The Pituitary gland The Pituitary gland II

GHGHGrowth hormoneGrowth hormone

TSHTSH Thyroid-stimulating hormoneThyroid-stimulating hormone

ProlactinProlactin

ACTHACTHAdrenocorticotropinAdrenocorticotropin

FSH FSH Follicle-stimulating hormoneFollicle-stimulating hormone

LHLHLuteinizing hormoneLuteinizing hormone

Anterior lobeAnterior lobe

Page 28: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

The Pituitary gland The Pituitary gland VIVI Anterior lobe Hypothalamic Controlling FactorsAnterior lobe Hypothalamic Controlling Factors

FSHFSH : stimulated by : stimulated by GnRH GnRH (gonadotropin-realising (gonadotropin-realising

hormone)hormone)

LH LH : stimulated by : stimulated by GnRHGnRH

PROLACTINPROLACTIN : stimulated by : stimulated by PRHPRH (prolactin-realising (prolactin-realising

hormone)hormone)

Inibited by Inibited by PIHPIH (prolactin-inibiting hormone) (prolactin-inibiting hormone)

Page 29: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

The Pituitary gland The Pituitary gland IVIVAnterior lobeAnterior lobe

TARGET TARGET ORGANORGAN

Thyroid glandThyroid gland

Adrenal cortexAdrenal cortex

BreastsBreasts

MAJORMAJOR FUNCTIONSFUNCTIONS Controls the amount of T3 and T4 Controls the amount of T3 and T4

produced and released by the produced and released by the thyroid gland thyroid gland

Controls the secretion of Controls the secretion of

hormones from the adrenal hormones from the adrenal cortex cortex

Stimulates breasts developement Stimulates breasts developement and milk secretionand milk secretion

HORMONEHORMONE

TSHTSH

ACTHACTH

PROLACTINPROLACTIN

Page 30: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

The Pituitary gland VAnterior lobe

TARGET TARGET ORGANORGAN

Ovaries, TestesOvaries, Testes

Ovaries, TestesOvaries, Testes

MAJORMAJOR FUNCTIONSFUNCTIONS Initiates growth of follicles inthe Initiates growth of follicles inthe

ovaries and promotes secretion of ovaries and promotes secretion of estrogen from the ovaries. estrogen from the ovaries. Promotes developement of sperm Promotes developement of sperm in testes.in testes.

Promotes secretion of estrogen Promotes secretion of estrogen and progesterone and causes the and progesterone and causes the follicle to rupture, releasing the follicle to rupture, releasing the ovum. Causes testes to secrete ovum. Causes testes to secrete testosteronetestosterone

HORMONEHORMONE

FSHFSH

LHLH

Page 31: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Secondary amenorrhea in athletes

The prevalence of secondary amenorrhea The prevalence of secondary amenorrhea

among athletes is not well documented, but is among athletes is not well documented, but is

estimated to be 5% to 40% (2-3% in general estimated to be 5% to 40% (2-3% in general

population), depending on the sport and the population), depending on the sport and the

level of competition. Prevalence appears to be level of competition. Prevalence appears to be

greater in those who train many hours each day greater in those who train many hours each day

and in those who train at very high intensities. and in those who train at very high intensities.

Page 32: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Secondary amenorrhea in athletes

The causes of secondary amenorrhea in The causes of secondary amenorrhea in

athletes are unknown, however the two principal athletes are unknown, however the two principal

causes seem to be:causes seem to be:

•• inadeguate nutritioninadeguate nutrition

•• hormonal changeshormonal changes related to exercise stress related to exercise stress

might disrupt GnRH secretion which is needed might disrupt GnRH secretion which is needed

to ‘direct’ the normal menstrual cycleto ‘direct’ the normal menstrual cycle

Page 33: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disorders in female Eating disorders in female athletesathletes

Eating disorders must be considered among the Eating disorders must be considered among the

most serious problems facing female athletes most serious problems facing female athletes

today, considering the severe physiological today, considering the severe physiological

conseguences of this disorder (until death) and conseguences of this disorder (until death) and

the extraordinary costs of specific treatment. the extraordinary costs of specific treatment.

Page 34: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disorders in female Eating disorders in female athletesathletes

Athletic trainers and coaches, who are the Athletic trainers and coaches, who are the

people closest to the elite athletes , should be people closest to the elite athletes , should be

able to suspect eating disorders and recognize able to suspect eating disorders and recognize

the seriousness of the problem, in order to refer the seriousness of the problem, in order to refer

the athlete to a person specifically trained in the athlete to a person specifically trained in

dealing with this kind of problems.dealing with this kind of problems.

Page 35: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disorders

The two most commonly The two most commonly diagnosed eating disorders diagnosed eating disorders are:are: anorexia nervosaanorexia nervosa and and bulimia nervosabulimia nervosa

Page 36: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disordersAnorexia nervosaAnorexia nervosa

anorexia nervosaanorexia nervosa is characterized by:is characterized by:

• • refusal to maintain more than the minimal refusal to maintain more than the minimal

normal weight based on an age and heigthnormal weight based on an age and heigth

• • distorted body imagedistorted body image

• • intense fear of fatness or gaining weigthintense fear of fatness or gaining weigth

• • amenorrheaamenorrhea

Prevalence: about 1% in females from ages 12 to 21

Page 37: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disordersBulimia nervosaBulimia nervosa

bulimia nervosabulimia nervosa is characterized by:is characterized by:

• • reccurent episodes of binge eatingreccurent episodes of binge eating

• • a feeling of lack of control during these binges a feeling of lack of control during these binges

• • purging behaviour, which can include self purging behaviour, which can include self

induced vomiting, laxative use and diuretic useinduced vomiting, laxative use and diuretic use

Prevalence: about 1% in females from ages 12 to 21

Page 38: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disordersAnorexia athleticaAnorexia athletica

Anorexia athleticaAnorexia athletica is characterized by: is characterized by:

• • an intense fear of gaining weigth or becaming an intense fear of gaining weigth or becaming

fat even though one is under-weigthfat even though one is under-weigth

• • A weigth loss of at least 5%, resulted from a A weigth loss of at least 5%, resulted from a

reduction of total energy intake with extensive reduction of total energy intake with extensive

exerciseexercise

• • reported use of self-induced vomiting or use of reported use of self-induced vomiting or use of

laxative or diuretics laxative or diuretics

Page 39: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Anorexia athletica: Anorexia athletica: problem dimensionproblem dimension

Prevalence of anorexia athletica is not wellPrevalence of anorexia athletica is not well

understood, however some reserchers have understood, however some reserchers have

estimated the prevalence to be as estimated the prevalence to be as 50%50% for elite for elite

athletes in higher risks sports.athletes in higher risks sports.

Page 40: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disordersAnorexia athleticaAnorexia athletica

As in the general population , female athletes As in the general population , female athletes

are exposed at a higher risk than male athletes.are exposed at a higher risk than male athletes.

The high risk sports can be grouped into 3 The high risk sports can be grouped into 3

categories:categories:

• • ‘‘Appearence sports’Appearence sports’: figure skating, gymnastic, : figure skating, gymnastic,

body building, balletbody building, ballet

• • Endurance sportsEndurance sports: distance running, swimming: distance running, swimming

• • Weight-classification sportsWeight-classification sports: horse racing, : horse racing,

boxing, wrestlingboxing, wrestling

Page 41: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Warning signs for eating Warning signs for eating disorders in female athletesdisorders in female athletes

Warning signs for anorexia nervosa:Warning signs for anorexia nervosa:1.1. Dramatic loss in weigthDramatic loss in weigth2.2. A preoccupation with food, calories and A preoccupation with food, calories and

weigthweigth3.3. Wearing baggy or layered clothingWearing baggy or layered clothing4.4. Relentless, excessive exerciseRelentless, excessive exercise5.5. Mood swingsMood swings6.6. Avoiding food-related social activitiesAvoiding food-related social activities

Adapted from National Collegiate Athletic Association

Page 42: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Warning signs for eating Warning signs for eating disorders in female athletesdisorders in female athletes

Warning signs for bulimia nervosa:Warning signs for bulimia nervosa:

1.1. A noticeble weigth loss or gainA noticeble weigth loss or gain

2.2. Excessive concern about weigthExcessive concern about weigth

3.3. Bathroom visits after mealsBathroom visits after meals

4.4. Depressed moodsDepressed moods

5.5. Strict dieting followed by eating bingesStrict dieting followed by eating binges

6.6. Increased criticism of one’s bodyIncreased criticism of one’s body

Adapted from National Collegiate Athletic Association

Page 43: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

OsteoporosisOsteoporosisOsteoporosisOsteoporosis

Page 44: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

18201820 :Lobstein :Lobstein described a “deteriorated described a “deteriorated human bone” and defined this pathology human bone” and defined this pathology as “osteoporosis” (‘osteon’ + ‘porous’)as “osteoporosis” (‘osteon’ + ‘porous’)

19411941: Albrigth: Albrigth described osteoporosis as described osteoporosis as “ a decreased production of osteoid by the “ a decreased production of osteoid by the osteoblasts”osteoblasts”

OsteoporosisOsteoporosis First DescriptionsFirst Descriptions

Page 45: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Osteoporosis Osteoporosis Recent DefinitionsRecent Definitions

‘‘An age-related disorder characterized by a reduced An age-related disorder characterized by a reduced bone mass and an increase in susceptibility to bone mass and an increase in susceptibility to

fracture, in the absence of other recognisable causesfracture, in the absence of other recognisable causesof bone loss.of bone loss.

(Consensus Development Conference 1987)(Consensus Development Conference 1987)

‘‘An disorder characterized by increased skeletalAn disorder characterized by increased skeletalfragility due to decreased bone mass and to fragility due to decreased bone mass and to

microarchitectural deterioration of bone tissue. microarchitectural deterioration of bone tissue. (Consensus Development Conference 1996)(Consensus Development Conference 1996)

Page 46: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

OsteoporosisOsteoporosis

The principal complications of osteoporosis are the fractures in

particular sites:

• proximal femur

• Vertebral body

• Distal radius (Colle’s fracture)

Page 47: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Peak bone massPeak bone massPeak bone massPeak bone mass

Troughout childhood, bone mass Troughout childhood, bone mass increases linearly with skeletal growth.increases linearly with skeletal growth.

A rapid incresease in density occurs A rapid incresease in density occurs during puberty, as much as 40%.during puberty, as much as 40%.

Bone density continues to increase for Bone density continues to increase for several years until maximum bone mass is several years until maximum bone mass is

achieved achieved (peak bone mass)(peak bone mass)

Page 48: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Peak bone massPeak bone massPeak bone massPeak bone mass

Genetic Genetic InfluencesInfluences (75%)(75%)

Genetic Genetic InfluencesInfluences (75%)(75%)

MechanicalMechanical factorsfactors MechanicalMechanical factorsfactors

HormonalHormonal factorsfactors HormonalHormonal factorsfactors

NutritionalNutritional factorsfactors NutritionalNutritional factorsfactors

Peak Bone MassPeak Bone Mass

Page 49: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Bone remodellingBone remodellingannual rate of 25% in trabecular bone, annual rate of 25% in trabecular bone,

2-3% in compact, cortical bone2-3% in compact, cortical bone

Bone remodellingBone remodellingannual rate of 25% in trabecular bone, annual rate of 25% in trabecular bone,

2-3% in compact, cortical bone2-3% in compact, cortical bone

Page 50: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Age-related bone lossAge-related bone lossAge-related bone lossAge-related bone loss

Following attainment of peak bone mass, a Following attainment of peak bone mass, a gradual loss of bone occurs with ageing, in both gradual loss of bone occurs with ageing, in both sexes.sexes.

In women, bone loss before menopausa is small In women, bone loss before menopausa is small (<1% per annum), accelerating in the 5 years (<1% per annum), accelerating in the 5 years postmenopausal period to 1-2% per annum.postmenopausal period to 1-2% per annum.

Page 51: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

OsteoporosisOsteoporosisMain causesMain causes

OsteoporosisOsteoporosisMain causesMain causes

•• Estrogen deficiencyEstrogen deficiency•• inadeguate calcium intakeinadeguate calcium intake•• inadeguate physical activityinadeguate physical activity

Page 52: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Osteoporosis Osteoporosis EpidemiologyEpidemiology

Osteoporosis Osteoporosis EpidemiologyEpidemiology

OSTEOPOROSIS OSTEOPOROSIS interests two main groups of people:interests two main groups of people: •• women beyond menopausawomen beyond menopausa lack of estrogenslack of estrogens• • elderly women and men elderly women and men carence of vit D carence of vit D PTH PTH reducted physical activityreducted physical activity reducted calcium dietary apportreducted calcium dietary apport

Page 53: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Female young athletes at Female young athletes at risk of osteoporosisrisk of osteoporosis

Female young athletes at Female young athletes at risk of osteoporosisrisk of osteoporosis

Premature osteoporosis is not frequent in female Premature osteoporosis is not frequent in female athletes. It generally results as a conseguence athletes. It generally results as a conseguence of the secondary amenorrhea (lack of estrogens’ of the secondary amenorrhea (lack of estrogens’ influence on bone tissue) and the eating disorders influence on bone tissue) and the eating disorders (inadeguate calcium intake). (inadeguate calcium intake). So, the best way to prevent osteoporosis in female So, the best way to prevent osteoporosis in female athletes is to prevent , or correct at their onset,athletes is to prevent , or correct at their onset,the menstrual and the eating disorders . the menstrual and the eating disorders .

Page 54: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Eating disordersEating disorders

Inadeguate calcium Inadeguate calcium intakeintake

AmenorrheaAmenorrhea

Lack of estrogens Lack of estrogens Influence on bone tissueInfluence on bone tissue

OsteoporosisOsteoporosis

Female athlete triadeFemale athlete triade

Page 55: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Correlation between Correlation between bone density,mentrual function bone density,mentrual function

and physical activity and physical activity

Correlation between Correlation between bone density,mentrual function bone density,mentrual function

and physical activity and physical activity

0

20

40

60

80

100

120

140

160

180

Am Untrained Am runners Eu Untrained Eu runners

Bon

e M

iner

al C

onte

nt (

mg/

BS

A)

Bon

e M

iner

al C

onte

nt (

mg/

BS

A)

Am= Amenorrheic Eu= EumenorreichAm= Amenorrheic Eu= Eumenorreich

Page 56: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

In developing people exercise and a In developing people exercise and a

calcium rich diet allow the calcium rich diet allow the

achievement of an higher value of achievement of an higher value of

bone mass peak, that is a fondamental bone mass peak, that is a fondamental

step in the prevention of osteoporosisstep in the prevention of osteoporosis

OsteoporosisOsteoporosispreventionprevention

Page 57: The female athlete athlete The female athlete athlete Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004

Evidence certainly suggests that :Evidence certainly suggests that :

•• Increased physical activity Increased physical activity

•• adeguate calcium intake adeguate calcium intake

•• adeguate caloric intake adeguate caloric intake

is a sensible approach to preserve the is a sensible approach to preserve the

integrity of bone, at any ageintegrity of bone, at any age

OsteoporosisOsteoporosispreventionprevention