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Preventing Osteoporosis in Women Athletes
Stanton Davis, M.D.
WHAT IS IT? A common disorder affecting both women and men that leads to fragility fractures. WHO GETS IT? 25 million Americans (80% are women) A third of white women over age 65 have osteoporosis; lifetime risk of any fracture among white women Bone loss in women occurs most after menopause, when the rate of loss may be as high as 2% per year. RISK FACTORS for fracture
1.
Insufficient bone mass at time of maturity ***** Rapid loss of bone after menopause ***** Family history Fair skin and hair Northern European background Scoliosis Early menopause Slender built Excessive alcohol use Smoking Inactivity Malnutrition Low calcium intake High phosphate diet (sodas) High fiber High protein
WHY SHOULD I WORRY ABOUT IT?
Fractures increase exponentially with aging in both men and women of all races.
Bone density
Decreased bone mass(1.0-2.5 SDs) – hip fractures increased 2 ½ X; spine fracture increased 2X Severe osteoporosis(>2.5 SDs +fragility fracture) Bone Density determination- indicated for perimenopausal and postmenopausal women to determine their
need for hormone replacement therapy, patients with metabolic bone disease or high number of risk factors.
To monitor the effects of treatment.
The rate of active bone loss detected by breakdown products in urine (e.g. N-telopeptide, pyridinoline)
*** Thus your doctor now can determine bone mass (densitometer), the rate of bone breakdown (in urine),
and the risk of fragility fracture by your weight, fracture history and smoking history.
TREATMENT
Must rule out secondary medical causes first.
1.
PREVENTION
a. Maximize peak bone mass (achieved by age 25) by:
adequate caloric intake Calcium- taken throughout day, no dose larger than 500 mg (TABLE) Calcium carbonate requires acidity to be absorbed Calcium citrate normal menstrual status appropriate exercise 2.
INTERVENTION
a. For men and premenopausal women
Physiologic calcium Vit D (400-800 U/day) Adequate nutrition Exercise (impact exercises, strengthening, and balance training) ** tai chi chuan – most successful in decreasing falls** b. For postmenopausal women or sooner if appropriate due to risk factors (6-10 years rapid Estrogen (with progestin if no hysterectomy done)- decrease fracture rate 50-75%, live longer because of reduced cardiovascular disease but potentially increase risk of breast CA Alendronate (Fosamax)- 5 mg/d for mild-mod, 10 mg/d if mod-severe Calcitonin (Miacalcin)- 200 U/d via nasal spray for mild bone loss, new fractures, bone pain Pamidronate (IV infusion) Paget’s disease or malignancy Raloxifene (Evista)- an antiestrogen approved for prevention **Not FDA approved/ experimental- Tamoxifen, Monoflourophosphate (Monocal), 24mg elemental
fluoride/day, Slow-release sodium fluoride (under study)

Source: https://www.visittoc.com/provider-directory/uploads/DAVIS_preventing_osteoporosis_in_women_athletes.pdf