EXERCISE, AMENORRHEA AND THE SKELETON

One of the accepted benefits of regular exercise is the development of increased bone mineral density (BMD) and hence a skeleton more capable of withstanding the rigours of physical activity throughout life. However an apparent paradox is seen in the observed decrease in lumbar BMD in female athletes who experience menstrual disturbance and athletic amenorrhoea (AA). Despite high levels of activity these athletes suffer the consequences of hormonal deficiency and are at risk of not achieving peak BMD and experiencing further bone loss. It is increasingly evident however that exercise itself continues to exert a protective effect of maintaining BMD at skeletal sites under physical stress. The observed increase then of stress fractures at these sites in amenorrhoeic athletes remains unexplained.