title: Decreased nitric oxide levels and bone turnover in amenorrheic athletes with spinal osteopenia.
abstract: Amenorrheic athletes have been likened to postmenopausal women, with low estrogen levels and osteopenia. It has been suggested that estrogen exerts its antiresorptive actions on bone via a nitric oxide (NO)-dependent mechanism. This study investigated whether the mechanism of bone loss in amenorrheic athletes is similar to that of postmenopausal women with reduced NO levels and high bone turnover. Eleven amenorrheic athletes, 15 eumenorrheic athletes, and 10 sedentary controls were studied. Spine and hip bone mineral density was measured using dual-energy x-ray absorptiometry. Bone turnover was assessed by biochemical markers of formation (osteocalcin and bone-specific alkaline phosphatase) and resorption (deoxypyridinoline). NO metabolites were measured from 24-h urine samples using a chemiluminescence assay. Spine, but not hip, bone mineral density was reduced in the amenorrheic group, compared with the eumenorrheic (P = 0.0001) and control (P = 0.04) groups. Osteocalcin, bone-specific alkaline phosphatase, and deoxypyridinoline were similar in all groups. NO metabolites were lower in the amenorrheic group, compared with controls (P = 0.035), despite a higher dietary intake of nitrates. Unlike postmenopausal women, amenorrheic athletes do not have raised bone turnover but do have reduced NO metabolites and spinal osteopenia. The results show, however, that reduced NO production is a common denominator in both conditions and further support the importance of NO in estrogen-mediated protection of skeletal mass and strength.
authors.affiliation: Department of Physiology, Imperial College School of Medicine, London, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Stacey
authors.forename: P
authors.initials: P
authors.lastname: Korkia
authors.forename: M V
authors.initials: MV
authors.lastname: Hukkanen
authors.forename: J M
authors.initials: JM
authors.lastname: Polak
authors.forename: O M
authors.initials: OM
authors.lastname: Rutherford
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000568:Amenorrhea / Q000209:etiology / Q000378:metabolism*; D000596:Amino Acids / Q000652:urine; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000378:metabolism*; D016723:Bone Remodeling; D005260:Female; D006801:Humans; D009569:Nitric Oxide / Q000652:urine*; D015675:Osteocalcin / Q000097:blood; D017698:Postmenopause; D013122:Spinal Diseases / Q000378:metabolism*; D013177:Sports
chemical_list: D000596:Amino Acids; D015675:Osteocalcin; D009569:Nitric Oxide; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase