title: Bone parameters in relation to attitudes and feelings associated with disordered eating in oligo-amenorrheic athletes, eumenorrheic athletes, and nonathletes.
abstract: OBJECTIVE
  Disordered eating may negatively impact bone in athletes. However, it is not known whether this effect is independent of the associated amenorrhea and relative hypercortisolemia. We aimed to compare attitudes, feelings, and cognitions associated with disordered eating using the Three-Factor Eating Questionnaire (TFEQ) and Eating Disorder Inventory-2 (EDI-2) in normal-weight oligomenorrheic athletes (OA), eumenorrheic athletes (EA), and nonathletes, and determine the associations with bone independent of confounders.
  
  
  METHODS
  109 OA, 39 EA, and 36 nonathletes (14-25 years) completed the TFEQ and EDI-2. Dual-energy X-ray absorptiometry was used to assess spine bone mineral density (BMD), and high-resolution pQCT to assess radius microarchitecture. We measured integrated cortisol (q 20', 11 PM-7 AM), bone formation (procollagen Type 1 N-terminal propeptide, P1NP), and resorption (C-telopeptide, CTX) markers in a subset.
  
  
  RESULTS
  OA had lower spine BMD Z-scores than EA. Cognitive eating restraint (CER), drive for thinness (DT), ineffectiveness, and interoceptive awareness (IA) were higher in OA than EA (p < 0.05); CER was higher in OA versus nonathletes (p = 0.03). Pulsatile cortisol was positively associated with DT, ineffectiveness, and IA (p < 0.03). CER was inversely associated with BMD Z-scores and P1NP, and ineffectiveness with radius cross-sectional area even after controlling for age, BMI, amenorrhea duration, and cortisol (p < 0.03).
  
  
  CONCLUSIONS
  Higher CER in athletes independently predicts lower BMD.
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Natalia
authors.initials: N
authors.lastname: Cano Sokoloff
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Eguiguren
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wargo
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.|Division of Sports Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Ackerman
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.|Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Baskaran
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.|Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts.
authors.forename: Vibha
authors.initials: V
authors.lastname: Singhal
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Hannah
authors.initials: H
authors.lastname: Clarke
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.
authors.forename: Meghan
authors.initials: M
authors.lastname: Slattery
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.|Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000503:physiopathology / Q000523:psychology*; D056352:Athletes / Q000523:psychology*; D001290:Attitude; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D024042:Collagen Type I / Q000097:blood; D003430:Cross-Sectional Studies; D004328:Drive; D004644:Emotions / Q000502:physiology*; D005247:Feeding Behavior / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D011347:Procollagen / Q000097:blood; D013851:Thinness / Q000523:psychology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D006854:Hydrocortisone
keywords: bone microarchitecture; bone mineral density; cognitive eating restraint; disordered eating; female athlete triad; oligomenorrhea
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