title: Altered trabecular bone morphology in adolescent and young adult athletes with menstrual dysfunction.
abstract: BACKGROUND
  Young amenorrheic athletes (AA) have lower bone mineral density (BMD) and an increased prevalence of fracture compared with eumenorrheic athletes (EA) and non-athletes. Trabecular morphology is a determinant of skeletal strength and may contribute to fracture risk.
  
  
  OBJECTIVE
  To determine the variation in trabecular morphology among AA, EA, and non-athletes and to determine the association of trabecular morphology with fracture among AA.
  
  
  METHODS
  A cross-sectional study performed at an academic clinical research center.
  
  
  METHODS
  161 girls and young women aged 14-26 years (97 AA, 32 EA, and 32 non-athletes).
  
  
  METHODS
  We measured volumetric BMD (vBMD) and skeletal microarchitecture using high-resolution peripheral quantitative computed tomography. We evaluated trabecular morphology (plate-like vs. rod-like), orientation, and connectivity by individual trabecula segmentation.
  
  
  RESULTS
  At the non-weight-bearing distal radius, the groups did not differ for trabecular vBMD. However, plate-like trabecular bone volume fraction (pBV/TV) was lower in AA vs. EA (p=0.03), as were plate number (p=0.03) and connectivity (p=0.03). At the weight-bearing distal tibia, trabecular vBMD was higher in athletes vs. non-athletes (p=0.05 for AA and p=0.009 for EA vs. non-athletes, respectively). pBV/TV was higher in athletes vs. non-athletes (p=0.04 AA and p=0.005 EA vs. non-athletes), as were axially-aligned trabeculae, plate number, and connectivity. Among AA, those with a history of recurrent stress fracture had lower pBV/TV, axially-aligned trabeculae, plate number, plate thickness, and connectivity at the distal radius.
  
  
  CONCLUSIONS
  Trabecular morphology and alignment differ among AA, EA, and non-athletes. These differences may be associated with increased fracture risk.
authors.affiliation: Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. Electronic address: dmmitchell@mgh.harvard.edu.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Mitchell
authors.affiliation: Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Padrig
authors.initials: P
authors.lastname: Tuck
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02116, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Ackerman
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Cano Sokoloff
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Woolley
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Slattery
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bouxsein
authors.affiliation: Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000150:complications*; D056352:Athletes; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D020342:Finite Element Analysis; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Amenorrhea; Athlete; Bone density; Microarchitecture