Osteoporosis in Sports: Physical Activity, Management of Athletes Osteoporosis

Subarna Debbarma (BPT, DNHE)
Osteoporosis in Sports: Physical Activity, Management of Athletes Osteoporosis

Osteoporosis is a major health problem in sports characterized by compromised bone strength predisposing patients to an increased risk of fracture. It has a complex etiopathogenesis, and may cause morbidity and mortality in elderly men and women. 

Osteoporosis most commonly affects postmenopausal women. The strategies for preventing osteoporotic fractures are maximizing peak bone mass, counteracting age and menopause related bone loss. The number of the people with osteoporosis increases as the population ages. Increasing number of patients with osteoporotic fractures may have a serious economic impact on society and on the quality of life of the patient. 

Awareness among clinicians and health care professionals on osteoporosis should be increased to overcome the burden of the disease. Although most of the osteoporotic fractures are treated by orthopedic surgeons, many patients with these problems are not diagnosed appropriately and treated for underlying osteoporosis. Early diagnosis of the disease is essential to prevent osteoporotic fractures and related mortality and morbidity. Indirect costs and sociologic and psychological impact of fractures should be evaluated together with the direct costs of the disease. 

Physical Activity and Osteoporosis

Physical activity is one of the major non-pharmacological methods for increasing and maintaining bone mineral density (BMD) and geometry. However, not all exercises are effective, so a prescription in terms of optimal type, intensity,frequency, and duration is required. Sport activity and exercise across the life span of the average female should be encouraged in the maintenance of bone health.

Athletes have a greater bone mineral density compared with non-active and physically active females. Participation in high school athletics is associated with greater BMD. Impact loading sports such as gymnastics, rugby, or volleyball tend to produce a better overall osteogenic response than sports without impact loading such as cycling, rowing, and swimming. Moderate impact exercise contributes to skeletal integrity even in older age

Tai Chi Chuan is a low- to moderate-intensity exercise particularly suitable for the elderly, and has been practiced by Chinese for centuries.Runners and swimmers and divers demonstrated some deficits in site-specific BMD values when compared with athletes in other sports . An elite Kenyan runner presented with a tibial fracture sustained during an international cross-country race . 

There was no clear history of symptoms suggestive of preceding overload and no radiological features of stress fracture. He was found to have sustained an osteoporotic, insufficiency fracture. Competitive running prior to the perimenopausal period seems to be associated with improved hip BMD . 

However, continued competitive running during the perimenopausal period is not associated with prevention of a perimenopausal hip BMD decline.

In contrast, competitive running had little effect on peri-menopausal lumbar spine BMD. When treating a female athlete, athletic trainers should consider her mass and sport type with regard to her bone health.

The positive impact of sports participation on bone mass can be tempered by nutritional and hormonal status . Zinc deficiency may lead to the increase of endogenous heparin probably causing degranulation of mast cells and release of endogenous heparin, and an increase in the bone-resorbing effect of prostaglandin E2. Endogenous heparin and prostaglandin E2 are probably cofactors of parathyroid hormone and may have a role in the pathogenesis of senile osteoporosis enhancing the action of parathyroid hormone.

Therefore, zinc replacement by dietary zinc supplementation might be valuable to prevent osteoporosis.

Female Athlete in sports 

Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight,some female athletes may develop low energy availability or an eating disorder and subsequently amenorrhoea and a loss of bone mineral density. The three interrelated clinical disorders are referred to as the female athlete triad (FAT).A substantial number of high school athletes (78%) and a surprising number of sedentary students (65%) have one or more components of the triad.

A significant proportion of female athletes suffer from the components of the FAT. In addition, the FAT is also present in normal active females. Therefore, prevention of one or more of the FAT components should be geared toward all physically active girls and young women.In a study among elite Malaysian athletes, the prevalence of the FAT was low (1.9%), but the prevalence for individual triad component was high, especially in the leanness group.

The prevalence of subjects who were at risk of menstrual irregularity, poor bone quality, and eating disorders were 47.6%, 13.3%, and 89.2%, respectively, in the leanness group; and 14.3%, 8.3%, and 89.2%, respectively, in the non-leanness group

O. Sahap Atik study the prevalence of amenorrhea/oligomenorrhea in elite Iranian female athletes was investigated. It is found that 71 (9.0%) individuals had amenorrhea/oli-gomenorrhea, among those, 11 (15.5%) had polycystic ovary syndrome. Brazilian investigators studied the prevalence of FAT in adolescent elite women swimmers. 

The prevalence of FAT was low. However, a significant number of athletes presented a partial status of FAT, especially of disordered eating.They concluded that this study suggests the need to monitor the causes of these disorders to create preventive actions that will reverse or avoid the development of the syndrome, thus preserving the athletes’ health.

Management of Osteoporosis in sports athletes

For the management of disordered eating (DE) in athletes, an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration is necessary. It is also important to establish educational initiatives for preventing DE .

Also physical therapists must have an important role for recognizing, treating, and preventing the female athlete triad.

There is still a greater need for knowledge regarding the triad to be incorporated into physical therapy curriculums, continuing education programs, and professional practice.

Conclusion Osteoporosis in sports athletes

In conclusion, high-impact and resistive exercise in childhood appears to be an important determinant of future peak bone mass and bone strength. However, exercise throughout adolescence and adulthood is necessary for the preservation or the bone mass and bone strength.Exercise later in life should focus on balance training and muscle strengthening to reduce fall risk. Following the occurrence of osteoporotic vertebral or hip fractures,early mobilization and a multidisciplinary rehabilitation program is important for having the prefracture level of Activity.

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