Old Bones in Young Bodies

American Fitness, Sept, 1999 by Christine F. Ridout

Low caloric intake and excessive exercise can often lead to osteoporosis--even in young women.

The bones of some young women, particularly athletes, are sometimes equivalent to the bones of 50- to 60-year-old women--and occasionally 70- or 80-year-old women. In one study, a roentgenogram (an X-ray of internal body structures) showed a young woman with a hip fracture, pelvic fracture and multiple stress fractures in her spine. Another study reported that poor bone formation in young women is "not just in the spine, but every place. These women have significantly lower bone densities throughout their entire bodies." The study, conducted by Barbara L. Drinkwater, Ph.D., a pioneer in osteoporosis research, cited the case of a woman who at 19 had a normal spine, but by age 23 had three vertebral fractures. "She will never have normal posture," she says. were not looking at a little old lady of 85. We're looking at a youngster."

Osteoporosis in young women sounds like a contradiction. After all, it is typically a disease found in older, post-menopausal women. Unfortunately, when young women, particularly athletes, maintain a low caloric intake and exercise to excess to keep their weight osteoporosis often results. This is particularly troubling because these are the years when young bodies should be building bone for the future, not losing it.

What is Osteoporosis?

Osteoporosis is a metabolic bone disease in which bones lose density and the spaces within them become enlarged, resulting in increased fragility and chance of breakage. It is a disease which is easier to prevent than treat.

The Causes of Osteoporosis in Young Women

Osteoporosis in young women usually results from disordered eating, low body weight and amenorrhea--the cessation of menstruation. For athletes, excessive exercise bordering on addiction is a major contributor. In addition, low calcium levels caused by constant dieting and calcium loss through sweating during exercise contribute to osteoporosis in young female athletes.

According to Dr. Mark Timmerman, assistant clinical professor in sports medicine at the University of Wisconsin and doctor of sports and family medicine at the Dean Clinic in Madison, Wisconsin, another problem in young female athletes is that 30 percent to 40 percent of them are anemic. Dr. Timmerman says young women concerned about their weight and athletic performance tend to eat low fat, higher fiber diets deficient in iron. The consequent anemia contributes to amenorrhea.

The focus on achieving or maintaining a specific body weight and shape contributes to osteoporosis. According to Dr. Kimberly K. Yeager, assistant director for Public Health Practice, San Diego State University, "There tends to be an increased incidence of osteoporosis among young women participating in appearance-based and endurance sports." This includes gymnastics, figure skating, ballet and running, where thin, girlish bodies are considered desirable. Women participating in these activities are believed to have higher levels of amenorrhea and osteoporosis than women in sports where weight and body type are not a major issue. Yeager found that "15.4 percent of college female swimmers were affected by eating disorders and amenorrhea, while the figure may be as high as 62 percent among gymnasts."

Dr. Ronald Young, director of the Division of Gynecology at Baylor College in Houston, Texas, says the need for calcium in both boys and girls increases dramatically around the time of puberty. For boys, this coincides with a period of life when food intake--particularly of calcium-rich foods--skyrockets. Girls, however, need calcium when they are beginning to worry about their figures, often trying to imitate the unrealistic bodies of fashion models and Barbie[R] dolls. Both caloric and calcium intake decline significantly when they should be trying to build bone.

Dr. Young says that between puberty and approximately age 30, young women should be acquiring bone mass. By 30, most women reach their maximum bone density, then level off and begin losing bone by age 35. This process accelerates considerably when estrogen levels decline after menopause. Dr. Young stresses anything that hinders bone development during puberty will hurt later in life. He has seen too many young women with bones "like their grandmothers'." Bone damage is cumulative and irreversible.

Exercise Addictions

In addition to disordered eating, young female athletes may be addicted to exercise. An exercise addiction damages a woman's body because there is no chance for the body to rest and repair itself. It also contributes to low body weight, amenorrhea and osteoporosis. Some of the hallmarks of exercise addiction are feeling angry or depressed when exercise is not possible, missing important events or not spending time with family or friends in favor of exercising, extreme fatigue and exercising even when sick.

Detection

Because it is a silent disease, there are no reliable statistics on how many young women have osteoporosis. Screening for osteoporosis is not routine in young women and is often not detected until fractures occur, sometimes accompanied by severe pain. According to doctors, however, there are several red flags which should not be ignored. The most important red flag is amenorrhea or other menstrual irregularities. "The cessation of menstruation should be like a smoke alarm going off," says Dr. Carol Otis in the Journal oft he American Medical Association. "It is a symptom of things going wrong." Abnormal menstruation is a marker of ovarian dysfunction and low estrogen levels.