Although exercise is vital for the development of peak bone mass in childhood and adolescence, excessive and elite level exercise undertaken in the adolescent years may have detrimental effects on the attainment of peak bone mass.

Adolescent females and young women who are involved in high levels of training leading to amenorrhoea (menstruation stops) or disordered eating habits are at high risk of developing osteopaenia or osteoporosis.^74-79

It is known that athletes who continue to menstruate (have periods) tend to have normal or increased bone density, whereas athletes who do not menstruate have reduced bone density.⁸⁰ However the effects of cessation of menses on the skeleton can be affected by the type of sport. For example, high impact loading such as gymnastics can partially offset the negative effects of menstrual disturbances⁹⁹. Hence the emphasis on treatment should be to restore normal menstrual patterns. This may require making a change to training regimes and attention to diet ensuring that there is adequate intake of calories from a wide variety of foods.⁷⁶ It may also be necessary to consider the use of the oral contraceptive pill in young women to restore oestrogen levels to normal, and thereby menstruation, if reduction in exercise and dietary changes are unsuccessful.^81,82  At present, though, it is not clear how effective the use of the oral contraceptive is in improving bone mass in athletes with diminished bone density.

Content updated 27 July, 2011