The IOC consensus statement: Beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S)

British Journal of Sports Medicine

Volumn 48, Issue 7, 2014, Pages 491-497

  Mountjoy, Margo ^a   Sundgot Borgen, Jorunn ^b   Burke, Louise ^c   Carter, Susan ^d   Constantini, Naama ^e   Lebrun, Constance ^f   Meyer, Nanna ^g   Sherman, Roberta ^h   Steffen, Kathrin ^b,i   Budgett, Richard ⁱ   Ljungqvist, Arne ⁱ  

^a MCMASTER UNIVERSITY   (Canada)

^b NORWEGIAN SCHOOL OF SPORT SCIENCES   (Norway)

^c AUSTRALIAN INSTITUTE OF SPORT   (Australia)

^d UNIVERSITY OF NORTHERN COLORADO   (United States)

^e HADASSAH HEBREW UNIVERSITY MEDICAL CENTER   (Israel)

^f UNIVERSITY OF ALBERTA   (Canada)

^g United States Olympic Committee   (United States)

^h Victory Program at McCallum Place ^*  (United States)

ⁱ Academic Medical Center VU University Medical Center   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

BONE DENSITY CONSERVATION AGENT;

ATHLETIC PERFORMANCE; BONE DENSITY; CALORIC INTAKE; CONFERENCE PAPER; CONSENSUS DEVELOPMENT; CONVALESCENCE; DIET SUPPLEMENTATION; ENERGY METABOLISM; ENERGY STORES, ENERGY DELIVERY AND SUBSTRATE UTILISATION DURING EXERCISE; FEMALE; FEMALE ATHLETE TRIAD; FOOD INTAKE/BODY WEIGHT REGULATION; HUMAN; MALE; METABOLIC DISORDER; METABOLISM; OSTEOPOROSIS; PHYSIOLOGY; RISK ASSESSMENT; SPORTS MEDICINE;

BONE MINERAL DENSITY; ENERGY STORES, ENERGY DELIVERY AND SUBSTRATE UTILISATION DURING EXERCISE; FOOD INTAKE/BODY WEIGHT REGULATION; OSTEOPOROSIS;

ATHLETIC PERFORMANCE; BONE DENSITY CONSERVATION AGENTS; DIETARY SUPPLEMENTS; ENERGY INTAKE; ENERGY METABOLISM; FEMALE; FEMALE ATHLETE TRIAD SYNDROME; HUMANS; MALE; METABOLIC DISEASES; RECOVERY OF FUNCTION; RISK ASSESSMENT; SPORTS MEDICINE;

EID: 84896346538     PISSN: 03063674     EISSN: 14730480     Source Type: Journal    
DOI: 10.1136/bjsports-2014-093502     Document Type: Article

References (144)

1. Olympic Charter. International Olympic Committee. Lausanne, Switzerland, 2011 http://www.olympic.org/Documents/olympic-charter-en.pdf (retrieved 23 Nov 2013)
2. Olympic Movement Medical Code. In force as from 1 Oct 2009. http://www.olympic. org/PageFiles/61597/Olympic-Movement-Medical-Code-eng.pd (retrieved 23 Nov 2013)
3. Committee Medical Commission Working Group Women in Sport:position stand on the female athlete triad.International Olympic Committee 2005. http://www. olympic.org/Documents/Reports/EN/en-report-917.pdf (Retrieved 23 Nov 2013)
4. IOC Consenus Statement on the Female Athlete Triad. 2005 http://www.olympic. org/Documents/Reports/EN/en-report-917.pd (Retrieved 23 Nov 2013)
5. Drinkwater BL, Nilson K, Ott S, et al. Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 1986;256:380-2
6. Nattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc 2007;39:1867-82
7. Loucks AB. Energy balance and body composition in sports and exercise. J Sports Sci 2004;22:1-14
8. Sundgot-Borgen J, Meyer NL, Lohman TG, et al. How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on ehalf of the Ad Hoc Research Working Group on Body Composition, Health and erformance, under the auspices of the IOC Medical Commission. Br J Sports Med 2013;47:1012-22
9. IOC Nutrition Working Group. Nutrition for Athletes: A Practical Guide to Eating for Health and Performance 2012
10. Loucks AB, Heath EM. Induction of low-T3 syndrome in exercising women occurs at a threshold of energy availability. Am J Physiol 1994;266(3 Pt 2):R817-23
11. Ihle R, Loucks AB. Dose-response relationships between energy availability and bone turnover in young exercising women. J Bone Miner Res 2004;19:1231-40
12. Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J Sports Sci 2011;29(Suppl 1):S7-15
13. Koehler K, Achtzehn S, Braun H, et al. Comparison of self-reported energy availability and metabolic hormones to assess adequacy of dietary energy intake in young elite athletes. Appl Physiol Nutr Metab 2013;38:725-33
14. Reed JL, De Souza MJ, Williams NI. Changes in energy availability across the season in Division I female soccer players. J Sports Sci 2013;31:314-24
15. Sundgot-Borgen J, Torstveit MK. Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 2010;20(Suppl 2):112-21
16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edn. Washington, DC: American Psychiatric Association, 2013
17. Stice E, South K, Shaw H. Future directions in etiologic, prevention, and treatment research for eating disorders. J Clin Child Adolesc Psychol 2012;41:845-55
18. Martinsen M, Sundgot-Borgen J. Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sports Exerc 2013;45:1188-97
19. ACOG Committee on Adolescent Health Care ACOG Committee Opinion No. 349, November 2006: menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol 2006;108:1323-8
20. American Society of Reproductive Medicine Practice Committee. Current evaluation of amenorrhea-has an update (reviewed June 2008). Fert Steril 2008;90:S219-25
21. Redman LM, Loucks AB. Menstrual disorders in athletes. Sports Med ;35:747-55
22. Abraham SF, Beumont PJ, Fraser IS, et al. Body weight, exercise and menstrual status among ballet dancers in training. Br J Obstet Gynaecol 1982;89:507-10
23. Dusek T. Influence of high intensity training on menstrual cycle disorders inathletes. Croat Med J 2001;42:79-82
24. Beals KA, Manore MM. Disorders of the female athlete triad among collegiate athletes. Int J Sport Nutr Exerc Metab 2002;12:281-93
25. De Souza MJ, Toombs RJ, Scheid JL, et al. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod 2010;25:491-503
26. Ellison PT, Lager C. Moderate recreational running is associated with lowered salivary progesterone profiles in women. Am J Obstet Gynecol 1986;154: 1000-3
27. Sonntag B, Ludwig M. An integrated view on the luteal phase: diagnosis and treatment in subfertility. Clin Endocrinol (Oxf) 2012;77:500-7
28. Wade GN, Jones JE. Neuroendocrinology of nutritional infertility. Am J Physiol Regul Integr Comp Physiol 2004;287:R1277-96
29. Areta JL, Burke LM, Ross ML, et al. Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. J Physiol 2013;591(Pt 9):2319-31.
30. Rickenlund A, Eriksson MJ, Schenck-Gustafsson K, et al. Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile. J Clin Endocrinol Metab 2005;90:1354-9.
31. Loucks AB, Thuma Jr. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab 2003;88:297-311.
32. Nappi RE, Facchinetti F. Psychoneuroendocrine correlates of secondary amenorrhea. Arch Womens Ment Health 2003;6:83-9.
33. Baxter-Jones AD, Faulkner RA, Forwood MR, et al. Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 2011;26:1729-39.
34. Seifert-Klauss V, Schmidmayr M, Hobmaier E, et al. Progesterone and bone: a closer link than previously realized. Climacteric 2012;15(Suppl 1):26-31.
35. Li D, Hitchcock CL, Barr SI, et al. Negative spinal bone mineral density changes and subclinical ovulatory disturbances-prospective data in healthy premenopausal women with regular menstrual cycles. Epidemiol Rev 2014;36:137-47.
36. Abu EO, Horner A, Kusec V, et al. The localization of androgen receptors in human bone. J Clin Endocrinol Metab 1997;82:3493-7.
37. Hind K, Truscott JG, Evans JA. Low lumbar spine bone mineral density in both male and female endurance runners. Bone 2006;39:880-5
38. Vanderschueren D, Vandenput L, Boonen S, et al. Androgens and bone. Endocr Rev 2004;25:389-425.
39. Vandenput L, Ohlsson C. Sex steroid metabolism in the regulation of bone health in men. J Steroid Biochem Mol Biol 2010;121:582-8
40. Fuqua JS, Rogol AD. Neuroendocrine alterations in the exercising human: implications for energy homeostasis. Metabolism 2013;62:911-21
41. Ackerman KE, Putman M, Guereca G, et al. Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes. Bone 2012;51:680-7
42. Lambrinoudaki I, Papadimitriou D. Pathophysiology of bone loss in the female athlete. Ann N Y Acad Sci 2010;1205:45-50
43. Keen AD, Drinkwater BL. Irreversible bone loss in former amenorrheic athletes. Osteoporos Int 1997;7:311-15
44. Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med 2013;6:173-81
45. McCabe MP, Smyth MP, Richardson DR. Current concept review: vitamin D and stress fractures. Foot Ankle Int 2012;33:526-33
46. Wentz L, Liu PY, Ilich JZ, et al. Dietary and training predictors of stress fractures in female runners. Int J Sport Nutr Exerc Metab 2012;22:374-82
47. Nattiv A. Stress fractures and bone health in track and field athletes. J Sci Med Sport 2000;3:268-79
48. Schnackenburg KE, Macdonald HM, Ferber R, et al. Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc 2011;43:2110-19.
49. Marx RG, Saint-Phard D, Callahan LR, et al. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med 2001;11:73-6.
50. Tenforde AS, Sayres LC, McCurdy ML, et al. Identifying sex-specific risk factors for stress fractures in adolescent runners. Med Sci Sports Exerc 2013;45:1843-51.
51. Duckham RL, Peirce N, Meyer C, et al. Risk factors for stress fracture in female endurance athletes: a cross-sectional study. BMJ Open 2012;19;2:pii e001920
52. Okamoto S, Arai Y, Hara K, et al. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: a case report. Sports Med Arthrosc Rehabil Ther Technol 2010;2:6.
53. Goolsby MA, Barrack MT, Nattiv A. A displaced femoral neck stress fracture in an amenorrheic adolescent female runner. Sports Health 2012;4:352-6
54. Constantini NW. Medical concerns of the dancer. Book of Abstracts, XXVII FIMS World Congress of Sports Medicine, Budapest, Hungary, 2002:151
55. Hagmar M, Hirschberg AL, Berglund L, et al. Special attention to the weight-control strategies employed by Olympic athletes striving for leanness is required. Clin J Sport Med 2008;18:5-9.
56. Thein-Nissenbaum JM, Rauh MJ, Carr KE, et al. Associations between disordered eating, menstrual dysfunction, and musculoskeletal injury among high school athletes. J Orthop Sports Phys Ther 2011;41:60-9.
57. Vanheest JL, Rodgers CD, Mahoney CE, et al. Ovarian Suppression Impairs Sport Performance in Junior Elite Female Swimmers. Med Sci Sports Exerc 2014;46:156-66.
58. http://www.wada-ama.org/en/world-anti-doping-program/ sports-and-anti-doping-organizations/international-standards/prohibited-list/
59. Vogt S, Heinrich L, Schumacher YO, et al. Energy intake and energy expenditure of elite cyclists during preseason training. Int J Sports Med 2005;26:701-6
60. Müller W, Groschl W, Müller R, et al. Underweight in ski jumping: the solution of the problem. Int J Sports Med 2006;27:926-34.
61. Baum A. Eating disorders in the male athlete. Sports Med 2006;36:1-6.
62. Ferrand C, Brunet E. Perfectionism and risk for disordered eating among young French male cyclists of high performance. Percept Mot Skills 2004;99(3 Pt 1):959-67
63. Dolan E, McGoldrick A, Davenport C, et al. An altered hormonal profile and elevated rate of bone loss are associated with low bone mass in professional horse-racing jockeys. J Bone Miner Metab 2012;30:534-42
64. Stewart AD, Hannan J. Total and regional bone density in male runners, cyclists, and controls. Med Sci Sports Exerc 2000;32:1373-7.
65. Hetland ML, Haarbo J, Christiansen C. Low bone mass and high bone turnover in male long distance runners. J Clin Endocrinol Metab 1993;77:770-5.
66. Smathers AM, Bemben MG, Bemben DA. Bone density comparisons in male competitive road cyclists and untrained controls. Med Sci Sports Exerc 2009;41:290-6.
67. Rector RS, Rogers R, Ruebel M, et al. Participation in road cycling vs running is associated with lower bone mineral density in men. Metabolism 2008;57:226-32.
68. Guillaume G, Chappard D, Audran M. Evaluation of the bone status in high-level cyclists. J Clin Densitom 2012;15:103-7.
69. Nichols JF, Palmer JE, Levy SS. Low bone mineral density in highly trained male master cyclists. Osteoporos Int 2003;14:644-9.
70. Hackney AC. Effects of endurance exercise on the reproductive system of men: the 'exercise-hypogonadal male condition'. J Endocrinol Invest 2008;31:932-8
71. Pernick Y, Nichols JF, Rauh MJ, et al. Disordered eating among a multi-racial/ ethnic sample of female high-school athletes. J Adolesc Health 2006;38:689-95.
72. Rhea DJ. Eating disorder behaviors of ethnically diverse urban female adolescent athletes and non-athletes. J Adolesc 1999;22:379-88.
73. Adams Hillard PJ. Menstruation in adolescents: what's normal? Medscape J Med 2008;10:295.
74. Fang J, Freeman R, Jeganathan R, et al. Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City. Ethn Dis 2004;14:280-4.
75. Lappe JM, Stegman MR, Recker RR. The impact of lifestyle factors on stress fractures in female Army recruits. Osteoporos Int 2001;12:35-42.
76. Kark S, Ochoa EA, Harris MM, et al. The Female Athlete Triad: Preliminary data from a multi-site study on triad and race. Med Sci Sports Exerc 2012; (in press)
77. Wright HH, Bota CR, Havemann-Nel L. White and black student athletes have a more favourable body composition and bone mineral density than non-athletes. Med Sci Sports Exerc 2012;44:269.
78. Quah YV, Poh BK, Ng LO, et al. The female athlete triad among elite Malaysian athletes: prevalence and associated factors. Asia Pac J Clin Nutr 2009;18: 200-8.
79. Jiang SD, Jiang LS, Dai LY. Mechanisms of osteoporosis in spinal cord injury. Clin Endocrinol (Oxf) 2006;65:555-65
80. Bragaru M, Dekker R, Geertzen JH, et al. Amputees and sports: a systematic review. Sports Med 2011;41:721-40.
81. Goosey-Tolfrey VL, Crosland J. Nutritional practices of competitive British wheelchair games players. Adapt Phys Activ Q 2010;27:47-59.
82. Ljungqvist A, Jenoure P, Engebretsen L, et al. The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. Br J Sports Med 2009;43:631-43.
83. Javed A, Tebben PJ, Fischer PR, et al. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc 2013;88: 996-1009.
84. Rumball JS, Lebrun CM. Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities. Clin J Sport Med 2005;15:320-5.
85. Mencias T, Noon M, Hoch AZ. Female athlete triad screening in National Collegiate Athletic Association Division I athletes: is the preparticipation evaluation form effective? Clin J Sport Med 2012;22:122-5.
86. Burke LM, Cox GR, Culmmings NK, et al. Guidelines for daily carbohydrate intake: do athletes achieve them? Sports Med 2001;31:267-99.
87. Ackland TR, Lohman TG, Sundgot-Borgen J, et al. Current status of body composition assessment in sport: review and position statement on behalf of the ad hoc research working group on body composition health and performance, under the auspices of the I.O.C. Medical Commission. Sports Med 2012;42:227-49
88. Martinsen M, Sundgot-Borgen J. The development of the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q). Med Sci Sports Exerc 2014 (In Press)
89. Fairburn CG, Cooper Z, O'Connor ME. Eating Disorder Examination (Edition 16.0D). In: Fairburn CG ed. Cognitive behavior therapy and eating disorders.New York: The Guilford Press, 2008:265-308.
90. De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014;48:289.
91. Bachrach LK, Sills IN. Clinical report-bone densitometry in children and adolescents. Pediatrics 2011;127:189-94.
92. Khan AA, Bachrach L, Brown JP, et al. Standards and guidelines for performing central dual-energy x-ray absorptiometry in premenopausal women, men, and children. J Clin Densitom 2004;7:51-64.
93. Duckham RL, Baxter-Jones AD, Johnston JD, et al. Does physical activity in adolescence have site and sex specific benefits on young adult bone size, content and estimated strength? J Bone Miner Res 2014;29:479-86.
94. Tenforde AS, Fredericson M. Influence of sports participation on bone health in the young athlete: a review of the literature. PM R 2011;3:861-7.
95. http://www.iscd.org/official-positions/2013-ascd-official-positions- adult/
96. Dueck CA, Matt KS, Manore MM, et al. Treatment of athletic amenorrhea with a diet and training intervention program. Int J Sport Nutr 1996;6:24-40.
97. Kopp-Woodroffe SA, Manore MM, Dueck CA, et al. Energy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program. Int J Sport Nutr 1999;9:70-88.
98. Guebels CP, Kam LC, Maddalozzo GF, et al. Active Women Before/After an Intervention Designed to Restore Menstrual Function: Resting Metabolic Rate and Comparison of Four Methods to Quantify Energy Expenditure and Energy Availability. Int J Sport Nutr Exerc Metab 2013; (in press).
99. Fredericson M, Kent K. Normalization of bone density in a previously amenorrheic runner with osteoporosis. Med Sci Sports Exerc 2005;37:1481-6.
100. Arends JC, Cheung MY, Barrack MT, et al. Restoration of menses with nonpharmacologic therapy in college athletes with menstrual disturbances: a 5-year retrospective study. Int J Sport Nutr Exerc Metab 2012;22:98-108.
101. Mallinson RJ, Williams NI, Olmsted MP, et al. A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration. J Int Soc Sports Nutr 2013;10:34.
102. Loucks AB, Verdun M, Heath EM. Low energy availability, not stress of exercise, alters LH pulsatility in exercising women. J Appl Physiol (1985) 1998;84:37-46
103. Blyth MJ, Diaz A. American Academy of Pediatrics Committee on Adolescence. Contraception and adolescents. Pediatrics 2007;120:1135-48.
104. Hergenroeder AC, Smith EO, Shypailo R, et al. Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months. Am J Obstet Gynecol 1997;176:1017-25.
105. Zhang MH, Zhang W, Zhang AD, et al. Effect of depot medroxyprogesterone acetate on bone mineral density in adolescent women. Chin Med J (Engl) 2013;126:4043-7.
106. Kaunitz AM, Arias R, McClung M. Bone density recovery after depot medrozyprogesterone acetate injectable contraception use. Contraception 2008;77:67-76.
107. Hartard M, Kleinmond C, Wiseman M, et al. Detrimental effect of oral contraceptives on parameters of bone mass and geometry in a cohort of 248 young women. Bone 2007;40:444-50.
108. Vescovi JD, Jamal SA, De Souza MJ. Strategies to reverse bone loss in women with functional hypothalamic amenorrhea: a systematic review of the literature. Osteoporos Int 2008;19:465-78.
109. Misra M, Prabhakaran R, Miller KK, et al. Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J Clin Endocrinol Metab 2008;93:1231-7.
110. Compston JE, McConachie C, Stott C, et al. Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study. Osteoporos Int 2006;17:77-84.
111. Ackerman KE, Misra M. Bone health and the female athlete triad in adolescentathletes. Phys Sports Med 2011;39:131-41.
112. Viapiana O, Gatti D, Dalle GR, et al. Marked increases in bone mineral density and biochemical markers of bone turnover in patients with anorexia nervosa gaining weight. Bone 2007;40:1073-7.
113. Nichols JF, Rauh MJ, Barrack MT, et al. Bone mineral density in female high school athletes: interactions of menstrual function and type of mechanical loading. Bone 2007;41:371-7.
114. Vicente-Rodriguez G. How does exercise affect bone development during growth? Sports Med 2006;36:561-9.
115. Michalopoulou M, Kambas A, Leontsini D, et al. Physical activity is associated with bone geometry of premenarcheal girls in a dose-dependent manner. Metabolism 2013;62:1811-18.
116. Maimoun L, Coste O, Philibert P, et al. Peripubertal female athletes in high-impact sports show improved bone mass acquisition and bone geometry. Metabolism 2013;62:1088-98.
117. Kitchin B. Nutrition counseling for patients with osteoporosis: a personal approach. J Clin Densitom 2013;16:426-31.
118. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.
119. Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010;95:4823-43.
120. Lovell G. Vitamin D status of females in an elite gymnastics program. Clin J Sport Med 2008;18:159-61.
121. Constantini NW, Arieli R, Chodick G, et al. High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med 2010;20:368-71.
122. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 2013;383:146-55.
123. Misra M, Klibanski A. Bone health in anorexia nervosa. Curr Opin Endocrinol Diabetes Obes 2011;18:376-82.
124. Cobb KL, Bachrach LK, Sowers M, et al. The effect of oral contraceptives on bone mass and stress fractures in female runners. Med Sci Sports Exerc 2007;39:1464-73.
125. Warren MP, Miller KK, Olson WH, et al. Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in women with hypothalamic amenorrhea and osteopenia: an open-label extension of a double-blind, placebo-controlled study. Contraception 2005;72:206-11.
126. Scheid JL, Toombs RJ, Ducher G, et al. Estrogen and peptide YY are associated with bone mineral density in premenopausal exercising women. Bone 2011;49:194-201.
127. Marini JC. Do bisphosphonates make children's bones better or brittle? N Engl J Med 2003;349:423-6.
128. Papapoulos SE, Cremers SC. Prolonged bisphosphonate release after treatment in children. N Engl J Med 2007;356:1075-6.
129. Canalis E. Update in new anabolic therapies for osteoporosis. J Clin Endocrinol Metab 2010;95:1496-504.
130. Eriksen EF, Halse J, Moen MH. New developments in the treatment of osteoporosis. Acta Obstet Gynecol Scand 2013;92:620-36.
131. Grinspoon S, Thomas L, Miller K, et al. Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. J Clin Endocrinol Metab 2002;87:2883-91.
132. Misra M, McGrane J, Miller KK, et al. Effects of rhIGF-1 administration on surrogate markers of bone turnover in adolescents with anorexia nervosa. Bone 2009;45:493-8.
133. Welt CK, Chan JL, Bullen J, et al. Recombinant human leptin in women with hypothalamic amenorrhea. N Engl J Med 2004;351:987-97.
134. Sienkiewicz E, Magkos F, Aronis KN, et al. Long-term metreleptin treatment increases bone mineral density and content at the lumbar spine of lean hypoleptinemic women. Metabolism 2011;60:1211-21.
135. Chou SH, Chamberland JP, Liu X, et al. Leptin is an effective treatment for hypothalamic amenorrhea. Proc Natl Acad Sci USA 2011;108:6585-90.
136. Sim I, Ebeling PR. Treatment of osteoporosis in men with bisphosphonates: rationale and latest evidence. Ther Adv Musculoskelet Dis 2013;5:259-67
137. Ebeling PR. Osteoporosis in men. Curr Opin Rheumatol 2013;25:542-52.
138. Thompson RA, Sherman RT. Eating disorders in sport. New York: Routledge, 2010.
139. Mitchell JE, Roerig J, Steffen K. Biological therapies for eating disorders. Int J Eat Disord 2013;46:470-7.
140. Skårderud F, Fladvad T, Garthe I, et al. Den dårlig ernærte utøveren. Vektreduksjon, kroppsmodifikasjon og spiseforstyrrelser i toppidrett. Retningslinjer for holdning og handling. Oslo: Olympiatoppen, 2012. http://www.olympiatoppen. no/fagomraader/idrettsernaering/ Fagstoff/page6827.html (accessed 4 June 2012)
141. Sutton L, Stewart AD. A professional discipline and inter-disciplinary toolkit. In: Stewart AD, Sutton L. eds Body composition in sport, exercise and health. Abingdon, UK: Routledge, 2012:187-208.
142. Jackson AS, Pollock ML. Practical assessment of body compositon. Phys Sports Med 1985;13:76-90.
143. Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med 2010;20:379-85.
144. Matheson GO, Shultz R, Bido J, et al. Return-to-play decisions: are they the team physician's responsibility? Clin J Sport Med 2011;21:25-30.