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Osteoporosis in young athletes

October 20, 2013
World Osteoporosis Day, on October 20 2013, is a global awareness-raising event. The theme this year is osteoporosis in women over 50 who have passed through the menopause. One in two such women are likely to have osteoporosis and be at risk of bone fractures of the hip, wrist and vertebrae. Men can be affected too, as our article on osteoporosis and fractures explains. And, as Dr Millicent Stone, Consultant Rheumatologist at The Physicians’ Clinic and The London Bridge Hospital illustrates in this article, a small proportion of the 3 million people with osteoporosis in the UK are actually young and very fit. “Generally, osteoporosis is rare in young people but a subgroup of young athletes is at great risk because of their lifestyle. It is particularly a problem in young women, who may be ballet dancers, figure skaters, swimmers, gymnasts or cross country runners, are very fit, they do regular vigorous exercise, but they keep their body weight low,” says Dr Stone. However, she stresses that the risk of osteoporosis can also be high in young male athletes (gymnasts, runners, swimmers – even rugby players) and she has advised several high profile male olympic athletes on this issue.

Why are young athletes at risk?

Dr Stone and her group have recently coined the term ‘BAD’ (Boy Athlete Disease), which describes the impact of developing osteoporosis in young male athletes. Their symptoms are the same, apart from the issue with periods, but they do experience hormonal deficiencies and bone weakness and need the same support, diagnosis and treatments.

What other symptoms do these athletes have?

As well irregular periods in female athletes, other symptoms can indicate osteoporosis may be likely:
  • Constant tiredness and fatigue
  • Finding it difficult to sleep, poor sleep patterns
  • Losing more hair than usual
  • Having cold feet and hands
  • Problems with dry skin
  • Slow healing of cuts and bruises
  • Stress fractures
“This condition is not all or nothing. A continuum exists in which young athletes can be at risk of osteoporosis and fractures even though their symptoms may be less severe – girls may have irregular periods rather than no periods, for example, Detecting which athletes are at risk early on in the process is vital to preventing severe life-long effects on the skeleton.”

Diagnosing osteoporosis in young athletes

Although the only way to officially diagnose osteoporosis is to perform a DEXA bone scan, Dr Stone often uses an ultrasound scan of the athlete’s heel. “I have an ultrasound in my clinic to give an indication of increased fracture risk in young athletes. We then generally follow up with a DEXA scan and if bone loss is apparent, treatment then involves working with Consultant Orthopaedic Surgeon Mr Gavin Jennings and Sports Medicine Physician Dr Julian Widdowson in a multidisciplinary setting. Our team has been screening male and female athletes at risk and we recently presented our findings from a cohort of rugby players at an international dance symposium. The evidence we have is that ultrasound does detect fracture risk in elite athletes – even if it can’t give a definitive diagnosis of osteoporosis.”

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