Young People Get Osteoporosis Too 

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Fitness & Bone Health:
The Skeletal Risk of Overtraining

Are you exercising too much? Eating too little? Have your periods become irregular or stopped? If so, you may be putting yourself at high risk for several serious health problems that could affect your health, your ability to remain active, and your risk for injuries. You also may be putting yourself at risk for developing osteoporosis, a disease in which bone density is decreased, leaving your bones vulnerable to fracture (breaking).

Why is missing my period such a big deal?
Some athletes see amenorrhea (the absence of menstrual periods) as a sign of appropriate levels of training. Others see it as a great answer to a monthly inconvenience. And some young women accept it blindly, not stopping to think of the consequences. But missing your menstrual periods is often a sign of decreased estrogen levels. And lower estrogen levels can lead to osteoporosis, a disease in which your bones become brittle and more likely to break.

Usually, bones become brittle and break when women are much older, but some young women, especially those who exercise so much that their periods stop, develop brittle bones and may start to have fractures at a very early age. Some 20-year-old female athletes have been described as "having the bones of an 80-year-old woman." Even if bones don't break when you're young, low estrogen levels during the peak years of bone-building, the pre-teen and teen years, can affect bone density for the rest of your life. And studies show that bone growth lost during these years may not ever be regained.

Broken bones don't just hurt--they can cause lasting deformities. Have you noticed that some older women and men have a stooped posture? This is not a normal sign of aging. Fractures from osteoporosis have left their spines permanently altered.

By the way, missing periods isn't the only problem. Not eating adequate amounts of calcium and vitamin D (among other nutrients) can also cause bone loss, and may lead to decreased athletic performance, decreased ability to exercise or train at desired levels of intensity or duration, and increased risk of injury.

Who is at risk for these problems?
Girls and women who may be trying to lose weight by restricting their eating and/or engaging in rigorous exercise regimes are at risk for these health problems. This may include serious athletes, "gym rats" (who spend considerable amounts of time and energy working out), and/or girls and women who believe "you can never be too thin."

How can I tell if someone I know, train with, or coach may be at risk for bone loss, fracture and other health problems?

Here are some signs to look for:

* missed or irregular menstrual periods
* extreme and/or "unhealthy-looking" thinness
* extreme or rapid weight loss
* frequent dieting behaviors such as:
  - eating very little
  - not eating in front of others
  - trips to the bathroom following meals
  - preoccupation with thinness or weight
  - focus on low-calorie and diet foods
  - possible increase in the consumption of water and other no- and low-calorie foods and beverages (possible increase in gum chewing, as well)
  - limiting diet to one food group or eliminating a food group
* frequent intense bouts of exercise such as:
  - continuous exercise or training sessions (e.g., taking an aerobics class, then running five miles, then swimming for an hour, followed by weight-lifting, etc.)
  - an "I can't miss a day of exercise/practice" attitude
  - an overly anxious preoccupation with an injury
  - exercising in spite of conditions that might lead others to "take the day off," including illness, inclement weather, injury, etc.
* high levels of self-criticism and/or self-dissatisfaction
* high levels of psychological or physical stress, such as:
  - depression
  - anxiety or nervousness
  - inability to concentrate
  - low levels of self-esteem
  - feeling cold all the time
  - problems sleeping
  - fatigue
  - injuries
  - talking about weight constantly

How can I make necessary changes in the interest of my bone health?
If you recognize some of these signs in yourself, the best thing you can do is to begin eating a more healthful diet, including enough calories to support your activity level. It's best to check with a doctor to make sure your missed periods aren't a sign of some other problem, and to get his or her help as you work toward a more healthy balance of food and exercise. Also, a doctor can help you take steps to protect your bones from further damage.

What can I do if I suspect a friend may have some of these signs?
First, be supportive. Approach your friend or teammate carefully and sensitively. She probably won't appreciate a lecture about how she should be taking better care of herself. But maybe you could share a copy of this brochure with her, or suggest that she talk to a trainer, coach, or doctor about the symptoms she's experiencing.

My friend drinks a lot of diet sodas. She says that this helps keep her trim.
Often, girls and women who may be dieting will drink diet sodas rather than much-needed milk. (Milk and other dairy products are a good source of calcium, an essential ingredient for healthy bones.) Drinking sodas instead of milk can be a problem, especially during the teen years when peak bone growth occurs. If you (or your friend) find yourself addicted to sodas, try drinking half as many sodas each day, and gradually add more milk and dairy products to your diet. A frozen yogurt shake can be an occasional low fat, tasty treat. Or try a fruit smoothie made with frozen yogurt, fruit, and/or calcium-enriched orange juice!

My coach and I think I should lose just a little more weight. I want to be able to excel at my sport!
Years ago, it was not unusual for coaches to encourage athletes to be as thin as possible for many sports (dancing, gymnastics, figure skating, swimming, diving, running, etc.). However, many coaches are realizing that being too thin is unhealthy and can negatively affect performance. It is important to exercise and watch what you eat. However, it's also important to develop and maintain healthy bones and bodies. Without these, it will not matter how fast you can run, how thin you are, or how long you exercise each day. Balance is the key!!!

I'm still not convinced. If my bones become brittle, so what? What's the worst thing that could happen to me?
Brittle bones may not sound as scary as some other fatal or rare disease. The fact is, osteoporosis can be very painful. It can cause disability. Imagine having so many spine fractures that you've lost inches in height and walk bent over. Imagine looking down at the ground everywhere you go because you can't straighten your back. Imagine not being able to find clothes that fit you. Imagine having difficulty breathing and eating because your lungs and stomach are compressed into a smaller space. Imagine having difficulty walking, let alone exercising, because of pain and deformity. Imagine constantly having to be aware of what you are doing and having to do things so slowly and carefully because of a very real fear and dread of a fracture...a fracture that could lead to a drastic change in your life - including pain, loss of independence, loss of mobility, loss of freedom and more.

But osteoporosis isn't just an "older person's" disease. Young women also experience fractures. Imagine being sidelined because of a broken bone and not being able to get those good feelings you get from regular activity.

Eating for Healthy Bones:

How much calcium do I need?
It is very important to your bone health that you receive adequate daily amounts of calcium, vitamin D, phosphorus, and magnesium. These are the vitamins and minerals that are most influential in building bones and teeth. This chart will help you decide how much calcium you need.

Recommended Calcium Intakes (mg/day)





Source: National Academy of Sciences, 1997

Where can I get calcium and Vitamin D?
Dairy products are the primary food sources of calcium. Choose milk, yogurt, cheeses, ice cream, or products made or served with these choices to fulfill your daily requirement. Three servings of dairy products per day should give you at least 900 milligrams of calcium. Green vegetables are another source. A cup of broccoli, for example, has about 136 milligrams of calcium. Sunlight is one important source of vitamin D, but when the sun isn't shining, milk is also a good source of vitamin D.

Milk and Dairy Products

There are many great snack and meal items that contain calcium. With a little planning and "know how," you can make meals and snacks calcium-rich!

Wouldn't a tall, cold glass of this refreshing thirst quencher be great right now? If you're concerned about fat and calories, you can drink 1% or skim milk. You can drink it plain, or with a low/no-fat syrup or flavoring, such as chocolate syrup, vanilla extract, hazelnut flavoring, cinnamon, etc.

* Cheese is another winner...
Again, you can choose the low/no fat varieties. Use all different types of cheese for sandwiches, bagels, omelets, vegetable dishes, pasta creations...or as a snack by itself!

* Puddings (prepared with milk)...
You can now purchase (or make your own from a mix) a variety of flavors with little or no fat. Rocky road, butterscotch, vanilla, chocolate, pistachio....Try them all!

* Yogurt...
Add fruit. Eat it plain. Add a low/no fat sauce or syrup. No matter how you choose to eat this calcium-rich food, it remains a quick, easy, and convenient choice. It's also available in a variety of flavors. Try mocha-fudge-peppermint-swirl for the more adventurous at heart, and vanilla for the more traditional yogurt snacker!

* Frozen yogurt (or fat free ice cream)...
Everybody loves ice cream...And now, without the unnecessary fat grams, you can enjoy it more often! Mix yogurt, milk, and fruit to create a breakfast shake. Have a cone at lunchtime or as a snack. A scoop or two after dinner can be cool and refreshing.

What are other sources of calcium?
Many foods you already buy and eat may be "calcium-fortified". Try calcium-fortified orange juice or calcium-fortified cereal. Check food labels to see if some of your other favorite foods may be good sources of calcium. By the way, you can also take calcium supplements if you think you may not be getting enough from your diet.