Female Athlete Triad Article Flashcards
How is low energy availability dx?
BMI <17.5 in adults <85% expected body wt in adolescents (<20 yo) Reduced resting metabolic rate (RMR) Low T3 Ratio of measured RMR/predicted RMR <0.9
What must be ruled out in primary & secondary amenorrhea?
Pregnancy Endocrinopathy (thyroid dysfxn, hyperprolactinemia, primary ovarian insufficiency, hypothalamic and pituitary disorders, hyperandrogenic cond) Outflow tract obstruction
How is daily energy availability defined?
Energy intake (kcal) - energy expenditure (kcal) / kilograms of fat free mass or lean body mass
How can the degree of hypoestrogenism be determined?
Serum oestradiol &/or progesterone challenge test
medroxyprogesterone acetate 10mg for 10 days
What should be measured if androgen excess is suspected?
Free testosterone
Dehydroepiandrosterone
DHEA
17-hydroxyprogesterone
What are high RF for getting DEXA scan?
h/o DMS-V dx eating d/o BMI <17.5, <85% est wt, OR recent wt loss >10% in 1 mo Menarche >16 yo Current or h/o <6 menses over 12 mo 2 prior stress fx 1 high risk stress fx Low energy non-traumatic fx Prior Z-score of
What are moderate RF for getting DEXA scan?
Current or h/o disordered eating BMI 17.5-18.5 <90% est wt Recent Wt loss of 5-10% in 1 mo Menarche 15-16 yo 6-8 menses over 12 mo 1 prior stress fx/rxn Prio Z score -1.0- -2.0
What medications warrant a DEXA scan?
> 6 mo of prednisone
depot medroxyprogesterone acetate
What should be assessed on DEXA scans in premenopausal women >20yo?
WB sites: posteroanterior spine, total hip, femoral neck
NWB sites: radius if WB sites cannot be assessed
What should be assessed on DEXA scans in children, adolescents and women <20yo?
Posteroanterior lumbar spine bone mineral content & areal BMD
Whole body BMC & areal BMD
Adjust for growth delay (height) or maturational delay (bone age)
Height-adjusted Z-scores
What is a clinically significant fracture in ages 5-9?
Long bone fx of LE
Vertebral compression fx
2 or more long bone fx of UE
What is low bone mineral content or areal bone mineral density in ages 5-9?
Z-score that is
What is low BMD & osteoporosis in premenopausal women?
Z-score
What are targets for low energy availability?
Reversal of recent wt loss
Return to body wt w/ normal menses
Wt gain to achieve BMI >18.5 or >90% predicted wt
Energy intake min of 2,000 kcal/day or more
What should prescribed changes in energy intake be to achieve BMI or wt goals?
20-30% inc in caloric intake over baseline energy needs
Gain 0.5 kg ~ 7-10 days
What can help to inc BMD?
Ca and Vit D
Wt gain in under wt
Return of menses
WB exercise
What medications can help tx bulimia nervosa?
Selective serotonin reuptake inhibitors
Who can respond to nutritional education alone?
Unintentional low energy availability pts
Disordered eating
Who needs mental health counseling with nutrition education?
Eating disorders
When should pharmacological therapy be considered in hypogonadism athletes?
Estrogen def: vaginal dryness and dysparenuia
Infertility
Impaired bone health despite non-pharm tx
What is IGF-1?
Bone trophic factor secreed by the liver in response to GH & produced locally in an autocrine manner by bone
How can IGF-1 be suppressed?
Amenorrheic pts
Exogenous estrogen by 1st pass effect
Which type of estrogen does not suppress IGF-1?
Transdermal and vaginal estrogen
What can exogenous testosterone help with?
Inc lean body mass and bone markers
Does not inc BMD
Which combo replacements has been shown to inc BMD?
Recombinant human IGF-1 with estrogen
Who is at risk of fx with Z-score of < -1.0?
High impact stress or repetitive stress athletes
What are the risks of long term bisphosphonate use?
Atypical femur fx
Osteonecrosis of the jaw
Why should bisphosphonate use be with caution in childbearing years?
Long half life and risk of teratogenicity
When can bisphosphonates be used in children?
Glucocorticoid induced osteoporosis
Osteogenesis imperfecta
