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
