Osteoporosis For Dummies
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You may remember the teenage angst of feeling "too fat," even when your weight barely touched the 100-pound mark. Teens today are as acutely aware of their weight, and many, if not most, teenage girls want to be thin. Unfortunately, the desire to be thin can lead to behaviors that can have disastrous consequences for bones down the road.

Because the teen years are so important in building the bone mass that you draw from for the rest of your life, behaviors aimed at staying thin, such as smoking and excessive dieting, will result in bone loss that can never be regained, even if you change behaviors as an adult.

For example, some teenage girls see smoking cigarettes as a way to curb their weight. One Japanese study showed teens that were concerned about their weight were four times more likely to start smoking. In fact, nearly 30 percent of American teenage girls are regular smokers.

Dieting and bone loss

Avoiding the "it's in to be thin" emphasis today is difficult, especially if you're young and impressionable. Being severely underweight can have devastating consequences to bone, especially if there is an associated eating disorder, such as anorexia and bulimia.

The American Psychiatric Society defines anorexia nervosa and bulimia nervosa in the following way:

Anorexia nervosa is

  • A refusal to maintain weight that's over the lowest weight considered normal for age and height
  • An intense fear of gaining weight or becoming fat, even though underweight
  • A distorted body image
  • In women, three consecutive missed menstrual periods without pregnancy

Doctors and counselors direct treatment of anorexia at achieving weight gain. When an anorexic reaches 90 percent of her normal body weight, her period usually resumes. Estrogen therapy may also help. Studies have shown that bone lost during this time period isn't easily regained, and the increased risk of fracture may be permanent, even with treatment.

Meanwhile, bulimia nervosa is

  • Recurrent episodes of binge eating, which means eating more than needed to satisfy hunger; (minimum average of two binge-eating episodes a week for at least three months)
  • A feeling of lack of control over eating during the binges
  • A regular use of one or more of the following to prevent weight gain:

• Self-induced vomiting

• Strict dieting or fasting

• Use of laxatives or diuretics

• Vigorous exercise

  • A persistent over-concern with body shape and weight

Bulimics aren't always underweight; many maintain their weight within normal limits and don't experience the stopping of menstrual periods and bone loss that anorexics do.

The female athlete triad

The female athlete triad may sound like some sort of Olympic event, but it actually describes a serious result of eating disorders combined with too much exercise. Young athletes involved in sports, such as ballet, gymnastics, and figure skating, where keeping their weight low is important, often suffer from this condition.

What causes this condition? The combination of stringent dieting and excessive exercise results in a loss of menstrual periods, which lowers estrogen levels. The outcome? The athlete lacks the nutrients to grow strong bones and hormones to maintain bone, which causes osteoporosis at a young age, leading to stress fractures and weakened bones that can last a lifetime.

A young athlete may seem to be taking in a normal number of calories, but the amount eaten may be far below what she needs because of her greatly increased physical activity.

The female athlete triad isn't an uncommon problem. In fact, among female athletes, the syndrome may be present in as many as 50 percent or more of athletes. If you're a parent, grandparent, or close friend of a young athlete, watch for these signs to see if the child is taking training to a dangerous level:

  • Loss of menstrual periods for three months in a row
  • Preoccupation with eating and/or using diet pills, laxatives, or diuretics
  • Frequent visits to the bathroom immediately after eating
  • Menstruation not begun by age 16
  • Always wearing baggy sweatshirts and pants so weight loss isn't evident

Girls with the female athlete triad may be put on hormone replacement therapy to supply necessary hormones. They also need to be under a physician's care.

If you're the relative, coach, or friend of a young athlete, how can you help them avoid the trap of the female athlete triad? Follow these three simple steps:

1. Don't emphasize winning as the most important thing.

The benefits of sports are many, and although winning is great, don't seek it at the price of permanent health problems.

2. Be aware.

Watch for the signs that your athlete is taking diet and exercise to an extreme, and don't wait until you notice everything is out of hand before doing something about it.

3. Take action.

Don't bury your head in the sand when you see signs. Don't assume that just talking to your athlete will fix the problem. Enlist the help of your doctor and the coach.

About This Article

This article is from the book:

About the book authors:

Carolyn Riester O'Connor, MD, is certified in bone densitometry and is a fellow of the American College of Rheumatology. Sharon Perkins, RN, is the coauthor of Breastfeeding For Dummies and Fertility For Dummies.

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