The impact of high level basketball competition, calcium intake, menses, and hormone levels in adolescent bone density: a three-year follow-up.

AIM: The main goal of the present work is to establish the positive influence high-impact physical exercise, specifically high-level basketball, on bone acquisition in adolescent female and verify if the long-term exposure to such programs is the major modifiable factor explaining bone acquisition during adolescence. METHODS: A prospective cohort study comparing the development of bone mass in the lumbar spine, proximal femur and distal radius was carried out over a three-year period in two groups of adolescents: elite basketball players and age-matched controls. Baseline hormone levels and bone remodelling were evaluated. Bone mass, hours of physical exercise, diet, unhealthy habits, anthropometry and menstrual cycle were assessed at baseline and yearly. Differences in acquisition of bone mass were assessed by two-way repeated measures analysis of variance (ANOVA). RESULTS: Elite basketball training and competition appears to increase bone mass in girls aged 14-18 years. The most pronounced benefits were observed in lumbar spine and proximal femur, sites most directly involved in the exercise and subjected to greatest impact. CONCLUSION: The intensive basketball training and competition in adolescent females increases bone mass in the lumbar spine and femur, skeletal sites submitted to high impact in this sport. No significant gain in bone mass was observed in age-matched, normally active, controls.

[Guide for the prevention and treatment of glucocorticoid-induced osteoporosis of the Spanish Society of Internal Medicine]. / Guía de prevención y tratamiento de la osteoporosis inducida por glucocorticoides de la Sociedad Española de Medicina Interna.

Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.