athletes, osteoporosis is a common anomaly and is attributed to certain underlying factors or medical conditions that may contribute to both low bone mass and fertility issues in some cases. Hormones play a crucial role in both bone health and reproductive function. Hormonal imbalances lead to compensatory mechanisms that in turn increase the risk of bone fracture. Endurance athletes often experiences reduced food intake which results in reduced energy leading to decreased levels of sex hormones, which can cause physiologic changes that lead to relative osteoporosis despite the loading of the bone during exercise, which would normally increase bone mineral density. Inadequate intake of essential nutrients like calcium and vitamin D, which are crucial for bone health, is also a major contributor to low bone mass. Athletes may have higher nutritional needs due to increased energy expenditure.
Where does anabolic steroids play a part in it?
Anabolic steroids, which are synthetic variations of the male sex hormone testosterone, can have both positive and negative effects on bone health, depending on various factors such as dosage, duration of use, and individual susceptibility. Androgen primarily stimulate bone forming osteoblastscausing an increase in bone formation through androgen receptors in bone tissue.
Consequences and other risk factors?
Anabolic steroids cause elevated Renal parameters. It also causes acute renal failure, focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis. Anabolic steroids can cause hypertension and cardiac hypertrophy. These steroids also may adversely affect serum lipids and increase the coagulability of blood, which may leadto a high incidence of myocardial infarction (heart attack) due to spasms, coronary thrombus and coronary atherosclerosis.
Lastly, the use of anabolic steroids has been indicated to develop dependency due to feelings of well-being leading to withdrawal symptoms such as depression and fatigue when they stop taking the same.
How can they manage it?
Nutrition counselling, exercise counselling and psychological therapy may all be necessary aspects of treatment. Athletes at risk for bone loss, such as those with a history of stress fractures or hormonal imbalances, may benefit from regular bone density monitoring. This can help identify potential issues early on.
To optimise bone health, adequate nutrition, appropriate weight-bearing exercise, strength training and adequateintake of calcium and vitamin D are necessary throughout life. Dairy products, leafy green vegetables and fortified foods aresome good sources of nutrition. In females, addressing the hypoestrogenic state by considering estrogen replacement has to have beneficial effects on bone mass. Maintain a healthy hormonal balance through proper nutrition, adequate calorie intake and regular menstrual cycles. It is important to avoid the non-medical use of anabolic steroids, as they can disrupt hormonal balance and negatively impact bone health. For stress fractures with delayed healing adjunctive medications like nasal calcitonin, bisphosphonates and recombinant parathyroid hormone are used to address low Bone mineral density. For athletes engaging in high-impact activities, wearing proper footwear with shock absorption can help reduce the stress on bones and joints. Anabolic steroid abuse can be managed by psychological therapies, endocrine therapies, antidepressants, pharmacological and psychosocial treatments, and overall awareness.
Surge in pectoralis major muscle injuries linked to sports and steroids
Rupture of the pectoralis major muscle used to be a rare injury. But recently we have seen an increase in the same with the majority needing surgical intervention. It is stated that this increase in incidence can be attributed to the increased participation in competitive-contact sports and weightlifting training in combination with the use of anabolic steroids, which probably resulted in stiffer tendons with less collagen elongation, increased vascularisation and cellularity and associated microdamage of collagen fibers following repetitive loading stress.
Nutrition and mental well-being
Our eating habits have an impact on our mental well-being. According to the American Dietetic Association, depression or other mental health issues cause people to eat excessively or insufficiently. Eating too little can result in low energy levels. Low energy levels in the body can be harmful to both bones and the ability to perform long-term tasks. Energy is required for bone formation and remodeling. An athlete requires adequate energy levels to support optimal body functions, macronutrient and micronutrient intake and body composition maintenance. Women experience mood swings during menstruation or in the days leading up to menstruation, which are caused by hormonal fluctuations and can hurt a female’s appetite control and eating behaviour. Athletes who eat too little or improperly may lose bone density. Athletes use the majority of their energy from eating to push their bodies through various exercises and activities. To maintain proper bone health, energy is required and some of the energy obtained from eating will be used for this purpose. Aside from menstruation, another factor contributing to improper eating is women’s perception of maintaining a healthy body weight. Women who participate in sports that emphasise leanness, weight class, or endurance are more likely to eat too little. However, to maintain body weight, only a small proportion of food is required; thus, diet intake should be carefully planned so that, in addition to small proportions, it meets nutritional requirements. Foods high in vitamin D and calcium are essential for maintaining strong bones. A menstruating women athlete should ensure that she consumes enough vitamin D and calcium. Inadequate energy intake, due to eating disorderscan cause suppression of the normal hypothalamus pituitary axis leading to low bone mass and amenorrhea, commonly referred to as female athlete syndrome. Early detection and multimodality treatment with focus on nutrition is required to maintain the bone health of women Athletes and should be given priority by woman athlete coaches and health care providers as well as educating female athlete on early detection and correction should be given utmost importance.
(The author, Dr. Ayyappan V Nair, is a consultant – shoulder surgery, sports medicine and Aathroscopy, at Manipal Hospital Whitefield, Sarjapur and Jayanagar.)
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