ArticleBone2012
Cortical microstructure and estimated bone strength in young amenorrheic athletes, eumenorrheic athletes and non-athletes.
Article in Bone, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
66 citing papers in PubMed, 4 syntheses or guidelines pooled it, 139 citations in OpenAlex.
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 2: Clinical Guidelines for Screening, Diagnosis, Treatment, and Return to Play for Adolescents and Adults.Sports medicine (Auckland, N.Z.) · 2026Guideline
- Does Swimming Exercise Impair Bone Health? A Systematic Review and Meta-Analysis Comparing the Evidence in Humans and Rodent Models.Sports medicine (Auckland, N.Z.) · 2024Pooled it
- Bone Quality in Competitive Athletes: A Systematic Review.Journal of musculoskeletal & neuronal interactions · 2023Pooled it
- Geometric and "True" Densitometric Characteristics of Bones in Athletes with Stress Fracture and Menstrual Disturbances: A Systematic Review.Sports medicine (Auckland, N.Z.) · 2019Pooled it
- Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.PM & R : the journal of injury, function, and rehabilitation · 2026Trial
- Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: the REFUEL randomized controlled trial.The American journal of clinical nutrition · 2022Trial
- Effects of Estrogen Replacement on Bone Geometry and Microarchitecture in Adolescent and Young Adult Oligoamenorrheic Athletes: A Randomized Trial.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2020Trial
- Hip structural analysis in adolescent and young adult oligoamenorrheic and eumenorrheic athletes and nonathletes.The Journal of clinical endocrinology and metabolism · 2013Trial
- Sport-Specific Impact Loading is Associated with Bone Mineral Density in Athletes: Implications for Relative Energy Deficiency in Sport (REDs) Assessment.Sports medicine (Auckland, N.Z.) · 2026Article
- From amenorrhea to pregnancy: spontaneous recovery of the female athlete triad during the COVID-19 pandemic.Archives of endocrinology and metabolism · 2026Article
- Dual-energy X-ray absorptiometry per cent fat Z-score as a predictor of menstrual status in adolescent and young adult female athletes.British journal of sports medicine · 2026Article
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model.Sports medicine (Auckland, N.Z.) · 2026Review
- Low Energy Availability and Its Impact on Bone Health and Metabolism in Athletes: A Narrative Review.Physiological research · 2025Review
- Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective Analysis.Journal of cachexia, sarcopenia and muscle · 2025Article
- The Women's Tennis Association (WTA) Multidisciplinary Education and Treatment Protocol for the Female Athlete Triad (1996-2022).Sports (Basel, Switzerland) · 2025Article
- 'Bone Health-Across a Woman's Lifespan'.Clinical endocrinology · 2025Review
- Lower Bone Mineral Density in Female Elite Athletes With Menstrual Dysfunction From Mixed Sports.Translational sports medicine · 2025Article
- New approach to identifying elite winter sport athletes' risk of relative energy deficiency in sport (REDs).BMJ open sport & exercise medicine · 2025Article
- Multi-organ transcriptome atlas of a mouse model of relative energy deficiency in sport.Cell metabolism · 2024Article
- Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes?Sports medicine (Auckland, N.Z.) · 2024Review
6 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
contextLower bone density in young amenorrheic athletes (AA) compared to eumenorrheic athletes (EA) and non-athletes may increase fracture risk during a critical time of bone accrual. Finite element analysis (FEA) is a unique tool to estimate bone strength in vivo, and the contribution of cortical microstructure to bone strength in young athletes is not well understood.
objectiveWe hypothesized that FEA-estimated stiffness and failure load are impaired in AA at the distal radius and tibia compared to EA and non-athletes despite weight-bearing exercise. DESIGN AND
settingCross-sectional study; Clinical Research Center SUBJECTS: 34 female endurance athletes involved in weight-bearing sports (17 AA, 17 EA) and 16 non-athletes (14-21 years) of comparable age, maturity and BMI OUTCOME MEASURES: We used HR-pQCT images to assess cortical microarchitecture and FEA to estimate bone stiffness and failure load.
resultsCortical perimeter, porosity and trabecular area at the weight-bearing tibia were greater in both groups of athletes than non-athletes, whereas the ratio (%) of cortical to total area was lowest in AA. Despite greater cortical porosity in EA, estimated tibial stiffness and failure load was higher than in non-athletes. However, this advantage was lost in AA. At the non-weight-bearing radius, failure load and stiffness were lower in AA than non-athletes. After controlling for lean mass and menarchal age, athletic status accounted for 5-9% of the variability in stiffness and failure load, menarchal age for 8-23%, and lean mass for 12-37%.
conclusionAA have lower FEA-estimated bone strength at the distal radius than non-athletes, and lose the advantage of weight-bearing exercise seen in EA at the distal tibia.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.