ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2017
Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
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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
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Biochemical Responses to Experimentally Induced Short-Term Low Energy Availability in Athletes: A Systematic Review.Scandinavian journal of medicine & science in sports · 2026Pooled it
- 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
- 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
- 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
- Trial
- 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
- Menstrual Health in Servicewomen: The Menstrual Cycle, Menstrual Disturbances, and Occupational Consequences.Sports medicine - open · 2026Review
- Protecting women's health in sport: the role of low energy availability in the Female Athlete Triad and RED-S.Frontiers in sports and active living · 2026Review
- Low Energy Availability and Its Impact on Bone Health and Metabolism in Athletes: A Narrative Review.Physiological research · 2025Review
- Hormone Profiles After Planned Low Energy Availability Exposure in Naturally Menstruating and Hormonal Contraceptive Using Physique Athletes.European journal of sport science · 2025Observational
- Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective Analysis.Journal of cachexia, sarcopenia and muscle · 2025Article
- Effect of Transdermal Estrogen Therapy on Bone and Neurobehavioral Health in Youth with Premature Ovarian Insufficiency: A Case-Control Study.Journal of pediatric and adolescent gynecology · 2025Article
- The Women's Tennis Association (WTA) Multidisciplinary Education and Treatment Protocol for the Female Athlete Triad (1996-2022).Sports (Basel, Switzerland) · 2025Article
- New approach to identifying elite winter sport athletes' risk of relative energy deficiency in sport (REDs).BMJ open sport & exercise medicine · 2025Article
- Review
- 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
- The Prevalence of Stress Fractures and the Associated LEAF-Q Responses, Self-Reported Exercise Volume and Dietary Behaviors in Female Recreational Runners.International journal of exercise science · 2024Article
- Changes in the concentration of bone turnover markers in men after maximum intensity exercise.PeerJ · 2024Article
- Exercise training modifies the bone and endocrine response to graded reductions in energy availability in skeletally mature female rodents.Frontiers in endocrinology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Many female athletes are energy and/or estrogen deficient, but the independent effects on bone health have not been isolated. Energy deficiency was detrimental at the tibia while estrogen deficiency was detrimental at the radius. Nutrition must be considered alongside menstrual recovery when addressing compromised bone health in female athletes.
introductionThe purpose of this study was to describe volumetric bone mineral density (vBMD), bone geometry, and estimated bone strength in exercising women (n = 60) grouped according to energy status (energy replete (EnR: n = 30) vs. energy deficient (EnD: n = 30)) and estrogen status (estrogen replete (E
methodsEnergy status was determined using the ratio of measured to predicted resting energy expenditure (mREE/pREE). Estrogen status was based on self-reported menstrual status confirmed by daily evaluation of urinary estrone-1-glucoronide (E1G), pregnanediol glucuronide (PdG), and luteinizing hormone (LH). Eumenorrheic women were considered E
resultsEnD women exhibited lower total vBMD, trabecular vBMD, cortical area, and BSI at the distal tibia and lower total vBMD, smaller cortical area and cortical thickness, and larger endosteal circumference at the proximal tibia compared to EnR women (p < 0.042). E
conclusionsEfforts to correct energy deficiency, which in turn may promote reproductive health, are warranted in order to address the unique contributions of energy status versus estrogen status to bone health.
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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.