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 osteoblasts causing an increase in bone formation through androgen receptors in bone tissue. Anabolic steroids have revealed an increase in bone mineral content or bone mineral density and also decreased fat mass with an increase in lean body mass and muscle mass. It is found to have lessened bone pain in osteoporosis patients having a bone fracture, which is a favorable effect for elder osteoporosis patients.
What can it lead to?
When there is an imbalance between exercise and nutrition, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Bone stress injuries which include fractures and stress reactions, are more commonly observed in female athletes with menstrual irregularities and/or low bone mineral density (BMD). A prevalent injury among sports, stress fractures are frequently challenging to detect. A stress fracture is a fatigue-induced bone fracture that occurs due to repeated applications of stress for a prolonged period. They occur because of a disturbance in the equilibrium between bone formation and resorption.
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 lead to 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. Anabolic steroids have emotional effects, causing athletes to train more intensely and more frequently. This can result in premature deaths, especially suicide and acute myocardial infarction are more common with its use.
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 optimize bone health, adequate nutrition, appropriate weight-bearing exercise, strength training, and adequate intake of calcium and vitamin D are necessary throughout life. Dairy products, leafy green vegetables, and fortified foods are some 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.
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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 vascularization and cellularity, and associated microdamage of collagen fibers following repetitive loading stress.
Understanding the impact of bone loss in women athletes
Women athletes are particularly prone to bone density disorders. Bone loss severity ranges from osteopenia to osteoporosis. They are more likely to develop osteoporosis due to decreased bone accrual during their youth, which is frequently linked to hormonal imbalances and/or excessive physical activity. Low bone mass presents a unique challenge for athletes because it increases their susceptibility to stress-related bone injuries as well as their risk of osteoporosis and insufficiency fractures as they age. Many women athletes with amenorrhea experience stress fractures. Amenorrhea occurs when a woman misses one or more menstrual periods. It occurs as a result of estrogen deficiency, which affects peak bone mass.
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 behavior.
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 emphasize 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 disorders can 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.
(Author: Dr. Ayyappan V Nair, Consultant – Shoulder Surgery, Sports Medicine and Arthroscopy, Manipal Hospital Whitefield, Sarjapur and Jayanagar)