Diet, hormonal, and metabolic factors affecting bone mineral density in adolescent amenorrheic and eumenorrheic female runners.

Seven adolescent female runners with secondary amenorrhea and six adolescent eumenorrheic female runners received dietary supplements of 1200 mg calcium carbonate and 400 IU vitamin D/d for 12 months. Bone mineral density (BMD) of the axial skeleton was measured by dual photon densitometry at the beginning and end of the 12 month period. Plasma estradiol and ionized calcium concentration were also determined. Bone mineral density decreased in two of the amenorrheic subjects, with the lowest estradiol values concurrent with the severest training regimen and highest calcium intake. There was a significant decrease in plasma estradiol concentration in the amenorrheic runners (p less than 0.05). Plasma ionized calcium and estradiol explained 99% of the variation in BMD (r2 = 0.999). A significant inverse relationship between plasma estradiol and miles run/week was observed (r2 = -0.748). Adolescent female runners who train extensively and have low plasma estradiol levels may be adversely affecting BMD despite supplemental calcium and vitamin D intake.