Athletic amenorrhea and its influence on skeletal integrity.

Athletic amenorrhea is seen frequently in competitive athletes and is strongly associated with diminished bone mineral density and disordered eating behavior. It is important, however, to note that most of the studies performed to date have been influenced significantly by selection bias. A recent Scandinavian study has shown that the great majority of women who exercise at regular and moderate levels are not at significant risk for athletic amenorrhea and its adverse effect on bone mineral density. Nevertheless, athletic amenorrhea should never be minimized when detected, and appropriate evaluation should be undertaken to prevent the adverse effects of prolonged amenorrhea on skeletal integrity.