Altered trabecular bone morphology in adolescent and young adult athletes with menstrual dysfunction

Abstract Context Young amenorrheic athletes (AA) have lower bone mineral density (BMD) and an increased prevalence of fracture compared with eumenorrheic athletes (EA) and non-athletes. Trabecular morphology is a determinant of skeletal strength and may contribute to fracture risk. Objectives To determine the variation in trabecular morphology among AA, EA, and non-athletes and to determine the association of trabecular morphology with fracture among AA. Design and setting A cross-sectional study performed at an academic clinical research center. Participants 161 girls and young women aged 14–26 years (97 AA, 32 EA, and 32 non-athletes). Main outcome measure We measured volumetric BMD (vBMD) and skeletal microarchitecture using high-resolution peripheral quantitative computed tomography. We evaluated trabecular morphology (plate-like vs. rod-like), orientation, and connectivity by individual trabecula segmentation. Results At the non-weight-bearing distal radius, the groups did not differ for trabecular vBMD. However, plate-like trabecular bone volume fraction (pBV/TV) was lower in AA vs. EA (p = 0.03), as were plate number (p = 0.03) and connectivity (p = 0.03). At the weight-bearing distal tibia, trabecular vBMD was higher in athletes vs. non-athletes (p = 0.05 for AA and p = 0.009 for EA vs. non-athletes, respectively). pBV/TV was higher in athletes vs. non-athletes (p = 0.04 AA and p = 0.005 EA vs. non-athletes), as were axially-aligned trabeculae, plate number, and connectivity. Among AA, those with a history of recurrent stress fracture had lower pBV/TV, axially-aligned trabeculae, plate number, plate thickness, and connectivity at the distal radius. Conclusions Trabecular morphology and alignment differ among AA, EA, and non-athletes. These differences may be associated with increased fracture risk.