Disordered Eating, Menstrual Irregularity, and Bone Mineral Density in Female Runners

COBB, K. L., L. K. BACHRACH, G. GREENDALE, R. MARCUS, R. M. NEER, J. NIEVES, M. F. SOWERS, B. W. BROWN, JR., G. GOPALAKRISHNAN, C. LUETTERS, H. K. TANNER, B. WARD, and J. L. KELSEY. Disordered Eating, Menstrual Irregularity, and Bone Mineral Density in Female Runners. Med. Sci. Sports Exerc., Vol. 35, No. 5, pp. 711–719, 2003. Purpose: To examine the relationships between disordered eating, menstrual irregularity, and low bone mineral density (BMD) in young female runners. Methods: Subjects were 91 competitive female distance runners aged 18–26 yr. Disordered eating was measured by the Eating Disorder Inventory (EDI). Menstrual irregularity was defined as oligo/amenorrhea (0–9 menses per year). BMD was measured by dual x-ray absorptiometry. Results: An elevated score on the EDI (highest quartile) was associated with oligo/amenorrhea, after adjusting for percent body fat, age, miles run per week, age at menarche, and dietary fat, (OR [95% CI]: 4.6 [1.1–18.6]). Oligo/amenorrheic runners had lower BMD than eumenorrheic runners at the spine (-5%), hip (-6%), and whole body (-3%), even after accounting for weight, percent body fat, EDI score, and age at menarche. Eumenorrheic runners with elevated EDI scores had lower BMD than eumenorrheic runners with normal EDI scores at the spine (-11%), with trends at the hip (-5%), and whole body (-5%), after adjusting for differences in weight and percent body fat. Runners with both an elevated EDI score and oligo/amenorrhea had no further reduction in BMD than runners with only one of these risk factors. Conclusion: In young competitive female distance runners, (i) disordered eating is strongly related to menstrual irregularity, (ii) menstrual irregularity is associated with low BMD, and (iii) disordered eating is associated with low BMD in the absence of menstrual irregularity.