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Osteoporosis pp 101–107Cite as

Relative Energy Deficiency in Sport/Functional Hypothalamic Amenorrhea

Abstract

Functional hypothalamic amenorrhea (FHA) is a relatively common disorder in which patients develop secondary amenorrhea and are found to have low estrogen levels without evidence of organic abnormality. The etiology is disruption of the hypothalamic-pituitary-gonadal axis, which can be caused by weight loss, eating disorders, excessive exercise, or psychological stress.

Relative energy deficiency in sport (RED-S) is a type of FHA that occurs in athletes, wherein low energy availability affects multiple organ systems, including the bones. In addition to hypogonadism, patients with RED-S often have elevated cortisol and ghrelin, as well as lower leptin and insulin-like growth factor. Treatment of FHA requires an interdisciplinary approach and should focus on correcting the energy deficit. Oral contraceptives, bisphosphonates, and denosumab are not routinely recommended as treatment.

Keywords

  • Functional hypothalamic amenorrhea
  • Relative energy deficiency in sport
  • Female athlete triad
  • Bone mineral density
  • Hypogonadism

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Fig. 9.1

References

  1. Caronia LM, Martin C, Welt CK, Sykiotis GP, Quinton R, Thambundit A, Avbelj M, Dhruvakumar S, Plummer L, Hughes VA, Seminara SB, Boepple PA, Sidis Y, Crowley WF Jr, Martin KA, Hall JE, Pitteloud N. A genetic basis for functional hypothalamic amenorrhea. N Engl J Med. 2011;364(3):215–25.

    CAS  CrossRef  Google Scholar 

  2. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48:491–7.

    CrossRef  Google Scholar 

  3. Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52:687–97.

    CrossRef  Google Scholar 

  4. De Souza MJ, Williams NI, Nattiv A, et al. Misunderstanding the female athlete triad: refuting the IOC consensus statement on Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48:1461–5.

    CrossRef  Google Scholar 

  5. Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, Murad MH, Santoro NF, Warren MP. Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(5):1413–39. https://doi.org/10.1210/jc.2017-00131.

    CrossRef  PubMed  Google Scholar 

  6. Logue D, Madigan SM, Delahunt E, et al. Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance. Sports Med. 2018;48:73–96. https://doi-org.ezproxy.med.cornell.edu/10.1007/s40279-017-0790-3.

    CrossRef  Google Scholar 

  7. Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001;170(1):3–11. https://doi.org/10.1677/joe.0.1700003. PMID: 11431132.

    CAS  CrossRef  PubMed  Google Scholar 

  8. Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med. 2014;42(4):949–58. https://doi.org/10.1177/0363546513520295. Epub 2014 Feb 24. PMID: 24567250.

    CrossRef  PubMed  Google Scholar 

  9. Christo K, Prabhakaran R, Lamparello B, et al. Bone metabolism in adolescent athletes with amenorrhea, athletes with eumenorrhea, and control subjects. Pediatrics. 2008;121(6):1127–36. https://doi.org/10.1542/peds.2007-2392.

    CrossRef  PubMed  Google Scholar 

  10. Tenforde AS, Barrack MT, Nattiv A, Fredericson M. Parallels with the female athlete triad in male athletes. Sports Med. 2016;46(2):171–82. https://doi.org/10.1007/s40279-015-0411-y. PMID: 26497148.

    CrossRef  PubMed  Google Scholar 

  11. Michopoulos V, Mancini F, Loucks TL, Berga SL. Neuroendocrine recovery initiated by cognitive behavioral therapy in women with functional hypothalamic amenorrhea: a randomized, controlled trial. Fertil Steril. 2013;99(7):2084–91.e1. https://doi.org/10.1016/j.fertnstert.2013.02.036.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  12. Kunstel K. Calcium requirements for the athlete. Curr Sports Med Rep. 2005;4(4):203–6. https://doi.org/10.1097/01.CSMR.0000306208.56939.01.

    CrossRef  PubMed  Google Scholar 

  13. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.

    CAS  CrossRef  Google Scholar 

  14. Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH. Treatments to prevent bone loss in functional hypothalamic amenorrhea: a systematic review and meta-analysis. J Endocr Soc. 2017;1(5):500–11. Published 2017 Apr 26. https://doi.org/10.1210/js.2017-00102.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

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Haseltine, K., Starr, J. (2021). Relative Energy Deficiency in Sport/Functional Hypothalamic Amenorrhea. In: Cusano, N.E. (eds) Osteoporosis. Springer, Cham. https://doi.org/10.1007/978-3-030-83951-2_9

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  • DOI: https://doi.org/10.1007/978-3-030-83951-2_9

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