New study intervenes to help female collegiate distance runners eat enough

Photo by David Gonzalez

Like other athletes at risk, female collegiate distance runners are predisposed to develop bone stress injuries from a condition known as the female athlete triad triad, said Michael Fredericson, MD, a professor of orthopaedic surgery and sports medicine at Stanford, who has worked with Stanford athletes for more than 25 years.

The triad stems from an energy deficiency, he explained:

“When your body isn’t getting enough food, then you stop producing normal levels of sex hormones, which leads to menstrual dysfunction. Your growth hormones go down, so you lose muscle mass. Your thyroid hormones go down, so your metabolism gets suppressed. And your stress hormones go up, which also leads to menstrual dysfunction and reduced muscle mass. And all of that leads to lower bone density, and eventually osteopenia [low bone strength] or even osteoporosis.”

The problem is common. “Based on our historical data, 38 percent of our female runners developed stress fractures over a three-year period from 2010-2013,” Fredericson said. “I knew the time had come to do something to prevent this.”

He is investigating the effectiveness of a nutritional intervention, in collaboration with Aurelia Nattiv, MD, from the University of California, Los Angeles. They have enrolled about 180 male and female runners from Stanford and UCLA in their study.

“The goal is to have our runners eat 45 kcal/kg/fat free mass per day, which is really just a normal diet — so their energy input equals their energy output,” Fredericson said. “We found a third of the women were getting less than this and half of the men were getting less. So it’s fair to say that a significant number of our runners were not getting adequate nutrition or calories.”

The runners met individually with a sports dietician and filled out an extensive dietary questionnaire to estimate their food intake, Fredericson told me. A low-dose x-ray machine was also used to measure their bone density and basic blood work measured vitamin D and thyroid levels, he said. Finally, their risk of female athlete triad was assessed using an established point system.

After their health assessment, a dietician helped each runner select individual nutrition goals, like adding a snack or increasing the energy density of a current meal, Fredericson said. “We typically want them to eat smaller more frequent meals — particularly right before and immediately after exercising,” he said.

The runners also used an app developed by collaborators at UCLA, which provided an eight-week nutrition education curriculum, including handouts, video clips, recipes and behavior modifying exercises.

Although the researchers have only completed the first year of a three-year study, they have found their intervention is working. “A majority of the runners have increased their bone density over the one year period by 2 to 5 percent,” Fredericson said. “ Our preliminary findings also show for every one-point increase in risk score, there was a 17 percent increase in the time it took to recover after an injury. … Anecdotally, we are seeing less injuries and the type of injuries that we are seeing are less severe.”

He emphasized the importance of the work:

“We have a number of young women that are exercising at levels beyond their ability to support their nutritional requirements. By the time they enter college many of them have osteoporosis … Ours is the first attempt to address these issues in an organized study with elite athletes. We need to turn things around for these young women, and prevent more serious health problems later in life.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

CTs predict survival by measuring frailty following hip fractures, study shows

Photo by PublicDomainPictures

When elderly people fall, a hip fracture is a common and serious result. It is typically treated with surgery, but physicians need a better way to determine how frail a patient is in order to select the best surgical method. The need is great: Each year over 300,000 older people are hospitalized in the United States for hip fractures. These disabling injuries are associated with significant mortality, loss of independence and financial burden.

Now, a new research study led by radiologists from the University of California, Davis and Wake Forest Baptist medical centers may help guide these critical treatment decisions.

The research team performed a retrospective 10-year study of 274 patients who were 65 years or older and treated for hip fractures at the UC Davis Medical Center. Using CT images previously taken to diagnose the hip fracture, the researchers measured the size and density of the patients’ core muscles that stabilize the spine. They then compared the health of these core muscles with survival rates. The reported 1-year mortality rate after fracturing a hip is between 14 and 58 percent.

They found that hip-fracture patients with better thoracic (mid-upper back) core muscles had significantly better survival rates, whereas no significant trend was seen for patients with better lumbar (low back) muscles, as recently reported in the American Journal of Roentgenology.

Robert Boutin, MD, a radiologist at UC Davis and the lead author, summarized the importance of their results in a recent news release:

As patients age, it becomes increasingly important to identify the safest and most beneficial orthopaedic treatments, but there currently is no objective way to do this. Using CT scans to evaluate the muscles is addition to hip bones can help predict longevity and personalize treatment to a patient’s needs. We’re excited because information on muscles is included on every routine CT scan of the chest, abdomen and pelvis, so the additional evaluations can be done without the costs of additional tests, equipment or software.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.