Bone parameters in relation to attitudes and feelings associated with disordered eating in oligo-amenorrheic athletes, eumenorrheic athletes, and nonathletes


  • female athlete triad;
  • oligomenorrhea;
  • disordered eating;
  • cognitive eating restraint;
  • bone microarchitecture;
  • bone mineral density



Disordered eating may negatively impact bone in athletes. However, it is not known whether this effect is independent of the associated amenorrhea and relative hypercortisolemia. We aimed to compare attitudes, feelings, and cognitions associated with disordered eating using the Three-Factor Eating Questionnaire (TFEQ) and Eating Disorder Inventory-2 (EDI-2) in normal-weight oligomenorrheic athletes (OA), eumenorrheic athletes (EA), and nonathletes, and determine the associations with bone independent of confounders.


109 OA, 39 EA, and 36 nonathletes (14–25 years) completed the TFEQ and EDI-2. Dual-energy X-ray absorptiometry was used to assess spine bone mineral density (BMD), and high-resolution pQCT to assess radius microarchitecture. We measured integrated cortisol (q 20′, 11 PM–7 AM), bone formation (procollagen Type 1 N-terminal propeptide, P1NP), and resorption (C-telopeptide, CTX) markers in a subset.


OA had lower spine BMD Z-scores than EA. Cognitive eating restraint (CER), drive for thinness (DT), ineffectiveness, and interoceptive awareness (IA) were higher in OA than EA (p < 0.05); CER was higher in OA versus nonathletes (p = 0.03). Pulsatile cortisol was positively associated with DT, ineffectiveness, and IA (p < 0.03). CER was inversely associated with BMD Z-scores and P1NP, and ineffectiveness with radius cross-sectional area even after controlling for age, BMI, amenorrhea duration, and cortisol (p < 0.03).


Higher CER in athletes independently predicts lower BMD. © 2015 Wiley Periodicals, Inc (Int J Eat Disord 2015).


Autor / Fonte:Natalia Cano Sokoloff, Maria L Eguiguren, Katherine Wargo, Kathryn E Ackerman, Charumathi Baskaran, Vibha Singhal, Hannah Clarke, Meghan Slattery, Hang Lee, Kamryn T Eddy, Madhusmita Misra International Journal of Eating Disorders 2015 March 30