Sports Endocrine Research
The female athlete triad is the interrelationship of amenorrhea, low energy availability, and decreased bone mineral density. Many young female athletes are afflicted with some aspect of this condition. It has been determined that up to 69% of women participating in sports such as running experience menstrual dysfunction, as compared to only 2-5% of the general population. A major concern associated with the female athlete triad is low bone mineral density. Decreased bone mineral density has been reported in 22-50% of female athletes as compared to 12% of the normal population. Decreased bone mineral density during adolescence puts these athletes at higher fracture risk. Therefore, it is imperative to address this serious and widespread issue.
Bionutritionist Tara Holmes obtaining readings during the VO2 endurance test.
Our research group has made significant progress in investigating this condition within a population of teenage girls and young adult women. In an effort to adapt the treatment model for this disorder, we hope to further elucidate the factors that lead to menstrual dysfunction in some but not all athletes. We are also exploring associations of components of the triad with bone structure and strength, hormone levels, body composition, and other clinical variables.
Current research studies are aimed at further investigating:
Our group has demonstrated that low bone density is prevalent in adolescent girls and boys with anorexia nervosa and is associated with decreased bone turnover. Hormonal alterations that predict low bone density in this disorder include hypogonadism, a nutritionally acquired resistance to growth hormone effects, and high cortisol levels. Weight gain and resumption of menses are associated with some improvement in bone parameters, however, residual deficits persist, raising concerns regarding inadequate catch-up and suboptimal peak bone mass acquisition. Studies exploring possible therapeutic strategies to improve bone density in teenagers with anorexia nervosa are ongoing.
Our group has demonstrated that growth hormone and cortisol status are important determinants of visceral fat and cardiometabolic risk in teenagers with obesity. We are currently evaluating the effect of low dose growth hormone administration on body composition and cardiometabolic risk in obese adolescent girls.
| Anne Klibanski, MD
Laurie Carrol Guthart Professor of Medicine, Harvard Medical School
Chief, Neuroendocrine Unit, Massachusetts General Hospital
Phone: 617 726 3870 Fax: 617 726 5072
| Madhusmita (Madhu) Misra, MD, MPH
Associate Professor of Pediatrics, Harvard Medical School
Program Director, Pediatric Endocrinology, MassGeneral Hospital for Children
Co-Chair, MGHfC Research Council
Associate Director, HCCRC, Harvard Catalyst
Pediatrician, MassGeneral Hospital for Children
Phone: 617 726 3870 Fax: 617 726 8528 E-mail: firstname.lastname@example.org
|Sports Medicine and Endocrinology|
| Kathryn Ackerman, MD, MPH
Instructor in Medicine, Harvard Medical School
Assistant in Medicine, Massachusetts General Hospital
Phone: 617-726-7528 Fax: 617 726 8528 E-mail: email@example.com
|Clinical Research Fellow|
|Vibha Singhal, MD
Phone: 617-726-1428 Fax: 617-726-8528
|Meghan Slattery, NP
Phone: 617-643-0267 Fax: 617 726 8528 E-mail: firstname.lastname@example.org
Study Coordinators and Assistants
Hannah Clarke, BS
Phone: 617-724-6046 Fax: 617 726 8528 E-mail: email@example.com
Katherine Wargo, BA
Phone: 617-643-6739 Fax: 617 726 8528
Amelia Mostovoy, BA
Phone: 617-643-0266 Fax: 617-726-8528
Female Athlete Study
We have an on-going clinical trial involving the study of female adolescent athletes, ages 14-25, who are not getting their periods compared to athletes who are getting their periods and non-athletes. Athletes who are not getting their periods will receive either a low-dose transdermal estrogen patch along with oral progesterone, a low dose estrogen and progesterone pill, or no hormonal treatment. One aim of this study is to determine changes in body composition and hormones that differentiate those receiving transdermal therapy, oral therapy, or no therapy. Another aim of the study is to determine whether transdermal or oral estrogen (versus no estrogen) is effective in increasing bone density and improving bone microarchitecture in adolescent athletes who are not getting their periods and are thus estrogen deficient.
Frequently Asked Questions
1. Will scheduling be a problem since I’m a full-time student and a division one athlete?
We understand that most participants are in high school or college and have very busy schedules. We respect your time commitments and work hard to plan visits around your schedules so that participants do not have to miss their classes, jobs, or team commitments. For example, some visits can take place on your campus and we often see participants at MGH on weekends.
2. I will be out of town for the summer months. Will that be an issue for scheduling my visits?
Not at all! Visits occur at 3 month intervals so we can coordinate a visit before you leave for the summer and then again when you return in the fall. If you let us know ahead of time when you’ll be away, we can work out the dates so they fit best with your schedule.
3. Is it safe for me to participate?
All the components of this study have been approved by a human safety board called the Institutional Review Board to ensure that the protocol and all the procedures we do are safe for participants.
4. How much radiation do I get from all the imaging during the study?
The total radiation from participation in our study for 1 year is only 3% of the average person’s annual exposure. To put it in perspective, the total radiation a person is exposed to on a one-way flight from New York to Seattle is 0.14 millisieverts (mSV) and from New York to London is 0.236 mSV but girls in our study are only exposed to 0.074 mSV over the course of the entire year.
5. What is a DXA scan?
A DXA scan is a non-invasive test for measurement of bone mineral density (BMD), and measures “central” or “axial” skeletal sites (spine), “peripheral” sites (hip), as well as fat and muscle mass. In conventional DXA systems, 2 energies of x-rays are used to calculate a 2-D measurement of bone density. For this test, participants will need to remove all metal items (jewelry, underwire bras, etc.) and will be required to change into hospital pants and gown and lie still on a table for just a few minutes while the whole body is scanned by the DXA machine. This test usually costs up to $500, but since it is a part of the study, all participants get to keep their results from the scan for free.
6. What is the METCART assessment/indirect calorimetry test?
A metabolic cart assessment, sometimes referred to as indirect calorimetry, is used to estimate the number of calories burned by the body in a resting state. After an 8- to 12-hour fast (no food or beverages except water), the participant is instructed to lie down and a clear plastic hood or “canopy” is placed over her head. For the next 20 minutes, she simply lies still and breathes normally while the machine collects and analyzes her breath, providing an estimate of her metabolic rate. This test provides information for both athletes and non-athletes about their metabolism, and by being a part of the study, all participants get to keep the results from this assessment.
7. What is the purpose of the CT scan?
The CT scan is an imaging study that helps us visualize the structure of bones at a microscopic level. This gives us a more detailed picture of bone than a DXA does, and may better predict fracture risk. The CT scan will help us determine how bone structure is affected by hormonal changes in female athletes.
8. How does the treadmill exercise test work?
The treadmill test is a way for us to determine your endurance level. During this test, participants are hooked up to:
(i) EKG leads (small stickers are placed on the chest and wires connected to the EKG machine are attached to these stickers to allow us to examine the heart’s activity)
(ii) a blood pressure cuff, and
(iii) a facemask that measures VO2 (from oxygen consumption and carbon dioxide produced) while they run on the treadmill.
The treadmill gradually increases in speed and incline until the participant signals that she is ready to stop, or when heart rate, blood pressure, EKG or VO2 measurements indicate that the test is complete or should be stopped. The results help us determine the metabolic rate and endurance capacity of all participants in the study for comparison. And again, as a participant, you get to keep these results. We suggest that subjects come dressed in comfortable gym clothes for this component of the study.
9. How do I get paid for my participation?
Participants are compensated for every visit except the screening visit. Participants will be mailed a check shortly after completion of any specific visit.
10. I received a bill for a study visit in the mail. Should I pay it?
From time to time, participants are sent bills by mistake. Participants should not pay for anything related to a study visit. If you receive a bill, either mail it or bring it in to your next visit and a study coordinator will take care of it.
11. Will my doctor receive the results from the study?
That is up to you. If you would like us to mail results from your visits to your primary care doctor we can do so. However, you will need to sign a release of information form in order for us to send your information to your doctor/s. No information will be relayed to your doctor unless you want it to be.
Other Peer-reviewed Publications (case reports, proceedings of meetings)
Reviews, chapters, monographs and editorials
DeSouza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G Expert Panel. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014; 48:289-308.
I was a member of the committee within the Female Athlete Triad Coalition that developed these guidelines, and my co-authors and I contributed equally to this work.
Fax: 617 726 8528
Public Transportation Access: yes
Disabled Access: yes
Madhusmita Misra, MD
Director, MGH Pediatric Endocrine-Neuroendocrine-Sports Endocrine Research Lab