Low Energy Availability Interferes With Exercise-Associated Bone Effects in Female Long-Distance Triathletes as Detected by HR-pQCT.

Female Athlete Triad, initially described as the association of disordered eating, amenorrhea and osteoporosis, was further redefined to focus on low energy availability (EA), which has a central role in development of hypoestrogenism and low bone mineral density (BMD). However, the contribution of each variable, that is, low EA and hypoestrogenism, for bone derangements is still an open question. To evaluate body composition and bone status in long-distance triathletes without hypoestrogenism, as compared to non-athletes, using DXA and HR-pQCT, and the influence of EA. Population comprised 23 triathletes who had completed at least one long-distance race in the previous year, and 17 non-athletic healthy controls. The athletes denied previous oligo-amenorrhea and had spontaneous regular menses or were on hormonal contraceptives. Control patients also had regular menses. Energy deficiency (low EA) was defined as energy intake below the recommended level for athletes, that is, 45 kcal/kg free fat mass/day. Only femoral neck BMD Z-score measured by DXA trended higher in athletes (p = 0.05), whereas high-resolution peripheral quantitative computed tomography detected significantly higher values of entire bone and trabecular bone area, cortical perimeter, trabecular vBMD and trabecular bone volume/tissue volume, and lower trabecular separation and trabecular inhomogeneity in athletes. No difference was found between athletes with spontaneous menses and those on hormone contraceptives in respect to all parameters. The effects of exercise on bone were not so pronounced in athletes with low EA, although they still had better bone parameters than controls. Stress fractures were reported by 4:12 athletes with low EA and by 2:11 athletes with adequate EA. Long-distance female triathletes without hypoestrogenism show higher values of cortical perimeter, bone area, volumetric density and trabecular microstructure, but low EA interferes with exercise-associated bone effects. These innovative findings reinforce the importance of adequate EA in female athletes to guarantee skeletal health.

Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity.

The influence of vitamin D on the severity of systemic lupus erythematosus (SLE) has been studied. Our objectives were to determine the prevalence of vitamin D insufficiency in Brazilian lupus patients and its relationship with demographic, clinical, and laboratory variables and to study the relationship between vitamin D insufficiency and disease activity. This is a cross-sectional study of 159 SLE patients. Levels of serum 25-hydroxyvitamin D (25(OH)D) <30 ng/ml were defined as vitamin D insufficiency and <20 ng/ml as deficiency. Data collected included sex, age, ethnicity, postmenopausal status, disease duration, cumulative amount of oral glucocorticoids (GC) in the last six months, duration of GC usage, calcium and vitamin D supplements, photosensitivity, sunscreen usage, sun exposure, diabetes mellitus, creatinine clearance, lifestyle habits, and smoking. Disease activity was measured by the SLE Disease Activity Index 2000 (SLEDAI-2K). Bivariate statistical analysis was performed using the Mann-Whitney test, Spearman's correlation coefficient, Chi-square test, and Fisher's exact test. Multivariate analysis was performed with multiple linear regression. The prevalence of vitamin D insufficiency and deficiency were 37.7% and 8.2%, respectively. Levels of 25(OH) D were not associated with lupus activity score, disease duration, sun exposure, vitamin D supplementation, or use of corticosteroids.