Exercise in Adolescence as Primary Prevention of Osteoporosis and Fragility Fractures in Female

Problem: Physical activity has been well demonstrated to have short term benefits on bone density. However, there are currently limited studies on the long term effects of exercise on bone density, especially during a critical time of growth in adolescence. Additionally, not all exercise has been shown to be beneficial, as seen in exercising females with evidence of hypomenorrhea. Purpose: To determine if there is significant risk reduction of developing osteoporosis in subjects who participated in various levels of physical activity during their adolescence. Research Questions: Do the benefits of physical activity on bone health during adolescence last long term into postmenopause? Consequently, does hypothalamic-pituitary-gonadal axis dysfunction due to excessive exercise in adolescence have any long term negative effects on bone health? Methods: A retrospective cohort study will be conducted on postmenopausal females undergoing routine DEXA scan as per American Association of Obstetrics and Gynecology guidelines. Surveys will be given regarding participants' levels of activity during their adolescent years, specifically during high school and college (estimated range 13 to 24 years). Secondary factors will be taken into account including diet and menstrual status. Subjects will be followed for 10 years and any fragility fractures will be recorded. Outcomes: It is expected that adolescents who engage in a moderate amount of activity have increased peak bone mineral density during adolescence, leading to a smaller risk of osteoporosis in old age, and those who engage in a high amount of activity with evidence of disordered eating and amenorrhea have increased risk of osteoporosis in old age. Benefit: This study will benefit clinicians by providing them with a better understanding of the risks and benefits of exercise on bone density in adolescents and their long term effects. By promoting early intervention and primary prevention, the clinician can better guide the patient towards lifestyle changes that may have an impact on their morbidity and mortality in senescence.