Effects of reduced energy availability on bone metabolism in women and men

Background: The short-term effects of low energy availability (EA) on bone metabolism in physically active women and men are currently unknown. Purpose: We evaluated the effects of low EA on bone turnover markers (BTMs) in a cohort of women and a cohort of men, and compared effects between sexes. Methods: These studies were performed using a randomised, counterbalanced, crossover design. Eleven eumenorrheic women and eleven men completed two 5-day protocols of controlled (CON; 45 kcal·kgLBM-1.d-1) and restricted (RES; 15 kcal.kgLBM-1·d-1) EAs. Participants ran daily on a treadmill at 70% of their peak aerobic capacity (VO2 peak) resulting in an exercise energy expenditure of 15 kcal·kgLBM-1·d-1 and consumed diets providing 60 and 30 kcal·kgLBM-1·d-1. Blood was analysed for BTMs [β-carboxyl-terminal cross-linked telopeptide of type I collagen (β-CTX) and amino-terminal propeptide of type 1 procollagen (P1NP)], markers of calcium metabolism [( parathyroid hormone (PTH), albumin-adjusted calcium (ACa), magnesium (Mg) and phosphate (PO4)] and regulatory hormones [sclerostin, insulin-like growth factor 1 (IGF-1), triiodothyronine (T3), insulin, leptin, glucagon-like- peptide-2 (GLP-2)]. Results: In women,β-CTX AUC was significantly higher P=0.03) and P1NP AUC was significantly lower (P=0.01) in RES compared to CON. In men, neither β-CTX (P=0.46) n or P1NP (P=0.12) AUCs were significantly different between CON and RES. There were no significant differences between sexes for any BTM AUCs (all P values>0.05). Insulin and leptin AUCs were significantly lower following RES in women only (for both P=0.01). There were no differences in any AUCs of regulatory hormones or markers of calcium metabolism between men and women following RES (all P values>0.05). Conclusions: When comparing within groups, five days of low EA (15 kcal·kgLBM-1·d-1) decreased bone formation and increased bone resorption in women, but not in men, and no sex specific differences were detected

SNPs in the vicinity of P2X7R, RANK/RANKL/OPG and Wnt signalling pathways and their association with bone phenotypes in academy footballers

Context: Genotype plays an important role in influencing bone phenotypes, such as bone mineral density, but the role of genotype in determining responses of bone to exercise has yet to be elucidated. Objective: To determine whether 10 SNPs associated with genes in the vicinity of P2X7R, RANK/RANKL/OPG and Wnt Signalling Pathways are associated with bone phenotypes in elite academy footballers (Soccer players) and to determine whether these genotypes are associated with training induced changes in bone. Design, participants, and methods: 99 elite academy footballers volunteered to participate. Peripheral computed tomography of the tibia (4%, 14%, 38% and 66% sites) was performed immediately before and 12 weeks after an increase in football training volume. Genotypes were determined using proprietary fluorescence-based competitive allele-specific PCR assays. Results: No significant genotype x time interactions were shown for any of the SNPs analysed (P > 0.05). A main effect of genotype was shown. SOST SNP rs1877632 (trabecular density), P2X7R SNPs rs1718119 (cortical thickness and CSA), rs3751143 (SSI, CSA, cortical CSA and periosteal circumference) RANK/RANKL/OPG SNPs rs9594738 (periosteal circumference), rs1021188 (cortical thickness and CSA) and rs9594759 (cortical density) were associated with bone phenotypes (P < 0.05). Conclusions: No association was shown between P2X7R, RANK/RANKL/OPG and Wnt Signalling SNPs and a change in bone phenotypes following 12 weeks of increased training volume in elite academy footballers. However, SNPs were associated with bone phenotypes pre training. These data highlight the complexity of SNPs in the vicinity of the RANK/RANKL/OPG, P2X7R and Wnt metabolic regulatory pathways with bone phenotypes in elite academy footballers

Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women

Purpose: We aimed to explore the effects of low energy availability (EA)[15 kcal·kg lean body mass (LBM)−1·d−1] achieved by diet or exercise on bone turnover markers in active, eumenorrheic women. Methods: By using a crossover design, ten eumenorrheic women (VO2 peak: 48.1 ± 3.3 ml·kg−1·min−1) completed all three, 3-day conditions in a randomised order: controlled EA (CON; 45 kcal·kgLBM−1·d−1), low EA through dietary energy restriction (D-RES; 15 kcal·kgLBM−1·d−1) and low EA through increasing exercise energy expenditure (E-RES; 15 kcal·kgLBM−1·d−1), during the follicular phase of three menstrual cycles. In CON, D-RES and E-RES, participants consumed diets providing 45, 15 and 45 kcal·kgLBM−1·d−1. In E-RES only, participants completed supervised running sessions (129 ± 10 min·d−1) at 70% of their VO2 peak that resulted in an exercise energy expenditure of 30 kcal·kg LBM−1·d−1. Blood samples were collected at baseline (BASE) and at the end of the 3-day period (D6) and analysed for bone turnover markers (β-CTX and P1NP), markers of calcium metabolism (PTH, albumin-adjusted Ca, Mg and PO4) and hormones (IGF-1, T3, insulin, leptin and 17β-oestradiol). Results: In D-RES, P1NP concentrations at D6 decreased by 17% (BASE: 54.8 ± 12.7 μg·L−1, D6: 45.2 ± 9.3 μg·L−1, P < 0.001, d = 0.91) and were lower than D6 concentrations in CON (D6: 52.5 ± 11.9 μg·L−1, P = 0.001). P1NP did not change significantly in E-RES (BASE: 55.3 ± 14.4 μg·L−1, D6: 50.9 ± 15.8 μg·L−1, P = 0.14). β-CTX concentrations did not change following D-RES (BASE: 0.48 ± 0.18 μg·L−1, D6: 0.55 ± 0.17 μg·L−1) or E-RES (BASE: 0.47 ± 0.24 μg·L−1, D6: 0.49 ± 0.18 μg·L−1) (condition × time interaction effect, P = 0.17). There were no significant differences in P1NP (P = 0.25) or β-CTX (P = 0.13) responses between D-RES and E-RES. Both conditions resulted in reductions in IGF-1 (−13% and − 23% from BASE in D-RES and E-RES, both P < 0.01) and leptin (−59% and − 61% from BASE in D-RES and E-RES, both P < 0.001); T3 decreased in D-RES only (−15% from BASE, P = 0.002) and PO4 concentrations decreased in E-RES only (−9%, P = 0.03). Conclusions: Low EA achieved through dietary energy restriction resulted in a significant decrease in bone formation but no change in bone resorption, whereas low EA achieved through exercise energy expenditure did not significantly influence bone metabolism. Both low EA conditions elicited significant and similar changes in hormone concentrations

The effect of sex, stature, and limb length on the preferred walk-to-run transition speed

Background The preferred walk-to-run transition speed (PTS) for healthy adults is approximately 2 m∙s-1, however, PTS is influenced by anthropometric factors. Yet despite known sex differences in anthropometrics, studies have reported no sex differences in PTS. Research question Do stature and limb length affect PTS in the same way for both male and female healthy adults? Methods Thirty-seven (19 female) non-injured adults volunteered for this study. Participants completed a walk-to-run transition protocol, where the treadmill speed was increased from 1.2 m∙s-1 to 2.2 m∙s-1, in increments of 0.1 m∙s-1 every two minutes. An independent t-test compared PTS between sexes. Multiple regression analysis determined the effect of sex and stature and sex and limb length on PTS. Results Female participants transitioned at a lower PTS than male participants (1.8 (0.2) m∙s-1 versus 1.9 (0.1) m∙s-1; p ≤ 0.026). Sex and stature explained 19% of the variance in PTS, while sex and limb length explained 21% of the variance. Including interactions increased the variance explained by 23% and 2% for sex and stature and sex and limb length, respectively. The significant interaction between sex and stature showed PTS was inversely proportional to stature for male participants but directly proportional for female participants. Significance These findings suggest that the extent to which stature and limb length influence the preferred transition speed may differ between sexes

Supplementary Energy Increases Bone Formation during Arduous Military Training

Purpose: This study aimed to investigate the effect of supplementary energy on bone formation and resorption during arduous military training in energy deficit. Methods: Thirty male soldiers completed an 8-wk military combat course (mean ± SD, age = 25 ± 3 yr, height = 1.78 ± 0.05 m, body mass = 80.9 ± 7.7 kg). Participants received either the habitual diet (control group, n = 15) or an additional 5.1 MJ·d−1 to eliminate the energy deficit (supplemented group, n = 15). Circulating markers of bone formation and resorption, and reproductive, thyroid, and metabolic status, were measured at baseline and weeks 6 and 8 of training. Results: Bone-specific alkaline phosphatase decreased in controls (−4.4 ± 1.9 μg·L−1) and increased in the supplemented group (16.0 ± 6.6 μg·L−1), between baseline and week 8 (P < 0.001). Procollagen type 1 N-terminal propeptide increased between baseline and week 6 for both groups (5.6 ± 8.1 μg·L−1, P = 0.005). Beta carboxy-terminal cross-linking telopeptide of type 1 collagen decreased between baseline and week 8 for both groups (−0.16 ± 0.20 μg·L−1, P < 0.001). Prolactin increased from baseline to week 8 for the supplemented group (148 ± 151 IU·L−1, P = 0.041). The increase in adiponectin from baseline to week 8 was higher in controls (4.3 ± 1.8 mg·L−1, P < 0.001) than that in the supplemented group (1.4 ± 1.0 mg·L−1, P < 0.001). Insulin-like growth factor binding protein-3 was lower at week 8 than baseline for controls (−461 ± 395 ng·mL−1, P < 0.001). Conclusion: The increase in bone-specific alkaline phosphatase, a marker of bone formation, with supplementation supports a role of energy in osteoblastic activity; the implications for skeletal adaptation and stress fracture risk are unclear. The mechanism is likely through protecting markers of metabolic, but not reproductive or thyroid, function

The association of novel polymorphisms with stress fracture injury in elite athletes: further insights from the SFEA cohort

Objective: To determine, in conjunction with a wider investigation, whether 11 genetic variants in the vicinity vitamin D, collagen and Wnt signalling pathways were associated with stress fracture injury in the Stress Fracture Elite Athlete (SFEA) cohort. Design: Genotype-phenotype association study. Method: Self-reported stress fracture history and demographic data were recorded in 518 elite athletes, 449 male and 69 female (mean age 24.2±5.5 y) from the SFEA cohort. Elite athletes were assigned to two groups based on history stress fracture injury. Data were analysed for the whole cohort and sub-stratified in male only and multiple stress fracture cases. Genotype was determined using a proprietary fluorescence-based competitive allele-specific polymerase chain reaction assay. Results: SOST SNP rs1877632 and VDR SNPs rs10735810 and rs731236 were associated with stress fracture (p0.05). Conclusions: These data suggest an important role for SOST SNP rs1877632 and VDR SNPs rs10735810 and rs731236 in the pathophysiology of stress fracture. This might be due to the role of the SNPs in the regulation of bone remodelling and adaptation to mechanical loading, with potential implications for the prevention and treatment of stress fracture

Good perceived sleep quality protects against the raised risk of respiratory infection during sleep restriction in young adults.

Study Objectives: Prospectively examine the association between sleep restriction, perceived sleep quality (PSQ) and upper respiratory tract infection (URTI). Methods: In 1318 military recruits (68% males) self-reported sleep was assessed at the beginning and end of a 12-week training course. Sleep restriction was defined as an individualized reduction in sleep duration of ≥2 hours/night compared with civilian life. URTIs were retrieved from medical records. Results: On commencing training, approximately half of recruits were sleep restricted (52%; 2.1 ± 1.6 h); despite the sleep debt, 58% of recruits with sleep restriction reported good PSQ. Regression adjusted for covariates showed that recruits commencing training with sleep restriction were more likely to suffer URTI during the course (OR = 2.93, 95% CI 1.29–6.69, p = .011). Moderation analysis showed this finding was driven by poor PSQ (B = −1.12, SE 0.50, p = .023), as no significant association between sleep restriction and URTI was observed in recruits reporting good PSQ, despite a similar magnitude of sleep restriction during training. Associations remained in the population completing training, accounting for loss to follow-up. Recruits reporting poor PSQ when healthy at the start and end of training were more susceptible to URTI (OR = 3.16, 95% CI 1.31–7.61, p = .010, vs good PSQ). Conclusion: Good perceived sleep quality was associated with protection against the raised risk of respiratory infection during sleep restriction. Studies should determine whether improvements in sleep quality arising from behavioral sleep interventions translate to reduced respiratory infection during sleep restriction

Role of sex and stature on the biomechanics of normal and loaded walking : implications for injury risk in the military

Load carriage and marching ‘in-step’ are routine military activities associated with lower limb injury risk in service personnel. The fixed pace and stride length of marching typically vary from the preferred walking gait and may result in overstriding. Overstriding increases ground reaction forces and muscle forces. Women are more likely to overstride than men due to their shorter stature. These biomechanical responses to overstriding may be most pronounced when marching close to the preferred walk-to-run transition speed. Load carriage also affects walking gait and increases ground reaction forces, joint moments and the demands on the muscles. Few studies have examined the effects of sex and stature on the biomechanics of marching and load carriage; this evidence is required to inform injury prevention strategies, particularly with the full integration of women in some defence forces. This narrative review explores the effects of sex and stature on the biomechanics of unloaded and loaded marching at a fixed pace and evaluates the implications for injury risk. The knowledge gaps in the literature, and distinct lack of studies on women, are highlighted, and areas that need more research to support evidence-based injury prevention measures, especially for women in arduous military roles, are identified

Sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged arduous military training

Energy deficits are common in military training and can result in endocrine and metabolic disturbances. This study provides first investigation of sex differences in energy balance, body composition, and endocrine and metabolic markers in response to prolonged and arduous military training. Men experienced greater energy deficits than women due to higher energy expenditure, which was not compensated for by increased energy intake. These energy deficits were not associated with decreases in fat or lean mass or metabolic or endocrine function

Influence of Vitamin D Supplementation by Simulated Sunlight or Oral D3 on Respiratory Infection during Military Training.

PURPOSE: To determine the relationship between vitamin D status and upper respiratory tract infection (URTI) of physically active men and women across seasons (study 1). Then, to investigate the effects on URTI and mucosal immunity of achieving vitamin D sufficiency (25(OH)D ≥50 nmol·L-1) by a unique comparison of safe, simulated-sunlight or oral D3 supplementation in winter (study 2). METHODS: In study 1, 1,644 military recruits were observed across basic military training. In study 2, a randomized controlled trial, 250 men undertaking military training received either placebo, simulated-sunlight (1.3x standard erythemal dose, three-times-per-week for 4-weeks and then once-per-week for 8-weeks) or oral vitamin D3 (1,000 IU·day-1 for 4-weeks and then 400 IU·day-1 for 8-weeks). URTI was diagnosed by physician (study 1) and Jackson common cold questionnaire (study 2). Serum 25(OH)D, salivary secretory immunoglobulin A (SIgA) and cathelicidin were assessed by LC-MS/MS and ELISA. RESULTS: In study 1, only 21% of recruits were vitamin D sufficient during winter. Vitamin D sufficient recruits were 40% less likely to suffer URTI than recruits with 25(OH)D 0.05). Supplementation did not affect salivary SIgA or cathelicidin. CONCLUSION: Vitamin D sufficiency reduced the URTI burden during military training