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Bone mineral density levels in elite female athletes.

Exercise affects the bone mineral density (BMD) of female athletes in several important ways. Exercise can have a direct action on bone. The type and intensity of exercise and the anatomical site where the stress is applied can all be influential. Exercise can also act indirectly by modifying the function of the hypothalamicpituitary-ovarian axis, leading to reduced oestrogen status. Finally, illicit drugs used by some athletes, such as anabolic steroids and growth hormone, may also influence BMD. The relation of BMD with exercise and low oestrogen status is reviewed together with the link which exists between exercise and amenorrhoea.