Journal of Endocrinological Investigation

, Volume 16, Issue 10, pp 829–839 | Cite as

Estrogen status and bone mass in the premenopausal period: Is osteoporosis a developmental disease?

  • Roberto Civitelli
  • D. T. Villareal
  • R. Armamento-Villareal
Review Article


Osteoporosis bone density menarche menopause pathogenesis estrogen 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Goldsmith N.F., Johnston J.O., Picetti G., Garcia C. Bone mineral in the radius and vertebral osteoporosis in an insured population. A correlative study using 125l photon absorption and miniature roentgenography. J. Bone Joint Surg. 55-a: 1276, 1973.Google Scholar
  2. 2.
    Rodin A., Murby B., Smith M.A., Caleffi M., Fentiman I., Chapman M.G., Fogelman I. Premenopausal bone loss in the lumbar spine and neck of femur: A study of 225 Caucasian women. Bone 221: 1, 1990.CrossRefGoogle Scholar
  3. 3.
    Rosenthal D.I., Mayo-Smith W., Hayes C, Khurana J.S., Biller B.M.K., Neer R.M., Klibanski A. Age and bone mass in premenopausal women. J. Bone Min. Res. 4: 533, 1989.CrossRefGoogle Scholar
  4. 4.
    Buchanan J.R., Myers C, Lloyd T., Greer R.B., III. Early vertebral trabecular bone loss in normal premenopausal women. J. Bone Min. Res. 3: 583, 1988.CrossRefGoogle Scholar
  5. 5.
    Gilsanz V., Gibbens D.T., Carlson M., Boechat M.I., Cann C.E., Schulz E.E. Peak trabecular vertebral density: A comparison of adolescent and adult females. Calcif. Tissue Int. 43: 260, 1988.PubMedCrossRefGoogle Scholar
  6. 6.
    Gilsanz V., Gibbens D.T., Roe T.F. Vertebral bone density in children: Effect of puberty. Radiology 166: 847, 1988.PubMedGoogle Scholar
  7. 7.
    Theintz G., Buchs B., Rizzoli R., Slosman D., Clavien H., Sizonenko P.C., Bonjour J.P. Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the level of lumbar spine and femoral neck in female subjects. J. Clin. Endocrinol. Metab. 75: 1060, 1992.PubMedGoogle Scholar
  8. 8.
    Lloyd T., Rollings N., Andon M.B., Demers L.M., Eggli D.F., Kieselhorst K., Kulin H., Landis J.R., Martel J.K., Orr G., Smith P. Determinants of bone density in young women. I. Relationships among pubertal development, total body bone mass, and total body density in premenarchal females. J. Clin. Endocrinol. Metab. 75: 383, 1992.PubMedGoogle Scholar
  9. 9.
    Gryfe C.I., Exton-Smith A.N., Payne P.R., Wheeler E.F. Pattern of development of bone in childhood and adolescence. Lancet. 1: 523, 1971.PubMedCrossRefGoogle Scholar
  10. 10.
    Ott S.M. Editorial: Attainment of peak bone mass. J. Clin. Endocrinol. Metab. 71: 1082A, 1990.PubMedCrossRefGoogle Scholar
  11. 11.
    Pollitzer W.S., Anderson J.J.B. Ethnic and genetic differences in bone mass: A review with a hereditary vs. environmental perspective. Am. J. Clin. Nutr. 50: 1244, 1989.PubMedGoogle Scholar
  12. 12.
    Trotter M., Broman G.E., Peterson R.R. Densities of bones of white and Negro skeletons. J. Bone Joint Surg. 42-A: 50, 1960.PubMedGoogle Scholar
  13. 13.
    Garn S.M., Sandusky ST., Nagy J.M., McCann M.B. Advanced skeletal development in low-income negro children. J. Pediatr. 80: 965, 1972.PubMedCrossRefGoogle Scholar
  14. 14.
    Garn S.M., Clark D.C. Tendency toward greater stature in American black children. Am. J. Dis. Child. 126: 164, 1973.PubMedGoogle Scholar
  15. 15.
    Liel Y., Edwards J., Shary J., Spicer K.M., Gordon L, Bell N.H. The effect of race and body habitus on bone mineral density of the radius, hip and spine in premenopausal women. J. Clin. Endocrinol. Metab. 66: 1247, 1988.PubMedCrossRefGoogle Scholar
  16. 16.
    Luckey M.M., Meier D.E., Mandeli J.P., DaCosta M.C, Hubbard M.L., Goldsmith S.J. Radial and vertebral bone density in white and black women: evidence for racial differences in premenopausal bone homeostasis. J. Clin. Endocrinol. Metab. 69: 762, 1989.PubMedCrossRefGoogle Scholar
  17. 17.
    McCormick D.P., Ponder S.W., Fawcett H.D., Palmer J.L. Spinal bone mineral density in 335 normal and obese children and adolescents: evidence for ethnic and sex differences. J. BoneMin. Res. 6: 507, 1991.CrossRefGoogle Scholar
  18. 18.
    Gilsanz V., Roe T.F., Mora S., Costin G., Goodman W.G. Changes in vertebral bone density in black girls and white girls during childhood and puberty. N. Engl. J. Med. 325: 1597, 1991.PubMedCrossRefGoogle Scholar
  19. 19.
    Farmer M.E., White L.R., Brody J.A. Race and sex differences in hip fracture incidence. Am. J. Public Health 44: 1374, 1984.CrossRefGoogle Scholar
  20. 20.
    Melton L.J. Ill, Riggs B.L. Epidemiology of age-related fractures. In: Avioli L.V. (Ed.), The Osteoporotic Syndrome: Detection, Prevention and Treatment, ed. 3. WileyLiss, Inc., New York, 1993, p. 17.Google Scholar
  21. 21.
    Hollis B.W., Pittard W.B., III. Evaluation of the total fetomatemal vitamin D relationships at term: Evidence for racial differences. J. Clin. Endocrinol. Metab. 59: 652, 1984.PubMedCrossRefGoogle Scholar
  22. 22.
    Bell N.H., Greene A., Epstein R.S., Oexmann M.I., Shaw S., Shary J. Evidence for alteration of the vitamin D-endocrine system in blacks. J. Clin. Invest. 76: 470, 1985.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    M’Buyamba-Kabangu J.R., Fagard R., Lijnen P., Bouillon R., Lissens W., Amery A. Calcium, vitamin D-endocrine system, and parathyroid hormone in black and white males. Calcif. Tissue Int. 41: 70, 1987.PubMedCrossRefGoogle Scholar
  24. 24.
    Meier D.E., Luckey M.M., Wallenstein S., Clemens T.L. Orwall E.S., Waslien C.I. Calcium, vitamin D, and parathyroid hormone status in young white and black women: Association with racial differences in bone mass. J. Clin. Endocrinol. Metab. 72: 703, 1991.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith D.M., Nance W.E., Kang K.W., Christian J.C, Johnston C.C. jr. Genetic factors in determining bone mass. J. Clin. Invest. 52: 2800, 1973.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Pocock N.A., Eisman J.A., Hopper J.L., Yeates M.G., Sambrook P.N., Eberi S. Genetic determinants of bone mass in adults. J. Clin. Invest. 80: 706, 1987.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Dequeker J., Nijs J., Verstraeten A., Geusens P., Gevers G. Genetic determinants of bone mineral content at the spine and radius: A twin study. Bone 8: 207, 1987.PubMedCrossRefGoogle Scholar
  28. 28.
    Kelly P.J., Hopper J.L, Macaskill G.T., Pocock N.A., Sambrook P.N., Eisman J.A. Genetic factors in bone turnover. J. Clin. Endocrinol. Metab. 72: 808, 1991.PubMedCrossRefGoogle Scholar
  29. 29.
    Seeman E., Hooper J.L., Bach L.A., Cooper M.E., Parkinson E., McKay J., Jerums G. Reduced bone mass in daughters of women with osteoporosis. N. Engl. J. Med. 320: 954, 1989.CrossRefGoogle Scholar
  30. 30.
    Lutz J. Bone mineral, serum calcium, and dietary intakes of mother/daughter pairs. Am. J. Clin. Nutr. 44: 99, 1986.PubMedGoogle Scholar
  31. 31.
    Tylavsky F.A., Bortz A.D., Hancock R.L., Anderson J.J.B. Familial resemblance of radial bone mass between premenopausal mothers and their college-age daughters. Calcif. Tissue Int. 45: 265, 1989.PubMedCrossRefGoogle Scholar
  32. 32.
    Lutz J., Tesar R. Mother-daughter pairs: Spinal and femoral bone densities and dietary intakes. Am. J. Clin. Nutr. 52: 872, 1990.PubMedGoogle Scholar
  33. 33.
    Matkovic V., Fontana D., Tominac C, Goel P., Chesnut CH. III. Factors that influence peak bone mass formation: A study of calcium balance and the inheritance of bone mass in adolescent females. Am. J. Clin. Nutr. 52: 878, 1990.PubMedGoogle Scholar
  34. 34.
    Armamento-Villareal R., Villareal D.T., Avioli L.V., Civitelli R. Estrogen status and heredity are major determinants of premenopausal bone mass. J. Clin. Invest. 90: 2464, 1992.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Evans R.A., Marel G.M., Lancaster E.K., Kos S., Evans M., Wong S.Y.P. Bone mass is low in relatives of osteoporotic patients. Ann. Intern. Med. 109: 870, 1988.PubMedCrossRefGoogle Scholar
  36. 36.
    Sandler R.B., Slemenda C.W., LaPorte R.E., Cauley J.A., Schramm M.M., Barresi M.L., Kriska A.M. Postmenopausal bone density and milk consumption in childhood and adolescence. Am. J. Clin. Nutr. 42: 270, 1985.PubMedGoogle Scholar
  37. 37.
    Halioua L., Anderson J.J.B. Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal Caucasian women. Am. J. Clin. Nutr. 49: S34, 1989.Google Scholar
  38. 38.
    Baran D., Sorensen A., Grimes J., Lew R., Karellas A., Johnson B., Roche J. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: A three-year prospective study. J. Clin. Endocrinol. Metab. 70: 264, 1989.CrossRefGoogle Scholar
  39. 39.
    Johnston C.C. jr., Miller J.Z., Slemenda C.W., Reister T.K., Hui S.L., Christian J.C, Peacok M. Calcium supplementation and increses in bone mineral density in children. N. Engl. J. Med. 327: 82, 1992.PubMedCrossRefGoogle Scholar
  40. 40.
    Kanders B., Dempster D.W., Lindsay R. Interaction of calcium nutrition and physical activity on bone mass in young women. J. Bone Min. Res. 3: 145, 1988.CrossRefGoogle Scholar
  41. 41.
    Dhuper S., Warren M.P., Brooks-Gunn J., Fox R. Effect of hormonal status on bone density in adolescent girls. J. Clin. Endocrinol. Metab. 71: 1083, 1990.PubMedCrossRefGoogle Scholar
  42. 42.
    Katzman D.K., Bachrach L.K., Carter D.R., Marcus R. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J. Clin. Endocrinol. Metab. 73: 1332, 1991.PubMedCrossRefGoogle Scholar
  43. 43.
    Pruzansky M.E., Turano M., Luckey M.M., Senie R. Low body weight as a risk factor for hip fractures in both black and white women. J. Orthop. Res. 7: 192, 1989.PubMedCrossRefGoogle Scholar
  44. 44.
    Longcope C, Baker R., Johnston C.C. jr. Androgen and estrogen metabolism: relationship to obesity. Metabolism. 35: 235, 1986.PubMedCrossRefGoogle Scholar
  45. 45.
    Mazess R.B., Barden H.S. Bone density in premenopausal women: Effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am. J. Clin. Nutr. 53: 132, 1991.PubMedGoogle Scholar
  46. 46.
    Aloia J.F., Vaswani A.N., Yeh J.K., Cohn S.H. Premenopausal bone mass is related to physical activity. Arch. Intern. Med. 148: 121, 1988.PubMedCrossRefGoogle Scholar
  47. 47.
    Pocock N.A., Eisman J.A., Yeates M.G., Sambrook P.N., Eberi S. Physical fitness is a major determinant of femoral neck and lumbar spine bone mineral density. J. Clin. Invest. 78: 618, 1986.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Davee A.M., Rosen C.J., Adler R.A. Exercise pattern and trabecular bone density in college women. J. Bone Min. Res. 5: 245, 1990.CrossRefGoogle Scholar
  49. 49.
    Rubin C.T., Lanyon L.E. Regulation of bone mass by mechanical strain magnitude. Calcif. Tissue Int. 37: 411, 1985.PubMedCrossRefGoogle Scholar
  50. 50.
    Nelson M.E., Meredith C.N., Dawson-Hughes B., Evans W.J. Hormone and bone mineral status in endurance-trained and sedentary postmenopausal women. J. Clin. Endocrinol. Metab. 66: 927, 1988.PubMedCrossRefGoogle Scholar
  51. 51.
    Drinkwater B.L., Nilson K., Chesnut CH. Ill, Bremner W.J., Shainholtz S., Southworth M.B. Bone mineral content of amenorrheic and eumenorrheic athletes. N. Engl. J. Med. 311: 277, 1984.PubMedCrossRefGoogle Scholar
  52. 52.
    Marcus R., Cann C.E., Madvig P., Minkoff J., Goddard M., Bayer M., Martin M.C., Gaudiani L., Haskell W., Genant H.K. Menstrual function and bone in elite women distance runners. Endocrine and metabolic features. Ann. Intern. Med. 102: 158, 1985.PubMedCrossRefGoogle Scholar
  53. 53.
    Lindberg J.S., Fears W.B., Hunt M.M., Powell M.R., Boll D., Wade C.E. Exercise-induced amenorrhea and bone density. Ann. Intern. Med. 101: 647, 1984.PubMedCrossRefGoogle Scholar
  54. 54.
    Parker Jones K., Ravnikar V.A., Tulchinsky D., Schiff I. Comparison of bone density in amenorrheic women due to athletics, weight loss and premature menopause. Obstet. Gynecol. 66: 5, 1985.Google Scholar
  55. 55.
    Slemenda C.W., Hui S.L., Longcope C, Johnston C.C. jr. Cigarette smoking, obesity, and bone mass. J. Bone Min. Res. 4: 737,1989.CrossRefGoogle Scholar
  56. 56.
    Jensen I., Christiansen C, Rødbro P. Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause. N. Engl. J. Med. 313: 973, 1983.CrossRefGoogle Scholar
  57. 57.
    Jensen G.F. Osteoporosis of the slender smoker revisited by epidemiologic approach. Eur. J. Clin. Invest. 16: 239, 1986.PubMedCrossRefGoogle Scholar
  58. 58.
    Jick H., Porter J., Morrison A.S. Relation between smoking and age of natural menopause. Lancet. 1: 1354, 1977.PubMedCrossRefGoogle Scholar
  59. 59.
    Michnovicz J.J., Hershcopf R.J., Naganuma H., Bradlow H.L., Fishman J. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N. Engl. J. Med. 315: 1305, 1986.PubMedCrossRefGoogle Scholar
  60. 60.
    Cann C.E., Martin M.C., Genant H.K., Jaffe R.B. Decreased spinal mineral content in amenorrheic women. JAMA 251: 626, 1984.PubMedCrossRefGoogle Scholar
  61. 61.
    Lloyd T., Buchanan I.R., Bitzer S., Waldman C.J., Myers L, Ford B.G. Interrelationships of diet, athletic activity, menstrual status and bone density in collegiate women. Am. J. Clin. Nutr. 46: 681, 1987.PubMedGoogle Scholar
  62. 62.
    Bachrach L.K., Katzman D.K., Litt I.F., Guido D., Marcus R. Recovery from osteopenia in adolescent girls with anorexia nervosa. J. Clin. Endocrinol. Metab. 72: 602, 1991.PubMedCrossRefGoogle Scholar
  63. 63.
    Ayers J.W.T., Gidwani G.P., Schmidt I.M.V., Gross M. Osteopenia in hypoestrogenic young women with anorexia nervosa. Fertil. Steril. 41: 224, 1984.PubMedGoogle Scholar
  64. 64.
    Johnston C.C. jr., Hui S.L, Witt R.M., Appledorn C.R., Baker R.S., Longcope C. Early menopausal changes in bone mass and sex steroids. J. Clin. Endocrinol. Metab. 61: 905, 1985.PubMedCrossRefGoogle Scholar
  65. 65.
    Steinberg K.K., Freni-Titulaer L.W., DePuey E.G., Miller D.T., Sgoutas A.S., Coralli C.H., Phillips D.L., Rogers T.N., Clark R.V. Sex steroids and bone density in premenopausal and perimenopausal women. J. Clin. Endocrinol. Metab. 69: 533, 1989.PubMedCrossRefGoogle Scholar
  66. 66.
    Buchanan J.R., Myers C, Lloyd T., Leunenberger P., Demers L.M. Determinants of peak trabecular bone density in women: The role of androgens, estrogen, and exercise. J. Bone Min. Res. 6: 673, 1988.Google Scholar
  67. 67.
    Sowers M.R., Shapiro B., Gilbraith M.A., Jannausch M. Health andhormonal characteristics of premenopausal women with lower bone mass. Calcif. Tissue Int. 47: 130, 1990.PubMedCrossRefGoogle Scholar
  68. 68.
    Fox K.M., Magaziner I., Sherwin R., Scott J.C., Plato C.C., Nevitt M.C., Cummings S.R. Reproductive correlates of bone mass in elderly women. J. Bone Min. Res. 8: 901, 1993.CrossRefGoogle Scholar
  69. 69.
    Drinkwater B.L., Bruemner B., Chesnut C.H., III. Menstrual history as a determinant of current bone density in young athletes. JAMA 263: 545, 1990.PubMedCrossRefGoogle Scholar
  70. 70.
    Prior J.C, Vigna Y.M., Schechter M.T., Burgess A.E. Spinal bone loss and ovulatory disturbances. N. Engl. J. Med. 323: 1221, 1990.PubMedCrossRefGoogle Scholar
  71. 71.
    Buchanan J.R., Hospodar P., Myers C, Leunenberger P., Demers L.M. Effect of excess endogenous androgens on bone density in young women. J. Clin. Endocrinol. Metab. 67: 937, 1988.PubMedCrossRefGoogle Scholar
  72. 72.
    Bikle D.D., Halloran B.P., Harris S.T., Portale A.A. Progestin antagonism of estrogen stimulated 1,25-dihydroxyvitamin D levels. J. Clin. Endocrinol. Metab. 75: 519, 1992.PubMedGoogle Scholar
  73. 73.
    Goldsmith N.F., Johnston J.O. Bone mineral: Effects of oral contraceptives, pregnancy and lactation. J. Bone Joint Surg. 574: 657, 1975.Google Scholar
  74. 74.
    Lindsay R., Tohme J., Kanders B. The effect of oral contraceptive use on vertebral bone mass in pre- and post-menopausal women. Contraception 34: 333, 1986.PubMedCrossRefGoogle Scholar
  75. 75.
    Lloyd T., Buchanan J.R., Ursino G.R., Myers C, Woodward G., Halbert D.R. Long-term oral contraceptive use does not affect trabecular bone density. Am. J. Obstet. Gynecol. 160: 402, 1989.PubMedCrossRefGoogle Scholar
  76. 76.
    Hreshchyshyn M.M., Hopkins A., Zylstra S., Anbar M. Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck densities. Am. J. Obstet. Gynecol. 159: 318, 1988.PubMedCrossRefGoogle Scholar
  77. 77.
    Mishell D.R., jr., Thorneycroft I.H., Nakamura R.M., Nagata Y., Stone SC. Serum estradiol in women ingesting combination oral contraceptive steroids. Am. J. Obstet. Gynecol. 114: 923, 1972.PubMedGoogle Scholar
  78. 78.
    Pitkin R.M. Calcium metabolism in pregnancy and the perinatal period: A review. Am. J. Obstet. Gynecol. 151: 99, 1985.PubMedCrossRefGoogle Scholar
  79. 79.
    Koetting CA.,. Wardlaw G.M. Wrist, spine, and hip bone density in women with variable histories of lactation. Am. J. Clin. Nutr. 48: 1479, 1988.PubMedGoogle Scholar
  80. 80.
    Hayslip C.C., Klein T.A., Wray H.L., Duncan W.E. The effects of lactation on bone mineral content in healthy postpartum women. Obstet. Gynecol. 73: 588, 1989.PubMedGoogle Scholar
  81. 81.
    Aloia J.F., Vaswani A.N., Yeh J.K., Ross P.D., Ellis K., Cohn S.H. Determinants of bone mass in postmenopausal women. Arch. Intern. Med. 143: 1700, 1983.PubMedCrossRefGoogle Scholar
  82. 82.
    Drinkwater B.L., Chesnut C.H. III. Bone density changes during pregnancy and lactation in active women: a longitudinal study. Bone Min. 14: 153, 1991.CrossRefGoogle Scholar
  83. 83.
    Alderman B.W., Weiss N.S., Daling J.R., Ure C.L., Ballard J.H. Reproductive history and postmenopausal risk of hip and forearm fracture. Am. J. Epidemiol. 124: 262, 1986.PubMedGoogle Scholar
  84. 84.
    Beaulieu J.G., Razzano OD., Levine R.B. Transient osteoporosis of the hip in pregnancy. Clin. Orthop. Rel. Res. 115: 165, 1976.Google Scholar
  85. 85.
    Brodell J.D., Burns J.E., Heiple K.G. Transient osteoporosis of the hip in pregnancy. J. Bone Joint Surg. 71A: 1252, 1989.Google Scholar
  86. 86.
    Smith R., Stevenson J.C, Winearls C.G., Woods C.G., Wordsworth B.P. Osteoporosis of pregnancy. Lancet. 1: 1178, 1985.PubMedCrossRefGoogle Scholar
  87. 87.
    Chan G.M., McMurray M., Westover K., Engelbert-Fenton K., Thomas M.R. Effects of increased dietary calcium intake upon the calcium and bone mineral status of lactating adolescents and adult women. Am. J. Clin. Nutr. 46: 319, 1987.PubMedGoogle Scholar
  88. 88.
    Meunier P J, Sellami S., Briançon D., Edouard C. Histological heterogeneity of apparently idiopathic osteoporosis. In: DeLuca H.F., Frost H.M., Jee W.S.S., Johnston CO, jr., Parfitt A.M. (Eds.), Osteoporosis: Recent Advances in Pathogenesis and Treatment, University Park Press, Baltimore, 1980, p. 293.Google Scholar
  89. 89.
    Whyte M.P., Bergfeld M.A., Murphy W.A., Avioli L.V., Teitelbaum S.L. Postmenopausal osteoporosis: A heterogeneous disorder as assessed by histomorphometric analysis of iliac crest bone form untreated patients. Am. J. Med. 72: 193, 1982.PubMedCrossRefGoogle Scholar
  90. 90.
    Civitelli R., Gonnelli S., Zacchei F., Bigazzi S., Vattimo A., Avioli L.V., Gennari C. Bone turnover in postmenopausal osteoporosis: effect of calcitonin treatment. J. Clin. Invest. 82: 1268, 1988.PubMedCentralPubMedCrossRefGoogle Scholar
  91. 91.
    Slemenda C.W., Hui S.L., Longcopee C, Johnston C.C, jr. Sex steroids and bone mass. J. Clin. Invest. 80: 1261, 1987.PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.
    Uebelhart D., Schlemmer A., Johansen J.S., Gineyts E., Christiansen C, Delmas P.D. Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium cross-links. J. Clin. Endocrinol. Metab. 72: 367, 1991.PubMedCrossRefGoogle Scholar
  93. 93.
    Drinkwater B.L., Nilson K., Ott S.M., Chesnut C.H. III. Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 256: 380, 1986.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 1993

Authors and Affiliations

  • Roberto Civitelli
    • 1
  • D. T. Villareal
    • 1
  • R. Armamento-Villareal
    • 1
  1. 1.Division of Endocrinology and Bone and Mineral DiseaseThe Jewish Hospital Washington of University Medical CenterSt. Louis.USA

Personalised recommendations