Q.What are the causes of Oestoporosis ?

The Female Athlete Triad represents a serious health concern that emerges at the intersection of intense physical training and inadequate nutrition. It was first formally recognized in the 1990s when sports medicine professionals began noticing a troubling pattern among female athletes—particularly those in sports emphasizing leanness or a specific body aesthetic, such as gymnastics, distance running, figure skating, and ballet.

The syndrome revolves around three interconnected components that form a vicious cycle. At its core lies low energy availability, which occurs when an athlete's energy intake (calories consumed) fails to meet the energy expenditure from exercise and basic bodily functions. This deficit may result from deliberate food restriction, disordered eating patterns, or simply not eating enough to compensate for high training volumes. The body, sensing this energy shortage, begins to shut down non-essential functions to conserve resources.

This energy deficit triggers the second component: menstrual dysfunction. The body suppresses reproductive hormones, leading to irregular periods (oligomenorrhea) or complete cessation of menstruation (amenorrhea). Many young athletes mistakenly view this as a normal consequence of training or even a convenience, not recognizing it as a red flag signaling physiological stress.

The third pillar, decreased bone mineral density, follows as a consequence of both inadequate nutrition (particularly calcium and vitamin D) and reduced estrogen levels from menstrual disruption. Estrogen plays a crucial role in bone health, and its absence during the critical bone-building years of adolescence and early adulthood can lead to premature osteoporosis. Athletes may suffer stress fractures that heal slowly or recur frequently—a particularly cruel irony for those whose passion is physical performance.

Part (a)

Osteoporosis is a condition in which bones become porous, brittle and prone to fracture because bone resorption (breakdown) outpaces bone formation. Its main causes are:

• Nutritional deficiency: inadequate calcium and vitamin D. Calcium is the chief mineral of bone; when dietary intake is low the body draws calcium out of the bones. Vitamin D is required for calcium to be absorbed from the intestine, so a deficiency makes even good calcium intake ineffective.
• Hormonal factors: estrogen protects bone by restraining bone-resorbing cells. After menopause estrogen levels fall sharply and bone loss accelerates, which is why post-menopausal women are at highest risk. In athletes, low body fat and disordered eating can cause amenorrhoea and the same hormonal bone loss (the Female Athlete Triad). In men, declining testosterone has a comparable, slower effect.
• Physical inactivity: weight-bearing and resistance exercise stress the bones and signal them to strengthen; a sedentary lifestyle removes this stimulus and bones thin.
• Ageing: bone density peaks around age 30 and then gradually declines.
• Genetic predisposition: family history and a small/thin body frame lower peak bone mass.
• Other lifestyle and medical factors: smoking, excessive alcohol and caffeine interfere with calcium metabolism, and long-term corticosteroid use accelerates bone breakdown.

Part (b)

Anorexia nervosa is an eating disorder marked by severe food restriction, an intense fear of gaining weight, and a distorted body image in which the person feels overweight even when dangerously underweight.

Prevention:

• Foster healthy attitudes to food, body image and self-worth from childhood, valuing children beyond appearance.
• Challenge unrealistic media beauty standards and emphasise balanced nutrition over thinness.
• Educate adolescents about normal body changes at puberty so they do not resort to extreme dieting.
• Recognise early warning signs — rapid weight loss, obsessive calorie counting, excessive exercise, and social withdrawal around meals — so help can be sought before the disorder becomes entrenched.

Management requires a multidisciplinary approach:

• Medical stabilisation first when malnutrition is severe, with hospitalisation if needed. Refeeding must be gradual and supervised to avoid refeeding syndrome. …