The pill, the boot, and bone density

Members of the women's golf, crew, and lacrosse teams have taken time from their competitive schedules to aid science—they are participating in a study to test the effect of oral contraceptives on bone density in female athletes. Stephanie Holler, MED '03, is conducting the study.

REBECCA ROSENTHAL/YH If Stephanie Holler's, MED '73, research proves that the pill helps protect women athletes from losing bone density, there may be another reason to head to YUHS..

The premise of Holler's work is that women with low estrogen levels brought about by irregular menstrual cycles can experience decreased bone density. She is investigating whether regulating women's menstrual cycles through birth control pills can help maintain bone density and prevent injuries.

Varsity athletes were obvious subjects for her research for several reasons. Due to the intensity of their exercise regimen, female athletes are more likely than other women to experience irregularities in their menstrual cycles or even the cessation of their periods altogether (a condition called amenorrhea). The resulting decrease in bone density also places female athletes at high risk for sports-related injuries.

Holler was surprised by the interest and cooperation athletes showed. But their interest is not so surprising when one considers the two words that strike fear into the heart of every Yale athlete: "the boot." Athletes with stress fractures are condemned to hobble around campus wearing the stabilizing but unwieldy brace.

Holler's project appealed to athletes who consider themselves especially vulnerable to injury. "I was concerned that I might have low bone density," one participant said. "Most people felt that since it's not something that's included in normal physicals, it would be a good test to have done."

Athletes were motivated not only by personal interest but also by a concern for the common good. Citing the dearth of research into the side effects of oral contraceptives, one participant said that it was "a study whose findings could be very informative to all of us."

The structure of Holler's study is quite simple. Participants first complete an anonymous questionnaire inquiring into their menstrual, dietary, and exercise history. They are then divided into groups according to whether or not they are currently on the pill. The participants are subject to two dual-energy densitometry studies that determine their bone density both before and after their athletic seasons. In this test, a low radiation x-ray beam passes above and below the patient.

Currently, the athletes are undergoing their final scans. Holler may soon have answers to her question of whether intense athletic activity affects bone density and whether the pill might protect bone density levels.

Holler, however, is concerned that her subject pool may be too small to produce any definite results, and she is considering expanding the study to include fall and winter sports next year. By sampling a variety, she may be able to compare events in order to determine if specific sports predispose athletes to decreased bone density in certain areas of their bodies.

Holler first became interested in sports-related injuries—particularly among females—as an undergraduate at Duke, where she was a member of the crew team. She stopped rowing to devote herself to academics but continued to study the medical aspect of sports. In one of her projects she sought to understand the reasons for the higher incidence of ACL tears in women's athletes.

Holler fortifies her research with a first-hand understanding of female athletics. Her advisor, Lee Katz, a professor at the Medical School, contributes his perspective as an experienced radiologist to the project. In his line of work, osteoporosis in women is often discovered too late, when the condition is irremediable.

"To make a dent on a condition that costs millions of dollars in treatment, we ought to look at women in their 20s or 30s, in order to identify if they have osteoporosis or have a tendency toward osteoporosis," Katz said. He admitted that such a screening process would be too expensive. That is why the development of possible preventative measures, such as the one that Holler is investigating, could prove useful in the fight against bone disease.

Due to the enthusiasm and cooperation of the students participating in the study, it has progressed smoothly and efficiently. The women are not reimbursed for their efforts, although they may benefit from knowing their own results, which they may request to see. Katz said that the voluntary participation of these women "says a lot for Yale women in general, and their interest in their own health care." Geoff Chepiga contributed to this article.

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