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Referenties, Engelstalige samenvatting en vaststellen van de botgezondheid: botkwantiteit vs botkwaliteit

Referenties

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Engelstalige samenvatting

Research shows that most male and approximately half of the female professional cyclists display low bone mineral density (BMD) values. This low BMD is accompanied by impairments in bone microarchitecture. The primary risk factors for impaired bone health include a lack of bone-loading physical activity, prolonged periods of low energy availability, and a (pursuit of) low body weight. Cyclists with lower BMD appear to have a higher incidence of traumatic fractures during their active careers compared to those with higher BMD. Furthermore, reduced BMD at a young age is a strong predictor of osteoporosis in later life.

Preventing bone health issues in young cyclists is crucial, as significant increases in BMD are almost impossible to achieve later in life. It is important to encourage young, talented cyclists to continue participating in bone-loading sports alongside cycling for as long as possible. Both emerging talents and professionals should be encouraged to incorporate high-intensity strength training and/or impact exercises to maintain or improve bone health. In addition, adequate nutritional intake is essential to prevent prolonged periods of low energy availability. Adequate calcium intake and optimal vitamin D status require particular attention, with supplementation recommended based on periodic serum 25(OH)D measurements. Although anti-resorptive and bone-forming medication may improve bone health, evidence for a subsequent reduction in fracture incidence in young, healthy athletes is unavailable. Moreover, the appropriateness of medication use in this population of young elite athletes can be debated.

Sports physicians involved in (elite) cycling should be particularly attentive to bone health. A multidisciplinary approach is essential for the prevention and treatment of low BMD, and should involve close collaboration between sports physicians, sports dietitians, and, in severe cases, an endocrinologist specialized in bone disorders.

Vaststellen van de botgezondheid: botkwantiteit vs. botkwaliteit

DXA

De gouden standaard om de botdichtheid te meten is dual-energy X-ray absorptiometry (DXA; Afbeelding 1). De International Society for Clinical Densitometry (ISCD) adviseert om de BMD van de heup en de lumbale wervelkolom te bepalen, omdat deze locaties gevoelig zijn voor veranderingen in BMD, het locaties zijn waar ernstige botbreuken kunnen plaatsvinden (bij ouderen) en omdat er internationale normwaarden beschikbaar zijn voor deze locaties 2. De resultaten van een botdichtheidsmeting met DXA worden gewoonlijk op twee manieren uitgedrukt: de T-score en de Z-score. De Z-score geeft het aantal standaarddeviaties aan waarmee een persoon afwijkt van het gemiddelde van een referentiepopulatie met dezelfde leeftijd en etniciteit. De T-score geeft het aantal standaarddeviaties aan waarmee een persoon afwijkt van het gemiddelde van een 30-jarige referentiepopulatie. Een verlaagde BMD wordt bij individuen jonger dan 50 jaar door de ISCD gedefinieerd als een Z-score ≤-2 2. Bij sporters spreekt het American College of Sports Medicine (ACSM) van een verlaagde BMD bij een Z-score <-1 en van een sterk verlaagde BMD bij een Z-score van ≤-2 3. Bij individuen jonger dan 50 jaar wordt de diagnose osteoporose niet uitsluitend gebaseerd op DXA (Z-score ≤ -2), maar ook op het optreden van een fractuur 4. Meer dan 2 fracturen is bij volwassenen tot 50 jaar een indicatie voor een DXA scan 5.

HR-pQCT

Naast BMD zijn er ook andere factoren die bijdragen aan de botsterkte, waaronder de microarchitectuur en geometrie van het bot. Met microarchitectuur wordt onder andere bedoeld het aantal, de dikte en de onderlinge afstand van de botbalkjes in het trabeculaire bot, evenals kenmerken van het corticale bot, zoals corticale porositeit, dikte en dichtheid. Geometrie verwijst naar de structurele eigenschappen van het bot, zoals de grootte en vorm. Een relatief nieuwe techniek om deze aspecten nauwkeurig te beoordelen is high-resolution peripheral computed tomography (HR-pQCT; Afbeelding 1). HR-pQCT is een gevalideerde en CE gecertificeerde meting die slechts in een beperkt aantal centra in de wereld beschikbaar is en gedetailleerde informatie over de botstructuur geeft. Het biedt namelijk op microniveau (de resolutie van de scanner is 60 micrometer) inzicht in de geometrie en microarchitectuur van zowel het compacte als trabeculaire bot 6. Hierdoor levert deze techniek meer informatie over de botkwaliteit. Omdat HR-pQCT driedimensionale beelden van het bot genereert, kan de volumetrische BMD berekend worden, uitgedrukt in cm³. Nadelen van deze techniek zijn de beperking tot het meten van alleen de distale radius en distale tibia, en de beperkte beschikbaarheid van het apparaat. In Nederland is slechts één tweede-generatie HR-pQCT-scanner beschikbaar, namelijk in het VieCuri Medisch Centrum in Venlo.

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