Keith Loud | Geisel Medical School at Dartmouth (original) (raw)
Papers by Keith Loud
Journal of Adolescent Health, Feb 1, 2005
activity levels. Future research is needed to determine if inequalities in school facilities or p... more activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences.
Current Opinion in Pediatrics, Dec 1, 2013
Purpose of review Female participation in athletics has increased significantly over the past sev... more Purpose of review Female participation in athletics has increased significantly over the past several decades. For most young women, participation in sport fosters self-confidence, positive relationships with peers, and good physical health. However, with growing female representation in athletics, the sport community has become increasingly aware of the syndrome known as 'female athlete triad,' which describes the interplay between low energy availability (LEA), menstrual disturbances, and decreased bone mineral density (BMD). This review aims to discuss the definition and prevalence of the triad and prevention, detection, and treatment strategies. Recent findings Current research has elucidated the importance of identifying and treating the triad in young athletes, as adolescence is a critical time for bone development and failure to intervene can lead to long-term problems. First defined in 1992, full characterization of the triad in adolescents has been elusive because of difficulties in diagnosing low BMD in this population and reliance on self-report for menstrual disturbances and LEA. A 2007 reformulation of the triad incorporated research demonstrating that the full deleterious triad is rare and emphasized that its components exist on a spectrum. Removal of the stigma from the triad has the potential to allow earlier detection and treatment, thereby improving outcomes.
Journal of Adolescent Health, Feb 1, 2005
activity levels. Future research is needed to determine if inequalities in school facilities or p... more activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences.
Journal of Athletic Training, 2012
Context: The female athlete triad describes the interrelatedness of energy availability, menstrua... more Context: The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (MI) and INJ in the high school population. Objective: To determine the prevalence of and relationship between MI and INJ in high school athletes. Design: Cross-sectional study. Setting: High schools. Patients or Other Participants: The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season. Main Outcome Measure(s): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year. Results: The prevalences of M I and INJ were 19.7% and 63.1 %, respectively. Athletes who reported MI sustained a higher percentage of severe injuries (missing ;:>:22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with MI were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio=2.7, 95% confidence interval = 0.8, 8.8) than those who sustained an injury resulting in 7 or fewer days of time lost. Conclusions: The incidences of MI and INJ in this high school population during the study period were high. Athletes who reported MI sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management of MI and its potential effects on injury in female high school athletes are warranted.
Archives of pediatrics & adolescent medicine, Oct 1, 2006
ediatric and adolescent care professionals have increasingly recognized the importance of underst... more ediatric and adolescent care professionals have increasingly recognized the importance of understanding the skeletal health of their patients. Peak bone mass, the "bone bank" on which an individual will draw for their entire adult life, is likely achieved by late adolescence, with the critical window for accumulation occurring much earlier. This review outlines the known conditions that are associated with impaired bone mineral accrual and clinical settings in which the evaluation of "at-risk" adolescents should be considered. We describe the methods available to the health care professional for evaluating bone density, along with the limitations of each technology. Potential therapeutic options for patients identified to have a low bone mineral density are discussed. Finally, current recommendations regarding physical activity and nutrition, beneficial interventions for all adolescents, are presented.
Journal of Athletic Training, Mar 1, 2011
Objective: To provide certified athletic trainers, physicians, and other health care professional... more Objective: To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6-18 years). Background: Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches. Recommendations: Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.
JAMA Pediatrics, Feb 1, 2019
Adolescence provides a uniquely important period of opportunity to improve skeletal health across... more Adolescence provides a uniquely important period of opportunity to improve skeletal health across the lifespan, potentially even reducing the lifetime risk of osteoporosis. Because inherited factors account for as much as 80% of predicted peak bone mass, the relatively few factors amenable to modification become essential to understand for those clinicians who monitor the growth and development of children and adolescents. The modifiable factors include such lifestyle choices as dietary intake, physical activity, maintaining a healthy weight for height, contraceptive choice, and use of tobacco and alcohol. In addition to ensuring normal pubertal development, primary care providers can help guide patients to healthy choices for the bone that are aligned perfectly with other lifelong benefits.
Medicine and Science in Sports and Exercise, May 1, 2006
Pediatrics, Aug 1, 2007
OBJECTIVE-Increased physical activity and menstrual irregularity have been associated with increa... more OBJECTIVE-Increased physical activity and menstrual irregularity have been associated with increased risk for stress fracture among adult women active in athletics. The purposes of this study were to determine whether menstrual irregularity is also a risk factor for stress fracture in active female adolescents and to estimate the quantity of exercise associated with an increased risk for this injury. PATIENTS AND METHODS-A case-control study was conducted of 13-to 22-year-old females diagnosed with their first stress fracture, each matched prospectively on age and selfreported ethnicity with 2 controls. Patients with chronic illnesses or use of medications known to affect bone mineral density were excluded, including use of hormonal preparations that could alter menstrual cycles. The primary outcome, stress fracture in any extremity or the spine, was confirmed radiographically. Girls with stress fracture had bone mineral density measured at the lumbar spine by dual-energy x-ray absorptiometry. RESULTS-The mean ± SD age of the 168 participants was 15.9 ± 2.1 years; 91.7% were postmenarchal, with a mean age at menarche of 13.1 ± 1.1 years. The prevalence of menstrual irregularity was similar among cases and controls. There was no significant difference in the mean hours per week of total physical activity between girls in this sample with stress fracture (8.2 hours/week) and those without (7.4 hours/week). In multivariate models, case subjects had nearly 3 times the odds of having a family member with osteoporosis or osteopenia. In secondary analyses, participants with stress fracture had a low mean spinal bone mineral density for their age. CONCLUSIONS-Among highly active female adolescents, only family history was independently associated with stress fracture. The magnitude of this association suggests that further investigations of inheritable skeletal factors are warranted in this population, along with evaluation of bone mineral density in girls with stress fracture.
Clinical Pediatrics, Mar 22, 2010
Purpose. To evaluate relationships between seasonal patterns of athletic participation and overus... more Purpose. To evaluate relationships between seasonal patterns of athletic participation and overuse injuries in high school athletes. Methods. Self-reported survey of sports played and injuries sustained during the preceding 12 months administered anonymously to 9th-12th graders in school. Results. Females suffered more overuse injuries than males. Overuse injuries increased slightly with age and with seasons of sports played per calendar year. Students who played sports all year long had 42% increased risk of overuse injury compared to those who played fewer than 4 seasons. Conclusions. Reducing the number of sport seasons played by high school athletes could decrease their rate of overuse injuries, with the greatest gains potentially achieved by taking at least one season off from sports entirely each calendar year.
Journal of Orthopaedic & Sports Physical Therapy, Feb 1, 2011
Eating Disorder Examination Questionnaire. *Adjusted for all variables in table and menstrual dys... more Eating Disorder Examination Questionnaire. *Adjusted for all variables in table and menstrual dysfunction status, sport type, oral contraceptive use, BMI, and age. Odds ratio for injury is significantly greater for disordered eating group when compared to the reference group, as CI does not include 1 (P.05)
Springer eBooks, Sep 22, 2014
Clinical Pediatrics, Jun 1, 2001
... DOI: 10.1177/000992280104000607 2001 40: 343 CLIN PEDIATR Leigh M. Ettinger, Keith J. Loud, K... more ... DOI: 10.1177/000992280104000607 2001 40: 343 CLIN PEDIATR Leigh M. Ettinger, Keith J. Loud, Kenneth L. Serra and Scott A. Shipman Arterial Disease Causing Refusal to Walk in a Toddler Published by: http://www.sagepublications.com ...
Journal of Adolescent Health, Feb 1, 2006
Journal of Adolescent Health, Dec 1, 2006
Quantitative ultrasound (QUS) evaluation of bone is attractive for evaluating skeletal status in ... more Quantitative ultrasound (QUS) evaluation of bone is attractive for evaluating skeletal status in adolescents, but its use is limited in the United States due to sparse pediatric reference data. This study evaluated associations between radial and tibial speed of sound (SOS) measurements via QUS and demographic, anthropometric and nutritional variables. We enrolled 151 healthy participants, aged 11-26 years, during routine visits to an urban adolescent clinic. SOS measurements were obtained using the Omnisense 7000P (Sunlight Medical Ltd., Tel-Aviv, Israel) and correlated with weight, height, gender, race, sexual maturity rating (SMR), and reported nutritional intake. The sample was 53% female; aged 17+/- 2.8 years (mean +/- SD); and 48% African-American, 21% Hispanic, and 21% Caucasian. Seventy percent of males and 91% of females had achieved SMR 5; 96% of females were postmenarchal. Males met the recommended daily allowance for calcium intake, on average; the females did not. Both the girls and boys reported consumption of inadequate vitamin D. Intake of neither calcium nor vitamin D was correlated with SOS. Radial and tibial SOS were significantly higher in those with SMR 5 (p < .001) and were moderately correlated with age in both genders (r = .42-.64, p < .001). In multivariate analyses, age was associated with SOS at both sites (p < .0001). This study provides QUS measurements of the peripheral skeleton among healthy adolescents. QUS measurements followed similar age and pubertal distributions to dual-energy X-ray absorptiometry (DXA) bone density measurements; other variables did not follow expected trends. Further research is needed to clarify what skeletal properties are assessed by this technique. This study adds to accumulating evidence that many adolescents do not consume adequate vitamin D or calcium.
Clinical Journal of Sport Medicine, Nov 1, 2005
Objective: To review the literature for evidence that pertains to return to play and spine injuri... more Objective: To review the literature for evidence that pertains to return to play and spine injuries, including cervical spinal stenosis, congenital and developmental abnormalities of the cervical spine, stingers, herniated nucleus pulposus, and spondylolysis/spondylolisthesis.
Journal of Adolescent Health, Feb 1, 2005
activity levels. Future research is needed to determine if inequalities in school facilities or p... more activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences.
Current Opinion in Pediatrics, Dec 1, 2013
Purpose of review Female participation in athletics has increased significantly over the past sev... more Purpose of review Female participation in athletics has increased significantly over the past several decades. For most young women, participation in sport fosters self-confidence, positive relationships with peers, and good physical health. However, with growing female representation in athletics, the sport community has become increasingly aware of the syndrome known as 'female athlete triad,' which describes the interplay between low energy availability (LEA), menstrual disturbances, and decreased bone mineral density (BMD). This review aims to discuss the definition and prevalence of the triad and prevention, detection, and treatment strategies. Recent findings Current research has elucidated the importance of identifying and treating the triad in young athletes, as adolescence is a critical time for bone development and failure to intervene can lead to long-term problems. First defined in 1992, full characterization of the triad in adolescents has been elusive because of difficulties in diagnosing low BMD in this population and reliance on self-report for menstrual disturbances and LEA. A 2007 reformulation of the triad incorporated research demonstrating that the full deleterious triad is rare and emphasized that its components exist on a spectrum. Removal of the stigma from the triad has the potential to allow earlier detection and treatment, thereby improving outcomes.
Journal of Adolescent Health, Feb 1, 2005
activity levels. Future research is needed to determine if inequalities in school facilities or p... more activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences.
Journal of Athletic Training, 2012
Context: The female athlete triad describes the interrelatedness of energy availability, menstrua... more Context: The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (MI) and INJ in the high school population. Objective: To determine the prevalence of and relationship between MI and INJ in high school athletes. Design: Cross-sectional study. Setting: High schools. Patients or Other Participants: The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season. Main Outcome Measure(s): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year. Results: The prevalences of M I and INJ were 19.7% and 63.1 %, respectively. Athletes who reported MI sustained a higher percentage of severe injuries (missing ;:>:22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with MI were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio=2.7, 95% confidence interval = 0.8, 8.8) than those who sustained an injury resulting in 7 or fewer days of time lost. Conclusions: The incidences of MI and INJ in this high school population during the study period were high. Athletes who reported MI sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management of MI and its potential effects on injury in female high school athletes are warranted.
Archives of pediatrics & adolescent medicine, Oct 1, 2006
ediatric and adolescent care professionals have increasingly recognized the importance of underst... more ediatric and adolescent care professionals have increasingly recognized the importance of understanding the skeletal health of their patients. Peak bone mass, the "bone bank" on which an individual will draw for their entire adult life, is likely achieved by late adolescence, with the critical window for accumulation occurring much earlier. This review outlines the known conditions that are associated with impaired bone mineral accrual and clinical settings in which the evaluation of "at-risk" adolescents should be considered. We describe the methods available to the health care professional for evaluating bone density, along with the limitations of each technology. Potential therapeutic options for patients identified to have a low bone mineral density are discussed. Finally, current recommendations regarding physical activity and nutrition, beneficial interventions for all adolescents, are presented.
Journal of Athletic Training, Mar 1, 2011
Objective: To provide certified athletic trainers, physicians, and other health care professional... more Objective: To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6-18 years). Background: Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches. Recommendations: Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.
JAMA Pediatrics, Feb 1, 2019
Adolescence provides a uniquely important period of opportunity to improve skeletal health across... more Adolescence provides a uniquely important period of opportunity to improve skeletal health across the lifespan, potentially even reducing the lifetime risk of osteoporosis. Because inherited factors account for as much as 80% of predicted peak bone mass, the relatively few factors amenable to modification become essential to understand for those clinicians who monitor the growth and development of children and adolescents. The modifiable factors include such lifestyle choices as dietary intake, physical activity, maintaining a healthy weight for height, contraceptive choice, and use of tobacco and alcohol. In addition to ensuring normal pubertal development, primary care providers can help guide patients to healthy choices for the bone that are aligned perfectly with other lifelong benefits.
Medicine and Science in Sports and Exercise, May 1, 2006
Pediatrics, Aug 1, 2007
OBJECTIVE-Increased physical activity and menstrual irregularity have been associated with increa... more OBJECTIVE-Increased physical activity and menstrual irregularity have been associated with increased risk for stress fracture among adult women active in athletics. The purposes of this study were to determine whether menstrual irregularity is also a risk factor for stress fracture in active female adolescents and to estimate the quantity of exercise associated with an increased risk for this injury. PATIENTS AND METHODS-A case-control study was conducted of 13-to 22-year-old females diagnosed with their first stress fracture, each matched prospectively on age and selfreported ethnicity with 2 controls. Patients with chronic illnesses or use of medications known to affect bone mineral density were excluded, including use of hormonal preparations that could alter menstrual cycles. The primary outcome, stress fracture in any extremity or the spine, was confirmed radiographically. Girls with stress fracture had bone mineral density measured at the lumbar spine by dual-energy x-ray absorptiometry. RESULTS-The mean ± SD age of the 168 participants was 15.9 ± 2.1 years; 91.7% were postmenarchal, with a mean age at menarche of 13.1 ± 1.1 years. The prevalence of menstrual irregularity was similar among cases and controls. There was no significant difference in the mean hours per week of total physical activity between girls in this sample with stress fracture (8.2 hours/week) and those without (7.4 hours/week). In multivariate models, case subjects had nearly 3 times the odds of having a family member with osteoporosis or osteopenia. In secondary analyses, participants with stress fracture had a low mean spinal bone mineral density for their age. CONCLUSIONS-Among highly active female adolescents, only family history was independently associated with stress fracture. The magnitude of this association suggests that further investigations of inheritable skeletal factors are warranted in this population, along with evaluation of bone mineral density in girls with stress fracture.
Clinical Pediatrics, Mar 22, 2010
Purpose. To evaluate relationships between seasonal patterns of athletic participation and overus... more Purpose. To evaluate relationships between seasonal patterns of athletic participation and overuse injuries in high school athletes. Methods. Self-reported survey of sports played and injuries sustained during the preceding 12 months administered anonymously to 9th-12th graders in school. Results. Females suffered more overuse injuries than males. Overuse injuries increased slightly with age and with seasons of sports played per calendar year. Students who played sports all year long had 42% increased risk of overuse injury compared to those who played fewer than 4 seasons. Conclusions. Reducing the number of sport seasons played by high school athletes could decrease their rate of overuse injuries, with the greatest gains potentially achieved by taking at least one season off from sports entirely each calendar year.
Journal of Orthopaedic & Sports Physical Therapy, Feb 1, 2011
Eating Disorder Examination Questionnaire. *Adjusted for all variables in table and menstrual dys... more Eating Disorder Examination Questionnaire. *Adjusted for all variables in table and menstrual dysfunction status, sport type, oral contraceptive use, BMI, and age. Odds ratio for injury is significantly greater for disordered eating group when compared to the reference group, as CI does not include 1 (P.05)
Springer eBooks, Sep 22, 2014
Clinical Pediatrics, Jun 1, 2001
... DOI: 10.1177/000992280104000607 2001 40: 343 CLIN PEDIATR Leigh M. Ettinger, Keith J. Loud, K... more ... DOI: 10.1177/000992280104000607 2001 40: 343 CLIN PEDIATR Leigh M. Ettinger, Keith J. Loud, Kenneth L. Serra and Scott A. Shipman Arterial Disease Causing Refusal to Walk in a Toddler Published by: http://www.sagepublications.com ...
Journal of Adolescent Health, Feb 1, 2006
Journal of Adolescent Health, Dec 1, 2006
Quantitative ultrasound (QUS) evaluation of bone is attractive for evaluating skeletal status in ... more Quantitative ultrasound (QUS) evaluation of bone is attractive for evaluating skeletal status in adolescents, but its use is limited in the United States due to sparse pediatric reference data. This study evaluated associations between radial and tibial speed of sound (SOS) measurements via QUS and demographic, anthropometric and nutritional variables. We enrolled 151 healthy participants, aged 11-26 years, during routine visits to an urban adolescent clinic. SOS measurements were obtained using the Omnisense 7000P (Sunlight Medical Ltd., Tel-Aviv, Israel) and correlated with weight, height, gender, race, sexual maturity rating (SMR), and reported nutritional intake. The sample was 53% female; aged 17+/- 2.8 years (mean +/- SD); and 48% African-American, 21% Hispanic, and 21% Caucasian. Seventy percent of males and 91% of females had achieved SMR 5; 96% of females were postmenarchal. Males met the recommended daily allowance for calcium intake, on average; the females did not. Both the girls and boys reported consumption of inadequate vitamin D. Intake of neither calcium nor vitamin D was correlated with SOS. Radial and tibial SOS were significantly higher in those with SMR 5 (p < .001) and were moderately correlated with age in both genders (r = .42-.64, p < .001). In multivariate analyses, age was associated with SOS at both sites (p < .0001). This study provides QUS measurements of the peripheral skeleton among healthy adolescents. QUS measurements followed similar age and pubertal distributions to dual-energy X-ray absorptiometry (DXA) bone density measurements; other variables did not follow expected trends. Further research is needed to clarify what skeletal properties are assessed by this technique. This study adds to accumulating evidence that many adolescents do not consume adequate vitamin D or calcium.
Clinical Journal of Sport Medicine, Nov 1, 2005
Objective: To review the literature for evidence that pertains to return to play and spine injuri... more Objective: To review the literature for evidence that pertains to return to play and spine injuries, including cervical spinal stenosis, congenital and developmental abnormalities of the cervical spine, stingers, herniated nucleus pulposus, and spondylolysis/spondylolisthesis.