18/19 January 2021
Center for Continuing Education, University of Zurich
Objectives of the module
- are aware of the special features of the care of female recreational and competitive athletes with regard to injury patterns, measures for prevention, trainability and training design, prevention, recognition and therapy of energy deficit syndromes, pregnancy.
- know the sex-specific differences of the immune system and are able to draw correct conclusions regarding immunopathogenesis, prevalence, phenotype and thus diagnostics as well as outcome and therapy of autoimmune diseases.
- know the various examination methods for diagnosing osteoporosis and can interpret their findings.
- know the epidemiological differences in forensic medicine with regard to sex and gender and can derive individual approaches from this.
Content of the module
In this module, the influence of sex and gender on various aspects and pathologies affecting the musculoskeletal system is conveyed. In addition to the points that directly affect the musculoskeletal system, the immune system as well as trainability and performance will be examined more closely.
In concrete terms, the module comprises the following blocks
- Sports medicine
- With regard to the musculoskeletal aspects of sports medicine, a sex- and gender-specific distribution of injury patterns can be observed. In female athletes, for example, injuries of the ligamentous apparatus as well as stress fractures and overloading of the ankle joint are more common, whereas in male athletes, muscular injuries are the most common. The causes for this sex- and gender-specific distribution, especially of ligament injuries, are multifactorial. However, in addition to extrinsic factors, intrinsic factors such as ligament laxity, hormonal influences or anatomical peculiarities seem to play a decisive role. Also biomechanically there are sex-specific differences with regard to movement sequences or patterns and neuromuscular control.
- In sports-associated craniocerebral traumas (e.g. concussions) there seems to be a difference in both frequency and outcome between female and male athletes.
- There are also differences between women and men in terms of metabolism under physical strain. Probably the most important differences for sport concern both glucose metabolism and muscle fibre distribution.
- The sex hormones seem to have an influence on trainability. Thus it seems to be comparable between the sexes up to adolescence. Only after puberty does the higher testosterone levels in men and the higher estrogen levels in women lead to adjustments in muscle mass, glucose sensitivity of the muscles and fatty acid oxidation.
- Women-specific topics in sports medicine include the so-called „female athlete triad“ and sport during pregnancy.
- Sex-specific differences in the prevalence and severity of numerous immunological diseases have long been known. The causes for this seem to lie in the sex chromosomes per se as well as in differences in gene regulation caused by sex hormones, in interactions with the microbiome and in membrane receptor-mediated reactions. The fact that the incidence of rheumatoid arthritis in women increases both postpartum and at the onset of menopause indicates that absolute hormone levels do not necessarily play a role in the development of the disease.
- In addition to different pathophysiological sex differences, differences in response to therapeutics (e.g. in patients with psoriatic arthritis and therapy with TNFa inhibitors) could also be shown. Thus, sex seems to be of crucial importance also with regard to an optimal personalized therapy.
In terms of strength and stability of the bone or skeleton, both bone mass and bone density play a decisive role. Up to an age of approximately 30 years, both men and women experience an almost linear increase in bone density and bone mass, albeit at a slightly lower level in women. In the following decade of life the bone mass remains almost constant and then decreases again at the age of about 40 years. This decrease is almost linear in men and significantly increased in women after menopause, resulting in a loss of up to 40% of bone mass.
- Forensic Medicine
- Suicidality: differences in epidemiology, risk factors, gender paradox
- Intoxications: In adulthood predominantly women affected & poisoning by medication particularly frequent
- Injuries/(car) accidents: for men more at work or sport, for women more at home
- Sex offences in adults: „Bernese model“
Prof. Dr. med. Johannes Scherr, Universitäres Zentrum für Prävention und Sportmedizin, Universitätsklinik Balgrist (Chair)
Prof. Dr. med. Oliver Distler, Klinik für Rheumatologie, Universitätsspital Zürich
Prof. Dr. med. Mazda Farshad, Universitätsklinik Balgrist
Prof. Dr. med. Frauke Förger, Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universität Bern
Dr.med. Stefan Fröhlich, Universitäres Zentrum für Prävention und Sportmedizin, Universitätsklinik Balgrist
Prof. Dr. med. Rahel Kubik, Departement Medizinische Dienste, Kantonsspital Baden
Dr. med. Carina Mihai, Klinik für Rheumatologie, Universitätsspital Zürich
Prof. Dr. med. Burkhard Möller, Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universität Bern
Prof. Dr. med. Michael Thali, Institut für Rechtsmedizin, Universitätsspital Zürich
Tbd (December 2020)