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Center for the Study of Retired Athletes Panders to Anti-Steroid Propaganda with Flawed Study

A recent survey of retired NFL football players reported that 9.1% of 2,552 former players used anabolic-androgenic steroids (AAS). The researchers reported a strong association or correlation between anabolic steroids and musculoskeletal injury (MSI); the steroid-hysterical media interpreted this to mean anabolic steroids cause musculoskeletal injury. Specifically, researchers only found an association between steroids and a specific type of MSI - joint and cartilaginous injuries. Contrary to expectations, there was NO association between steroids and tendon and muscle injuries. Very few news and media outlets reported that finding!

The survey was conducted by Kevin Guskiewicz, PhD, the professor of exercise and sport science at the University of North Carolina and the research director of the Center for the Study of Retired Athletes, and his colleagues at the center. They made the following conclusions in a paper entitled "Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: Findings from the Center for the Study of Retired Athletes health survey of retired NFL players”:

“Our findings demonstrate that an association may exist between anabolic-androgenic steroids use and the prevalence of reported musculoskeletal injury sustained during a professional football career, particularly ligamentous/joint-related injuries.”

Unfortunately, the researchers made conclusions that are not well-supported by their analyses. The survey was compromised by flawed methodology and various confounding variables.

The major flaw of the survey goes to the very survey question that is the basis for the research. The University of North Carolina researchers NEVER asked respondents about "anabolic steroids" or "anabolic-androgenic steroids"! They only referred to “performance-enhancing steroids”.

"During the time in which it was acceptable to use performance-enhancing steroids, did you use steroids?"

Frederick Fu, M.D., professor and chairman of Orthopedic Surgery at the University of Pittsburgh, was skeptical of the survey and concerned that respondents did not understand the questions. The broad and vague question could easily encompass corticosteroids and/or anabolic steroids. Both types of steroids can provide an athlete with "performance-enhancing" effects albeit by vastly different mechanisms of action. The lack of validity of this question makes it impossible to know for certain if researchers measured what they intended to measure i.e. anabolic-androgenic steroid use.

Were retired football players responding to “corticosteroid use” or “anabolic steroid use”? We do not know. Nonetheless, the researchers make the leap from "performance-enhancing steroids" to interpretations and conclusions involving "anabolic-androgenic steroids". The two phrases can not be used interchangeably as the authors did in their article.

As a result, the survey is confounded by a potential association between corticosteroids and musculoskeletal injury. The entire study is called into question due to the poorly worded survey item. Which group of athletes is most likely to use corticosteroids? Of course, it would be athletes with joint-related injuries. We do not know if an association between steroids and MSI involves (a) corticosteroids, (b) anabolic steroids or; (c) a combination of the two types of steroids. It is unknown why the researchers didn’t explicitly ask the following:

"During the time in which it was acceptable to use anabolic-androgenic steroids, did you use anabolic steroids?"

Another major flaw in the survey is the failure of researchers to control for body weight and/or body mass index (BMI) during data analysis. Which group of athletes is most likely to experience ligament and joint-related injuries? Of course, it would be the football players who weighed the most and had the highest BMI. The researchers acknowledged that the football players who used AAS were the ones with the highest BMI and played in positions requiring greater size and strength e.g. offensive line, tight end, etc. The researchers still did not control for this variable. Would the nature of the association between AAS and MSI be affected after controlling for the confounding variable of BW or BMI? We don’t know.

The most curious finding was the lack of ANY association between steroids and tendon and muscle injuries. The authors predicted beforehand that tendons would represent the “weakest link” and would be most susceptible to injury in anabolic-androgenic steroid users. Several studies, along with anecdotal evidence, have suggested that anabolic steroids could lead to collagen abnormalities and alterations in tendon elasticity; such changes could make the tendon vulnerable to injury since tendons are slower to adapt to steroid-induced increases in strength.

The research team modified their predictions accordingly to support the findings that anabolic steroids were NOT associated with tendon injury in this survey. The lead author Dr. Scott Horn suggested that it may be the ligaments/joints/cartilage, rather than muscle tendons, that represent the “weakest link in the chain”.

Sadly, it seems that the popular press has little interest in identifying the flaws in a survey about the use of anabolic steroids. They would rather report on a study that conforms to the message that anabolic steroids are dangerous drugs with harmful side effects. They welcome a nice sound bite pandering to anti-steroid. The media prefers to ignore the technical gobbledygook involving methodology and statistical analysis but loves finding the money quote happily provided, in this case, by Kevin Guskiewicz, “Our findings speak to the compounded medical problems that appear with steroid use, with negative effects on joint health starting a ‘snowball effect’ that can lead to other chronic diseases later in life”.

 

Anabolic steroids users may actually be predisposed to musculoskeletal injury. The proposed mechanisms by which this can occur seem plausible. But the “retired NFL player survey” is flawed and cannot support the conclusions that the researchers attempt to make.

 

Sources

 

“Steroid use may be linked to risk for some musculoskeletal diseases,” February 20, 2009

 

“NFL players who use steroids have more injuries,” February 20, 2009

 

References

 

Horn S. Gregory P, Guskiewicz KM. Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: Findings from the Center for the Study of Retired Athletes health survey of retired NFL players. Am J Phys Med & Rehab. 88(3):192-200.

 

Center for the Study of Retired Athletes at the University of North Carolina at Chapel Hill in affiliation with the National Football League's Players Association.

 

By Millard Baker

http://www.millardbaker.com

www.SteroidsRx.com