Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Nose‐Ogura, Sayaka; Yokosuka, Osamu; Dohi, Michiko; Kigawa, Mika; Harada, Miyuki; Wada-Hiraike, Osamu; Onda, Takashi; Osuga, Yutaka; Fujii, Tomoyuki; Saito, Shigeru

doi:10.1111/sms.13464

Cited by 48 publications

(52 citation statements)

References 25 publications

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“…The risk of low EA has been investigated using surrogate markers or self-reported symptoms of low EA in various athlete populations including elite para-athletes [34], adolescent/young adult [35,36] and Olympic athletes [40], female sprinters [41], male jockeys [39] and recreationally active individuals [33,37], and ranges from 14% to 63% ( Table 3). The largest cross-sectional study investigating self-reported health and performance outcomes linked to low EA and RED-S [5] placed emphasis on including body systems beyond reproductive function and bone health such as metabolic, haematological, psychological and cardiovascular health and gastrointestinal function.…”

Section: Low Energy Availability Riskmentioning

confidence: 99%

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

et al. 2020

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Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

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Section: Low Energy Availability Riskmentioning

confidence: 99%

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

et al. 2020

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“…The American College of Sports Medicine (ACSM) defines the Female Athlete Triad (Triad) as low energy availability (LEA) with or without disordered eating, menstrual dysfunction, and low BMD 1 . This Triad increases the risk of bone stress fractures 4,14 . However, there are few established pharmacological treatments for low BMD in athletes.…”

Section: Introductionmentioning

confidence: 99%

Effect of transdermal estradiol therapy on bone mineral density of amenorrheic female athletes

Nose‐Ogura

Yokosuka

Kanatani

et al. 2020

Scandinavian Med Sci Sports

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Background The effects of transdermal estradiol treatment (HT) in amenorrheic athletes (AA) with low body weight (BW) and low bone mineral density (BMD) are unknown. Purpose To investigate whether HT increases BMD in AA with low BW and to compare the results with levels in AA who have recovered spontaneous menstruation (SM). Methods Female athletes (n = 151) were recruited at the Japan Institute of Sports Sciences and the University of Tokyo. All participants were divided into four groups: an AA group (untreated group) (n = 36), a HT group (n = 55), a SM group (n = 21), and an eumenorrheic athletes (EA) group (n = 39). Height, body weight, blood tests, and dual‐energy X‐ray absorptiometry were measured at baseline and after 12 months. The HT group was treated daily for 12 months with transdermal estrogen therapy. In addition, participants received oral progestin for 7 days once every 3 months. Results After 12 months, BMD in the AA group was significantly lower than at baseline; however, BMD in the other three groups was significantly higher than at baseline. The ratio of the change in BMD values before and after 12 months was −1.6 ± 3.2% for the AA group, 5.3 ± 8.7% for the HT group, 11.1 ± 8.9% for the SM group, and 2.3 ± 5.7% for the EA group. The rate of change in BMD values in the SM group was greater than that in the HT group. Conclusion HT increased BMD in AA with low BW, and the increase in those with SM was greater than that in those treated with HT.

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“…Stress fractures occur as a result of repetitive mechanical loading. Female athletes are at a higher risk of stress fractures than male athletes, with a frequency of 1–3% in male athletes and 10–12% in female athletes . Moreover, it has been reported that the frequency of stress fractures among 1616 female athletes and 537 controls (non‐athletes) was 22.6% for athletes competing at the international level, 23.3% for athletes competing at the national level, 20.8% for athletes competing at the local level, 18.8% for athletes competing at other levels and 4.3% for controls .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, it has been reported that the frequency of stress fractures among 1616 female athletes and 537 controls (non‐athletes) was 22.6% for athletes competing at the international level, 23.3% for athletes competing at the national level, 20.8% for athletes competing at the local level, 18.8% for athletes competing at other levels and 4.3% for controls . Stress fractures are associated with the Female Athlete Triad (Triad), which is defined by the American College of Sports Medicine (ACSM) as low energy availability with or without disordered eating, menstrual dysfunction and low bone mineral density. Barrack et al .…”

Section: Introductionmentioning

confidence: 99%

“…reported that the frequency of stress fractures in female athletes with a single component and more than two components of Triad was 15–20% and 30–50%, respectively . Moreover, it has been reported that secondary amenorrhea, low BMD and low body weight in teenage Japanese female athletes increased the risk for stress fractures by 12.9, 4.5 and 1.1 times, respectively …”

Section: Introductionmentioning

confidence: 99%

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Relationship between tartrate‐resistant acid phosphatase 5b and stress fractures in female athletes

Nose‐Ogura

Yokosuka

Dohi

et al. 2020

J of Obstet and Gynaecol

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Background Approximately 10% of female athletes have a history of stress fractures, which most commonly occur between the ages of 16 and 17 years old. Purpose We investigated whether tartrate‐resistant acid phosphatase 5b (TRACP‐5b), which is a bone resorption marker, can serve as a valid predictor of stress fractures in female athletes in their teens and 20s. Methods Three hundred and sixteen elite female athletes were recruited between 2013 and 2015. Serum TRACP‐5b and various hormones were examined in blood samples. The serum TRACP‐5b level was compared between athletes with and without stress fractures within 3 months after the initial collection of their blood samples. Results The 316 athletes were divided into two age groups: 13–19 years old and 20–29 years old. Thirty‐six athletes (11.4%) experienced new stress fractures within 3 months after the initial collection of their blood samples. The median serum TRACP‐5b level was significantly higher in teenage athletes with new stress fractures than in teenage athletes without new stress fractures. In univariate logistic regression analysis, the Z‐score of serum TRACP‐5b was a significant predictive factor of stress fractures in teenage athletes only (odds ratio: 1.87; 95% CI: 1.31–2.66; P < 0.0012). Conclusion For teenage female athletes, TRACP‐5b is a predictor of the risk of stress fractures, and measuring TRACP‐5b levels may be useful to prevent stress fractures.

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Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Cited by 48 publications

References 25 publications

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

Effect of transdermal estradiol therapy on bone mineral density of amenorrheic female athletes

Relationship between tartrate‐resistant acid phosphatase 5b and stress fractures in female athletes

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