The Female Athlete Triad

Kelly, Amanda K. Weiss; Hecht, Suzanne; Brenner, Joel S.; LaBella, Cynthia R.; Brooks, M. Alison; Diamond, Alex B.; Hennrikus, William; LaBotz, Michele; Logan, Kelsey; Loud, Keith J.; Moffatt, Kody; Nemeth, Blaise A.; Pengel, Brooke

doi:10.1542/peds.2016-0922

Cited by 69 publications

(34 citation statements)

References 74 publications

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“…Examples of intrinsic factors include metabolic bone diseases and nutritional or hormonal deficiencies. In particular, young female athletes with a low BMI and history of amenorrhea are at increased risk for stress fractures and should be screened for possible female athlete triad (11). Extrinsic factors include type of sport, training surface, shoe wear, and most commonly a sudden increase in training regimen (12).…”

Section: Discussionmentioning

confidence: 99%

Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention

et al. 2019

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Case: A 16-year-old African American multi-sport female athlete presents with bilateral worsening activity-related leg pain for 5 months. Multiple bilateral anterior tibial diaphyseal stress fractures and significant vitamin D deficiency were identified. She was treated with a combination of vitamin D supplements and static intramedullary nailing of the bilateral tibias resulting in clinical and radiographic healing and return to sports.Discussion: Vitamin D deficiency and high level of activity in a young athlete may be the etiology to atypical multiple stress fractures. In athletes who may want to return to sport rapidly, early operative intervention and correction of vitamin D deficiency may be treatment options.Level of Evidence: Level V- case report.

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Section: Discussionmentioning

confidence: 99%

Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention

et al. 2019

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“…The questions in this survey were derived from athlete screening during previous research trials and included questions from the Female Athlete Triad Screening Questionnaire, Triad Consensus Panel Screening Questionnaire, Athlete Sleep Screening Questionnaire, and the Recovery Stress Questionnaire for Athletes. 7 , 4 , 9 , 20 …”

Section: Methodsmentioning

confidence: 99%

Prevalence of Female Athlete Triad Risk Factors and Iron Supplementation Among High School Distance Runners: Results From a Triad Risk Screening Tool

Skorseth

Segovia

Hastings

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Investigations of the female athlete triad (Triad) in high school athletes have found that 36% had low energy availability, 54% had menstrual abnormalities, and 16% had low bone mineral density (BMD). Limited data are available showing the prevalence of these risk factors in high school distance runners or regarding best practice on screening for the Triad in the adolescent population. Purpose: To (1) evaluate the prevalence of Triad risk factors and iron supplementation in high school distance runners and (2) pilot a screening tool for Triad risk score. Study Design: Descriptive epidemiology study. Methods: The study population included female high school athletes who participated in cross-country/track. Participants completed a survey including questions regarding dietary habits, menstrual history, and bone stress injury (BSI) history. They then underwent evaluation of 25-hydroxyvitamin D, free triiodothyronine (T3), and dual-energy x-ray absorptiometry scan to measure body fat and BMD through use of age-, sex-, and ethnicity-matched Z scores. Triad scores were calculated. Relationships were analyzed using Spearman correlation coefficient. Results: There were 38 study participants (mean age, 16.9 years). Average body mass index was 19.8 kg/m2. Disordered eating or eating disorders were reported in 76.3% of runners; in addition, 23.7% reported delayed menarche, 45.9% had a history of amenorrhea or oligomenorrhea, 42.1% had low BMD ( Z score < –1.0), and 15.8% reported prior BSI. Low free T3 was significantly associated with higher Triad risk scores ( r S = –0.36; P = .028). More than 42% of athletes were supplementing iron. Conclusion: The prevalence of Triad risk factors in high school distance runners was high. Free T3 was inversely associated with Triad score, which may serve as an indicator of low energy availability. Nearly half of the athletes were using iron supplementation.

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“…When examined by sport, bones of the lower extremities and lumbar vertebrae show high values at the load sites in volleyball and weight lifting players, whereas competitive swimmers show lower bone density compared with athletes who play other sports with a lack of load . It has been reported that non‐athletes with oligomenorrhea or amenorrhea have low BMD compared with those with eumenorrhea . However, bone density has not been shown to be low in gymnasts with amenorrhea compared with those with eumenorrhea.…”

Section: Factors Composing Fatmentioning

confidence: 99%

Management of the female athlete triad

Nose‐Ogura

Harada

Wada-Hiraike

et al. 2018

J of Obstet and Gynaecol

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The female athlete triad (FAT) is defined by the American College of Sports Medicine (ACSM) as low energy availability (low EA), functional hypothalamic amenorrhoea and osteoporosis. In low EA, lutein dysfunction first develops, followed by anovulation and, subsequently, oligomenorrhea, leading to amenorrhea. Moreover, low estradiol concentrations due to amenorrhea decrease bone mineral density (BMD). In athletes with one of the factors of FAT, the risk of a stress fracture is 2.4-4.9 times higher and may increase the risk of fracture throughout the lifespan. Low EA is the starting point of FAT, and the FAT concept emphasizes the importance of energy intake that is commensurate with exercise energy expenditure in athletes. In amenorrheic athletes who undergo gynecological examination, it is important to appropriately evaluate whether the cause is low EA and to review exercise energy expenditure and energy intake. It remains difficult even for experts to calculate available energy using the ACSM definition formula when evaluating energy deficiency. Moreover, performing early FAT screening during teenage years and cooperation between the department of obstetrics and gynecology and sports dietitians are also issues. The aim of this paper is to review the management of FAT from the viewpoint of gynecologists.

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The Female Athlete Triad

Cited by 69 publications

References 74 publications

Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention

Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention

Prevalence of Female Athlete Triad Risk Factors and Iron Supplementation Among High School Distance Runners: Results From a Triad Risk Screening Tool

Management of the female athlete triad

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