The female athlete triad: disordered eating, amenorrhea, osteoporosis

Yeager, Kimberly K.; Agostini, Rosemary; Nattiv, Aurelia; Drinkwater, Barbara L.

doi:10.1249/00005768-199307000-00003

Cited by 360 publications

(183 citation statements)

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“…We, therefore, constructed a pathogenetic model of stress fracture on the basis of studies in the adult literature and the observations of experienced clinicians. The risk factors deemed most important in our model included BMI, dietary intake of calcium and vitamin D, and heredity and were identified, a priori, as covariates to be measured in the study.Even before the American College of Sports Medicine coined the term "female athlete triad" in 1992 to describe the interrelatedness of disordered eating, amenorrhea, and osteoporosis in young female athletes, 17,18 another area of significant interest in women's skeletal health has been menstrual irregularity (MI). 19,20 Studies have inconsistently shown MI to be a risk factor for stress fracture in active adult women, 21-26 but information on menstrual history was not available from the large epidemiologic cohort that we analyzed previously.…”

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Family History Predicts Stress Fracture in Active Female Adolescents

Loud

Micheli²,

Bristol

et al. 2007

Pediatrics

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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. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 October 25. Stress fractures are particularly concerning in active female adolescents and young adults because they may signify insufficiency of the bones to withstand repetitive loading. Although a "fracture threshold"is not yet defined for children and adolescents, ~80% to 90% of in vitro skeletal strength in adults is determined by bone mineral density (BMD). 12 A woman's peak bone mass is achieved by her early 20s 13,14 and is one of the strongest predictors of her long-term risk of osteoporosis. 15,16 Understanding the risk factors that predispose to stress fracture in this population could, therefore, indirectly elucidate the risk factors for a low BMD.To our knowledge, no data exist regarding risk factors for stress fracture in adolescents younger than age 17 years. We, therefore, constructed a pathogenetic model of stress fracture on the basis of studies in the adult literature and the observations of experienced clinicians. The risk factors deem...

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Family History Predicts Stress Fracture in Active Female Adolescents

Loud

Micheli²,

Bristol

et al. 2007

Pediatrics

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“…[13][14][15] This constellation of disordered eating, amenorrhea, and osteoporosis has come to be known as the "female athlete triad," a term coined by the American College of Sports Medicine in 1993. 16,17 To begin to assess which stress fractures may be markers of compromised bone health, one must understand the epidemiology and causes of these injuries. Although stress fractures cause considerable impairment, 2 unfortunately little is known about the prevalence of or risk factors for stress fractures among young women.…”

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Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

Gordon²,

et al. 2005

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ABSTRACT. Objective. Although stress fractures are a source of significant morbidity in active populations, particularly among young female athletes, the causes of stress fractures have not been explored among females <17 years of age or in the general population. The purpose of this study was to examine correlates of stress fractures in a large, population-based, national, cohort study of preadolescent and adolescent girls.Methods. A cross-sectional analysis of data from 5461 girls, 11 to 17 years of age, in the Growing Up Today Study, an ongoing longitudinal study of the children of registered female nurses participating in Nurses' Health Study II, was performed. Mothers self-reported information regarding their children's histories of stress fractures on their 1998 annual questionnaire. Growing Up Today Study participants self-reported their weight and height, menarcheal status, physical activity, dietary intake, and disordered eating habits on annual surveys.Results. In 1998, the mean age of the participants was 13.9 years. Approximately 2.7% of the girls had a history of stress fracture, 3% engaged in disordered eating (using fasting, diet pills, laxatives, or vomiting to control weight), and 16% participated in >16 hours per week of moderate to vigorous activity. Age at menarche, z score of BMI in 1998, calcium intake, vitamin D intake, and daily dairy intake were all unrelated to stress fractures after controlling for age. Independent of age and BMI, girls who participated in >16 hours per week of activity in 1998 had 1.88 greater odds of a history of stress fracture than did girls who participated in <4 hours per week (95% confidence interval [CI]: 1.18 -3.30). Girls who participated in >16 hours per week of activity were also more likely than their peers to engage in disordered eating (4.6% vs 2.8%); however, disordered eating did not have an independent association with stress fractures (odds ratio Conclusions. These findings suggest that, although activity can be beneficial for bone health, there is a threshold over which the risk of stress fracture increases significantly among adolescent girls. High-impact activities, particularly running, cheerleading, and gymnastics, appear to be higher risk than other activities. Prospective studies are needed to explore the directionality of these relationships, as well as the role of menstrual history. In the meantime, clinicians should remain vigilant in identifying and treating disordered eating and menstrual irregularities among their highly active, young, female patients. Pediatrics 2005; 115:e399-e406. URL: www.pediatrics.org/cgi[

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“…It is often accompanied with nutrition and menstrual cycle dysfunctions thus constituting a syndrome often called »Female Sports Triad« (12)(13)(14). Functional hypo thalamic amenorrhea (HPA) is a condition charac terized by the absence of menstrual cycle due to suppression of hypothalamic-pituitary-ovarian axis, without the presence of morphological or organic defects (5).…”

Section: Discussionmentioning

confidence: 99%

Bone Metabolism Markers in Sportswomen with Menstrual Cycle Dysfunctions

Ponorac¹,

Rašeta²,

Radovanović³

et al. 2011

Journal of Medical Biochemistry

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Kratak sadr`aj: Dobro je poznata ~injenica da su sport ist kinje sa neredovnim menstrualnim ciklusom izlo`ene riziku od smanjenja ko{tane mineralne gustine i posledi~no osteoporozi. Pra}enje nivoa biohemijskih markera ko {tanog metabolizma omogu}ava razumevanje dina m i ~kih promena tokom procesa remodeliranja kosti. Ciljevi spro vedenog istra`ivanja bili su: utvrditi prevalence men stru alnih poreme}aja na uzorku sportistkinja i kontrolne grupe, kao i odrediti nivoe markera ko{tanog metabolizma u grupama ispitanica sa menstrualnim disfunkcijama. Ispi tanice (n=117) bile su podeljene u dve grupe, ekspe rimentalnu (S) (n=84) podeljenu u tri podgrupe (34 sportistkinje igara sa loptom, 27 atleti~arki i 23 takmi~arke u sportskom plesu) i kontrolnu grupu (C) (n=34). Za odre|ivanje menstrualnog profila i poreme}aja menstrual nog ciklusa kori{}en je upitnik. Odre|en je nivo srednjeg fragmenta osteokalcina (N-MID osteokalcin) kao markera formiranja kosti i b-CrossLaps (b-CTx -marker resorpcije kosti) elektroluminiscentnom imunohemijskom metodom na automatskom aparatu Elecsys 1010. Primarna ame noreja na|ena je kod 7 (8,33%) a oligomenoreja kod 11 (13,09%) sportistkinja, {to je statisti~ki zna~ajno vi{a incidenca u odnosu na kontrolnu grupu. Vrednosti markera ko{tanog metabo lizma su pokazale statisti~ki zna~ajnu razliku u nivou mar ke ra resorpcije kosti, b-CrossLaps, izme|u grupa ameno rei~ nih i oligomenorei~nih sportistkinja u odnosu na eume no rei ~ne ispitanice, kako sportistkinje tako i kontrolnu grupu. Ubrzanu resorpciju je pratilo i ubrzano formiranje kosti (pove}ane Summary: It is a well known fact that sportswomen with irregular menstrual cycle are exposed to the risk of dimi nished bone mineral density, and consequentially osteoporosis may appear. Monitoring of the levels of biochemical markers of bone metabolism enables understanding of the dynamic changes during the bone remodeling process. The objectives of the conducted research were to determine the prevalence of menstrual dysfunctions in a sportswomen sample and a control group, and also to determine the levels of bone metabolism markers in groups of women with menstrual dysfunctions. The women (n=117) were separated into two groups, the experi men tal group (S) (n=84) comprised of three subgroups of sports women (34 women who play ball game sports, 27 athletes and 23 sport dancers) and the control group (C) (n=34). To establish the menstrual profile and dys function of the menstrual cycle, we used a very detailed questionnaire. The level of mid-fragment osteo calcin (N-MID osteocalcin) as a mar ker of bone forma tion was deter mined, as well as b-Cross Laps (bCTx-bone resorption marker) via the electro luminescent immunoche mistry method on an Elecsys 1010 automated machine. Pri mary amenorrhea was found in 7 (8.33%) and oligome norrhea in 11 (13.09%) sportswomen, which was statistically a much higher incidence (p<0.05) than in the control group (0/34). Values of bone metabolism markers showed a sta tistically significant difference in the level of the...

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The female athlete triad: disordered eating, amenorrhea, osteoporosis

Cited by 360 publications

References 0 publications

Family History Predicts Stress Fracture in Active Female Adolescents

Family History Predicts Stress Fracture in Active Female Adolescents

Correlates of Stress Fractures Among Preadolescent and Adolescent Girls

Bone Metabolism Markers in Sportswomen with Menstrual Cycle Dysfunctions

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