DOES THE FEMALE ATHLETE TRIAD REALLY EXIST?

Ivana Petrović

DOI Number
https://doi.org/10.22190/FUPES191019005P
First page
037
Last page
048

Abstract


The Female Athlete Triad (Triad) is a medical condition of female athletes consisting of three components: low energy availability (EA), menstrual dysfunction (MD), and low bone mineral density (BMD). The prevalence of all three components of the Triad ranges from 1-14%. In last ten years, it has ranged from 1.3% up to 23% with 78% of female athletes having at least one of the three components of the Triad. The aim of this systematic review is to collect and analyze recent studies of the Female Athlete Triad. Based on an analysis of electronic databases and the inclusion criteria set, 20 studies were included in the analysis. The following conclusions are proposed based on their analysis: MD was the most prevalent among endurance athletes with ranges from 35.5% to 60.7%, with the presence of secondary amenorrhea and oligomenorrhea, 30% to 64.0% and 18% to 27.0% and with a very high level of cases with irregular menorrhea, 72.3%. Low/negative EA ranges from 19.8% among non-leanness athletes and up to 77%. The greatest proportion of athletes in moderate- and high-risk categories for expressing the Triad participated in sports that emphasize leanness, including cross-country, gymnastics running, and lacrosse. A recommendation for future research is that they should focus on enhanced monitoring of physically active women, and the prevention of the Triad, stress fractures and osteoporosis.


Keywords

Female Athlete Triad, Stress Fracture, Energy Availability, Menstrual Disorders, Amenorrhea, Bone Mineral Density

Full Text:

PDF

References


Ackerman, K.E., Sokoloff, N.C., Maffazioli, G.D.N., Clarke, H., Lee, H., & Misra, M. (2015). Fractures in relation to menstrual status and bone parameters in young athletes. Medicine and Science in Sports and Eexercise, 47(8), 1577.

Austin, T.Μ., Reinking, M.F., & Hayes, A.Μ. (2009). Menstrual function in female high school cross-country athletes. International Journal of Adolescent Medicine and Health, 21(4), 555-566.

Bachrach, L.K. (2001). Acquisition of optimal bone mass in childhood and adolescence. Trends in Endocrinology & Metabolism, 12(1), 22-28.

Barrack, M.T., Gibbs, J.C., de Souza, M.J., Williams, N.I., Nichols, J.F., Rauh, M.J., et al. (2014). Higher incidence of bone stress injuries with increasing female athlete triad–related risk factors: a prospective multisite study of exercising girls and women. The American Journal of Sports Medicine, 42(4), 949-958.

Baxter‐Jones, A.D., Faulkner, R.A., Forwood, M.R., Mirwald, R.L., & Bailey, D.A. (2011). Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. Journal of Bone and Mineral Research, 26(8), 1729-1739.

Beachy, G., Akau, C.K., Martinson, M., & Olderr, T.F. (1997). High school sports injuries: a longitudinal study at Punahou School: 1988 to 1996. The American Journal of Sports Medicine, 25(5), 675-681.

Beals, K.A., & Hill, A.K. (2006). The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate athletes. International Journal of Sport Nutrition and Exercise Metabolism, 16(1), 1-23.

Bennell, K.L., & Crossley, K. (1996). Musculoskeletal injuries in track and field: Incidence, distribution and risk factors. Australian Journal of Science and Medicine in Sport, 28(3), 69-75.

Bennell, K., & Brukner, P. (2005). Preventing and managing stress fractures in athletes. Physical Therapy in Sport, 6(4), 171-180.

Brook, E.M., Tenforde, A.S., Broad, E.M., Matzkin, E.G., Yang, H.Y., Collins, J.E., et al. (2019). Low energy availability, menstrual dysfunction, and impaired bone health: a survey of elite para athletes. Scandinavian Journal of Medicine & Science in Sports, 29(5), 678-685.

Brown, K.N., Wengreen, H.J., & Beals, K.A. (2014). Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches. Journal of Pediatric and Adolescent Gynecology, 27(5), 278-282.

Clark, L.R., Dellogono, M.J., Mangano, K.M., & Wilson, T.A. (2018). Clinical menstrual dysfunction is associated with low energy availability but not dyslipidemia in division I female endurance runners. Journal of Exercise Physiology Online, 21(2), 265-277.

Cobb, K.L., Bachrach, L.K., Greendale, G., Marcus, R., Neer, R.M., Nieves, J.E.R.I., et al. (2003). Disordered eating, menstrual irregularity, and bone mineral density in female runners. Medicine & Science in Sports & Exercise, 35(5), 711-719.

Cosman, F., Ruffing, J., Zion, M., Uhorchak, J., Ralston, S., Tendy, S., et al. (2013). Determinants of stress fracture risk in United States Military Academy cadets. Bone, 55(2), 359-366.

Dadgostar, H., Razi, M., Aleyasin, A., Alenabi, T., & Dahaghin, S. (2009). The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. BMC Sports Science, Medicine and Rehabilitation, 1(1), 16.

Duckham, R.L., Brooke‐Wavell, K., Summers, G.D., Cameron, N., & Peirce, N. (2015). Stress fracture injury in female endurance athletes in the United Kingdom: a 12‐month prospective study. Scandinavian Journal of Medicine & Science in Sports, 25(6), 854-859.

Henriksson, G.B., Schnell, C., & Hirschberg, A.L. (2000). Women endurance runners with menstrual dysfunction have prolonged interruption of training due to injury. Gynecologic and Obstetric Investigation, 49(1), 41-46.

Hoch, A.Z., Pajewski, N.M., Moraski, L., Carrera, G.F., Wilson, C.R., Hoffmann, R.G., et al. (2009). Prevalence of the female athlete triad in high school athletes and sedentary students. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 19(5), 421-428.

Hoch, A.Z., Papanek, P., Szabo, A., Widlansky, M.E., Schimke, J.E., & Gutterman, D.D. (2011). Association between the female athlete triad and endothelial dysfunction in dancers. Clinical Journal of Sport Medicine: Official Journal of The Canadian Academy of Sport Medicine, 21(2), 119-125.

Joy, E., de Souza, M.J., Nattiv, A., Misra, M., Williams, N.I., Mallinson, R.J., et al. (2014). 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad. Current Sports Medicine Reports, 13(4), 219-232.

Kelsey, J.L., Bachrach, L.K., Procter-Gray, E., Nieves, J.E.R.I., Greendale, G.A., Sowers, M., et al. (2007). Risk factors for stress fracture among young female cross-country runners. Medicine & Science in Sports & Exercise, 39(9), 1457-1463.

Loucks, A.B., & Thuma, J.R. (2003). Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. The Journal of Clinical Endocrinology & Metabolism, 88(1), 297-311.

Meczekalski, B., Podfigurna-Stopa, A., & Katulski, K. (2013). Long-term consequences of anorexia nervosa. Maturitas, 75(3), 215-220.

Melin, A., Tornberg, A.B., Skouby, S., Møller, S.S., Sundgot‐Borgen, J., Faber, J., et al. (2015). Energy availability and the female athlete triad in elite endurance athletes. Scandinavian Journal of Medicine & Science in Sports, 25(5), 610-622.

Micklesfield, L.K., Hugo, J., Johnson, C., Noakes, T.D., & Lambert, E.V. (2007). Factors associated with menstrual dysfunction and self-reported bone stress injuries in female runners in the ultra-and half-marathons of the Two Oceans. British Journal of Sports Medicine, 41(10), 679-683.

Movaseghi, S., Dadgostar, H., Dahaghin, S., Chimeh, N., Alenabi, T., Dadgostar, E., et al. (2012). Clinical manifestations of the female athlete triad among some Iranian athletes. Medicine and Science in Sports and Exercise, 44(5), 958-965.

Myburgh, K.H., Hutchins, J., Fataar, A.B., Hough, S.F., & Noakes, T.D. (1990). Low bone density is an etiologic factor for stress fractures in athletes. Annals of Internal Medicine, 113(10), 754-759.

Nattiv, A., Agostini, R., Yeager, K.K., & Drinkwater, B. (1993). The female athlete triad: Disordered eating, amenorrhea, osteoporosis. Women in Sport & Physical Activity Journal, 2(1), 90-93.

Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., & Warren, M.P. (2007). American College of Sports Medicine position stand. The female athlete triad. Medicine Science & Sports Exercise, 39(10), 1867-1882.

Nichols, J.F., Rauh, M.J., Lawson, M.J., Ji, M., & Barkai, H.S. (2006). Prevalence of the female athlete triad syndrome among high school athletes. Archives of Pediatrics & Adolescent Medicine, 160(2), 137-142.

Nieves, J.W., Ruffing, J.A., Zion, M., Tendy, S., Yavorek, T., Lindsay, R., et al. (2016). Eating disorders, menstrual dysfunction, weight change and DMPA use predict bone density change in college-aged women. Bone, 84, 113-119.

Ohwada, R., Hotta, M., Oikawa, S., & Takano, K. (2006). Etiology of hypercholesterolemia in patients with anorexia nervosa. International Journal of Eating Disorders, 39(7), 598-601.

Øyen, J., Torstveit, M.K., & Sundgot-Borgen, J. (2009). Self-reported versus diagnosed stress fractures in Norwegian female elite athletes. Journal of Sports Science & Medicine, 8(1), 130-135.

Prather, H., Hunt, D., McKeon, K., Simpson, S., Meyer, E. B., Yemm, T., et al. (2016). Are elite female soccer athletes at risk for disordered eating attitudes, menstrual dysfunction, and stress fractures? PM&R, 8(3), 208-213.

Rauh, M.J., Nichols, J.F., & Barrack, M.T. (2010). Relationships among injury and disordered eating, menstrual dysfunction, and low bone mineral density in high school athletes: a prospective study. Journal of Athletic Training, 45(3), 243-252.

Rauh, M.J., Barrack, M., & Nichols, J.F. (2014). Associations between the female athlete triad and injury among high school runners. International Journal of Sports Physical Therapy, 9(7), 948-958.

Rickenlund, A., Eriksson, M.J., Schenck-Gustafsson, K., & Hirschberg, A.L. (2005). Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile. The Journal of Clinical Endocrinology & Metabolism, 90(3), 1354-1359.

Schnaper, H.W., McGuire, J., Runyan, C., & Hubchak, S. C. (2000). Sex steroids and the endothelium. Current Medicinal Chemistry, 7(5), 519-531.

Schtscherbyna, A., Soares, E.A., de Oliveira, F.P., & Ribeiro, B.G. (2009). Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil. Nutrition, 25(6), 634-639.

de Souza, M.J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., et al. (2014). 2014 Female Athlete Triad Coalition Consensus Statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. British Journal of Sports Medicine, 48(4), 289-289.

Sullivan, D., Warren, R.F., Pavlov, H., & Kelman, G. (1984). Stress fractures in 51 runners. Clinical Orthopaedics and Related Research, 187, 188-192.

Tenforde, A.S., Carlson, J.L., Chang, A., Sainani, K.L., Shultz, R., Kim, J.H., et al. (2017). Association of the female athlete triad risk assessment stratification to the development of bone stress injuries in collegiate athletes. The American Journal of Sports Medicine, 45(2), 302-310.

Tenforde, A.S., Fredericson, M., Sayres, L.C., Cutti, P., & Sainani, K.L. (2015). Identifying sex-specific risk factors for low bone mineral density in adolescent runners. The American Journal of Jports Jedicine, 43(6), 1494-1504.

Tenforde, A.S., Carlson, J.L., Sainani, K.L., Chang, A.O., Kim, J.H., Golden, N.H., et al. (2018). Sport and triad risk factors influence bone mineral density in collegiate athletes. Medicine & Science in Sports & Exercise, 50(12), 2536-2543.

Torstveit, M.K., Rosenvinge, J.H., & Sundgot‐Borgen, J. (2008). Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. Scandinavian Journal of Medicine & Science in Sports, 18(1), 108-118.

Torstveit, M.K., & Sundgot-Borgen, J. (2005). The female athlete triad exists in both elite athletes and controls. Medicine & Science in Sports & Exercise, 37(9), 1449-1459.

Tosi, M., Maslyanskaya, S., Dodson, N.A., & Coupey, S.M. (2019). The female athlete triad: A comparison of knowledge and risk in adolescent and young adult figure skaters, dancers, and runners. Journal of Pediatric and Adolescent Gynecology, 32(2), 165-169.

Thralls, K.J., Nichols, J.F., Barrack, M.T., Kern, M., & Rauh, M.J. (2016). Body mass-related predictors of the female athlete triad among adolescent athletes. International Journal of Sport Nutrition and Exercise Metabolism, 26(1), 17-25.

Warren, M.P., & Stiehl, A.L. (1999). Exercise and female adolescents: effects on the reproductive and skeletal systems. Journal of the American Medical Women's Association (1972), 54(3), 115-120.

Weaver, C.M. (2002). Adolescence. Endocrine, 17(1), 43-48.

Yang, L-C., Lan, Y., Hu, J., Yang, Y-H., Zhang, Q., Huang, Z-W., et al. (2010). Relatively high bone mineral density in Chinese adolescent dancers despite lower energy intake and menstrual disorder. Biomedical and Environmental Sciences, 23(2), 130-136.

Yeager, K.K., Agostini, R., Nattiv, A., & Drinkwater, B. (1993). The female athlete triad. Medicine & Science in Sports & Exercise, 25(7), 775-777.




DOI: https://doi.org/10.22190/FUPES191019005P

Refbacks

  • There are currently no refbacks.


ISSN   1451-740X (Print)

ISSN   2406-0496 (Online)