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Definition and Epidemiology of the Female Athlete Triad

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The Female Athlete Triad

Abstract

The Female Athlete Triad is a function of the interrelationships among energy availability, menstrual function, and bone mineral density/skeletal fragility. These three components of the Triad have been conceptualized as being on a continuum to reinforce the idea that graded negative health outcomes can occur at varying levels of each component; these continua range from optimal health on one end to pathology and disease on the other. Estimates for the prevalence of the Triad and its components are wide, ranging from a low end of 1 % to a high end of over 50 %, with this variability attributable to different conceptual definitions of the components of the Triad, different measurement choices in operationalizing the components, and different sport, age, and competitive level of populations sampled.

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References

  1. Women’s Sports Foundation. Women’s sports & fitness facts & statistics 2011. [cited 2014 Jan 26]. Available from: http://www.womenssportsfoundation.org/en/home/research/articles-and-reports/athletes/womens-sports-facts

  2. National Federation of State High School Associations. Historical sport and activity statistics. [cited 2014 Jan 26]. Available from: http://www.nfhs.org/participation/HistoricalSearch.aspx

  3. Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10:98. doi:10.1186/1479-5868-10-98.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sundgot-Borgen J, Meyer NL, Lohman TG, Ackland TR, Maughan RJ, Stewart AD, Muller W. How to minimize the health risks to athletes who compete in weight sensitive sports review and position statement on behalf of the Ad Hoc Research Working Group on Body Competition, Health and Performance, under the auspices of the IOC Medical Commission. Br J Sports Med. 2013;47:1012–22.

    Article  PubMed  Google Scholar 

  5. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. The Female Athlete Triad. Position stand. Med Sci Sports Exerc. 2007;39(10):1867–82.

    Article  PubMed  Google Scholar 

  6. Moutjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, LeBrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungvist A. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48:491–7.

    Article  Google Scholar 

  7. Hoek HW. Classification, epidemiology and treatment of DSM-5 feeding and eating disorders. Curr Opin Psychiatr. 2013;26(6):529–31.

    Article  Google Scholar 

  8. IOC Medical Commission Working Group on Women in Sport (IOC-MCWGWS). Position stand on the female athlete triad. 2006. [cited 2014 Jan 26]. Available from: http://www.femaleathletetriad.org/~triad/wp-content/uploads/2008/10/ioc_position_stand_on_female_athlete_triad.pdf

  9. American Society of Reproductive Medicine Practice Committee (ASR-MPC). Current evaluation of amenorrhea. Fertil Steril. 2006;86:S148–55.

    Google Scholar 

  10. Stager JM, Wigglesworth JK, Hatler LK. Interpreting the relationship between age of menarche and prepubertal training. Med Sci Sports Exerc. 1990;22:54–8.

    Article  PubMed  CAS  Google Scholar 

  11. Jones J, Mosher WD, Daniels K. Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995. Natl Health Stat Rep. 2012;(60). Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf. Accessed 7 May 2014.

  12. Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med. 2006;40(1):11–24.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Bonnick SL. Current controversies in bone densitometry. Curr Opin Rheumatol. 2002;14: 416–20.

    Article  PubMed  Google Scholar 

  14. Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, El-Hagg Fuleihan G, Kecskemethy HH, Jaworski M, Gordon CM. Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions. J Clin Densitom. 2014;17(2):225–42.

    Article  PubMed  Google Scholar 

  15. Lewiecki E, Gordon C, Baim S, Leonard M, Bishop N, Bianchi M, Kalkwarf H, Langman S, Plotkin H, Rauch F. International Society for Clinical Densitometry 2007. Adult and pediatric official positions. Bone. 2008;43(6):1115–21.

    Article  PubMed  Google Scholar 

  16. Gibbs JC, Williams NI, De Souza MJ. Prevalence of individual and combined components of the Female Athlete Triad. Med Sci Sports Exerc. 2013;45(5):985–96.

    Article  PubMed  Google Scholar 

  17. Coelho GMO, de Faris MLF, Mello DB, Lanzillotti HS, Ribeiro BG, Soares EA. The prevalence of disordered eating and possible health consequences in adolescent female tennis players from Rio de Janeiro, Brazil. Appetite. 2013;64:39–47.

    Article  PubMed  Google Scholar 

  18. Burrows M, Shepherd H, Bird S, Macleod K, Ward B. The components of the female athlete triad do not identify all physically active females at risk. J Sports Sci. 2007;25(12):1289–97.

    Article  PubMed  Google Scholar 

  19. Hoch AZ, Pajewski NM, Moraski L, Carrera GF, Wilson CR, Hoffmann RG, et al. Prevalence of the female athlete triad in high school athletes and sedentary students. Clin J Sport Med. 2009;19(5):421–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pollock N, Grogan C, Perry M, Pedlar C, Cooke K, Morrissey D, et al. Bone-mineral density and other features of the female athlete triad in elite endurance runners: a longitudinal and cross-sectional observational study. Int J Sport Nutr Exerc Metab. 2010;20(5):418–26.

    PubMed  Google Scholar 

  21. Schtscherbyna A, Soares EA, de Oliveira FP, Ribeiro BG. Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil. Nutrition. 2009;25(6):634–9.

    Article  PubMed  Google Scholar 

  22. Reed JL, De Souza MJ, Williams NI. Changes in energy availability across the season in Division I female soccer players. J Sports Sci. 2013;31(3):314–24.

    Article  PubMed  Google Scholar 

  23. Da Costa NF, Schtscherbyna A, Soares EA, Ribeiro BG. Disordered eating among adolescent female swimmers: dietary, biochemical, and body composition factors. Nutrition. 2013;29: 172–7.

    Article  PubMed  Google Scholar 

  24. Martinsen M, Sundgot-Borgen J. Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sports Exerc. 2007;39:1867–82.

    Article  Google Scholar 

  25. Bacchi E, Spiazzi G, Zendrini G, Bonin C, Pghetti P. Low body weight and menstrual dysfunction are common findings in both elite and amateur ballet dancers. J Endocrinol Invest. 2013;36: 343–6.

    PubMed  CAS  Google Scholar 

  26. Duckham RL, Peirce N, Meyer C, Summers GD, Cameron N, Brooke-Wavell K. Risk factors for stress fractures in female endurance athletes: a cross-sectional study. BMJ Open. 2012;2(6):e001920. doi:10.1136/bmjopen-2012-001920.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Thein-Nissenbaum JM, Rauh MJ, Carr KE, Loud KJ, McGuine TA. Menstrual irregularity and musculoskeletal injury in female high school athletes. J Athl Train. 2012;47(1):74–82.

    PubMed  PubMed Central  Google Scholar 

  28. Movaseghi S, Dadgostar H, Dahaghin S, Chimeh N, Alenabi T, Dadgostar E, Davatchi F. Clinical manifestations of the Female Athlete Triad among some Iranian athletes. Med Sci Sports Exerc. 2013;44(5):958–65.

    Article  Google Scholar 

  29. Wodarska M, Witkos J, Drosdzol-Cop, Dabrowska J, Dabrowska-Galas M, Hartman M, Plinta R, Skrzypulec-Linta V. Menstrual cycle disorders in female volleyball players. J Obstet Gynaecol. 2013;33(5):484–8.

    Article  PubMed  CAS  Google Scholar 

  30. Barrack MT, Giacomazzi C, Barrack FA, Nattiv A. Diet patterns, anthropometric measures, bone density and injury among male adolescent runners and non runner athletes. Med Sci Sports Exerc. 2012;44(2):109.

    Google Scholar 

  31. Castro J, Toro J, Lazaro L, Pons F, Halperin I. Bone mineral density in male adolescents with anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2002;41:613–8.

    Article  PubMed  Google Scholar 

  32. Fredericson M, Chew K, Ngo J, Cleek T, Kiratli J, Cobb K. Regional bone mineral density in male athletes: a comparison of soccer players, runners, and controls. Br J Sports Med. 2007;41:664–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kemmler W, Engelke K, Baumann H, Beeskow C, von Stengel S, Weineck J, et al. Bone status in elite male runners. Eur J Appl Physiol. 2006;96:78–85.

    Article  PubMed  Google Scholar 

  34. Hind K, Truscott JG, Evans JA. Low lumbar spine bone mineral density in both male and female endurance runners. Bone. 2006;39:880–5.

    Article  PubMed  CAS  Google Scholar 

  35. Hackney AC. The male reproductive system and endurance exercise. Med Sci Sports Exerc. 1996;28:180–9.

    Article  PubMed  CAS  Google Scholar 

  36. Hackney AC, Fahrner CL, Stupnicki R. Reproductive hormonal responses to maximal exercise in endurance-trained men with low resting testosterone levels. Exp Clin Endocrinol Diabetes. 1997;105:291–5.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

E. Kroshus and S.B. Austin are supported by the Ellen Feldberg Gordon Fund for Eating Disorders Research and the Strategic Training Initiative for the Prevention of Eating Disorders at the Harvard School of Public Health. S.B. Austin is also supported by the Maternal and Child Health Bureau, Health Resources and Services Administration, training grants MC00001 and Leadership Education in Adolescent Health Project 6T71-MC00009.

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Correspondence to Emily Kroshus MPH .

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Kroshus, E., Austin, S.B. (2015). Definition and Epidemiology of the Female Athlete Triad. In: Gordon, C., LeBoff, M. (eds) The Female Athlete Triad. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7525-6_1

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  • DOI: https://doi.org/10.1007/978-1-4899-7525-6_1

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