The Female Athlete Triad - Are You At Risk?

The Female Athlete Triad is a condition that includes three components:
– Low bone density (risk for stress fractures and osteoporosis)
– Disordered eating
– Amenorrhea (no menstrual cycle for three months or more)
(Matzkin et al., 2015).

The consequences of the Female Athlete Triad can be long-term and irreversible, and include stunting of growth, reproductive dysfunction, and osteoporosis. Any female athlete is at risk for this syndrome, but women who participate in dance are more susceptible because of the desired lean aesthetic and rigorous training schedule (Barrack et al., 2014). Peak bone density is achieved between ages 18 to 25 years. Poor nutrition (i.e., insufficient calories, calcium and vitamin D), stress, and intense training lead to hormonal disruption during the peak-forming period. Reduced estrogen production leads to bone resorption, and this can occur despite the fact that load-bearing physical activity such as dance usually improves bone-mineral density. Some female athletes have bone density similar to older postmenopausal women, which is dangerously low. One study reported that 80% of female dancers diagnosed with stress fractures of the second metatarsal started their menstrual period late (O’Malley, 1996). This type of bony injury  requires at least 6-8 weeks to heal and even longer to rehab.

The remedy for Female Athlete Triad requires that energy needs be met consistently, either by modifying diet or reducing exercise. If body fat is inadequate, restoring body weight to a healthy level is the best strategy for normalizing menstrual periods and improving bone health.

References:

1. Barrack, M. T., Gibbs, J. C., De Souza, M. J., Williams, N. I., Nichols, J. F., Rauh, M. J., & Nattiv, A. (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.
2. Little, M., Brown, K., Brown, A. F., & Meenan, M. (2017). Dancers' Risk for the Female Athlete Triad, Disordered Eating, and Changes in Triad Knowledge Following Educational Intervention. Journal of the Academy of Nutrition and Dietetics, 117(9), A85.
3. Matzkin, E., Curry, E. J., & Whitlock, K. (2015). Female athlete triad: past, present, and future. Journal of the American Academy of Orthopaedic Surgeons, 23(7), 424-432.
4. O’Malley, M., Hamilton, W, Munyak, J., DeFranco, B. (1996). Second Metatarsal Stress Fractures in Dancers. Foot and Ankle International, 17(2): 89-92 ​​