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Katherine A. Beals and Amanda K. Hill

The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below −2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below −1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad.

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Margo Mountjoy, Jorunn Sundgot-Borgen, Louise Burke, Kathryn E. Ackerman, Cheri Blauwet, Naama Constantini, Constance Lebrun, Bronwen Lundy, Anna Melin, Nanna Meyer, Roberta Sherman, Adam S. Tenforde, Monica Klungland Torstveit and Richard Budgett

.3109/02699052.2016.1144081 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 . PubMed ID: 20446837 doi:10

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Carl Persson, Flinn Shiel, Mike Climstein and James Furness

Low bone mineral density (BMD) and associated conditions such as osteoporosis and osteopenia are health problems that annually costs over 830 million dollars in Australia, and osteoporosis is a significant cause of morbidity and mortality ( Johnell & Kanis, 2006 ; Watts et al., 2013 ). The need to

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Sarah Staal, Anders Sjödin, Ida Fahrenholtz, Karen Bonnesen and Anna Katarina Melin

Sportsmedicine, 39 , 131 – 141 . PubMed ID: 21378496 doi:10.3810/psm.2011.02.1871 10.3810/psm.2011.02.1871 Amorim , T. , Wyon , M. , Maia , J. , Machado , J. , Marques , F. , Metsios , G. , … Koutedakis , Y. ( 2015 ). Prevalence of low bone mineral density in female dancers . Sports Medicine

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Jennifer Sygo, Alexandra M. Coates, Erik Sesbreno, Margo L. Mountjoy and Jamie F. Burr

, menstrual dysfunction, and low bone mineral density in individuals with a disability: Implications for the para athlete population . Sports Medicine, 47 , 1697 – 1708 . PubMed ID: 28213754 doi:10.1007/s40279-017-0696-0 10.1007/s40279-017-0696-0 Braun , H. , von Andrian-Werburg , J. , Schanzer , W

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Noel Pollock, Claire Grogan, Mark Perry, Charles Pedlar, Karl Cooke, Dylan Morrissey and Lygeri Dimitriou

Low bone-mineral density (BMD) is associated with menstrual dysfunction and negative energy balance in the female athlete triad. This study determines BMD in elite female endurance runners and the associations between BMD, menstrual status, disordered eating, and training volume. Forty-four elite endurance runners participated in the cross-sectional study, and 7 provided longitudinal data. Low BMD was noted in 34.2% of the athletes at the lumbar spine, and osteoporosis in 33% at the radius. In cross-sectional analysis, there were no significant relationships between BMD and the possible associations. Menstrual dysfunction, disordered eating, and low BMD were coexistent in 15.9% of athletes. Longitudinal analysis identified a positive association between the BMD reduction at the lumbar spine and training volume (p = .026). This study confirms the presence of aspects of the female athlete triad in elite female endurance athletes and notes a substantial prevalence of low BMD and osteoporosis. Normal menstrual status was not significantly associated with normal BMD, and it is the authors’ practice that all elite female endurance athletes undergo dual-X-ray absorptiometry screening. The association between increased training volume, trend for menstrual dysfunction, and increased loss of lumbar BMD may support the concept that negative energy balance contributes to bone loss in athletes.

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Katie J. Thralls, Jeanne F. Nichols, Michelle T. Barrack, Mark Kern and Mitchell J. Rauh

Early detection of the female athlete triad is essential for the long-term health of adolescent female athletes. The purpose of this study was to assess relationships between common anthropometric markers (ideal body weight [IBW] via the Hamwi formula, youth-percentile body mass index [BMI], adult BMI categories, and body fat percentage [BF%]) and triad components, (low energy availability [EA], measured by dietary restraint [DR], menstrual dysfunction [MD], low bone mineral density [BMD]). In the sample (n = 320) of adolescent female athletes (age 15.9± 1.2 y), Spearman’s rho correlations and multiple logistic regression analyses evaluated associations between anthropometric clinical cutoffs and triad components. All underweight categories for the anthropometric measures predicted greater likelihood of MD and low BMD. Athletes with an IBW ≤85% were nearly 4 times more likely to report MD (OR = 3.7, 95% CI [1.8, 7.9]) and had low BMD (OR = 4.1, 95% CI [1.2, 14.2]). Those in <5th percentile for their age-specific BMI were 9 times more likely to report MD (OR 9.1, 95% CI [1.8, 46.9]) and had low BMD than those in the 50th to 85th percentile. Athletes with a high BF% were almost 3 times more likely to report DR (OR = 2.8, 95% CI [1.4, 6.1]). Our study indicates that low age-adjusted BMI and low IBW may serve as evidence-based clinical indicators that may be practically evaluated in the field, predicting MD and low BMD in adolescents. These measures should be tested for their ability as tools to minimize the risk for the triad.

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Ben T. Stephenson, Eleanor Hynes, Christof A. Leicht, Keith Tolfrey and Victoria L. Goosey-Tolfrey

, menstrual dysfunction, and low bone mineral density in individuals with a disability: implications for the para athlete population . Sports Med . 2017 ; 47 : 1697 – 1708 . PubMed ID: 28213754 doi:10.1007/s40279-017-0696-0 10.1007/s40279-017-0696-0 28213754 9. Leicht CA , Bishop NC , Paulson TAW

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Sherry Robertson and Margo Mountjoy

components—that is, low energy availability (LEA), menstrual dysfunction (MD), and low bone mineral density (BMD) ( Nattiv et al., 2007 ). The International Olympic Committee (IOC) Consensus Group coined the more comprehensive term, RED-S, to more accurately describe the pathophysiology and multisystem

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Ida A. Heikura, Arja L.T. Uusitalo, Trent Stellingwerff, Dan Bergland, Antti A. Mero and Louise M. Burke

.C. , Cutti , P. , & Sainani , K.L. ( 2015 ). Identifying sex-specific risk factors for low bone mineral density in adolescent runners . The American Journal of Sports Medicine, 43 ( 6 ), 1494 – 1504 . doi:10.1177/0363546515572142 10.1177/0363546515572142 Torstveit , M.K. , & Sundgot-Borgen , J