Those With “Female Athlete Triad” More at Risk for Bone Stress, Fractures

New research from Brigham and Women’s Hospital has found that women who have symptoms known as the “female athlete triad” are more likely to develop bone stress injuries and fractures. The study, published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), found that the risk of these injuries increases with each symptom.

“The female athlete triad is a spectrum of symptoms that include low energy availability, menstrual cycle abnormalities, and low bone mineral density. Low energy availability can mean taking in inadequate calories or expending more energy than the body is designed to do. It can result from poor nutrition or eating habits or any type of eating disorder. Any combination of these conditions can lead to premature bone loss in females, ” explains lead study author and orthopedic surgeon Elizabeth Matzkin, M.D., in the July 1, 2015 news release.

According to the news release, “The increase is substantial: 15-21% with one symptom; 21-30% with two symptoms; and 29-50% with all three symptoms. The study authors also found that female athletes diagnosed with poor nutrition or low energy availability are two to four times more likely to sustain a sports-related injury. Female athletes who self-reported menstrual cycle abnormalities had a nearly three times greater risk of a bone and joint injury.”

Dr. Matzkin, surgical director of Women’s Musculoskeletal Health at Brigham and Women’s Hospital, told OTW, “There is a significant lack of education regarding the female athlete triad and the potential consequences among health care providers, coaches and athletes. The true prevalence of the female athlete triad is unknown. A full 90% of peak bone mass is accrued by the age of 18 and usually completed by the age of 25. After this, peak bone mass can only be lost or maintained. Thus, it is paramount that our younger athletes maximize their bone density when they can.”

“We are currently working on trying to understand the true prevalence of the female athlete triad. We do know that a relative energy deficiency can result in bone density problems. Any female athlete that presents to the orthopedic surgeon with a stress fracture or stress reaction should be questioned about her nutrition/energy availability for exercise and menstrual cycle. This is important to prevent further bone loss and address any underlying problems contributing to the bone injury in the first place.”