New Study: The Female Athlete Triad and Injury

Not aggressively treating the Female Athlete Triad could lead to potentially season-ending bone stress injury, according to new research published in the December issue of The American Journal of Sports Medicine.

The Female Athlete Triad is a syndrome in which eating disorders (or low energy availability), amenorrhoea/oligomenorrhoea, and decreased bone mineral density (osteoporosis and osteopenia) are present.

Researchers from Stanford University and Harvard Medical School categorized college athletes involved in 16 sports by risk level for bone stress injury—low, moderate, high—based on their Female Athlete Triad Cumulative Risk Assessment Score. Of the 239 athletes assigned a risk category, 61 (25.5%) were considered of moderate or high risk. The most common sports that these athletes were involved in were gymnastics, lacrosse, cross-country, swimming/diving, sailing and volleyball.

The next step was to review subsequent bone stress injuries. The researchers discovered that 25 athletes (10.5%) had experienced one or more. According to the data, those athletes in the moderate-risk group had double the risk of those in the low-risk group, and that risk almost quadrupled for those in the high risk category.

Another interesting finding was that cross-country runners accounted for most of the bone stress injuries (16; 64%).

One of the lead researchers, Adam S. Tenforde, M.D. of the Spaulding Rehabilitation Hospital, Spaulding National Running Center and of the department of physical medicine and rehabilitation at Harvard Medical School in Cambridge, Massachusetts, explained to OTW that long-distance running causes “cumulative repetitive load on the skeleton.”

“We suspect both behaviors of cross-country athletes and demands of the sport places these athletes at high risk for injury.”

Tenforde added that “part of what has made the Triad challenging to manage is coming up with criteria to understand how to gauge risk for the athlete. This is one reason I think this article is important: It identifies that a significant number of elite female athletes are at moderate or high risk for the Triad.”

“The high likelihood for sustaining a bone stress injury (on average within one year of their score being determined) highlights this is not just a theoretical risk. There are consequences if Triad risk factors are not managed aggressively, including a potential season-ending injury.”

Screening questions for the Female Athlete Triad proposed by the Female Athlete Triad Coalition are available online. Positive response to one or more should prompt further evaluation.

“We need to be consistently screening all female athletes for Triad risk factors and manage these athletes appropriately to reduce risk for subsequent bone stress injury, ” Tenforde said.