The Female Athlete Triad

Sports Health: A Multidisciplinary Approach July/August 2012 vol. 4 no. 4 302-311
Taraneh Gharib Nazem, BA*
Kathryn E. Ackerman, MD, MPH† Kathryn.ackerman at childrens.harvard.edu)
*Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
†Division of Sports Medicine, Children’s Hospital Boston and Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts

Context: The female athlete triad (the triad) is an interrelationship of

1. menstrual dysfunction,
2. low energy availability (with or without an eating disorder), and
3. decreased bone mineral density;

it is relatively common among young women participating in sports.

Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team.

Evidence Acquisition: Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions.

Results: The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended.

Conclusions: Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.
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Wonder:

1. Is this triad is more prevalent with indoor female athletes – who get less sunshine?
2. Is this triad is more prevalent at higher latitudes? – who get less sunshine?
3. Is this triad is more prevalent with women with darker skins? – who get less benefit from sunshine?
4. Is this triad less prevalent in women on the pill - as they lose less blood/iron

Notes:

• All three elements of the triad have been separately associated with low vitamin D
• Vitamin D is very important for athletes

See also Vitamin D Life

• Overview of Sports and Vitamin D
• All items in category Sports and Vitamin D 231 items
• Overview Fractures and Vitamin D
• Overview Women and Vitamin D
• All items in category Women and vitamin D 139 items
• All items in category Iron and Vitamin D 53 items

See also web

• Wikipedia
  ‘’ Gymnastics, figure skating, ballet, diving, swimming, and long distance running are examples of sports which emphasize low body weight.’’
  Notice that 4 of the 5 examples are indoor sports
• Iraqui women not allowed to play outdoor sports and must ware sun blocking clothing

See also attached to the bottom of this page

• PDF of 2007 paper on this topic
• PDF of Master of Science attached below has the following quote
  ‘’ Athletes in northern latitudes or indoor sports participants may be particularly at risk for inadequate vitamin D status and related skeletal issues (59)’’