Sports Medicine

, Volume 41, Issue 7, pp 587–607

Obstacles in the Optimization of Bone Health Outcomes in the Female Athlete Triad

Authors

    • Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition SciencesDeakin University
    • 123 Noll Laboratory, Department of KinesiologyPennsylvania State University, State College
  • Anne I. Turner
    • Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition SciencesDeakin University
  • Sonja Kukuljan
    • Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition SciencesDeakin University
  • Kathleen J. Pantano
    • Physical Therapy Program, Department of Health SciencesCleveland State University
  • Jennifer L. Carlson
    • Division of Adolescent Medicine, Department of PediatricsLucile Packard Children’s Hospital at Stanford
  • Nancy I. Williams
    • 123 Noll Laboratory, Department of KinesiologyPennsylvania State University, State College
  • Mary Jane De Souza
    • 123 Noll Laboratory, Department of KinesiologyPennsylvania State University, State College
Review Article

DOI: 10.2165/11588770-000000000-00000

Cite this article as:
Ducher, G., Turner, A.I., Kukuljan, S. et al. Sports Med (2011) 41: 587. doi:10.2165/11588770-000000000-00000

Abstract

Maintaining low body weight for the sake of performance and aesthetic purposes is a common feature among young girls and women who exercise on a regular basis, including elite, college and high-school athletes, members of fitness centres, and recreational exercisers. High energy expenditure without adequate compensation in energy intake leads to an energy deficiency, which may ultimately affect reproductive function and bone health. The combination of low energy availability, menstrual disturbances and low bone mineral density is referred to as the ‘female athlete triad’. Not all athletes seek medical assistance in response to the absence of menstruation for 3 or more months as some believe that long-term amenorrhoea is not harmful. Indeed, many women may not seek medical attention until they sustain a stress fracture.

This review investigates current issues, controversies and strategies in the clinical management of bone health concerns related to the female athlete triad. Current recommendations focus on either increasing energy intake or decreasing energy expenditure, as this approach remains the most efficient strategy to prevent further bone health complications. However, convincing the athlete to increase energy availability can be extremely challenging.

Oral contraceptive therapy seems to be a common strategy chosen by many physicians to address bone health issues in young women with amenorrhoea, although there is little evidence that this strategy improves bone mineral density in this population. Assessment of bone health itself is difficult due to the limitations of dual-energy X-ray absorptiometry (DXA) to estimate bone strength. Understanding how bone strength is affected by low energy availability, weight gain and resumption of menses requires further investigations using 3-dimensional bone imaging techniques in order to improve the clinical management of the female athlete triad.

Copyright information

© Adis Data Information BV 2011