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Energy deficiency, menstrual disorders, and low bone mineral density in female athletes: a systematic review

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Abstract

Purpose

Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad. The primary aim of the present review was to systematically investigate the impact of chronic strenuous exercise on the energy status of professional female athletes compared to sedentary, recreationally active controls as concerns their menstrual status and bone mineral density (BMD). A secondary aim was evaluation of the combined prevalence of the components of the female athlete triad in athletes as compared to non-athletes.

Methods

A systematic review was conducted from 2007 to February 2018. The inclusion and exclusion criteria of the studies were established in advance of the literature search according to the clinical inquiry and the study design.

Results

Four studies were included in this systematic review. The female athlete triad was more prevalent in professional athletes compared to non-athletes. The same results were obtained for both LEA and menstrual disorders. However, BMD and Z-scores showed high heterogeneity among the studies.

Conclusion

Both female athletes and non-athletes are prone to LEA and subsequent menstrual disorders and low BMD or osteoporosis. Future studies are needed to examine energy availability in elite female athletes as well as in non-athletes.

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Authors and Affiliations

  1. Peripheral General Hospital Athens Giorgos Gennimatas Geniko Nosokomeio Athenon Giorgos Gennematas, Athens, Greece

    Nikitas S. Skarakis

  2. Third Department of Pediatrics, Endocrinology Unit, School of Medicine, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Nikitas S. Skarakis

  3. Department of Endocrinology, Metabolism and Diabetes, School of Medicine, Aretaeio Hospital, National and Kapodistrian University Athens, 76 Vas. Sofias, 11528, Athens, Greece

    George Mastorakos

  4. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Medical School, University of Patras, Patras, Greece

    Neoklis Georgopoulos

  5. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Goulis

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  1. Nikitas S. Skarakis
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  2. George Mastorakos
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  4. Dimitrios G. Goulis
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Skarakis, N.S., Mastorakos, G., Georgopoulos, N. et al. Energy deficiency, menstrual disorders, and low bone mineral density in female athletes: a systematic review. Hormones 20, 439–448 (2021). https://doi.org/10.1007/s42000-021-00288-0

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