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Female athlete triad linked to bone health problems

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Women with symptoms known as the “female athlete triad” face a greater risk of bone stress injuries and fractures, new research shows.

The female athlete triad was first defined in 1992, when diagnosis required the presence of an eating disorder, amenorrhea and osteoporosis. In 2007, the definition was modified to a spectrum disorder involving low energy availability (with or without an eating disorder), menstrual dysfunction and low bone mineral density. Under the new definition, all three components need not be present for a diagnosis of female athlete triad.

Reporting their findings in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the study authors said that female athletes diagnosed with poor nutrition or low energy availability are two to four times more likely to sustain a sports-related injury. Meanwhile, female athletes who self-reported menstrual cycle abnormalities had a nearly three times greater risk of a bone and joint injury.

The researchers also found that the likelihood of female athletes sustaining a bone stress injury significantly increases as the number of symptoms they have increases.

“Proper nutrition and energy balance are key to staying healthy in athletes of all ages. But maximizing bone health when you are young is paramount to your bone health later in life,” said lead study author and orthopaedic surgeon Dr. Elizabeth Matzkin. “It is important for young females to maximize their bone density until about the age of 25 — anything lost before then cannot be regained. After age 25 we can only hope to maintain what we have.”

Commenting on the research, the American Academy of Orthopaedic Surgeons said that, as participation in sports by women and girls continues to increase and become more competitive, it is important to prevent, diagnose and manage the components of the female athlete triad.

The organisation also pointed out that, although this disorder poses a risk to health, that risk is outweighed by the benefits of participation in sports.