title: The components of the female athlete triad do not identify all physically active females at risk.
abstract: The purpose of the present study was to assess the effectiveness of the triad components (amenorrhoea, disordered eating, and osteoporosis) in identifying physically active women at risk of long-term health problems. Eighty-two females (mean age 31.1 years, s = 6.7; body mass 58.4 kg, s = 6.6; stature 1.65 m, s = 0.06) completed training, menstrual, and dietary questionnaires. Bone mineral density and size-adjusted bone mineral density were assessed at the femoral neck and lumbar spine using dual energy X-ray absorptiometry. Seventy-eight percent of participants were eumenorrhoeic, 20% were oligomenorrhoeic, and 2% were amenorrhoeic. Thirty-six percent and 55% reported disordered eating practices in the present and past respectively. Eighty-one percent, 17%, and 2% were classified as normal, osteopaenic, and osteoporotic at the femoral neck respectively; 92% were normal, 7% osteopaenic, and 1% osteoporotic at the lumbar spine. No significant differences in femoral neck size-adjusted bone mineral density were observed between eumenorrhoeic and oligo/amenorrhoeic participants (F(2,80) = 0.119, P = 0.73); eumenorrhoeic participants had significantly greater lumbar spine size-adjusted bone mineral density (F(2,80) = 9.79, P = 0.003). Disordered eating participants had significantly lower femoral neck size-adjusted bone mineral density than those reporting no disordered eating (F(2,80) = 13.816, P = 0.000). Twenty-two percent of participants fulfilled triad criteria, while 55% were "at risk" of long-term health problems. An accumulation of conditions resulted in lower lumbar spine size-adjusted bone mineral density (F(1,80) = 6.074, P = 0.004). The current triad components do not identify all women "at risk" and more appropriate criteria such as exercise-related menstrual alterations, disordered eating, and osteopaenia are suggested.
authors.affiliation: School of Sport and Health Sciences, University of Exeter, Exeter, UK. m.burrows@ex.ac.uk
authors.forename: Melonie
authors.initials: M
authors.lastname: Burrows
authors.forename: Helen
authors.initials: H
authors.lastname: Shepherd
authors.forename: Stephen
authors.initials: S
authors.lastname: Bird
authors.forename: Kenneth
authors.initials: K
authors.lastname: MacLeod
authors.forename: Bob
authors.initials: B
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000453:epidemiology*; D015992:Body Mass Index; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity; D009749:Nutrition Surveys; D009752:Nutritional Status; D010024:Osteoporosis / Q000453:epidemiology*; D010807:Physical Endurance / Q000502:physiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology