title: Relationships among injury and disordered eating, menstrual dysfunction, and low bone mineral density in high school athletes: a prospective study.
abstract: BACKGROUND
  Prior authors have reported associations among increased risk of injury and factors of the female athlete triad, as defined before the 2007 American College of Sports Medicine position stand, in collegiate and adult club sport populations. Little is known about this relationship in an adolescent competitive sports population.
  
  
  OBJECTIVE
  To examine the relationship among disordered eating, menstrual dysfunction, and low bone mineral density (BMD) and musculoskeletal injury among girls in high school sports.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The sample consisted of 163 female athletes competing in 8 interscholastic sports in southern California during the 2003-2004 school year. Each participant was followed throughout her respective sport season for occurrence of musculoskeletal injuries.
  
  
  METHODS
  Data collected included daily injury reports, the Eating Disorder Examination Questionnaire that assessed disordered eating attitudes and behaviors, a dual-energy x-ray absorptiometry scan that measured BMD and lean tissue mass, anthropometric measurements, and a questionnaire on menstrual history and demographic characteristics.
  
  
  RESULTS
  Sixty-one athletes (37.4%) incurred 90 musculoskeletal injuries. In our BMD z score model of <or=-1 SD, a history of oligomenorrhea/amenorrhea during the past year and low BMD (z score <or=-1 SD) were associated with the occurrence of musculoskeletal injury during the interscholastic sport season. In our BMD z score model of <or=-2 SDs, disordered eating (Eating Disorder Examination Questionnaire score >or=4.0), a history of oligomenorrhea/amenorrhea during the past year, and a low BMD (z score <or=-2 SDs) were associated with musculoskeletal injury occurrence.
  
  
  CONCLUSIONS
  These findings indicate that disordered eating, oligomenorrhea/amenorrhea, and low BMD were associated with musculoskeletal injuries in these female high school athletes. Programs designed to identify and prevent disordered eating and menstrual dysfunction and to increase bone mass in athletes may help to reduce musculoskeletal injuries.
authors.affiliation: School of Exercise & Nutritional Sciences, San Diego State University, CA, USA. mrauh@rmuohp.edu
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Rauh
authors.forename: Jeanne F
authors.initials: JF
authors.lastname: Nichols
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Barrack
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000453:epidemiology* / Q000209:etiology; D015519:Bone Density; D002140:California / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008599:Menstruation Disturbances / Q000150:complications* / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D012574:Schools; D012720:Severity of Illness Index; D013177:Sports; D011795:Surveys and Questionnaires
references.citation: Med Sci Sports Exerc. 2007 Sep;39(9):1464-73
references.pmid: 17805075
references.citation: J Athl Train. 2008 Jan-Mar;43(1):80-108
references.pmid: 18335017
references.citation: Med Sci Sports Exerc. 2007 Oct;39(10):1867-82
references.pmid: 17909417
references.citation: J Adolesc Health Care. 1986 Jul;7(4):236-44
references.pmid: 3721946
references.citation: Am J Sports Med. 2001 Nov-Dec;29(6):712-5
references.pmid: 11734482
references.citation: Bone. 2000 Sep;27(3):437-44
references.pmid: 10962357
references.citation: Fertil Steril. 1995 Jun;63(6):1190-4
references.pmid: 7750587
references.citation: Med Sci Sports Exerc. 2006 Sep;38(9):1571-7
references.pmid: 16960517
references.citation: Exerc Sport Sci Rev. 2003 Jul;31(3):144-8
references.pmid: 12882481
references.citation: Sports Med. 2007;37(4-5):348-52
references.pmid: 17465605
references.citation: Am J Sports Med. 1996 Nov-Dec;24(6):810-8
references.pmid: 8947404
references.citation: Clin J Sport Med. 1995 Oct;5(4):229-35
references.pmid: 7496847
references.citation: Sports Med. 2002;32(14):887-901
references.pmid: 12427050
references.citation: J Clin Endocrinol Metab. 2001 Nov;86(11):5184-93
references.pmid: 11701675
references.citation: J Bone Miner Res. 2004 Aug;19(8):1231-40
references.pmid: 15231009
references.citation: Int J Eat Disord. 1994 Dec;16(4):363-70
references.pmid: 7866415
references.citation: Clin Sports Med. 1995 Jul;14(3):687-707
references.pmid: 7553928
references.citation: Behav Res Ther. 2004 May;42(5):551-67
references.pmid: 15033501
references.citation: Gynecol Obstet Invest. 2000;49(1):41-6
references.pmid: 10629372
references.citation: Am J Sports Med. 1988 May-Jun;16(3):209-16
references.pmid: 3381976
references.citation: Med Sci Sports Exerc. 2007 Sep;39(9):1457-63
references.pmid: 17805074
references.citation: Int J Eat Disord. 2000 Apr;27(3):259-69
references.pmid: 10694711
references.citation: Am J Sports Med. 2006 Sep;34(9):1500-7
references.pmid: 16636349
references.citation: Int J Sport Nutr Exerc Metab. 2002 Sep;12(3):281-93
references.pmid: 12432173
references.citation: J Clin Endocrinol Metab. 1989 Feb;68(2):402-11
references.pmid: 2537332
references.citation: Clin J Sport Med. 2000 Apr;10(2):110-6
references.pmid: 10798792
references.citation: Behav Res Ther. 2001 May;39(5):625-32
references.pmid: 11341255
references.citation: Int J Sport Nutr Exerc Metab. 2005 Apr;15(2):147-59
references.pmid: 16089273
references.citation: Am J Sports Med. 2000 May-Jun;28(3):385-91
references.pmid: 10843133
references.citation: Pediatrics. 2008 Jun;121(6):1127-36
references.pmid: 18519482
references.citation: Eur J Appl Physiol. 2004 Apr;91(4):382-91
references.pmid: 14608461
references.citation: Am J Sports Med. 2006 Jan;34(1):108-15
references.pmid: 16170040
references.citation: J Am Acad Orthop Surg. 2003 Nov-Dec;11(6):439-43
references.pmid: 14686829
references.citation: J Bone Miner Res. 1994 Aug;9(8):1137-41
references.pmid: 7976495
references.citation: Bone. 2004 Sep;35(3):806-16
references.pmid: 15336620
references.citation: J Clin Endocrinol Metab. 1994 Apr;78(4):910-5
references.pmid: 8157720
references.citation: Pediatrics. 2005 Apr;115(4):e399-406
references.pmid: 15805341
references.citation: Am J Clin Nutr. 2008 Jan;87(1):36-43
references.pmid: 18175735
references.citation: J Clin Densitom. 2004 Spring;7(1):17-26
references.pmid: 14742884
references.citation: Clin J Sport Med. 1997 Oct;7(4):262-72
references.pmid: 9397325
references.citation: Ann Intern Med. 1990 Nov 15;113(10):754-9
references.pmid: 1978620
references.citation: Am J Epidemiol. 2006 Jan 15;163(2):151-9
references.pmid: 16306308
references.citation: Gynecol Obstet Invest. 1993;36(3):176-80
references.pmid: 8244193
references.citation: Am J Epidemiol. 2006 Dec 15;164(12):1209-21
references.pmid: 17012366
references.citation: Arch Pediatr Adolesc Med. 2006 Feb;160(2):137-42
references.pmid: 16461868