title: Association between the female athlete triad and endothelial dysfunction in dancers.
abstract: OBJECTIVE
  To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Academic institution in the Midwest.
  
  
  METHODS
  Twenty-two professional ballet dancers volunteered for this study.
  
  
  METHODS
  The prevalence of the female athlete triad and its relationship to endothelial dysfunction.
  
  
  METHODS
  Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction.
  
  
  RESULTS
  Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score < -1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation (<5%). Flow-mediated dilation values were significantly correlated with serum estrogen and whole-body and lumbar BMD. All the 3 components of the triad plus endothelial dysfunction were present in 14% of the subjects.
  
  
  CONCLUSIONS
  Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Ave., Milwaukee, WI 43226, USA. azeni@mcw.edu
authors.forename: Anne Z
authors.initials: AZ
authors.lastname: Hoch
authors.forename: Paula
authors.initials: P
authors.lastname: Papanek
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Michael E
authors.initials: ME
authors.lastname: Widlansky
authors.forename: Jane E
authors.initials: JE
authors.lastname: Schimke
authors.forename: David D
authors.initials: DD
authors.lastname: Gutterman
mesh_terms: D000328:Adult; D001916:Brachial Artery / Q000503:physiopathology*; D003615:Dancing / Q000502:physiology*; D004108:Dilatation, Pathologic; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D053716:Female Athlete Triad Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult