title: Are Elite Female Soccer Athletes at Risk for Disordered Eating Attitudes, Menstrual Dysfunction, and Stress Fractures?
abstract: OBJECTIVE
  To determine the prevalence of stress fractures, menstrual dysfunction and disordered eating attitudes in elite female soccer athletes.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Female soccer athletes were recruited from a national level youth soccer club, an NCAA Division I university team, and a women's professional team.
  
  
  METHODS
  Two hundred twenty female soccer athletes with a mean age of 16.4 ± 4 years and BMI of 20.8 ± 2 kg/m(2) completed the study, representing all athletes from the included teams.
  
  
  METHODS
  One-time surveys completed by the athletes.
  
  
  METHODS
  Height and weight were recorded, and body mass index (BMI) was calculated for each athlete. Athletes reported age of menarche, history of missing 3 or more menses within a 12-month period and stress fracture. The Eating Attitudes Test (EAT-26) was used to assess the athlete's body perception and attitudes toward eating.
  
  
  RESULTS
  Of the 220 soccer athletes, 3 athletes (1.6%) had a low BMI for their age, and 19 (8.6%) reported stress fractures of the lower extremity. Among athletes who had reached menarche, the average onset was 13 + 1 year; menstrual dysfunction were present in 21 (19.3%). On the EAT-26, 1 player scored in the high risk range (>20) and 17 (7.7%) scored in the intermediate risk range (10-19) for eating disorders. Athletes with an EAT-26 score ≥ 10 points had a significantly higher prevalence of menstrual dysfunction in the past year compared to athletes with an EAT-26 score of less than 10 (P = .02).
  
  
  CONCLUSIONS
  Elite female soccer athletes are susceptible to stress fractures and menstrual dysfunction and have delayed onset of menarche despite normal BMI and appropriate body perception and attitudes towards eating. Further studies are needed to better understand stress fracture risk in female soccer athletes and in other team sports to determine how these findings relate to long-term bone health in this population.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO∗. Electronic address: pratherh@wudosis.wustl.edu.
authors.forename: Heidi
authors.initials: H
authors.lastname: Prather
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO(†).
authors.forename: Devyani
authors.initials: D
authors.lastname: Hunt
authors.affiliation: Andrews Sports Medicine & Orthopaedic Center, Birmingham, AL(‡).
authors.forename: Kathryn
authors.initials: K
authors.lastname: McKeon
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO(¶).
authors.forename: Scott
authors.initials: S
authors.lastname: Simpson
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO(§).
authors.forename: E Blair
authors.initials: EB
authors.lastname: Meyer
authors.affiliation: Peak Sport and Spine Rehab, Crestwood, MO(∗∗).
authors.forename: Ted
authors.initials: T
authors.lastname: Yemm
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO(††).
authors.forename: Robert
authors.initials: R
authors.lastname: Brophy
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D001290:Attitude; D001835:Body Weight; D015519:Bone Density; D002648:Child; D003430:Cross-Sectional Studies; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015775:Fractures, Stress / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008599:Menstruation Disturbances / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*; D014481:United States / Q000453:epidemiology; D055815:Young Adult