The female athletic triad: Disordered eating, amenorrhea, and osteoporosis

The female athlete triad is defined as the interrelationships among energy availability, menstrual function, and bone mineral density. These dynamic components may transcend towards various clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis. The occurrence of low energy availability, amenorrhea, and osteoporosis, alone or in combination, poses deleterious health risks to physically active girls and women. Deficits in energy intake may be acquired through excessive energy expenditure; however, disordered eating habits have been a tremendous concern and a risk factor for the female athlete triad. Therefore, clinicians and health care professionals must be highly aware of its prevalence for prevention. Low energy availability, with or without disordered eating, disrupts physiological function by suppressing the hypothalamic– pituitary–gonadal axis leading to functional amenorrhea. Additionally, recent literature has shown disturbances in endothelial function and may compromise the cardiovascular system. The prevalence of stress fractures has been linked to poor bone health and a severe risk factor for osteoporosis. The appropriate diagnosis and management is crucial to ameliorate health and quality of life. Recommendations have been made by various leading organizations, such as the American College of Sports Medicine, to successfully manage this syndrome. However, specific evidence-based guidelines are still being conducted. Nevertheless, solid background knowledge of the interrelationships of the various components of the triad is necessary for the allied health professional.