Female Athletes May Face Injury Risk, Low Bone Mineral Density

Bon Secours In Motion, female athlete triad, injury, risk, bone, stress, Female athletes – no matter their age – who have low energy levels and abnormal menstrual cycles may be at risk for bone stress injuries and fractures as well as sports-related injuries, according to a new study.

The symptoms – known as “the female triad” – include feeling like you have very low energy levels, experiencing menstrual cycle abnormalities, and having low bone mineral density, said orthopaedic surgeon Elizabeth Matzkin, MD, lead author of the study. The study appears in the Journal of the American Academy of Orthopaedic Surgeons.

“Low energy availability can mean taking in inadequate calories or expending more energy than the body is designed to do,” Matzkin said. “It can result from poor nutrition or eating habits or any type of eating disorder. Any combination of these conditions can lead to premature bone loss in females.”

Both athletes and non-athletes participating in any sports and exercise can develop symptoms of the female athlete triad, according to a news release from the American Academy of Orthopaedic Surgeons. The concern for female athletes is that as the number of symptoms increase, so does their risk for sustaining a bone stress injury.

According to the study, the increased risk is substantial:

15 percent to 21 percent with one symptom;
21 percent to 30 percent with two symptoms; and,
29 percent to 50 percent with all three symptoms.
The study authors also found that female athletes diagnosed with poor nutrition or low energy availability are two to four times more likely to sustain a sports-related injury. Female athletes who self-reported menstrual cycle abnormalities had a nearly three times greater risk of a bone and joint injury.

“Proper nutrition and energy balance are key to staying healthy in athletes of all ages. But maximizing bone health when you are young is paramount to your bone health later in life,” Matzkin said. “It is important for young females to maximize their bone density until about the age of 25—anything lost before then cannot be regained. After age 25 we can only hope to maintain what we have.”

The findings apply to millions of women and girls who play sports. Participation in sports by women and girls has increased from 310,000 individuals in 1971 to 3.37 million in 2010, according to the AAOS. At the same time, sports-related injuries among female athletes have skyrocketed.

As participation in sports by women and girls continues to increase and become more competitive, it is important to prevent, diagnose, and manage the components of the female athlete triad, the study concludes. Although the female athlete triad poses a great health risk, the benefits of participation in sports significantly outweigh the risks.

“Any athlete who falls under the ‘umbrella’ of the triad should be questioned by their physicians and educated regarding all of the components and potential health risks of this condition. By preventing premature bone loss in young female athletes, we can potentially prevent future fragility fractures,” Matzkin said.

Source: American Academy of Orthopaedic Surgeons news release

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