Jeanne F. Nichols, PhD; Mitchell J. Rauh, PhD, PT, MPH; Mandra J. Lawson, MS, RD; Ming Ji, PhD; Hava-Shoshana Barkai, MS. Arch Pediatr Adolesc Med. 2006; 160:137-142
As of recent years, most literature surrounding the female athlete triad subsisted solely in collegiate female athletes. Data regarding high school-aged athletic females was severely lacking. In 2006, Nichols et al performed an observational cross-sectional study to estimate the prevalence of the female athlete triad among high school athletes. One-hundred-seventy female athletes representing eight sports from six high schools in southern California were included in the analysis to determine prevalence of the three aspects of the triad: disordered eating, menstrual status and bone health. Disordered eating and menstrual status were determined by interviewer-assisted questionnaires. Bone mineral density was determined via dual-energy x-ray absorptiometry (DXA) at the spine (L1-L4), hip and total body. Among athletes, 18.2% met criteria for disordered eating, 23.5% met criteria for menstrual irregularity and 21.8% met criteria for low bone mass. Ten of the 170 girls studied (5.9%) met criteria for 2 of the 3 components of the triad and 2 girls (1.2%) met criteria for all 3. In comparison to eumenorrheic athletes (regular menstrual cycles), oligomenorrheic (cycle length of 36-90 days) and amenorrheic (no menses for ≥ 90 days) athletes presented with high dietary restraint (the ability to restrict food intake) and Eating Disorder Examination Questionnaire global scores. As well, in comparison to eumenorrheic athletes, and after controlling for age, age at menarche, BMI, race/ethnicity and sport type, athletes with oligomenorrhea/amenorrhea had lower bone mineral densities at the trochanter (hip). In conclusion, the prevalence of the female athlete triad in high school-aged female athletes showed to be substantial illustrating that these women are at risk for one or more of the components of the triad. Long-term health consequences may be associated with the disordered eating, menstrual irregularities and poor bone health seen in this population. Preparticipation screening to identify these components should be encouraged as a preventive approach to identify high-risk athletes.