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Prevalence of the Female Athlete Triad Syndrome Among High School Athletes
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.
Objective To estimate the prevalence of the female athlete triad (disordered eating, menstrual irregularity, and low bone mass) among high school athletes.
Design Observational cross-sectional study.
Setting High school.
Participants Female athletes (n= 170) representing 8 sports were recruited from 6 high schools in southern California.
Main Outcome Measures Disordered eating and menstrual status were determined by interviewer-assisted questionnaires. Bone mineral density was measured by dual-energy x-ray absorptiometry of the hip, spine (L1-L4), and total body.
Results Among all athletes, 18.2%, 23.5%, and 21.8% met the criteria for disordered eating, menstrual irregularity, and low bone mass, respectively. Ten girls (5.9%) met criteria for 2 components of the triad, and 2 girls (1.2%) met criteria for all 3 components. Oligomenorrheic/amenorrheic athletes had higher mean ± SD eating restraint (1.55 ± 1.60 vs 1.04 ± 1.27; P = .02) and Eating Disorder Examination Questionnaire global scores (1.68 ± 1.20 vs 1.33 ± 1.14; P = .03) than eumenorrheic athletes. After controlling for age, age at menarche, body mass index, race/ethnicity, and sport type, athletes with oligomenorrhea/amenorrhea had significantly lower mean ± SD bone mineral densities for the trochanter (0.884 ± 0.090 g · cm–2) than eumenorrheic athletes (0.933 ± 0.130 g · cm–2; P = .04).
Conclusions The prevalence of the full female athlete triad was low in our sample; however, a substantial percentage of the athletes may be at risk for long-term health consequences associated with disordered eating, menstrual irregularity, or low bone mass. Preparticipation screening to identify these components should be encouraged as a preventive approach to identify high-risk athletes.
Author Affiliations: Department of Exercise and Nutritional Sciences (Drs Nichols and Rauh and Mss Lawson and Barkai) and Graduate School of Public Health (Drs Rauh and Ji), San Diego State University, San Diego, Calif; and Graduate Program in Orthopaedic and Sports Physical Therapy, Rocky Mountain University of Health Professions, Provo, Utah (Dr Rauh).
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