Management of Low Bone Mass in Female Athletes

Hoon Choi

doi:10.7180/kmj.2014.29.1.1

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Choi: Management of Low Bone Mass in Female Athletes

Review Article

Kosin Medical Journal 2014;29(1):1-10.

Published online: 17 December 2014

DOI: https://doi.org/10.7180/kmj.2014.29.1.1

Management of Low Bone Mass in Female Athletes

Hoon Choi

Department of Obstetrics and Gynecology, College of Medicine, Inje University, Sanggyepaik Hospital, Seoul, Korea

Corresponding Author: Hoon Choi, Department of Obstetrics and Gynecology, Inje University, School of Medicine Inje University Sanggyepaik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, 139-707, Korea TEL: +82-2-950-1058 FAX: +82-00-00-00 E-mail: hchoi@paik.ac.kr

Received 14 March 2014 Revised 14 March 2014 Accepted 17 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad and its components can occur in females of all ages in every sport. The Female Athlete Triad poses serious health risks, both short and long term, to the overall well-being of affected individuals. Sustained low energy availability can impair health, causing many medical complications within the skeletal, endocrine, cardiovascular, reproductive, and central nervous systems. With the surge of females participating in athletics within the past 10 to 15 years, it is both conceivable and likely that the prevalence of this syndrome will continue to grow. Therefore, it is imperative that appropriate screening and diagnostic measures are enacted by a multidisciplinary team of health care providers, counselors, teachers, and dieticians in order to provide the proper care to affected athletes. Initial awareness should take place within the educational confines of elementary and high schools. Screening for female athletes exhibiting risk factors for the triad should also take place at the time of sports physicals. If one component of the triad is identified, the clinician should take the time to effectively workup the other. Treatment for each component of the triad includes both pharmacological and nonpharmacological measures, with emphasis placed upon increased energy availability and overall improved nutritional health. Using this all-encompassing type of approach, sports medicine practitioners should feel empowered to continue to promote the lifelong well-being of female athletes in the years to come.

Keywords: Female Athlete Triad, Low bone mass, Menstrual dysfunction

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Fig. 1.

The female athlete triad.

Fig. 2.

Average bone mineral density among collegiate female athletes by sport.

Table 1.

Risk Factors and Warning Signs of the Female

Athlete Triad Athletes at risk for eating disorders
Restriction of dietary energy intake or vegetarianism
Psychosocial pressures to achieve thinness
Low self-esteem or poor family dynamics
Initiation of training at young age or increase in training
intensity
Participation in lean/aesthetic sports
Athletes at risk for menstrual dysfunction
Low body mass index
Participation in lean/aesthetic sports
Athletes at risk for stress fractures
Low bone mineral density or history of stress fractures
Menstrual disturbances
Delayed menarche
Dietary insufficiency
Errors in training
Warning signs
Decline in performance
Weight loss
Mood changes
Frequent illness or injury
Fractures
Dissatisfaction with appearance

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