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Orthop J Sports Med 2022 Jun 15;10(6):23259671221104793. Epub 2022 Jun 15.

Stanford Medical Center, Redwood City, California, USA.

Background: Bone stress injury (BSI) is a common reason for missed practices and competitions in elite track and field runners.

Hypothesis: It was hypothesized that, after accounting for medical risk factors, higher plantar loading during running, walking, and athletic movements would predict the risk of future BSI in elite collegiate runners.

Study Design: Cohort study; Level of evidence, 2. Read More

Int J Environ Res Public Health 2022 05 13;19(10). Epub 2022 May 13.

Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, Skłodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland.

Background: Kayaking is a high intensity sport that demands high levels of aerobic and anaerobic capacity as well as a great deal of strength and endurance. The aim of this study was an assessment of the frequency of occurrence of early low energy availability symptoms using the Low Energy Availability in Females Questionnaire for women belonging to the Polish national kayaking team. Additionally, quantitative measurements of body composition and levels of calcium were performed. Read More

Front Nutr 2022 26;9:875802. Epub 2022 Apr 26.

Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.

Int J Environ Res Public Health 2022 05 4;19(9). Epub 2022 May 4.

Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan.

The influence of low energy availability (LEA) on bone mineral density (BMD) and trabecular bone microarchitecture in pubescent female athletes is unclear. This study aimed to investigate the influence of LEA on BMD and trabecular bone microarchitecture in 21 pubescent female athletes (age, 12-15 years; 11 track and field athletes, 10 gymnasts). We used two indices to assess LEA: energy availability and the percent of ideal body weight. Read More

Int J Sport Nutr Exerc Metab 2022 May 6:1-9. Epub 2022 May 6.

Massachusetts General Hospital, Boston, MA,USA.

Bone stress injuries (BSIs) are common among athletes and have high rates of recurrence. However, risk factors for multiple or recurrent BSIs remain understudied. Thus, we aimed to explore whether energy availability, menstrual function, measures of bone health, and a modified Female Athlete Triad Cumulative Risk Assessment (CRA) tool are associated with a history of multiple BSIs. Read More

Calcif Tissue Int 2022 May 6. Epub 2022 May 6.

Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8572, Japan.

Energy availability (EA) is defined the difference in energy intake and exercise energy expenditure. Reduction of EA (i.e. Read More

PM R 2022 05 16;14(5):587-596. Epub 2022 May 16.

Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, United States.

Background: Exercise is an osteogenic stimulus that should increase bone mineral density (BMD) and protect against injury. However, some female athletes have lower BMD and increased bone stress injury (BSI) risk. Impaired bone health seen in athletes may be explained by low energy availability as described by concepts of Relative Energy Deficiency in Sport (RED-S) and Female Athlete Triad (Triad). Read More

Int J Environ Res Public Health 2022 04 16;19(8). Epub 2022 Apr 16.

Department of Nutrition, Dietetics and Food Sciences, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA.

This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries' income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Read More

J Athl Train 2022 Apr;57(4):385-392

Syracuse University, NY.

Context: Female endurance athletes exhibit an increased risk of the female athlete triad (Triad) and relative energy deficiency in sport (RED-S). The triad and RED-S are conditions that involve the health and performance consequences of low energy availability. Few authors of studies to date have assessed the knowledge that athletes, coaches, and athletic trainers (ATs) have regarding the Triad or RED-S. Read More

Sports (Basel) 2022 Mar 2;10(3). Epub 2022 Mar 2.

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway.

In general, aerobic exercise has a positive impact on the vascular system, but the syndrome of relative energy-deficiency in sports (RED-S) makes this impact less clear for the athlete. The present cross-sectional controlled study aimed to investigate the vascular function in female elite long-distance runners, compared to inactive women. Sixteen female elite long-distance runners and seventeen healthy controls were recruited. Read More

PeerJ 2022 2;10:e12903. Epub 2022 Mar 2.

Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland.

Background: The Female Athlete Triad (FAT) included three interrelated conditions including disordered eating, amenorrhea, and osteoporosis. The American College of Sports Medicine updated the definition of FAT to reflect the interdependence of low energy availability with or without eating disorders. The main aim of the study was to assess the impact of recreational running on potential disturbances in the regularity of women's menstrual cycles. Read More

Dis Mon 2022 Feb 13:101327. Epub 2022 Feb 13.

Department of Family Medicine, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan, United States.

Selective medical perspectives of pediatric sports medicine are explored in this issue and behavioral perspectives of pediatric sports medicine are discussed in a subsequent journal issue. Concepts are considered now dealing with sports readiness involving the child and adolescent that involve understanding the limits imposed by growth and development at different ages as well as pubertal stages. Specializing in one sport too soon is not recommended. Read More

Am J Clin Nutr 2022 Jun;115(6):1457-1472

Department of Kinesiology, Pennsylvania State University, University Park, PA, USA.

Background: Energy deficiency can result in menstrual disturbances and compromised bone health in women, a condition known as the Female Athlete Triad.

Objectives: The REFUEL randomized controlled trial assessed the impact of increased energy intake on bone health and menstrual function in exercising women with menstrual disturbances.

Methods: Exercising women with oligomenorrhea/amenorrhea (Oligo/Amen) were randomly assigned to an intervention group (Oligo/Amen + Cal, n = 40, mean ± SEM age: 21. Read More

Int J Environ Res Public Health 2022 01 26;19(3). Epub 2022 Jan 26.

Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA.

The purpose of this study was to examine individual and combined Female Athlete Triad components within collegiate cheerleaders, an at-risk group. Cheerleaders ( = 19; age: 20.3 ± 1. Read More

Int J Environ Res Public Health 2022 01 22;19(3). Epub 2022 Jan 22.

Department of Nutrition, Dietetics & Food Sciences, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA.

This study retrospectively compared the prevalence of factors related to the female athlete triad (low energy availability, secondary amenorrhea (SA), low bone mineral density (BMD)), and post-study BMD of female college students and female international volunteer missionaries (volunteers). Female college students (21-26 years) completed a survey that retrospectively assessed an 18-month study period (volunteer service or first 18 months of college); Diet History Questionnaire III (DHQ III) and Dual-Energy X-ray Absorptiometry (DXA) scan were optional. One-way ANOVAs and chi-squared distributions assessed group differences. Read More

Int J Sports Phys Ther 2022 1;17(2):210-217. Epub 2022 Feb 1.

Riphah International University.

Background: Female athletes who are not vigilant about their food choices and choose extraneous physical activities may head towards negative health effects.

Purpose: The purpose was to determine the prevalence of risk factors that may lead to the Female Athlete Triad among young elite athletes in Pakistan.

Study Design & Methods: A cross sectional questionnaire-based study was conducted in 2018 at Pakistan Sports Board to investigate the risk factors of The Female Athlete Triad among young elite athletes based in national training camps of major metropolitan cities. Read More

S D Med 2021 Oct;74(10):484-488

Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

The female athlete triad (FAT) is a disorder involving greater energy expenditure than energy consumption leading to 1) low energy availability (EA) with or without disordered eating 2) menstrual irregularities or amenorrhea and 3) low bone mineral density. Consequences of FAT include osteoporosis, stress fractures, increased cardiovascular risk, infertility, and negative psychological effects. The key risk factor for FAT is inadequate caloric intake when compared to the amount and intensity of exercise. Read More

Front Nutr 2021 26;8:737777. Epub 2021 Nov 26.

Exercise Science, Exercise Science Department, University of South Carolina, Columbia, SC, United States.

Studies examining the physiological consequences associated with deficits in energy availability (EA) for male athletes are sparse. To examine male athlete triad components; low energy availability (LEA) with or without an eating disorder risk (ED), reproductive hormone [testosterone (T)], and bone mineral density (BMD) in endurance-trained male athletes during different training periods. A cross-sectional design with 14 participants (age: 26. Read More

Rev Bras Ortop (Sao Paulo) 2021 Dec 7;56(6):813-818. Epub 2021 Dec 7.

Departamento de Medicina do Esporte, Esporte Clube Vitória, Salvador, BA, Brasil.

Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. Read More

Br J Sports Med 2022 Mar 26;56(5):244-245. Epub 2021 Nov 26.

Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.

Am J Sports Med 2022 01 24;50(1):58-67. Epub 2021 Nov 24.

American Hip Institute Research Foundation, Chicago, Illinois, USA.

Background: The effect of low body mass index (BMI) on outcomes in female athletes is unknown.

Purpose: (1) To report minimum 2-year patient-reported outcomes and return to sports for high-level female athletes with low BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare results with those of a propensity-matched control group of high-level female athletes with a normal BMI.

Study Design: Cohort study; Level of evidence, 3. Read More

Curr Opin Endocrinol Diabetes Obes 2022 02;29(1):44-51

Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Purpose Of Review: Adolescence and young adulthood are a critical period in the life of women for optimizing long-term bone health. Young athletes lead a demanding lifestyle with increased dietary requirements to meet the robust demands of energy expenditure to maintain a state of energy balance. During a time of fast paced changes and unpredictable societal demands on young athletes, it is important to review the severe consequences of energy deficiency and options for adequate management. Read More

J Int Soc Sports Nutr 2021 Nov 16;18(1):70. Epub 2021 Nov 16.

Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 20502, Malmö, Sweden.

Background: Resting metabolic rate (RMR) has been examined as a proxy for low energy availability (EA). Previous studies have been limited to adult athletes, despite the serious health consequences of low EA, particularly during adolescence. This study aimed to explore the relationship between RMR and EA in competitive teenage girl runners. Read More

Reprod Biomed Soc Online 2022 Mar 1;14:66-74. Epub 2021 Oct 1.

Department of Sociology and Demography, University of Rostock, Rostock, Germany.

Metabolic risk factors such as obesity are considered major obstacles to female fertility. Chronic infertility imposes psychological and social burdens on women because infertility violates societal gender roles. Although the prevalence of obesity among women is expected to increase in the future, the relevance of metabolic status for fertility is still underestimated. Read More

Curr Sports Med Rep 2021 Nov;20(11):591-593

Endocrinology Department, Peking University First Hospital, Beijing, CHINA.

Eur Spine J 2022 01 2;31(1):1-9. Epub 2021 Nov 2.

Department of Orthopedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel.

Purpose: Fatigue stress fractures are a common overuse injury, frequently associated with high load-bearing endurance activities such as running, military training and aerobic exercise. While these fractures can arise at any site, sacral stress fractures are poorly studied with evidence consisting mainly of case reports and limited case series. This review aims to analyze and summarize all reports published to date describing cases of sacral stress fracture in athletes. Read More

Sports Med 2022 Jan 19;52(1):13-23. Epub 2021 Oct 19.

Department of Kinesiology, Pennsylvania State University, University Park, PA, 16802, USA.

Energy status plays a key role in the health of athletes and exercising individuals. Energy deficiency/low energy availability (EA), referring to a state in which insufficient energy intake and/or excessive exercise energy expenditure has resulted in compensatory metabolic adaptations to conserve fuel, can affect numerous physiological systems in women and men. The Female Athlete Triad, Male Athlete Triad, and Relative Energy Deficiency in Sport (RED-S) models conceptualize the effects of energy deficiency in athletes, and each model has strengths and limitations. Read More

Arch Osteoporos 2021 09 24;16(1):141. Epub 2021 Sep 24.

The Faculty of Education, Health and Wellbeing, University of Wolverhampton, Gorway Rd, Walsall, Wolverhampton, WS1 3BE, UK.

Three years of study showed that female and male vocational dancers displayed lower bone mass compared to controls, at forearm, lumbar spine and femoral neck. Energy intake was found to positively predict bone mass accruals only in female dancers at femoral neck. Vocational dancers can be a risk population to develop osteoporosis. Read More

PeerJ 2021 3;9:e12118. Epub 2021 Sep 3.

Orthopaedic and Rehabilitation Department, Medical University of Warsaw, Warszawa, Poland.

Background: It has been noticed that Female Athlete Triad (Fat) and Relative Energy Deficiency (Red-S) in Sport are characterized by the symptoms of impaired endocrine-metabolic function and bone health in female athletes. In addition, it may be evaluated with a qualitative tool, such as Low Energy Availability in Females questionnaire (LEAF-Q) and quantitative measurements: bone mineral density (BMD), resting energy expenditure (REE), body composition, 24-hour dietary recall.

Methods: The aim of this study was to assess the prevalence of Triad and Red-S using the LEAF-Q in youth female football players. Read More

Curr Sports Med Rep 2021 Sep;20(9):489-493

Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, Stanford University, Palo Alto, CA.

Abstract: The electronic preparticipation physical examination (ePPE) is commonly used to identify health conditions that would affect participation in sports for athletes, including disordered eating and/or low energy availability (EA). A secondary analysis was performed using a cohort study of female college athletes attending a Division 1 university between 2008 and 2014. Descriptive statistics and logistic regression analyses were used to explore the association between responses to questions on the ePPE related to eating behaviors and Female Athlete Triad (Triad). Read More