The Female Athlete Triad
The Female Athlete Triad
Osteoporosis is a disease that causes bones to become weak and brittle. Normally, you would not associate weak and brittle bones with an athlete, however, osteoporosis can develop in female athletes with inadequate nutrition. The symptoms of osteoporosis are often hard to recognize, and many athletes do not know they have it until another condition, such as a stress fracture, severe back pain, or lack of menstrual periods, forces them to visit their doctor.
To understand the cause of osteoporosis, you have to examine the way the body maintains the skeletal system. As with all other cells of the body, old bone cells are removed and replaced with new bone cells. During the developmental years, new bone cells are added faster than old bone cells are removed. This exchange allows our skeletal system to grow and to become stronger, and it creates the bone density that will be needed later in life. After the age of 30, when bone density reaches its peak, the old bone cells are removed faster than the new bone cells are replaced. Therefore, the higher the bone mass at age 30, the less chance there is of osteoporosis developing.
During bone development, a female athlete can be especially vulnerable to developing osteoporosis because of a condition know as the female athlete triad. The triad is a triangle of events that can start with an eating disorder or excessive exercise, or both, which in turn cause amenorrhea-the lack of a menstrual period or an abnormal menstrual cycle-which then causes a reduction in estrogen levels that eventually leads to bone loss.
Concerns with body weight can lead many young women athletes to diet excessively, causing calcium and vitamin D to be eliminated from the diet. Disordered eating is most commonly found among participants in sports, such as gymnastics, ballet, figure skating, equestrian sports, and diving, in which the athlete is judged on appearance as well as on performance. However, eating disorders are also found among athletes who participate in swimming, tennis, and running-sports in which the athlete's appearance is not judged. Sometimes, an athlete's fear of being fat leads to eating disorders that range from moderate food restriction to occasional binging and purging to dangerous levels of severe food restriction. Unfortunately, there have been reports of 19-year-old female athletes who have the bone mass of an 80-year-old woman as a result of the female athlete triad. Friends, parents, coaches, athletic trainers, and physicians should be alert to an athlete's eating behaviors. Eating alone, trips to the bathroom during or right after a meal, and the frequent use of laxatives should be cause for concern.
The benefits of sport far outweigh the risk, but consequences of the female athlete triad can be irreversible bone loss, disorders related to starvation, decrease in estrogen levels, and premature death. The best treatment plan for osteoporosis in athletes is one that is developed by a physician after the proper assessment has been made.
Bruce Getz, ATC
Columbus, Georgia
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