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Clin J Sport Med. 2009 Sep;19(5):421-8. doi: 10.1097/JSM.0b013e3181b8c136.

Prevalence of the female athlete triad in high school athletes and sedentary students.

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  • 1Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.



To determine the prevalence of the female athlete triad (low energy availability, menstrual dysfunction, and low bone mineral density) in high school varsity athletes in a variety of sports compared with sedentary students/control subjects.


Prospective study.


Academic medical center in the Midwest.


Eighty varsity athletes and 80 sedentary students/control subjects volunteered for this study.


Subjects completed questionnaires, had their blood drawn, and underwent bone mineral density testing.


Each participant completed screening questionnaires assessing eating behavior, menstrual status, and physical activity. Each subject completed a 3-day food diary. Serum hormonal, thyroid-stimulating hormone, and prolactin levels were determined. Bone mineral density and body composition were measured by dual-energy x-ray absorptiometry.


Low energy availability was present in similar numbers of athletes (36%) and sedentary/control subjects (39%; P = 0.74). Athletes had more menstrual abnormalities (54%) compared with sedentary students/control subjects (21%) (P < 0.001). Dual-energy x-ray absorptiometry revealed that 16% of the athletes and 30% of the sedentary/control subjects had low bone mineral density (P = 0.03). Risk factors for reduced bone mineral density include sedentary control student, low body mass index, and increased caffeine consumption.


A substantial number of high school athletes (78%) and a surprising number of sedentary students (65%) have 1 or more components of the triad. Given the high prevalence of triad characteristics in both groups, education in the formative elementary school years has the potential to prevent several of the components in both groups, therefore improving health and averting long-term complications.

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