The Female Athlete Triad

John Furia, MD


Medscape General Medicine. 1999;1(1) 

In This Article


Osteoporosis is a syndrome characterized by decreased bone mass and increased risk of fracture.[1,17] Recent advances have made it possible to accurately quantify bone mineral density. Researchers have come to learn that preservation of bone mineral density is critical to future health.

Osteoporosis has long been recognized as a problem for postmenopausal women, but it wasn't until the mid 1980s that sports medicine physicians began to appreciate the relationship between secondary amenorrhea and osteoporosis.[24] The concern is that athletes with low bone mineral density will be at increased fracture risk during their competitive years. In 1985, Drinkwater and colleagues[24] reported -- and others have confirmed[25] -- that amenorrheic runners have much lower bone mineral density than normally menstruating runners. It has been shown that female athletes with stress fractures have lower bone mineral densities.[26]

Perhaps more important is the possibility of increased fracture risk after the competitive years. Because the Female Athlete Triad has been recognized only recently, it is unclear if osteoporosis induced by amenorrhea is completely reversible.

Even with treatment, physicians are unsure if women will develop normal bone mineral density. Research has indicated that amenorrheic women treated with hormone replacement maintain bone mineral density but replacement does not occur.[27] In theory, these women may always have a greater risk for developing hip or vertebral spine compression fractures.

As the home team took control of the game, we discussed the consequences of amenorrhea.
"What do you know about The Female Athlete Triad?" I asked.
"Never heard of it," she replied.