Relative Energy Deficiency (Female athlete triad)

NewsBot · Aug 7, 2019

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Drive for Thinness Predicts Musculoskeletal Injuries
in Division II NCAA Female Athletes
Jennifer L. Scheid et al
J. Funct. Morphol. Kinesiol. 2019, 4, 52

The female athlete triad is the interrelation of low energy availability, menstrual
dysfunction, and low bone mineral density. Previously, the components of the female athlete triad
have been linked to bone stress injuries. The objective of this study was to explore the relationship
between drive for thinness, a proxy indicator of low energy availability, and musculoskeletal
injuries. Fifty-seven female athletes, from an NCAA Division II college, were followed throughout
their respective sport season for musculoskeletal injuries. Women were grouped based on a
median split of the drive for thinness score (high drive for thinness (DT) vs. low DT). At the end of
each sport season, injury data were compiled using an electronic medical record database.
Forty-seven of the 57 women (82%) incurred 90 musculoskeletal injuries. The most prevalent
injuries included: Low back pain/spasm/strain (n = 12), followed by shin splints/medial tibial stress
syndrome (n = 9), general knee pain (n = 7), quadriceps strain (n = 6), and knee sprain (anterior
cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral
ligament sprains; n = 5). The number of in-season injuries in the High DT group (2.0 ± 0.3) was
significantly higher than the Low DT group (1.2 ± 0.2, p = 0.026). A high drive for thinness is
associated with an increased number of injuries during the competitive season.
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NewsBot · Jul 24, 2021

The relationship between the female athlete triad and injury rates in collegiate female athletes
Mutsuaki Edama et al
PeerJ. 2021 Apr 6

Background: This study aimed to clarify the relationship between the triad risk assessment score and the sports injury rate in 116 female college athletes (average age, 19.8 ± 1.3 years) in seven sports at the national level of competition; 67 were teenagers, and 49 were in their 20s.

Methods: Those with menstrual deficiency for >3 months or <6 menses in 12 months were classified as amenorrheic athletes. Low energy availability was defined as adolescent athletes having a body weight <85% of ideal body weight, and for adult athletes in their 20s, a body mass index ≤17.5 kg/m2. Bone mineral density (BMD) was measured on the heel of the right leg using an ultrasonic bone densitometer. Low BMD was defined as a BMD Z-score <-1.0. The total score for each athlete was calculated. The cumulative risk assessment was defined as follows: low risk (a total score of 0-1), moderate risk (2-5), and high risk (6). The injury survey recorded injuries referring to the injury survey items used by the International Olympic Committee.

Results: In swimming, significantly more athletes were in the low-risk category than in the moderate and high-risk categories (p = 0.004). In long-distance athletics, significantly more athletes were in the moderate-risk category than in the low and high-risk categories (p = 0.004). In the moderate and high-risk categories, significantly more athletes were in the injury group, whereas significantly more athletes in the low-risk category were in the non-injury group (p = 0.01). Significantly more athletes at moderate and high-risk categories had bone stress fractures and bursitis than athletes at low risk (p = 0.023).

Discussion: These results suggest that athletes with relative energy deficiency may have an increased injury risk.
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NewsBot · Oct 25, 2021

Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners
Høeg, Tracy Beth et al
Clinical Journal of Sport Medicine: July 5, 2021

Objective:
To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD).

Design:
Multiyear cross-sectional study.

Setting:
One hundred-mile ultramarathon.

Participants:
Competing runners were recruited in 2018 and 2019.

Assessment of Risk Factors:
Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only).

Main Outcome Measure:
A Triad Cumulative Risk Assessment Score was calculated for each participant.

Results:
One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <−1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <−1.0. Low body mass index (BMI) (<18.5 kg/m2) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk.

Conclusions:
Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.
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NewsBot · Mar 5, 2024

Relative Energy Deficiency in Sport (RED-S) and Bone Stress Injuries
Daniel R. Kim, Kathleen Weber
Operative Techniques in Sports Medicine; Volume 31, Issue 3, September 2023, 151025

Relative Energy Deficiency in Sport (RED-S) is a syndrome caused by low energy availability that has significant physiological consequences. Bone stress injuries (BSIs), including stress fractures, are overuse injuries that occur when there is an imbalance of bone microdamage and its removal and replacement via bone remodeling. Female athletes are at particular risk of RED-S, which can manifest as bone stress injury, as well as associated pathologies including disordered eating and oligomenorrhea/amenorrhea. Female athletes should be screened for risk factors for RED-S so that it can be identified and treated early. BSIs can be diagnosed by patient history and physical examination, with imaging used for confirmation. Management of BSIs differ according to their location, with high-risk injuries requiring a highly nuanced treatment approach in the context of shared decision-making. These athletes should also be concurrently evaluated for low energy availability, which if identified may require addressing disordered eating, hormone deficiency, and inadequate nutrition with an interdisciplinary team. Return to sport decisions should be individualized while informed by published guidelines.
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