Current perspectives on the etiology and manifestation of the "silent" component of the Female Athlete Triad - PubMed (original) (raw)

Review

Current perspectives on the etiology and manifestation of the "silent" component of the Female Athlete Triad

Rebecca J Mallinson et al. Int J Womens Health. 2014.

Abstract

The Female Athlete Triad (Triad) represents a syndrome of three interrelated conditions that originate from chronically inadequate energy intake to compensate for energy expenditure; this environment results in insufficient stored energy to maintain physiological processes, a condition known as low energy availability. The physiological adaptations associated with low energy availability, in turn, contribute to menstrual cycle disturbances. The downstream effects of both low energy availability and suppressed estrogen concentrations synergistically impair bone health, leading to low bone mineral density, compromised bone structure and microarchitecture, and ultimately, a decrease in bone strength. Unlike the other components of the Triad, poor bone health often does not have overt symptoms, and therefore develops silently, unbeknownst to the athlete. Compromised bone health among female athletes increases the risk of fracture throughout the lifespan, highlighting the long-term health consequences of the Triad. The purpose of this review is to examine the current state of Triad research related to the third component of the Triad, ie, poor bone health, in an effort to summarize what we know, what we are learning, and what remains unknown.

Keywords: bone health; female athlete Triad; treatment.

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Figures

Figure 1

Figure 1

Spectra of the Female Athlete Triad. The three interrelated conditions of the Triad include low energy availability, menstrual dysfunction, and poor bone health. Each of these conditions may occur anywhere along a continuum from optimal health to a severe clinical endpoint. Abbreviations: BMD, bone mineral density; w/, with; w/o, without.

Figure 2

Figure 2

Continuum of menstrual cycle disturbances. Notes: On the far left of the continuum is optimal menstrual health, which is characterized by regular ovulatory menstrual cycles that are 26–35 days in length. The subclinical/subtle menstrual cycle disturbances include luteal phase defects and anovulation, which represent the least severe disturbances. Menstrual cycles with a luteal phase defect are ovulatory but characterized by a short luteal phase and/or insufficient progesterone production during the luteal phase. Menstrual cycles in which ovulation does not occur and progesterone concentrations are notably low are called anovulatory cycles. It must be noted that cycles that have a luteal phase defect or are anovulatory frequently appear to be regular cycles due to intermenstrual intervals of normal length. The clinical/severe menstrual cycle disturbances include oligomenorrhea which is characterized by long, inconsistent intermenstrual intervals and amenorrhea, the most severe menstrual cycle disturbance, which is characterized by the absence of menses for at least 3 months.

Figure 3

Figure 3

Strong predictors of bone mineral density and bone structure in exercising women according to recent investigations. Notes: (A) Parameters of bone mineral density and bone structure that are predicted by age of menarche. (B) Parameters of bone mineral density and bone structure that are predicted by lean mass. Data from Ackerman et al and Mallinson et al. Abbreviations: aBMD, areal bone mineral density; vBMD, volumetric bone mineral density; CSA, cross-sectional area; CSMI, cross-sectional moment of inertia.

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