The Female Athlete Triad was initially defined as the constellation of three interrelated clinical entities typically found in active young women: amenorrhea, osteoporosis, and disordered eating. The definition has now been broadened to recognize that each component of the triad exists on a spectrum. Thus, menstrual irregularities (without amenorrhea), low bone mineral density (without full-blown osteoporosis) and deficits of energy availability due to a deficient nutrition (without a formal diagnosis of an eating disorder) may be sufficient to prompt this diagnosis. Notably, the Triad can appear when there is not enough caloric intake to balance caloric expenditure, independent of whether that imbalance is intentional or unintentional. For example, many runners do not realize how much to increase intake as they ramp up their training.
The Female Athlete Triad can have significant medical ramifications outside of musculoskeletal medicine – notably gynecological and psychological. Patients with the Female Athlete Triad usually come to attention of musculoskeletal practitioners because of stress fractures: skeletal damage caused by repetitive loading forces that exceed the bone’s mechanical resiliency.
The Female Athlete Triad is also relevant to musculoskeletal medicine in that even without a stress fracture, patients with this condition may fail to attain an optimal peak bone mass in adolescence –the time of maximal bone formation– and thus place themselves at higher risk for osteoporosis later in life.
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