Female athlete triad: past, present, and future directions
Since the passage of Title IX in 1972, female participation in athletics has increased significantly. More girls and young women have been able to experience the psychosocial and physical health-related benefits of organized sports. Hand-in-hand with increased participation, however, has been a dramatic increase in a dangerous yet widely underdiagnosed sports-related condition—the female athlete triad. The triad was originally defined as the presence of disordered eating (DE), amenorrhea, and osteoporosis. Further research revealed these diagnostic criteria to be too narrow in scope however, and today’s definition has evolved into that of a dynamic interrelationship between decreased energy availability (EA), menstrual dysfunction, and low bone mineral density (BMD). If left untreated, long-term consequences include irreversible decreases in BMD and a predisposition to potentially debilitating musculoskeletal injuries. First line therapy is generally non-pharmacological with treatments aimed at altering eating and exercise behavior. In behavior modification refractory cases, certain pharmacological treatments may be utilized but this practice remains controversial. While no pharmacological approach to treatment is yet recommended, a recent clinical trial provides compelling evidence and its implications warrant further investigation.