Prevalence of the Female Athlete Triad Syndrome Among High School Athletes

OBJECTIVE: To estimate the prevalence of the female athlete triad (disordered eating, menstrual irregularity, and low bone mass) among high school athletes. DESIGN: Observational cross-sectional study. SETTING: High school. PARTICIPANTS: Female athletes (n= 170) representing 8 sports were recruited from 6 high schools in southern California. MAIN OUTCOME MEASURES: Disordered eating and menstrual status were determined by interviewer-assisted questionnaires. Bone mineral density was measured by dual-energy x-ray absorptiometry of the hip, spine (L1-L4), and total body. RESULTS: Among all athletes, 18.2%, 23.5%, and 21.8% met the criteria for disordered eating, menstrual irregularity, and low bone mass, respectively. Ten girls (5.9%) met criteria for 2 components of the triad, and 2 girls (1.2%) met criteria for all 3 components. Oligomenorrheic/amenorrheic athletes had higher mean +/- SD eating restraint (1.55 +/- 1.60 vs 1.04 +/- 1.27; P = .02) and Eating Disorder Examination Questionnaire global scores (1.68 +/- 1.20 vs 1.33 +/- 1.14; P = .03) than eumenorrheic athletes. After controlling for age, age at menarche, body mass index, race/ethnicity, and sport type, athletes with oligomenorrhea/amenorrhea had significantly lower mean +/- SD bone mineral densities for the trochanter (0.884 +/- 0.090 g . cm(-2)) than eumenorrheic athletes (0.933 +/- 0.130 g . cm(-2); P = .04). CONCLUSIONS: The prevalence of the full female athlete triad was low in our sample; however, a substantial percentage of the athletes may be at risk for long-term health consequences associated with disordered eating, menstrual irregularity, or low bone mass. Preparticipation screening to identify these components should be encouraged as a preventive approach to identify high-risk athletes.