Public Release: 

Make no bones about it: The female athlete triad can lead to problems with bone health

American Academy of Orthopaedic Surgeons

ROSEMONT, Ill.--Participation in sports by women and girls has increased from 310,000 individuals in 1971 to 3.37 million in 2010. At the same time, sports-related injuries among female athletes have skyrocketed. According to a new study in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), women with symptoms known as the "female athlete triad" are at greater risk of bone stress injuries and fractures.

"The female athlete triad is a spectrum of symptoms that include low energy availability, menstrual cycle abnormalities, and low bone mineral density. Low energy availability can mean taking in inadequate calories or expending more energy than the body is designed to do. It can result from poor nutrition or eating habits or any type of eating disorder. Any combination of these conditions can lead to premature bone loss in females," explains lead study author and orthopaedic surgeon Elizabeth Matzkin, MD.

Both athletes and nonathletes participating in any sports and exercise can develop symptoms of the female athlete triad. But the likelihood of female athletes sustaining a bone stress injury significantly increases as the number of symptoms they have increases. The increase is substantial--

  • 15 percent to 21 percent with one symptom;
  • 21 percent to 30 percent with two symptoms; and,
  • 29 percent to 50 percent with all three symptoms.

The study authors also found that female athletes diagnosed with poor nutrition or low energy availability are two to four times more likely to sustain a sports-related injury. Female athletes who self-reported menstrual cycle abnormalities had a nearly three times greater risk of a bone and joint injury.

"Proper nutrition and energy balance are key to staying healthy in athletes of all ages. But maximizing bone health when you are young is paramount to your bone health later in life," says Dr. Matzkin. "It is important for young females to maximize their bone density until about the age of 25--anything lost before then cannot be regained. After age 25 we can only hope to maintain what we have."

As participation in sports by women and girls continues to increase and become more competitive, it is important to prevent, diagnose, and manage the components of the female athlete triad. Although the female athlete triad poses a great health risk, the benefits of participation in sports significantly outweigh the risks.

"Any athlete who falls under the 'umbrella' of the triad should be questioned by their physicians and educated regarding all of the components and potential health risks of this condition. By preventing premature bone loss in young female athletes, we can potentially prevent future fragility fractures," says Dr. Matzkin.


July 2015 Full JAAOS Table of Contents

  • Presidential Address: The House of Orthopaedics
  • Clinical Differentiation of Upper Extremity Pain Etiologies
  • Advances in Surgical Management of Intra-Articular Calcaneus Fractures
  • Proximal Junctional Kyphosis Following Spinal Deformity Surgery in the Pediatric Patient
  • Closed Sagittal Band Injury of the Metacarpophalangeal Joint
  • Female Athlete Triad: Past, Present, and Future
  • Novel Strategies for the Diagnosis of Posttraumatic Infections in Orthopaedic Trauma Patients
  • Contemporary Medical and Surgical Management of X-Linked Hypophosphatemic Rickets
  • On the Horizon From the ORS: Mesenchymal Stem Cells as a Source of Repair Cytokines: Mesenchymal Stem Cells as the Conductor
  • Online Extra: Symposium: Extremity War Injuries IX: Reducing Disability Within the Military

For more AAOS news, visit the News Bureau
Follow AAOS on Twitter
Follow AAOS on Facebook

Orthopaedic surgeons restore mobility and reduce pain; they help people get back to work and to independent, productive lives. Visit to read successful orthopaedic stories.

More information about the AAOS

Disclosures. From the Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.

Dr. Matzkin or an immediate family member has received research or institutional support from Zimmer. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.