Stress fractures and the female triad

You may be wondering what the female triad is and why stress fractures can be more common in women? The female athlete triad is an important area to discuss with female athletes and also something that male athletes and coaches should be aware of to help support women in sport.

The female athlete triad is defined in regards to energy availability, menstrual function and bone strength. This description is quite broad to encompass several different disorders that can lead to the female athlete triad being diagnosed. Energy availability refers to disordered eating this can be dieting at one end of the spectrum and anorexia nervous or Bulmeia at the other. This may come about where sports require specific weight requirements or appearance such as gymnastics, judo, dance and many others. As a result the diet impacts on the body in so many ways and can affect bone density.

Diet also affects menstrual function and hormone levels. This can be in the form of oligomenorrhea (irregular menstrual cycle) and amenorrhea (the absence of cycles). A female needs to be over a certain weight to have a menstrual cycle and to be able to sustain being pregnant. If the body doesn’t have this then menstrual cycles can become disrupted or cease.

As a result of not eating properly bone density can be affected. Normally the body recycles bone, which is called remodelling. Bone is reabsorbed and then new bone laid down. If an athlete is not getting the right nutrients or energy levels then the bone is reabsorbed and not laid down causing the bone density to decrease. This can make the prevalence of stress fracture more common in women and osteoporosis in older life if it is not caught and treated at a young age.

In sport there is pressure on young women to conform to certain ideals and body shapes, causing distorted body images and ideals. As a result the female athlete triad does come about. Young males can also experience distorted body images but it tends to be towards gaining muscle mass and the use of steroids which also can affect bone density and other health issues.

Sport as a whole needs to consider what psychological impact it can have on young people and that as adults we need to make sure that young people are accepted as they are and not made to conform to ideals that would harm their health. Openly talking about eating healthy balanced meals is key and not discussing diets in a restrictive manner. By educating young athletes and parents on what food is good for them and help performance will allow a much more positive mindset. I don’t think this is addressed enough in sport and is one reason why we see physical and psychological signs of restrictive eating in young adults.

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