Within the last decade, physicians and researchers have discovered that three disorders found in the female athletic population (disordered eating, amenorrhea, and osteoporosis) are frequently interrelated as components of the female athlete triad. Disordered eating can be mild or subtle at first, but can progress to the more serious eating disorders of anorexia and bulimia nervosa. Even in its earlier stages, it can lead to hypothalamic amenorrhea, secondary to an energy deficit. The resultant hypoestrogenism causes inadequate absorption of dietary calcium and poor incorporation into bone, leading to low bone mineral density and, eventually, premature osteoporosis. Treatment of an athlete with any of the triad disorders should be multi-disciplinary, beginning with non-pharmacologic intervention and lifestyle counseling. However, prevention is by far the best method of treatment. This can be accomplished through education and through annual preparticipation physical examinations (PPEs), which offer an excellent opportunity to screen for the triad disorders.
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