Anorexia nervosa, athletics, and amenorrhea: the female athlete triad

Purpose of reviewThe female athlete triad – anorexia, athletics, and amenorrhea – is a clinical problem found among young women who are engaged in intense physical activity. This review describes the psychological factors involved in the triad and the endocrine and skeletal consequences of the disorder. This subject is particularly timely and important as eating disorders are increasing in frequency among young women athletes. Recent findingsConcern about body weight and its effect on athletic performance can lead to chronic undernutrition. Complications of low body weight include hormonal disturbances, bone loss and fracture. The potential endocrine abnormalities seen in this group of women include anovulatory cycles, chronic elevation in glucocorticoids and lower serum leptin concentrations. Lower insulin-like growth factor-1 and resistance to growth hormone have also been described. Treatment of consequent bone loss with hormones, and most recently, with bisphosphonates, provides conflicting, but also encouraging data. SummaryThe pressures to improve peak athletic performance often underlie the abnormal behavior and eating disorders characteristic of the female athlete triad, with subsequent life-long consequences. Physicians should be made aware of such pressures, and their psychological and physical consequences. Prevention is the best medicine; but more research in ways to effectively and safely treat bone loss in young women is needed.