Well-visit screening, educated diagnosis and combined intervention by pediatricians are suggested to effectively treat the female athlete triad in adolescents, according to an AAP clinical report.
“Education of pediatricians, who are most likely to encounter adolescents with triad-related disorders, is especially important,” Amanda K. Weiss Kelly, MD, FAAP, chief of the department of pediatric sports medicine at Rainbow Babies and Children’s Hospital, and colleagues wrote. “Unfortunately, a 2009 study found that only 20% of pediatricians were able to correctly identify all three components of the triad, compared with 50% of family medicine physicians and 41% of orthopedic surgeons.”
The triad occurs when energy intake does not equal exercise-related energy expenditure, which can cause adverse effects in reproductive, bone and cardiovascular health in young women. Its components — menstrual dysfunction, decreased bone mineral density (BMD) and low energy availability (EA) — can present separately or simultaneously. Athletes at greatest risk perform in sports that center on endurance, aesthetics or weight-loss components where maintaining leanness are emphasized, the researchers wrote.
Kelly, members of the Council of Sports Medicine and Fitness executive committee and others pooled data on current clinical knowledge on the epidemiology, diagnosis and treatment of the triad. They recommended pediatricians follow a 13-step clinical guideline during patient examination. The researchers encouraged pediatricians to screen for the triad at well-visits, and that an athlete presenting with one component also should be assessed for the other two.
Athletes with menstrual dysfunction, they said, should be evaluated for inadequate EA, and pediatricians are urged to educate athletes and their parents on the effects of disordered eating. Key indicators for low BMD include menstrual dysfunction or low EA (less than 45 kcal/kg per fat-free mass per day) for 6 months or a history of stress or insufficiency fractures. When evaluating BMD measurements in adolescents, z-score values of less than –1 require further assessment.
Athletes should be prompted to take an adequate daily amount of vitamin D (600 IU) and calcium (1,300 mg) to maintain optimal bone mass. Matters involving weight-gain or loss, the researchers said, should be evaluated by a “multidisciplinary team capable of addressing medical, nutritional, psychological and sports-participation–related issues” and not necessarily coaches.
“Educational opportunities regarding the recognition, prevention and treatment of issues related to the triad should be available for practicing pediatricians, pediatric residents and medical students,” Weiss Kelly and colleagues wrote. – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.