January 2017

Study finds association between triad risk classification, bone stress injuries

In the moment: Sports medicine

By Jordana Bieze Foster

Nearly one third of female collegiate athletes have an elevated risk for the female athlete triad, and women in moderate- and high-risk categories for the triad also have an elevated risk of lower extremity bone stress injury (BSI), according to research from Spaulding Rehabilitation Hospital in Cambridge, MA.

Investigators assessed triad risk in 323 female collegiate athletes according to published criteria, including menstrual regularity, energy availability, and bone mineral density. Of the 239 women with known menstrual status, 25.5% were classified as moderate risk and 3.8% as high risk.

Moderate-risk athletes were 2.6 times as likely as low-risk athletes to sustain a subsequent BSI, and high-risk athletes were 3.8 times as likely. The majority (64%) of BSIs occurred in cross-country runners; among those women, those in the moderate triad risk category were four times as likely as their low-risk counterparts to sustain a BSI, and those in the high-risk category were 5.7 times as likely. The findings were epublished at the end of December by the American Journal of Sports Medicine.


Tenforde AS, Carlson JL, Chang A, et al. Association of Female Athlete Triad risk assessment stratification to the development of bone stress injuries in collegiate athletes. Am J Sports Med 2016 Dec 30. [Epub ahead of print]

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