New criteria for female athlete triad syndrome?

Abstract

We believe that the widespread association of the term osteoporosis with athletic activity through the term female athlete triad may not accurately reflect the currently available evidence. We note recent data emphasising the importance of disordered eating, not exercise per se, in causing suboptimal bone mass. Dr Carol Otis, one of America's greatest contributors to women's health, emphasises that "the triad is not caused by participation in sport". Thus, the word athlete appears to be a victim caught in the pathway from low energy availability to impaired bone health. This unfortunate association adds a hurdle for those committed to promoting recreational physical activity in the primary prevention of chronic disease. Our respectful suggestion should not, in any way, be considered a criticism of the ACSM or the authorities that have devoted their enormous scientific and educational endeavours to this important aspect of women's health. We support their commitment to preventing the complications associated with disordered eating, which, as in the case of US gymnast Christy Heinrick, include death. As the references in this leader attest, we commend and applaud the work of Anne Loucks and others who are authors of the ACSM position stand. We ourselves are proud to serve the ACSM in various capacities, and, together with our colleagues in the ACSM and around the world, aim to raise awareness of the threat of inadequate energy availability to bone health.