Six out of 10 elite female athletes of reproductive age are at risk of the so-called female athlete triad - disordered eating, amenorrhoea and osteoporosis - according to a large population-based study from Norway.

Contrary to the researchers’ expectations, non-athlete controls were at even higher risk of this potentially life-threatening syndrome than elite athletes – 62.9% compared with 60.4%. The non-athletes also reported greater body dissatisfaction and were more likely to use pathogenic’ weight-control methods.

However, more athletes than controls reported menstrual dysfunction and stress fractures. And when the athletes were subdivided into leanness sports (endurance, aesthetic, weight-class and anti-gravitational) and non-leanness sports technical, ball game and power), athletes competing in leanness sports were at highest risk of the female athlete triad (70.1%), while those in non-leanness sports were at lowest risk (55.3%).

The study included data from a total of 669 elite athletes representing national teams at junior or senior level (age 13-39) and 607 nonathlete controls in the same age group. All the participants filled in a detailed questionnaire including questions on menstrual, dietary and weight history, eating patterns, body dissatisfaction and drive for thinness.

It was designed to look at risk factors for the female athlete triad rather than test for the syndrome itself, with participants classified as ‘at risk’ once they reached particular scores on the various scales of the questionnaire.

According to the researchers, this is the first study to publish data from the total population of elite athletes and age-representative controls from the general population of a country. And they believe their findings can be generalised to national-level athletes and non-athletes in many other cultures and countries.

‘The high number of women classified as at risk of the female athlete triad in this study may actually reflect the present situation in young females today,’ they argue. ‘Western society’s focus on the female body – on thinness and low weight – may well lead to dissatisfaction with one’s own body, further leading to dieting and unhealthy eating behaviour and subsequent loss of menstruation and bone mass.

‘Based on the high prevalence of exercising girls and women at risk of female athlete triad, it is necessary to continue the ongoing education of the athletes themselves, coaches, leaders and parents, as well as physically active girls and women in general, about the life-threatening health consequences of inadequate energy intake and excessive exercise habits.’

Med Sci Sports Exerc, vol 37, no 2, pp184-193, 2005