Make no bones about it!
WHY IS THIS SO IMPORTANT?
Simply stated, it is important to diagnose and treat the triad syndrome to maintain optimal bone health. About 90% of peak bone mass is acquired by age 18. Bone density continues to build until about the age of 25, after which it is only possible to maintain. If young athletes are losing bone density, it cannot be replaced. Athletes who have a relative energy deficiency and are not maximizing bone growth will potentially struggle with lower bone mineral density later in life. Early awareness of bone health is paramount to sustaining it as we age.
Osteoporosis, often called a silent disease, affects more than 75 million men and women in the United States, Europe, and Japan.7 According to the International Osteoporosis Foundation, more than 8.9 million fractures are secondary to osteoporosis worldwide each year. Astoundingly, this epidemic equates to an osteoporotic fracture every 3 seconds.8
As physicians, we need to do what we can to prevent this, and the easiest prevention is maintaining bone health and adequate nutrition early in life. We know that weight-bearing exercise is important for bone health, but it is counterintuitive to think that active patients who are running and playing sports may be negatively affecting bone health if they have a relative energy deficiency.
Many females (professional athletes, competitive athletes, or just women who want to stay active) exercise excessively and restrict calories to lose or maintain weight. This can be a formula for disaster resulting in a sidelining bone stress injury. A stress fracture occurs when bone experiences more stress or impact than it can handle from overtraining or increasing training too quickly, not providing enough time for the bone to strengthen. Stress fractures can also occur when bone mineral density declines, lowering the impact threshold. This is most often a direct result of a relative energy deficiency or poor nutrition. The incidence of stress fractures in female athletes is 2 to 3 times higher than that in male athletes, and female athletes with missed menstrual cycles have a 2 to 4 times higher risk of stress fractures than females with a normal monthly menstrual cycle.9
The triad syndrome is seen not only in women but in all athletes—including men and Paralympic athletes.10,11 According to Tenforde et al,10 male athletes, particularly those who participate in sports requiring leanness such as cycling and running, can exhibit nutritional deficits, reduced sex hormone levels, and impaired bone health.10
If we can educate patients on the importance of maintaining a healthy diet and supplying active bodies with the energy they need, then many of these injuries could be prevented.
Make no bones about it.
