The Female Athlete Triad Exists in Both Elite Athletes and Controls

PURPOSE: To examine the prevalence of the female athlete triad (the Triad) in Norwegian elite athletes and controls. METHODS: This study was conducted in three phases: (part I) screening by means of a detailed questionnaire, (part II) measurement of bone mineral density (BMD), and (part III) clinical interview. In part I, all female elite athletes representing the national teams at junior or senior level, aged 13-39 yr (N = 938) and an age group-matched randomly selected population-based control group (N = 900) were invited to participate. The questionnaire was completed by 88% of the athletes and 70% of the controls. Based on data from part I, a stratified random sample of athletes (N = 300) and controls (N = 300) was selected and invited to participate in parts II and III of the study. 186 athletes (62%) and 145 controls (48%) participated in all parts of the study. RESULTS: Eight athletes (4.3%) and five controls (3.4%) met all the criteria for the Triad (disordered eating/eating disorder, menstrual dysfunction, and low BMD). Six of the athletes who met all the Triad criteria competed in leanness sports, and two in nonleanness sports. When evaluating the presence of two of the components of the Triad, prevalence ranged from 5.4 to 26.9% in the athletes and from 12.4 to 15.2% in the controls. CONCLUSION: Our results support the assumption that a significant proportion of female athletes suffer from the components of the Triad. In addition, we found that the Triad is also present in normal active females. Therefore, prevention of one or more of the Triad components should be geared towards all physically active girls and young women.