The third side effect, low bone density, may be the most dangerous part of the triad due to its irreversibility and its effect on the long-term health of these women. It is believed that the lack of estrogen due to secondary amenorrhea decreases bone density. An early sign of bone loss is stress fracture.

This diagnosis can be elusive because it often doesn’t show up in a x-ray. Since bone development is believed to occur only up to the age of thirty, adolescence and young adulthood is a prime time for the beginning of osteoporosis. Studies show that amenorrheic athletes have a lower bone mineral density that those with regular menstrual cycles, increasing their risk of osteoporosis. These women may be at greater risk for hip or vertebral spine compression fractures, which can be very painful and debilitating.

Understanding the female athlete triad, the importance of proper nutrition and a positive body image is imperative for coaches, trainers, parents and athletes. The following suggestions for coaches and trainers can also help:

1. Avoid weighing athletes and obtaining body composition data.

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2. Observe meals to check for disordered eating patterns.

3. Encourage a snack period midway through practice to replenish energy.