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Osteoporosis
0%
2/1057
Anorexia
4/1057
Secondary amenorrhea
1%
11/1057
Answer 2 and 3
17%
182/1057
All of the above
80%
847/1057
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An evaluation of eating disorders, osteoporosis, and amenorrhea should be performed in a young female athlete who presents with a stress fracture. The "female athlete triad" consists of disordered eating, secondary amenorrhea, and osteoporosis (which often manifests as a stress fracture). Treatment includes a multidisciplinary approach including psychological counseling, dietary management, training modifications, calcium and vitamin D supplements, and possibly oral contraceptive pills. Bennell et al. followed track and field athletes over 12 months. They looked at the risk factors for stress fractures, which occurred in 21% of their population. In female athletes, significant risk factors included lower bone density, a history of menstrual disturbance, less lean mass in the lower limb, a discrepancy in leg length, and a lower fat diet. Barrow et al. looked at menstrual irregularity in female athletes. Stress fractures occurred in 49% of the very irregular runners, 39% of the irregular runners, and 29% of the regular runners. Forty-seven percent of the amenorrheal group admitted to an eating behavior disorder. Figure A is a coronal MRI image showing marrow edema in the inferior aspect of the femoral neck consistent with a stress fracture.
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