Days before the 2006 Winter Olympics began, the International Olympic Committee Medical Commission issued treatment guidelines on "female athlete triad," a syndrome involving three interrelated conditions-disordered eating, menstrual irregularity, and low bone mass-that was first identified in the early 1990s and is most often seen in elite athletes. Now for the first time researchers have evaluated high school competitors to determine whether the syndrome-or any of its components-is present in a younger population not competing at the elite level. They discovered that about 20% of the study participants met the criteria for any one of the syndrome's conditions.

Researchers evaluated 170 girls from six California high schools who competed in one of eight interscholastic sports: track and field, cross-country running, soccer, softball, swimming, volleyball, tennis, or lacrosse. Bone mass was assessed with dual-energy X-ray absorptiometry. Participants completed questionnaires about their menstrual status and their attitudes about and behaviors surrounding food.

FIGURE. Female high school athletes, like these soccer players in Beckley, West Virginia, are susceptible to "female athlete triad," according to a recent study.

Roughly one-fifth of the study participants were found to have at least one of female athlete triad's component conditions. Specifically, 31 (18.2%) had disordered eating, 40 (23.5%) had menstrual irregularity (primary or secondary amenorrhea or oligomenorrhea), and 37 (21.8%) had low bone mass. Ten athletes (5.9%) were identified as having any two of these conditions. Prevalence of the full syndrome was low, with only two athletes (1.2%) having all three conditions.

Because disordered eating, often the first condition to appear, increases the risk of menstrual irregularity, and poor nutrition and low estrogen levels are risk factors in osteoporosis, the researchers concluded that "a substantial number of these young athletes may be at increased risk for the full triad over time." They also noted that adolescence is a critical time for bone formation and expressed their concern that suboptimal bone growth occurring during this period "may not be completely reversible." Screening female high school athletes for disordered eating and menstrual irregularities is recommended as a first step in preventing the development of female athlete triad.