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The Female Triad & Stress Fractures

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faantrunnerCompetitive female athletes at risk for stress fractures

As women, eating fresh and exercising regularly is an excellent healthy habit. But when can exercise and dieting become too much?

For female athletes, eating too little and exercising too much can become a heavy problem.  A long term low weight, minimal calorie with high activity lifestyle can lead to serious damage to the body and even death. The body is a machine and if it isn’t fueled properly, it can’t carry out its job properly.

In my experience the classic female triad patient is a competitive female marathon runner with a stress fracture in her foot or leg bones. The bones become weak because of repetitive activity, abnormal forces on the bones and leaching of the bone’s nutrients due to malnutrition of the body.

The “Triad” is one of extremes including:

  • Disordered eating –too little calories being absorbed in the body
  • Menstrual dysfunction-irregular or no periods, hormone imbalances during menopause
  • Bone density weakness- “early osteoporosis”-in women a lack of periods can interrupt the body’s bone building; this weakens the skeleton so the bones are more liable to break

Being highly competitive in sports where the body figure is important (cheerleading, gymnastics, figure skating) and where performance is improved (rowing, distance running, triathletes) can put an athlete at significant risk. This triad can wreak havoc on the body including dehydration, muscle fatigue and weakness. The organs can also be affected in causing an erratic heartbeat, kidney damage, and other serious conditions including breaks in any bone of the body.

Other underlying factors can contribute to this triad including a history of thyroid disease, osteoporosis, and use of hormone replacement therapy, vitamin deficiencies and stress in our environments.

In my office if a patient comes in with foot pain with an x-ray suspicious for a stress fracture, I start by treating them with immobilization in a walking boot or rigid shoe.  If she also has symptoms of this triad, I refer her to a primary physician for a bone density test and blood-work/evaluation.

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