Energy deficiency, menstrual disorders and low bone mineral density in female athletes: a systematic review

Nikitas S Skarakis, George Mastorakos, Neoklis Georgopoulos & Dimitrios G Goulis

* Poster Presentation in 7th ESE Young Endocrinologists and Scientists (EYES) Meeting

Background and aim: Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad (FAT) syndrome. The primary aim of this review was to systematically investigate the impact of sports on the energy status of professional female athletes compared to sedentary, recreationally active controls, with regard to their menstrual status and bone mineral density (BMD). A secondary aim was the estimation of the combined prevalence of the components of FAT in athletes as compared with non-athletes.
Materials and methods: A systematic review was conducted from 2007 to February 2018. Inclusion and exclusion criteria of studies were established in advance of the literature search, according to the clinical inquiry and the study design.
Results: Four studies were included in this systematic review. The FAT syndrome was more prevalent in professional athletes compared with non-athletes. The same results occurred for both LEA and menstrual disorders. However, BMD and Z-scores showed high heterogeneity among the studies.
Conclusions: Both professional athletes and sedentary women are prone to LEA and subsequent menstrual disorders and low BMD or osteoporosis. Future studies are needed to examine the energy availability in elite female athletes, as well as in non-athletes.