Session Information
Date: Thursday, November 14, 2019
Session Title: Musculoskeletal and Sports Medicine Research Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 8
Disclosures: Emily K. Miller, MD: Nothing to disclose
Objective: This study explores the prevalence of Female Athlete Triad (Triad) risk in ultramarathon runners using the female athlete cumulative risk assessment tool and a piloted male equivalent.
Design: Cohort study
Setting: The Western States 100-mile race
Participants: 61 (20 female, 41 male) runners
Interventions: Participants completed a questionnaire, which included history of disordered eating, bone stress injury (BSI), and menstrual irregularity. They completed dual-energy x-ray absorptiometry (DXA) to measure bone mineral density (BMD) of the lumbar spine, femoral neck, and total hip as Z-scores.
Main Outcome Measures: We assigned risk points for low energy availability (LEA), low body mass index (BMI), delayed age of menarche, oligomenorrhea, and low BMD. We calculated risk ratios for prior BSI using a Poisson regression model with robust standard errors.
Results: The mean age was 45.5. 52.8% of males and 57.9% of females scored moderate or high risk for LEA. 9% of runners had diagnosable eating disorders. 22.2% females had BMI<18.5 kg/m2. 42% females reported delayed menarche and 47% reported oligomenorrhea. 21% females and 29.3% males had “low bone mass” (Z-score≤-1.0). 3% of males had a Z-score≤-2.0. Eight females (40%) and 11 males (26.8%) reported ≥1 prior BSI. 63% and 11% females and 36% and 8% males received moderate and high cumulative risk scores. In females, BMI risk points (RR=1.72, P=.024) and higher weekly mileage (per mile per week) (RR=1.03, P=.018) were significantly associated with prior BSI. BMD risk points were associated with higher risk, but the effect was not statistically significant (RR=2.25, P=.082).
Conclusions: The majority of runners had a moderate or high cumulative risk scores indicating the severity of female or male athlete triad, which is known to have long term health repercussions including negative bone health effects. Risk factors for prior BSI in ultramarathon runners were low BMD in males and low BMI and higher weekly mileage in females.
Level of Evidence: Level III
To cite this abstract in AMA style:
Miller EK, Kraus E, Hoeg TB, Bodor M, Fredericson M, Sainani K. Identifying Risk Factors for Female Athlete Triad and a Male Equivalent in Ultramarathon Runners [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/identifying-risk-factors-for-female-athlete-triad-and-a-male-equivalent-in-ultramarathon-runners/. Accessed June 26, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/identifying-risk-factors-for-female-athlete-triad-and-a-male-equivalent-in-ultramarathon-runners/