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What is the Female Athlete Triad?

Female athletes often have higher calcium requirements compared to their male counterparts due to factors such as hormonal fluctuations, menstrual cycles, and the demands of physical training.

Calcium is essential for maintaining bone health, and female athletes may be more susceptible to bone density issues, especially during intense training periods.

The female athlete triad is a serious medical condition that can affect some female athletes, especially those in sports that emphasize low body weight or aesthetics.

The triad includes three interrelated components:

  • Low energy availability (often due to inadequate calorie intake for the level of exercise performed)

  • Menstrual dysfunction (such as irregular or absent periods)

  • Decreased bone mineral density (osteoporosis or osteopenia)

If untreated, the consequences of the Triad can be devastating, and include compromised reproductive health, increased rates of bone stress injuries, and other soft tissue musculoskeletal injuries, osteoporosis, and eating disorders.

The combination of disordered eating and irregular menstrual cycles eventually lead to a decrease in endogenous oestrogen and other hormones, resulting in low bone mineral density hence the term “Female Athlete Triad”.

Low energy availability and pathogenic weight control behaviors predispose the female athlete to menstrual dysfunction, subsequent decreased bone mineral density, increased risk of stress fractures, and a potential increase in the risk of premature osteoporosis and cardiovascular disease.

Disordered eating is often accompanied by psychological problems, including decreased self-esteem, anxiety, and depression.

These problems affect performance significantly. When the three disorders of the Female Athlete Triad occur together, the potential health consequences become more serious, and often life-threatening.

Addressing calcium intake is crucial in the prevention and management of the female athlete triad. Female athletes must prioritize a diet rich in calcium-containing foods and consider calcium supplements if necessary to support bone health and reduce the risk of developing the triad.

Moreover, healthcare professionals should be involved in the care of female athletes to monitor their nutritional status and address any potential disorders and deficiencies, which could have far-reaching effects on their athletic performance and overall well-being.

By recognizing the link between calcium deficiency and the female athlete triad, athletes and healthcare providers can work together to ensure optimal bone health, performance, and long-term health for female athletes.


  1. Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012 Jul;4(4):302-11. doi: 10.1177/1941738112439685. PMID: 23016101; PMCID: PMC3435916.



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