Thein-Nissenbaum Jill, Hammer Erin
Department of Family Medicine, University of Wisconsin-Madison, Madison, WI, USA.
Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
Open Access J Sports Med. 2017 Apr 4;8:85-95. doi: 10.2147/OAJSM.S100026. eCollection 2017.
Since the passage of Title IX in 1972, female sports participation has dramatically increased. The benefits of physical activity, including decreased risk for heart disease and diabetes as well as improved body image and self-esteem, far outweigh the risks. However, a select population of adolescent and young adult females may experience symptoms related to the female athlete triad (Triad), which refers to the interrelatedness of energy availability, menstrual function, and bone mineral density (BMD). These conditions often manifest clinically as disordered eating behaviors, menstrual irregularity, and stress fractures; an individual may suffer from 1 or all of the Triad components simultaneously. Because of the complex nature of the Triad, treatment is challenging and requires a multidisciplinary approach. Team members often include a physician, psychologist or psychiatrist, nutritionist or dietitian, physical therapist, athletic trainer, coach, family members, and most importantly, the patient. A thorough physical examination by a primary care physician is essential to identify all organs/systems that may be impacted by Triad-related conditions. Laboratory tests, assessment of bone density, nutritional assessment, and behavior health evaluation guide the management of the female athlete with Triad-related conditions. Treatment of the Triad includes adequate caloric consumption to restore a positive energy balance; this is often the first step in successful management of the Triad. In addition, determining the cause of menstrual dysfunction (MD) and resumption of menses is very important. Nonpharmacologic interventions are the first choice; pharmacologic treatment for MD is reserved only for those patients with symptoms of estrogen deficiency or infertility. Lastly, adequate intake of calcium and vitamin D is critical for lifelong bone health. For this review, a comprehensive search of relevant databases from the earliest dates to July 2016 was performed. Keywords, including female athlete triad, adolescent female athlete, disordered eating, eating disorder, low energy availability, relative energy deficit, anorexia, bulimia, menstrual dysfunction, amenorrhea, oligoamenorrhea, bone mineral density, osteopenia, osteoporosis, stress fracture, and stress reaction, were utilized to search for relevant articles. Articles that directly addressed assessment and management of any 1 or all of the Triad components were included in this comprehensive review. The purpose of this narrative review is to provide the reader with the latest terms used to define the components of the female athlete triad, to discuss examination and diagnosis of the Triad, and lastly, to provide the reader with the latest evidence to successfully implement a multidisciplinary treatment approach when providing care for the adolescent female athlete who may be suffering from Triad-related components.
自1972年《第九章》通过以来，女性参与体育运动的人数大幅增加。体育活动的益处，包括降低患心脏病和糖尿病的风险以及改善身体形象和自尊心，远远超过风险。然而，一部分青春期和年轻成年女性可能会出现与女性运动员三联征（三联征）相关的症状，三联征指的是能量供应、月经功能和骨矿物质密度（BMD）之间的相互关系。这些情况在临床上通常表现为饮食紊乱行为、月经不规律和应力性骨折；个体可能同时患有三联征的一个或所有组成部分。由于三联征的性质复杂，治疗具有挑战性，需要多学科方法。团队成员通常包括医生、心理学家或精神科医生、营养师或饮食学家、物理治疗师、运动训练师、教练、家庭成员，最重要的是患者。初级保健医生进行全面的体格检查对于识别所有可能受到三联征相关疾病影响的器官/系统至关重要。实验室检查、骨密度评估、营养评估和行为健康评估指导对患有三联征相关疾病的女性运动员的管理。三联征的治疗包括摄入足够的热量以恢复正能量平衡；这通常是成功管理三联征的第一步。此外，确定月经功能障碍（MD）的原因并恢复月经非常重要。非药物干预是首选；MD的药物治疗仅适用于那些有雌激素缺乏或不孕症状的患者。最后，充足摄入钙和维生素D对终身骨骼健康至关重要。在本次综述中，对从最早日期到2016年7月的相关数据库进行了全面搜索。使用了包括女性运动员三联征、青春期女性运动员、饮食紊乱、饮食失调、能量供应不足、相对能量缺乏、厌食症、贪食症、月经功能障碍、闭经、月经过少、骨矿物质密度、骨质减少、骨质疏松症、应力性骨折和应力反应等关键词来搜索相关文章。直接涉及三联征任何一个或所有组成部分的评估和管理的文章都被纳入了本次全面综述。本叙述性综述的目的是为读者提供用于定义女性运动员三联征组成部分的最新术语，讨论三联征的检查和诊断，最后，为读者提供最新证据，以便在为可能患有三联征相关组成部分的青春期女性运动员提供护理时成功实施多学科治疗方法。
