Female Athlete Triad: The 2014 Consensus Statement

Did you know that the most recent issue of CJSM contains the recent, important consensus statement on Female Athlete Triad (F.A.T.):  2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad?

Did you also know that we are always keen on having guest bloggers on this site?  Our guest blog post guidelines will help you get some idea of what we are looking for.  I am especially keen to see readers of CJSM studies write critical appraisals of commentary on those journal offerings; but we will also consider potential posts that look at anything new and exciting in the world of sport and exercise medicine (evidence-based preferred).

stacy fischer

Dr. Fischer: when not caring for patients
or researching Female Athlete Triad.
Eating up the roads in Vail pass.

This month, figuring you all might grow weary of my writing ‘voice,’ I sought out a colleague of mine with experience in the area of F.A.T. to write a post about the consensus statement.  Dr. Anastasia Fischer is a pediatric sports medicine specialist at Nationwide Children’s Hospital, and is leading that group’s investigations of F.A.T. in adolescent and younger female athletes.  In the brief amount of time she has between seeing patients, doing academic medicine, taking care of three children, and biking, she sat down to share some of her thoughts below.

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So what’s so cool about the new 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad (link to article)?  EVERYTHING.  Seriously, everything.  For any professional who takes care of female athletes, this is a must read and will become part of your reference library.  This new consensus statement offers several features – first, it gives a comprehensive overview of the Triad, encompassing where the science started and how it evolved, where it is, and where research is needed or headed.  It gives a comprehensive review of treatment strategies that have been proposed or studied and evaluates their efficacy for athletes, in a straightforward, bulleted manner that has never before been published.  Finally, the icing on the cake is an evidence-based risk stratification point system that takes into account the magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play.  Truly, this document can be used as a guide to managing the female athlete from youth to maturity, across any spectrum of athletic performance, and give physicians a framework for screening and managing athletes across their careers.  It can help providers (physicians, athletic trainers, dieticians, etc.) optimize the performance and ultimately, the health and wellbeing of their athletes for years to come.

A few standout points of the statement:

  • A list of screening questions and a review of the most important risk factors
  • A guide for when to order a DEXA scan on an athlete and how often to repeat it
  • A guide to treatment that emphasizes the importance of nutrition attitudes and behaviors
  • A full review of pharmacologic treatments available and when to use (or more importantly, when not to use) them
  • A cumulative risk assessment tool that provides an objective method of determining an athlete’s risk for the Triad and determining an athlete’s clearance for sports participation

How do you treat a girl with elements of the Triad?  You feed her.  And you’ll likely need the help of a sports dietician and perhaps others.  Do you let a girl participate if she suffered a femoral neck stress fracture, has a bone mineral density (BMD) with a Z score more than 2.0 standard deviations below the mean, and didn’t get her periods until after she turned 16?  No.  Do you start a girl on OCPs if she has menstrual dysfunction and has suffered a tibial stress fracture?  NO, not unless she has failed non-pharmacologic therapies for at least one year (with proof of declining BMD) and has poor bone mineral density.  Can you let a girl run XC if she’s had a stress fracture, missed 2 periods last year, but has good BMD?  Yes!  But get some education into her and her coaches and make sure she’s getting good nutrition and tracking her periods. 

And last of all, encourage your girls and women to be active.  To enjoy exercise for its freedom, its teamwork and friendship, its work ethic and character building, its beautiful experience and its health.

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Thanks so much Stacy for taking the time to share those thoughts. 

And to our readers:  have you had the chance to read the Consensus Statement?  What are your thoughts?  Do tell!!!

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About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Emerging Media Editor for the Clinical Journal of Sport Medicine.

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