Does oligomenorrhoea/amenorrhoea and underweight imply athlete triad syndrome in young female dancers?

Abstract

The aim of this study was to compare the bone mineral density (BMD) of young dancers suspected of suffering from the female athlete triad syndrome and eumenorrhoeic/normal weight dancers with eumenorrhoeic non-exercising controls. Full-time dance students from a collegiate academy of performing arts were recruited. The female athlete triad syndrome was suspected when oligo/amenorrhoea was present together with underweight (body mass index below 18.5 kg · m−2). The non-exercising group consisted of eumenorrhoeic age-matched patients presenting to an adolescent gynaecology clinic. All participants had a full hormonal profile, pelvic ultrasound, bio-impedance estimation of body fat, together with dual energy X-ray absorptiometry (DXA) and quantitative peripheral computed tomography scans (pQCT) to determine bone mineral density. A total of 47 dancers aged 17–20 years were recruited, of whom 14 (29.7%) fell within the criteria for suspected female athlete triad syndrome. Comparing the dancers with suspected female athlete triad with 36 non-exercising controls showed no significant differences in BMD at most sites between the two groups. Comparing the normal dancers (n=33) with the same control group showed the dancers had significantly higher BMD at the hip sites (P<0.005), as well as higher core tibial volumetric BMD (P=0.04) than the controls. Young dancers with oligo/amenorrhoea and apparent under-nutrition that fitted the clinical diagnosis of female athlete triad syndrome did not have lower BMD than non-exercising eumenorrhoeic controls, while eumenorrhoeic dancers actually had higher BMD. In addition, no significant differences were seen between eumenorrhoeic dancers and those with suspected female athlete triad. The risk of osteoporosis was apparently offset by the benefits of regular intensive weight-bearing exercises in those participants with suspected female athlete triad.