Female athlete triad cumulative risk assessment51
| Magnitude of risk | |||
|---|---|---|---|
| Risk factors | Low risk=0 points each | Moderate risk=1 point each | High risk=2 points each |
| Low EA with or without DE/ED | □ No dietary restriction | □ Some dietary restriction*; Current or history of DE | □ Meets DSM V criteria for ED† |
| Low BMI | □ BMI ≥ 18.5 kg/m2 or ≥ 90% EW‡ or weight stable | □ BMI 17.5 < 18.5 kg/m2 or < 90% EW or 5 to < 10% weight loss/month | □ BMI ≤17.5 kg/m2 or < 85% EW or ≥ 10% weight loss/month |
| Delayed menarche | □ Menarche <15 years | □ Menarche 15 to <16 years | □ Menarche ≥16 years |
| Oligomenorrhoea and/or amenorrhoea | □ >9 menses in 12 months† | □ 6–9 menses in 12 months† | □ <6 menses in 12 months† |
| Low BMD | □ Z-score ≥−1.0 | □ Z-score −1.0§ <—2.0 | □ Z-score ≤−2.0 |
| Stress reaction/fracture | □ None | □ 1 | □ ≥2; ≥1 high risk or of trabecular bone sites¶ |
| Cumulative risk (total each column, then add for total score) | _____points + | _____points + | _____ points=_____Total Score |
The cumulative risk assessment provides an objective method of determining an athlete's risk using risk stratification and evidence-based risk factors for the Female Athlete Triad. This assessment is then used in conjunction with the physician's clinical decision-making skills to determine an athlete's clearance for sport participation (table 10).
Reprinted with permission from BJSM.
*Some dietary restriction as evidenced by self-report or low/inadequate energy intake on diet logs.
†Current or history of disordered eating.
‡Absolute BMI cut-offs should not be used for adolescents.
§Weightbearing sport.
¶High-risk skeletal sites associated with low BMD and delay in return to play in athletes with one or more components of the triad include stress reaction/fracture of trabecular sites (femoral neck, sacrum, pelvis).
BMD, bone mineral density; BMI, body mass index; DE, disordered eating; EA, energy availability; ED, eating disorder; EW, expected weight.