Table 4

Female athlete triad cumulative risk assessment51

Magnitude of risk
Risk factorsLow risk=0 points eachModerate risk=1 point eachHigh 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.