TABLE 2
Diagnostic tests for the female athlete triad
| Low energy availability |
| Overt signs: body mass index < 17.5 kg/m2 or body weight < 85% of expected |
Calculation (with aid of daily food logs and accelerometer):
|
| Resting metabolic rate |
| Triiodothyronine (T3) level |
| Low bone mineral density |
| Dual-energy x-ray absorptiometry (DEXA) if any of the following: Oligomenorrhea or amenorrhea ≥ 6 months Disordered eating or an eating disorder ≥ 6 months Stress fracture or other fracture from minimal trauma |
| Interpretation: |
| Low bone mineral density |
| Ages 5–19: Z score ≤ –2.0 |
| Age ≥ 20: Z score between –1.0 and –2.0 with a history of nutritional deficiency, hypoestrogenism, stress fracture, or other secondary risk factor fracture |
| Osteoporosis |
| Ages 5–19: Z score ≤ –2.0 plus clinically significant fracture |
| Age ≥ 20: Z score ≤ –2.0 plus secondary cause of osteoporosis |
| Menstrual dysfunction |
| Rule out pregnancy and outflow tract obstruction |
| Oligomenorrhea: > 35 days between menses |
| Amenorrhea: Absence of menses |
| Laboratory tests to consider: Follicle-stimulating hormone Prolactin Progesterone challenge Thyroid-stimulating hormone, thyroxine (T4) |