Correction of misinterpretations and misrepresentations of the female athlete triad

The recent commentary by DiPietro and Stachenfeld1 is of great concern because it lacks scientific accuracy in the interpretation of data regarding the female athlete triad and promotes an unfounded fear that triad-related data will discourage girls and women from participating in sports. DiPietro and Stachenfeld state that they wish to “share comments and opinions which challenge many of the causal assumptions proposed in the current literature on this topic”. They first attack the triad from a sociological perspective, warning readers that decades of progress of women in sports is at risk owing to “the creation of yet another form of female specific pathology”. They are concerned that “Triad related data may be misinterpreted and used as justification for setting health and social policies that may ultimately counter the US Public Health Service efforts to promote the benefits of athletic participation and an active lifestyle among children and adolescents”. Using this logic, researchers and health professionals should abandon their efforts to understand and prevent anterior cruciate ligament injuries in women, which occur at a rate of 6–8 times that in men,2 for fear that attention to this “female specific pathology” would discourage participation in sports. Interestingly, although over one hundred studies document the existence of menstrual disturbances, disordered eating and low bone mass in exercising women,3,4 DiPietro and Stachenfeld do not offer a single data point in support of their “opinion” that education about the triad might discourage the participation of girls and women in physical activity. In fact, actual data suggest the opposite. The National Federation of State High Schools Associations (NFHS) High School Athletics Participation Survey 5 reports that the number of girls participating in high school sports set an all-time record in 2004–5, soaring to 2 908 390 participants and representing a 13% …