The Study
Higher Triad Risk Scores Are Associated With Increased Risk for Trabecular-Rich Bone Stress Injuries in Female Runners
This study found that girls who run a lot and have certain health risks (like not eating enough or missing periods) tend to get more bone injuries. But it doesn't prove that those risks cause the injuries — maybe other things like how hard they train or how much sleep they get are also involved.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
Female runners who don't eat enough, miss periods, or have low bone strength are more likely to get bone injuries — especially in spongy parts of bones.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 552 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — even tiny drops in energy or menstrual health significantly raise injury risk, meaning prevention should start early and focus on small changes.
- 2Runners with high risk scores had 4.4x more injuries in spongy bones and 2.9x more in hard bones.
- 3Every small increase in risk score raised spongy bone injury risk by 26%.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Clinical Journal of Sport Medicine
Year
2023
Authors
Megan Roche, A. Nattiv, Kristin L. Sainani, M. Barrack, Emily A Kraus, A. Tenforde, A. Kussman, E. Olson, Brian W. Kim, Katherine E Fahy, Emily K. Miller, E. Diamond, Sonya Meraz, Sonal Singh, A. Nattiv, M. Fredericson
Related Content
Claims (6)
Female distance runners who consume less total energy and fat have a higher rate of running-related injuries and bone stress injuries.
Female collegiate runners with higher scores on the Female Athlete Triad risk assessment have a 26% higher rate of certain bone injuries for each additional point on the scale.
Female runners at high risk for the Female Athlete Triad experience 2.9 times more bone injuries in the dense outer layer of bone compared to those at low risk, showing that this type of bone damage is directly linked to physiological stress.
Female runners with low energy availability, irregular menstrual cycles, and low bone density have a 4.4 times higher rate of certain bone stress injuries than those without these conditions.
Bone stress injuries occur 4.4 times more frequently in trabecular-rich bones than in cortical-rich bones among individuals at risk for Female Athlete Triad, indicating that trabecular bone is more affected by energy deficiency and hormonal imbalance.
For every one-point increase in the Female Athlete Triad risk score, the likelihood of developing a specific type of bone stress injury increases by 26%.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.