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Association between the female athlete triad and endothelial dysfunction in dancers. Clin J Sport Med 2011 Mar;21(2):119-25



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Pubmed Central ID




Scopus ID

2-s2.0-79952584200   65 Citations


OBJECTIVE: To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers.

DESIGN: Prospective study.

SETTING: Academic institution in the Midwest.

PARTICIPANTS: Twenty-two professional ballet dancers volunteered for this study.

INTERVENTIONS: The prevalence of the female athlete triad and its relationship to endothelial dysfunction.

MAIN OUTCOME MEASURES: Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction.

RESULTS: Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score < -1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation (<5%). Flow-mediated dilation values were significantly correlated with serum estrogen and whole-body and lumbar BMD. All the 3 components of the triad plus endothelial dysfunction were present in 14% of the subjects.

CONCLUSIONS: Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers.

Author List

Hoch AZ, Papanek P, Szabo A, Widlansky ME, Schimke JE, Gutterman DD


Anne Hoch DO Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
Paula Papanek PhD, MPT, LAT, FACSM Associate Professor & Director of Exercise Science in the Exercise Science & Physical Therapy department at Marquette University
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Michael E. Widlansky MD Associate Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Brachial Artery
Dilatation, Pathologic
Endothelium, Vascular
Female Athlete Triad Syndrome
Prospective Studies
Young Adult