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NEDA TOOLKIT for Educators • Low bone mass may manifest as stress fractures or full fractures (e.g., in a long bone such as the tibia or fibula or as a compression fracture in the spine). Some stress fractures are secondary to overuse and sports technique (such as an uneven running gait), while others, such as lumbar and femoral stress fractures, are highly correlated with disordered eating. Fractures are often early signs of low bone density. Other low bone mass risks include a history of malabsorption (e.g., Crohn’s disease, ulcerative colitis, celiac disease), low calcium and/or vitamin D intake, excessive alcohol consumption, steroid use, and those with either or both of the other two aspects of the Triad. Low bone density can be detected by a dual x-ray absorptiometry (DXA) scan. These conditions are a medical concern, and taken together they create serious, potentially life- threatening health risks. While any female athlete can develop this triad, adolescent girls are most at risk because of the active biological changes and growth spurts, peer and social pressures, and rapidly changing life circumstances that accompany the teenage years. Please note that your professional rights and responsibilities may vary by state and school system; please consult your school administration as well as any relevant local and professional organizations for information on regional guidelines. Page  | 29