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.
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