Document Type




Format of Original

7 p.

Publication Date



Lippincott Williams & Wilkins, Inc.

Source Publication

Clinical Journal of Sport Medicine

Source ISSN


Original Item ID

doi: 10.1097/JSM.0b013e3182042a9a


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

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 (

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.


Accepted version. Clinical Journal of Sport Medicine, Vol. 21, No. 2 (March 2011). DOI: 10.1097/JSM.0b013e3182042a9a. © 2011 Lippincott Williams & Wilkins, Inc. Used with permission.