RUNNING ON EMPTY: FEMALE ATHLETE TETRAD Physicians at Houston Methodist Orthopedics & Sports Medicine understand that female athletes are uniquely prone to develop what is known as the female athlete tetrad, a group of disorders characterized primarily by poor calorie balance, amenorrhea and stress fractures. The female athlete tetrad is instigated by the athlete consistently burning more calories than she ingests. The body will compensate for insufficient caloric intake by conserving and scrimping on other areas of function, such as menstruation or bone regrowth, which can lead to osteopenia, osteoporosis and stress fractures. “Physicians have long known about the connection between calorie imbalance, missed periods and stress fractures, but new research is indicating impacts on the vascular system, which is how the female athlete triad became the tetrad,” said Vijay Jotwani, MD, a Houston Methodist primary care sports medicine physician and team physician for Rice University Athletics. “Studies have shown that flow-mediated dilatation (FMD), which is considered by some to be an endothelium-dependent function, can be a serious consequence of caloric imbalance.” The FMD response may be an early risk marker of cardiovascular disease. “The cardiovascular association is a new finding,” Jotwani said. “One theory suggests the tetrad creates an inhibiting mechanism in the calcium channels that allow the blood vessel to dilate properly.” According to Jotwani, it is critical to understand that this tetrad of dysfunction is not necessarily temporary. “It potentially can have long-lasting effects on bone and cardiovascular health,” he said.
“ New research is indicating impacts on the vascular system, which is how the female athlete triad became the tetrad.” VIJAY JOTWANI, MD