Bone stress in females: what is the current state of play?

The ‘female athlete triad’ is not uncommon in the sporting population. Drs White and Sellwood present a practical approach to management.

Case presentation

A 20-year-old university student and recreational runner presents after recovering from her second tibial stress fracture in the last three years. She has been amenorrhoeic for this period of time but is otherwise well with no other significant medical history. Since her most recent stress fracture she has resumed running, and is now running about 70 km per week. She has no current musculoskeletal symptoms, and is presenting because a female relative has expressed concerns about her lack of menstruation and its possible association with her stress fractures.