{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:49:12Z","timestamp":1784774952014,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although the female athlete triad (Triad) has been associated with increased risk of bone\u2010stress injuries (BSIs), limited research among collegiate athletes has addressed the associations between the Triad and non\u2010BSI injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To elucidate the relationship between Triad and both BSI and non\u2010BSI in female athletes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Primary and tertiary care student athlete clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>National Collegiate Athletic Association Division I female athletes at a single institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Participants completed a pre\u2010participation questionnaire and dual\u2010energy x\u2010ray absorptiometry, which was used to generate a Triad cumulative risk assessment score (Triad score). The number of overuse musculoskeletal injuries that occurred while the athletes were still competing collegiately were identified through chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>BSI and non\u2010BSI were treated as count variables. The association between BSI, non\u2010BSI, and Triad score was measured using Poisson regression to calculate rate ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 239 athletes, 43% of athletes (<jats:italic>n<\/jats:italic>\u2009=\u2009103) sustained at least one injury. Of those, 40% (<jats:italic>n<\/jats:italic>\u2009=\u200995) sustained at least one non\u2010BSI and 10% (<jats:italic>n<\/jats:italic>\u2009=\u200924) sustained at least one BSI over an average follow\u2010up 2.5\u2009years. After accounting for sport type (non\u2010lean, runner, other endurance sport, or other lean advantage sport) and baseline age, we found that every additional Triad score risk point was associated with a significant 17% increase in the rate of BSI (rate ratio [RR] 1.17, 95% confidence interval [CI] 1.03\u20131.33; <jats:italic>p<\/jats:italic>\u2009=\u2009.016). However, Triad score was unrelated to non\u2010BSI (1.00, 95% CI 0.91\u20131.11; <jats:italic>p<\/jats:italic>\u2009=\u2009.99). Compared with athletes in non\u2010lean sports (<jats:italic>n<\/jats:italic>\u2009=\u2009108), athletes in other lean advantage sports (<jats:italic>n<\/jats:italic>\u2009=\u200930) had an increased rate of non\u2010BSI (RR: 2.09, <jats:italic>p<\/jats:italic>\u2009=\u2009.004) whereas distance runners (<jats:italic>n<\/jats:italic>\u2009=\u200946) had increased rates of BSI (RR: 7.65, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and non\u2010BSI (RR: 2.25, <jats:italic>p<\/jats:italic>\u2009&lt; .001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Higher Triad score is associated with an increased risk of BSI but not non\u2010BSI in collegiate athletes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.13201","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T11:52:21Z","timestamp":1717501941000},"page":"1290-1297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The association between overuse and musculoskeletal injuries and the female athlete triad in Division I collegiate athletes"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-3004","authenticated-orcid":false,"given":"Emily","family":"Miller Olson","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-303X","authenticated-orcid":false,"given":"Kristin L.","family":"Sainani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Dyrek","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bakal","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Division of Sports Medicine University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Kansas City VA Medical Center  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fredericson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Division of Physical Medicine &amp; Rehabilitation Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"NCAA.NCAA demographics database. 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