{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T07:13:46Z","timestamp":1779261226189,"version":"3.51.4"},"reference-count":53,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&R"],"published-print":{"date-parts":[[2026,5]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Differences in female athlete triad risk factors between runners from Japan and the United States have not been explored.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the prevalence of Triad risk factors and Triad components between female Japanese and American distance runners.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Observational, cross\u2010sectional.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Two universities; one in the United States and one in Japan.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A total of 77 female runners: 36 Japanese middle\u2010 and long\u2010distance runners, and 41 American distance runners.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Not applicable.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n \n Triad components were energy deficiency, menstrual disturbances, and poor bone health. Triad risk factors were, respectively for each component: body mass index, serum total triiodothyronine, and history of diagnosed eating disorders; delayed menarche, history of menstrual irregularity, and current oligoamenorrhea; and bone mineral density and history of stress fractures. Prevalence was compared with chi\u2010square and Fisher's exact tests. Group differences were assessed with\n t<\/jats:italic>\n \u2010tests and Mann\u2013Whitney\n U<\/jats:italic>\n tests. Data are mean difference (95% confidence interval [CI]).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Japanese runners had lower body weight (\u22124.15 [95% CI, \u22127.03.to \u22121.27] kg,\n p<\/jats:italic>\n \u2009=\u2009.005) and percentage of body fat (\u22125.2 [95% CI, \u22126.9 to \u22123.5] %,\n p<\/jats:italic>\n \u2009<\u2009.001) than American runners, with no differences in body mass index, serum total triiodothyronine, age of menarche, or menstrual cycle length (\n p<\/jats:italic>\n \u2009>\u2009.05). Japanese runners had significantly lower bone mineral density at the lumbar spine (\u22120.195 [95% CI, \u22120.246 to \u22120.143] g\/cm\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n \u2009<\u2009.001), total hip (\u22120.115 [95% CI, \u22120.165 to \u22120.064] g\/cm\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n \u2009<\u2009.001), and femoral neck (\u22120.214 [95% CI, \u22120.260 to \u22120.167] g\/cm\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n \u2009<\u2009.001), but higher total hip\n Z<\/jats:italic>\n \u2010scores than the American runners (0.5 [95% CI, 0.1 to 1.0],\n p<\/jats:italic>\n \u2009=\u2009.022). The prevalence of energy deficiency (56% vs. 32%,\n p<\/jats:italic>\n \u2009=\u2009.035), history of stress fractures (50% vs. 17%,\n p<\/jats:italic>\n \u2009=\u2009.003), and of runners experiencing all three Triad components (42% vs. 16%,\n p<\/jats:italic>\n \u2009=\u2009.014) was higher in Japanese than American runners. No other differences in prevalence were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Japanese female runners may be at a higher Triad risk than American peers, given their higher prevalence of energy deficiency risk factors, history of stress fractures, and of athletes experiencing all Triad components.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pmrj.70099","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T11:16:39Z","timestamp":1770808599000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in female athlete triad risk factors between Japanese and American female runners: A comparative study"],"prefix":"10.1002","volume":"18","author":[{"given":"Ana Carla C.","family":"Salamunes","sequence":"first","affiliation":[{"name":"Women's Health and Exercise Lab Pennsylvania State University University Park Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natsue","family":"Koikawa","sequence":"additional","affiliation":[{"name":"Japanese Center for Research on Women in Sport Juntendo University Tokyo Japan"},{"name":"Graduate School of Health and Sports Science Juntendo University Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy I.","family":"Williams","sequence":"additional","affiliation":[{"name":"Women's Health and Exercise Lab Pennsylvania State University University Park Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen J.","family":"Koltun","sequence":"additional","affiliation":[{"name":"Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maha L.","family":"Vijaya Krishnan","sequence":"additional","affiliation":[{"name":"Women's Health and Exercise 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