{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:51:56Z","timestamp":1788904316298,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T00:00:00Z","timestamp":1549411200000},"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":["Scandinavian Med Sci Sports"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Female Athlete Triad (Triad) is a syndrome describing three interrelated conditions: low energy availability (LEA), menstrual dysfunction, and low bone mineral density (BMD). Relative Energy Deficiency in Sport (RED\u2010S) expands the Triad to include multiple physiologic consequences of LEA in both sexes. The purpose of this study is to determine the prevalence of factors associated with the Triad\/RED\u2010S in an elite para athlete population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Athletes were U.S. elite para athletes training to qualify for the 2016 or the 2018 Paralympic Games. Participants completed an online questionnaire characterizing nutrition, menstrual status (in females), bone health, and awareness of the Triad\/RED\u2010S.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The athletes were 260 elite para athletes (150 male, 110 female). While few reported prior eating disorder (3.1%), 32.4% had elevated Eating Disorder Examination Questionnaire (EDE\u2010Q) pathologic behavior subscale scores. Most athletes (95 male, 65 female) were attempting to change their body composition or weight to improve performance. Forty\u2010four percent of premenopausal females had oligomenorrhea\/amenorrhea. Bone stress injury was reported in 9.2% of athletes; of these, 54.5% (n\u00a0=\u00a012) had low BMD. Less than 10% of athletes reported awareness of the Triad\/RED\u2010S.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Factors associated with the Triad\/RED\u2010S are present in an elite para athlete population, regardless of sex or sport type. Awareness of the Triad\/RED\u2010S in para athletes is low. The consequences of LEA in para athlete populations are poorly understood. However, the high prevalence of factors observed suggests value in advancing screening tools and education efforts to optimize health in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sms.13385","type":"journal-article","created":{"date-parts":[[2019,1,15]],"date-time":"2019-01-15T08:38:54Z","timestamp":1547541534000},"page":"678-685","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Low energy availability, menstrual dysfunction, and impaired bone health: A survey of elite para athletes"],"prefix":"10.1111","volume":"29","author":[{"given":"Emily M.","family":"Brook","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women\u2019s Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital and Brigham and Women\u2019s Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Broad","sequence":"additional","affiliation":[{"name":"U.S. Paralympics U.S. Olympic Committee  Chula Vista California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth G.","family":"Matzkin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women\u2019s Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi Y.","family":"Yang","sequence":"additional","affiliation":[{"name":"Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery Brigham and Women\u2019s Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie E.","family":"Collins","sequence":"additional","affiliation":[{"name":"Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery Brigham and Women\u2019s Hospital Boston Massachusetts"},{"name":"Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8568-1009","authenticated-orcid":false,"given":"Cheri A.","family":"Blauwet","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Brigham and Women\u2019s Hospital Boston Massachusetts"},{"name":"Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital and Brigham and Women\u2019s Hospital, Harvard Medical School Boston Massachusetts"},{"name":"International Paralympic Committee (IPC) Medical Committee Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-199307000-00003"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e318149f111"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093218"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099193"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093502"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-015-0411-y"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-017-0696-0"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12261"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516676262"},{"key":"e_1_2_7_11_1","unstructured":"Rio About.2016.https:\/\/www.paralympic.org\/rio-2016\/about-us. Published 2016. Accessed December 1 2017."},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.21.5.417"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eatbeh.2011.11.005"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-007-0789-1"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000118036.20170.6C"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.2165\/11531960-000000000-00000"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0000000000000532"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200737040-00019"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003677-200307000-00008"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/87.1.36"},{"issue":"7","key":"e_1_2_7_22_1","first-page":"420","article-title":"Daily energy expenditure and basal metabolic rates of patients with spinal cord injury","volume":"66","author":"Mollinger LA","year":"1985","journal-title":"Arch Phys Med Rehabil"},{"issue":"3","key":"e_1_2_7_23_1","first-page":"259","article-title":"An evaluation of wheelchair basketball players\u2019 nutritional status and nutritional knowledge levels","volume":"56","author":"Eskici G","year":"2016","journal-title":"J Sports Med Phys Fitness"},{"issue":"7","key":"e_1_2_7_24_1","first-page":"1018","article-title":"Nutrient intake of elite Canadian and American athletes with spinal cord injury","volume":"10","author":"Gerrish H","year":"2017","journal-title":"Int J Exerc Sci"},{"issue":"1","key":"e_1_2_7_25_1","first-page":"47","article-title":"Nutritional practices of competitive British wheelchair games players","volume":"27","author":"Goosey\u2010Tolfrey VL","year":"2010","journal-title":"Adapt Phys Act Q"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157931"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0026-0495(96)90137-7"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.1997.11719456"},{"issue":"3","key":"e_1_2_7_29_1","first-page":"192","article-title":"Sexual issues of women with spinal cord injuries","volume":"30","author":"Charlifue SW","year":"1992","journal-title":"Paraplegia"}],"container-title":["Scandinavian Journal of Medicine &amp; Science in Sports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fsms.13385","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sms.13385","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/sms.13385","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sms.13385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T15:00:45Z","timestamp":1694358045000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/sms.13385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,6]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1111\/sms.13385"],"URL":"https:\/\/doi.org\/10.1111\/sms.13385","archive":["Portico"],"relation":{},"ISSN":["0905-7188","1600-0838"],"issn-type":[{"value":"0905-7188","type":"print"},{"value":"1600-0838","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,6]]},"assertion":[{"value":"2018-01-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}