{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:06:02Z","timestamp":1792461962027,"version":"4.5.0"},"reference-count":63,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,1,14]]},"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine bone mineral density (BMD) and the associations among BMD, menstrual history, disordered eating (DE), training history, intentional weight loss (IWL) and rib pain for the first time in female lightweight rowers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>9 lightweight rowing clubs, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>29 Caucasian female lightweight rowers volunteered. 21 (12 active, 9 retired) completed the study. Inclusion criteria: female lightweight rowers aged over 18\u2005years. Exclusion criteria: participants with a history of bone disease, used medications known to influence BMD or if they were pregnant, lactating or postmenopausal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Dual-energy X-ray absorptiometry measured total body (TB) composition and BMD at the spine, femoral neck (FN), radius and TB. DE, oligomenorrhoea\/amenorrhoea years; rib pain and training history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>DE was reported in six of the rowers. The active with DE started rowing younger (p&lt;0.05) than those without, and their amount of IWL was associated with Eating Attitudes Test-26 score (p&lt;0.05). Some participants reported a history of oligomenorrhoea\/amenorrhoea 17 (76%) and\/or rib pain 7 (32%) with those with rib pain having lower spine and TB Z-scores (p&lt;0.05) than those without. Those with oligomenorrhoea\/amenorrhoea had lower spine Z-scores (p&lt;0.01) than those without. Twelve participants had low BMD; three at spine; one at FN; and eight at radius. Thirteen per cent of mean total training hours (18.6\u00b19.1 h\/week) were spent strength training (2.4\u00b12.2\u2005h\/week).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Upper body exercises incorporating multidimensional high peak bone strain were not reported and may need to be considered in their strength training to improve radial BMD. Results suggest IWL and high-level training at a young age increases the likelihood of DE and there may be a lack of quality nutritional support for these athletes. Thus, multidisciplinary sport science support should be offered at a young age and perhaps also to consider changing the weight rules to prevent the development of the Triad.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-004369","type":"journal-article","created":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T23:18:54Z","timestamp":1392247134000},"page":"e004369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Bone mineral density, rib pain and other features of the female athlete triad in elite lightweight rowers"],"prefix":"10.1136","volume":"4","author":[{"given":"Lygeri","family":"Dimitriou","sequence":"first","affiliation":[{"name":"Middlesex University, London Sport Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Weiler","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lloyd-Smith","sequence":"additional","affiliation":[{"name":"University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"Turner","sequence":"additional","affiliation":[{"name":"Middlesex University, London Sport Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Heath","sequence":"additional","affiliation":[{"name":"Middlesex University, London Sport Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nic","family":"James","sequence":"additional","affiliation":[{"name":"Middlesex University, London Sport Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Reid","sequence":"additional","affiliation":[{"name":"University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,2,12]]},"reference":[{"key":"2025121406581320000_4.2.e004369.1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200535060-00005"},{"key":"2025121406581320000_4.2.e004369.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2004.015990"},{"key":"2025121406581320000_4.2.e004369.3","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1123\/ijsn.8.4.377","article-title":"Fasting and energy intake influence bone turnover in lightweight male rowers","volume":"8","author":"Talbott","year":"1998","journal-title":"Int J Sport Nutr"},{"key":"2025121406581320000_4.2.e004369.4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1136\/bjsm.32.2.167","article-title":"Relation between bone turnover, oestradiol, and energy balance in women distance runners","volume":"32","author":"Zanker","year":"1998","journal-title":"Br J Sports Med"},{"key":"2025121406581320000_4.2.e004369.5","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e318149f111"},{"key":"2025121406581320000_4.2.e004369.6","doi-asserted-by":"crossref","unstructured":"Burr DB Milgrom C . Musculoskeletal fatigue and stress fractures. Boca Raton: CRC Press, 2001.","DOI":"10.1201\/9781420042191"},{"key":"2025121406581320000_4.2.e004369.7","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e3182042a9a"},{"key":"2025121406581320000_4.2.e004369.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.5.1407"},{"key":"2025121406581320000_4.2.e004369.9","doi-asserted-by":"publisher","DOI":"10.1007\/s004210000293"},{"key":"2025121406581320000_4.2.e004369.10","doi-asserted-by":"publisher","DOI":"10.1126\/science.3388021"},{"key":"2025121406581320000_4.2.e004369.11","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.040410"},{"key":"2025121406581320000_4.2.e004369.12","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/01.CSMR.0000306294.72578.a8","article-title":"Stress fractures in the female athlete","volume":"4","author":"Joy","year":"2005","journal-title":"Curr Sports Med Rep"},{"key":"2025121406581320000_4.2.e004369.13","doi-asserted-by":"publisher","DOI":"10.1210\/jc.87.7.3162"},{"key":"2025121406581320000_4.2.e004369.14","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1249\/01.MSS.0000356149.88979.66","article-title":"Prevalence of the female athlete triad\/tetrad in professional ballet dancers","volume":"41","author":"Hoch","year":"2009","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.02.035"},{"key":"2025121406581320000_4.2.e004369.16","doi-asserted-by":"publisher","DOI":"10.1249\/01.MSS.0000064935.68277.E7"},{"key":"2025121406581320000_4.2.e004369.17","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1123\/ijsnem.20.5.418","article-title":"Bone-mineral density and other features of the female athlete triad in elite endurance runners: a longitudinal and cross-sectional observational study","volume":"20","author":"Pollock","year":"2010","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2025121406581320000_4.2.e004369.18","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.nut.2008.11.029","article-title":"Female athlete triad in elite swimmers of the city of Rio de Janeiro, Brazil","volume":"25","author":"Schtscherbyna","year":"2009","journal-title":"Nutrition"},{"key":"2025121406581320000_4.2.e004369.19","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200232130-00002"},{"key":"2025121406581320000_4.2.e004369.20","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S0278-5919(20)30338-0","article-title":"The female athlete triad: the inter-relatedness of disordered eating, amenorrhea, and osteoporosis","volume":"13","author":"Nattiv","year":"1994","journal-title":"Clin Sports Med"},{"key":"2025121406581320000_4.2.e004369.21","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200401000-00005"},{"key":"2025121406581320000_4.2.e004369.22","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.csm.2005.05.005","article-title":"Eating disorders in athletes: managing the risks","volume":"24","author":"Currie","year":"2005","journal-title":"Clin Sports Med"},{"key":"2025121406581320000_4.2.e004369.23","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/S1440-2440(02)80029-9","article-title":"Elite athletes: effects of the pressure to be thin","volume":"5","author":"Byrne","year":"2002","journal-title":"J Sci Med Sport"},{"key":"2025121406581320000_4.2.e004369.24","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S1440-2440(99)80185-6","article-title":"Eating attitudes, body shape perceptions and mood of elite rowers","volume":"2","author":"Terry","year":"1999","journal-title":"J Sci Med Sport"},{"key":"2025121406581320000_4.2.e004369.25","first-page":"3","article-title":"Eating attitudes and body shape perceptions among elite rowers: effects of age, gender and weight category","volume":"28","author":"Terry","year":"1996","journal-title":"Aust J Sci Med Sport"},{"key":"2025121406581320000_4.2.e004369.26","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1123\/ijsn.3.1.29","article-title":"Prevalence of eating disorders in elite female athletes","volume":"3","author":"Sundgot-Borgen","year":"1993","journal-title":"Int J Sport Nutr"},{"key":"2025121406581320000_4.2.e004369.27","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-45.3.243"},{"key":"2025121406581320000_4.2.e004369.28","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(00)00342-2"},{"key":"2025121406581320000_4.2.e004369.29","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/j.1600-0838.2004.00400.x","article-title":"Exercise-induced rib stress fractures: influence of reduced bone mineral density","volume":"15","author":"Vinther","year":"2005","journal-title":"Scand J Med Sci Sports"},{"key":"2025121406581320000_4.2.e004369.30","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1097\/00005768-199712000-00004","article-title":"Injuries to elite rowers over a 10-year period","volume":"29","author":"Hickey","year":"1997","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.31","doi-asserted-by":"crossref","unstructured":"Budget R Hettinga DM Steinacker J . Sports medicine. In: Secher NH Volianitis S . eds Rowing. London: Blackwell, 2007:124\u201340.","DOI":"10.1002\/9781444312614.ch11"},{"key":"2025121406581320000_4.2.e004369.32","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623770"},{"key":"2025121406581320000_4.2.e004369.33","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e318201d7bb"},{"key":"2025121406581320000_4.2.e004369.34","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700049163"},{"key":"2025121406581320000_4.2.e004369.35","unstructured":"American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR\u00ae. Washington, DC: American Psychiatric Association, 2000."},{"key":"2025121406581320000_4.2.e004369.36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00042752-200101000-00006","article-title":"Prevalence of eating disordered behaviour in collegiate lightweight women rowers and distance runners","volume":"11","author":"Karlson","year":"2001","journal-title":"Clin J Sport Med"},{"key":"2025121406581320000_4.2.e004369.37","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1249\/00005768-199404000-00003","article-title":"Risk and trigger factors for the development of eating disorders in female elite athletes","volume":"26","author":"Sundgot-Borgen","year":"1994","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.38","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-108X(200005)27:4<371::AID-EAT1>3.0.CO;2-Y"},{"key":"2025121406581320000_4.2.e004369.39","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e318281a939"},{"key":"2025121406581320000_4.2.e004369.40","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1600-0447.1993.tb03454.x","article-title":"Subclinical eating disorders in male athletes: a study of the low weight category in rowers and wrestlers","volume":"88","author":"Thiel","year":"1993","journal-title":"Acta Psychiatr Scand"},{"key":"2025121406581320000_4.2.e004369.41","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1123\/ijsnem.10.2.128","article-title":"Behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders","volume":"10","author":"Beals","year":"2000","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"2025121406581320000_4.2.e004369.42","doi-asserted-by":"crossref","first-page":"S181","DOI":"10.1097\/00005768-199805001-01028","article-title":"The female athlete triad and the effect of preventative work","volume":"30","author":"Sundgot-Borgen","year":"1998","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.43","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/01.jsm.0000251179.90840.58","article-title":"Injury prevention in child and adolescent sport: whose responsibility is it?","volume":"6","author":"Emery","year":"2006","journal-title":"Clin J Sport Med"},{"key":"2025121406581320000_4.2.e004369.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(05)70374-9"},{"key":"2025121406581320000_4.2.e004369.45","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1249\/MSS.0b013e3181a7a5a2","article-title":"Bone volumetric density, geometry and strength in female and male collegiate runners","volume":"41","author":"Smock","year":"2009","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.46","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1056\/NEJM198408023110501","article-title":"Bone mineral content of amenorrheic and eumenorrheic athletes","volume":"2","author":"Drinkwater","year":"1984","journal-title":"N Engl J Med"},{"key":"2025121406581320000_4.2.e004369.47","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1249\/01.MSS.0000089250.86536.D8","article-title":"Spine bone mineral density increases in experienced but not novice collegiate female rowers","volume":"35","author":"Lariviere","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.48","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.301.6751.516"},{"key":"2025121406581320000_4.2.e004369.49","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1519\/JSC.0b013e3181e2e10e","article-title":"Strength and conditioning practices in rowing","volume":"25","author":"Gee","year":"2011","journal-title":"J Strength Cond Res"},{"key":"2025121406581320000_4.2.e004369.50","first-page":"10","article-title":"Strength training for the preparatory phase in collegiate women's rowing","volume":"26","author":"Ivey","year":"2004","journal-title":"Strength Cond J"},{"key":"2025121406581320000_4.2.e004369.51","first-page":"513","article-title":"The effect of high-load vs. high-repetition training on endurance performance","volume":"18","author":"Ebben","year":"2004","journal-title":"J Strength Cond Res"},{"key":"2025121406581320000_4.2.e004369.52","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1249\/01.MSS.0000089345.28012.23","article-title":"Does lower-body BMD develop at the expense of upper-body BMD in female runners?","volume":"35","author":"Nevill","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"2025121406581320000_4.2.e004369.53","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200232140-00002"},{"key":"2025121406581320000_4.2.e004369.54","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1997.12.8.1253"},{"key":"2025121406581320000_4.2.e004369.55","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-010-1470-2"},{"key":"2025121406581320000_4.2.e004369.56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17461390100071307","article-title":"Bone mineral density in top level male athletes of different sports","volume":"1","author":"Platen","year":"2001","journal-title":"Eur J Sport Sci"},{"key":"2025121406581320000_4.2.e004369.57","first-page":"42","article-title":"The myth of the intercostal muscle pull","volume":"22","author":"Strayer","year":"1990","journal-title":"Am Rowing"},{"key":"2025121406581320000_4.2.e004369.58","first-page":"130","article-title":"Self-reported versus diagnosed stress fractures in Norwegian female elite athletes","volume":"8","author":"\u00d8yen","year":"2009","journal-title":"J Sports Sci Med"},{"key":"2025121406581320000_4.2.e004369.59","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1002\/jbmr.5650081010","article-title":"Long-term fracture prediction by bone mineral assessed at different skeletal sites","volume":"8","author":"Melton","year":"1993","journal-title":"J Bone Miner Res"},{"key":"2025121406581320000_4.2.e004369.60","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0838.2003.00321.x"},{"key":"2025121406581320000_4.2.e004369.61","doi-asserted-by":"publisher","DOI":"10.1080\/14763140408522842"},{"key":"2025121406581320000_4.2.e004369.62","first-page":"43","article-title":"Strength and power determinants of rowing performance","volume":"10","author":"Chun-Jung","year":"2007","journal-title":"J Exerc Physiol Online"},{"key":"2025121406581320000_4.2.e004369.63","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jsams.2007.01.008","article-title":"Predicting the 1000 m rowing ergometer performance in 12\u201313-year-old rowers: the basis for selection process?","volume":"11","author":"Pavle","year":"2008","journal-title":"J Sci Med Sport"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2013-004369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T14:58:24Z","timestamp":1765724304000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2013-004369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":63,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2014,2,12]]},"published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1136\/bmjopen-2013-004369"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2013-004369","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}