Examining Risk Factors for Bone-Stress Injuries in High School Female Distance Runners: Energy Availability, Menstrual Health, and Training Intensity
DOI:
https://doi.org/10.58445/rars.3673Keywords:
Female Sports Medicine, RED-s, Bone Stress Injuries, Stress Fractures, Menstrual Cycle Irregularity, LEA, Low energy availability, Female Athlete Triad, RunningAbstract
Background:
Bone-stress injuries (BSIs) are a significant concern among young female athletes, particularly in endurance sports such as cross country and track. BSIs result from repetitive mechanical loading that disrupts bone remodeling and are commonly classified as overuse injuries. Research has traditionally focused on training load as the main contributor to mechanical stress on bone. However, recent evidence suggests BSI risk is influenced by additional physiological factors. Relative Energy Deficiency in Sport (RED-S), caused by low energy availability (LEA), may increase BSI risk because it disrupts the menstrual cycle and bone metabolism. This study examined the relationship between LEA and BSI risk and explored whether menstrual cycle irregularity and training intensity influence this relationship.
Methods:
Female high school cross country runners (n = 30; ages 13–18) completed a survey assessing indicators of LEA, menstrual cycle irregularity, training intensity, and BSI risk. A linear regression model tested whether LEA predicted BSI risk. A mediation analysis evaluated whether menstrual cycle regularity mediated the relationship between LEA and BSI. A moderation analysis tested whether training intensity interacted with LEA to influence BSI risk.
Results:
LEA did not significantly predict BSI risk. The mediation analysis yielded a non-significant overall effect; however, a positive association was observed between LEA and menstrual cycle irregularity (path A). No significant interaction between LEA and training intensity was found in predicting BSI risk.
Conclusion:
Findings did not show a direct association between LEA and BSI risk, nor evidence that menstrual cycle irregularity mediates this relationship. However, menstrual cycle irregularity may serve as a practical indicator of LEA and overall health in female athletes. Monitoring menstrual health may help identify risk earlier, and future studies with larger samples should further investigate physiological contributors to BSIs.
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