Ultramarathon running has gained popularity in the past decade, necessitating a better understanding of the health benefits and risks of this sport. The Female Athlete Triad (Triad) and a similar condition reported in males are common in endurance athletes, but the prevalence of triad risk factors in ultramarathon runners is unknown

PURPOSE: To identify the prevalence of Triad risk in ultramarathon runners.
METHODS: Runners who qualified to compete in a 100-mile endurance race were recruited pre-race to complete a survey assessing eating behaviors, menstrual history, training, and injury history; and dual-energy x-ray absorptiometry to assess bone mineral density (BMD). A cumulative Triad risk score was calculated using energy availability, body mass index (BMI), age of menarche and oligomenorrhea (for women), BMD, and history of bone stress injury.
RESULTS: 123 runners (40 female and 83 male) participants had a mean age, respectively, of 41.8 and 46.2 years. 57.5% of females and 26.5% of males received moderate cumulative risk scores; 5.0% of females and 4.8% of males were classified as high risk. 62.5% of females and 39.7% of males scored moderate or high risk for low energy availability, with 13% reporting a history of clinical eating disorders. Mean female and male BMI was, respectively 21.2 kg/m²(SD=2.1) and 22.9 kg/m² (SD=2.6). 15% of females and 0% of males scored moderate or high risk for low BMI, determined to be anything less than 18.5 kg/m². 15% of females and 28.9% of males had BMD Z-score<-1.0, and 6.0% of males had a Z-score<-2.0. 37.5% of females and 79.5% of males reported at least one prior bone stress injury.
CONCLUSIONS: Triad risk factors were common among ultramarathoners, particularly in men.
ACKNOWLEDGEMENTS: Supported with grants from the Western States Endurance Run Foundation and the Napa Medical Research Foundation. Laboratory testing was done in partnership with InsideTracker