Female Athlete Triad's Components in Practitioners of Dance: A Systematic Review.

Abstract

Dance involves relatively high energy demands and aesthetic pressures that can lead to low energy availability. These conditions increase the risk of the Female Athlete Triad (FAT) and Relative Energy Deficiency in Sport (REDs), which affect metabolic, menstrual, and bone health. Despite growing concern, evidence on the prevalence and characteristics of these conditions in female dancers remains limited. To investigate the risk factors associated with FAT and REDs in female dancers. This systematic review followed the PRISMA 2020 statement and was registered in PROSPERO (CRD-42024626363). Five electronic databases (PubMed, Web of Science, SCOPUS, EBSCO, and Embase) were searched up to December 2024, with an updated search conducted in May 2026. Eligibility criteria included original studies involving female dancers aged 15 to 39 years that assessed at least one Triad component. Screening and data extraction were conducted independently by 2 reviewers, and methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. A total of 6014 records were identified, and 11 studies met the inclusion criteria, comprising 906 female dancers from different dance styles, predominantly ballet. Disordered eating and risk of low energy availability were reported in nearly all studies, with prevalence ranging from 28% to 74%. Menstrual dysfunction occurred in 40% to 66% of participants, while low bone mineral density was observed in 15% to 40% of samples. Most studies demonstrated moderate to high methodological quality. The main associated factors included aesthetic demands, training volume, and body image dissatisfaction. Research on FAT and REDs in dancers remains limited. Current evidence indicates a high prevalence of disordered eating, menstrual dysfunction, and low bone mineral density, particularly in ballet. Most studies are cross-sectional and rely on self-reported data, limiting causal interpretation. Future research should employ longitudinal designs, objective measures, and standardized criteria to clarify underlying mechanisms and support preventive strategies.