Q.Read the following passage and answer the questions that follow. Riya, a 17-year-old long-distance runner, has increased her training to twice a day while cutting down her meals because her coach told her that being lighter would make her faster. Over the last five months she has not had a menstrual period. In the last two months she has suffered two stress fractures in her shin, and she often feels cold, tired and dizzy.

(i) Riya is most likely suffering from the Female Athlete Triad. Its three components are:

• Low energy availability (with or without disordered eating)
• Menstrual dysfunction (e.g., amenorrhea — absence of periods for ≥3 months)
• Low bone mineral density (leading to stress fractures and osteoporosis)

(ii) The component that explains her repeated stress fractures is low bone mineral density. It arises because prolonged low energy availability suppresses oestrogen production. Oestrogen is essential for bone formation and remodelling; without it, bone resorption outpaces deposition, leaving bones weak and brittle. At 17, Riya is still building toward peak bone mass (reached in the 20s–30s), so this bone loss is especially damaging and may not be fully reversible.

(iii) The underlying mechanism common to all three components is chronic low energy availability — the gap between dietary energy intake and the energy expended in training and daily life. The body perceives this deficit as a metabolic crisis and shuts down non-essential functions: it suppresses reproductive hormones (causing amenorrhea), reduces bone turnover (lowering bone density), and conserves heat (causing cold intolerance and fatigue).

(iv) Four preventive or corrective measures:

• Increase total daily calorie intake to match her training energy expenditure, with emphasis on carbohydrates for fuel and protein for repair.
• Include calcium-rich foods (milk, curd, ragi, leafy greens) and ensure adequate vitamin D (sunlight or supplementation) to support bone health. …

(i) Name the syndrome Riya is most likely suffering from, and list its three components.

Riya is suffering from the Female Athlete Triad. Its three components are:

• Low energy availability (with or without disordered eating)
• Menstrual dysfunction (specifically amenorrhea — absence of menstruation)
• Low bone mineral density (osteoporosis or osteopenia)

(ii) Which component of the syndrome explains her repeated stress fractures, and how does it arise?

The low bone mineral density component explains the stress fractures. It arises because:

• Chronic low energy availability suppresses estrogen production (via hypothalamic disruption).
• Estrogen normally inhibits bone resorption by osteoclasts. Without it, bone breakdown outpaces bone formation.
• The result is reduced bone mass and microarchitectural deterioration, making bones brittle and unable to withstand repetitive loading — hence stress fractures.

Because Riya is only 17, this is especially serious: bone is deposited through childhood and adolescence and does not peak until the 20s–30s, so she is still in the critical window for building peak bone mass. Bone lost now may never be fully regained, making the low bone density more consequential and longer-lasting than it would be in an older adult.

(iii) What is the underlying mechanism common to all three components?

The common mechanism is low energy availability — a state where dietary energy intake is insufficient to meet the energy demands of training plus basic physiological functions. The body perceives an energy deficit and shuts down non-essential processes:

• Reproductive function is suppressed (amenorrhea) to conserve energy.
• Bone turnover is impaired because bone formation is energetically costly and estrogen-mediated protection is lost.
• Metabolic rate drops, causing fatigue, cold intolerance, and dizziness — all signs of the body's attempt to reduce energy expenditure.

(iv) Suggest four preventive or corrective measures that Riya, her coach and a sports dietitian should take. …