Impact of relative energy deficiency in sport on adolescent athletes

Relative Energy Deficiency in Sport (RED-S), driven by problematic low energy availability (LEA), is common in adolescent athletes of all genders and sports and is associated with negative effects across multiple organ systems. In recent years, best practices for the screening, clinical evaluation, and management of RED-S health consequences have evolved for both female and male athletes.

LEA significantly affects physiological systems and sports performance and increases the likelihood of missed training due to illness. LEA has also been associated with higher bone resorption and reduced bone formation, increasing the risk for bone stress injury. Recent evidence suggests that low carbohydrate availability, even in the absence of LEA, can independently impair bone health, iron metabolism, and immune function. Recent updates have been made to guidelines for bone mineral density (BMD) screening and management of low BMD, as well as athlete risk stratification and return-to-play decision-making.

Early identification of RED-S and management of young athletes is essential for improving short- and long-term health outcomes. Caring for young athletes with RED-S should involve a comprehensive, individualized, multidisciplinary approach. Further research is needed to improve RED-S screening methods and treatment of low BMD, particularly among adolescent male athletes.