Relative Energy Deficiency in Sport (RED-S) among those conditions treated at Milford Regional’s new sports medicine center


Relative Energy Deficiency in Sport (RED-S)—a condition of energy imbalance in athletes in which the body will steal fuel from other sources—continues to be diagnosed in a growing number of athletes internationally and is among conditions treated at Milford Regional’s recently opened Orthopedics and Sports Medicine Center at 98 Prospect Street in Milford.

RED-S was introduced by the International Olympic Committee in 2014, refining the condition referred to as Female Athlete Triad which was coined in 1992. According to Milford Regional Family and Sports Medicine Physician Amy Costa, MD, CAQSM, the diagnoses began to evolve following the passage of Title IX of the Education Amendments in 1972, when the inclusion of women in sport was recognized and then increased dramatically.

Prior to the established diagnosis of Female Athlete Triad/RED-S, sports medicine clinicians thought that female athletes losing periods was a normal state with training and competition. “We now know this to be evidence of energy imbalance in female athletes,” said Dr. Costa, who has a special interest in RED-S, and treats patients for this and a number of other sport-induced injuries and conditions at the Orthopedics and Sports Medicine Center.

Often unrecognized and undiagnosed, RED-S is common in both male and female athletes, and can include:

  • Low energy;
  • The loss of menstrual periods in girls/women and drop in hormone levels for both boys/men and girls/women;
  • Low bone density;
  • High risk for overuse or other sports injury; and
  • Poor athletic performance.

According to Dr. Costa, competition and training will suffer without adequate fueling and recovery. She advises that athletes in training should be deliberate in their nutrient fueling, ensure that their diet includes plentiful and appropriate snacks and meals; and make certain that recovery days are worked into their training regimens.

“The body cannot utilize workouts without the building blocks it needs to become better, stronger, faster,” said Dr. Costa, who joined the Milford Regional Physician Group following 17 years as a staff physician in the department of Student Health Services and as Assistant Director of Sports Medicine at Boston College.

“Body Mass Index shouldn’t be the only consideration when evaluating adolescent and young adult athletes. Nutritional intake and recommendations need to be highly personalized to the individual athlete and his or her activity level and type,” said Dr. Costa, who explains that even nutrient fueling for athletes who play the same sport, but different positions, tends to vary. “I would treat and advise a lacrosse goalie differently than I would a lacrosse midfielder or attacker.”

To view an informative video on RED-S featuring Dr. Costa, or to learn more about Milford Regional’s Orthopedics and Sports Medicine Center, visit


Milford Regional Medical Center is a full-service, community and regional teaching hospital located in Milford, Mass. and serves patients from more than 20 towns in Central Massachusetts. The 149-bed medical center is a nonprofit, acute-care facility, where more than 300 primary care and specialty physicians are committed to providing exceptional healthcare services to our community with dignity, compassion and respect.

Milford Regional Physician Group (MRPG), Inc. was established in 1992 and is one of the largest physician practice groups in the MetroWest and Blackstone Valley Region. MRPG, along with Milford Regional Medical Center, forms the Milford Regional Healthcare System, and consists of 43 primary care and specialty practices, including over 130 physicians, 82 advanced practitioners, and 630 total staff. The group is principally comprised of primary care providers, including: internal medicine, pediatrics, family medicine, and adolescent medicine. MRPG specialties include: breast surgery; cardiology; diabetes education; ear, nose and throat surgery; endocrinology; infectious disease; hospital medicine; neurology; obstetrics and gynecology; orthopedics; pulmonology; rheumatology; sleep medicine; sports medicine; urogynecology; urgent care; and urology.

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