Technical Abstract: Since the onset of Title IX, opportunities have dramatically increased for female athletes, largely to their benefit. However, some negative health outcomes such as disordered eating, chronic menstrual disturbances and low bone mass have been associated with high-level competition among some female athletes, particularly in sports such as gymnastics and cross-country running, where a slender physique or lean body build is important. Adolescent female athletes, in a rapid growth and developmental phase, may be at greatest risk. We sought to identify athletes at risk, understand the etiology of possible negative outcomes and recommend behavioral modifications that promote participation in competitive sports while supporting lifetime health. This review discusses the development and impact of disordered eating and menstrual dysfunction on bone mass in young, competitive, female athletes and provides nutrition recommendations for their energy, carbohydrate, protein, and vitamin and mineral intake.