Bone Stress Injuries in Runners

Tenforde, Adam S.; Kraus, Emily; Fredericson, Michael

doi:10.1016/j.pmr.2015.08.008

Cited by 87 publications

(75 citation statements)

References 49 publications

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“…Stress fractures are one example of overuse syndromes and are most common between the ages of 16 and 17 years, regardless of competition level . Risk factors for stress fractures are both biological and biomechanical . Generally, biological factors include female gender, genetics, medication, the Triad, and other dietary contributors .…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors for stress fractures are both biological and biomechanical . Generally, biological factors include female gender, genetics, medication, the Triad, and other dietary contributors . Biomechanical factors include training pattern, bone characteristics, and anatomic considerations .…”

Section: Introductionmentioning

confidence: 99%

“…However, because the age of greatest susceptibility to stress fractures is between 16 and 17 years, it is assumed that the risk factors for stress fractures in female athletes with the Triad may differ for teens and those in their 20s. Although many reports have examined the relationship between the Triad and stress fractures, no prospective studies have stratified the risks according to age (teens vs 20s). Accordingly, we hypothesized that risk factors for stress fractures in teenage athletes might be different from those for athletes in their 20s.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Nose‐Ogura

Yokosuka

Dohi

et al. 2019

Scandinavian Med Sci Sports

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Background The female athlete triad (Triad), defined by the American College of Sports Medicine as low energy availability (LEA) with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD), is associated with stress fractures and athletes aged 16‐17 years are most susceptible. Purpose To examine whether the Triad increases the risk of stress fractures, athletes were assigned to a “teenage” group and a “20s” group. Methods This prospective study enrolled 390 elite female athletes and was conducted from 2012 to 2016 at Japan Institute of Sports Sciences. Blood concentrations of various hormones were examined, and BMD was measured at the lumbar spine and throughout the whole body using dual‐energy X‐ray absorptiometry. LEA was defined as body weight ≤85% of the ideal body weight for teenage athletes, or BMI ≤17.5 for athletes in their 20s. Low BMD was defined as a BMD Z‐score of <−1.0 in the lumbar spine and the whole body. Results Among 390 athletes enrolled, 36 developed new stress fractures within 3 months of registration. The risk for stress fractures due to the Triad in teenage athletes was higher than for athletes in their 20s. In teenage female athletes, secondary amenorrhea, low BMD for the whole body, and a low ratio of actual body weight to ideal body weight increased the risk for stress fractures by 12.9 times, 4.5 times, and 1.1 times, respectively. Conclusion To prevent stress fractures in female athletes with the Triad, age of athletes should be taken into consideration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Nose‐Ogura

Yokosuka

Dohi

et al. 2019

Scandinavian Med Sci Sports

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“…Stress fractures are injuries to the bone that occur as a result of repetitive loading and are common in physically active populations. Incidence rates of up to 20% per year have been reported in endurance athletes, and bone stress injuries account for 20% of physician office visits in runners . Similarly, during basic military training, approximately 3% to 6% of male recruits and 9% to 20% of female recruits suffer a stress fracture .…”

Section: Introductionmentioning

confidence: 99%

Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers

Bulathsinhala

Hughes

McKinnon

et al. 2017

Journal of Bone and Mineral Research

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Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in white and Hispanic Soldiers compared with black Soldiers. However, these studies did not account for the large ethnic diversity in the US military. We aimed to identify differences in SF risk among racial/ethnic groups within the US Army. A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex. We identified 21,549 SF cases in 1,299,332 Soldiers (more than 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1000 person-years (7.47 and 2.05 per 1000 person-years in women and men, respectively). Using non-Hispanic blacks as the referent group, non-Hispanic white women had the highest risk of SF, with a 92% higher risk of SF than non-Hispanic black women (1.92 [1.81-2.03]), followed by American Indian/Native Alaskan women (1.72 [1.44-1.79]), Hispanic women (1.65 [1.53-1.79]), and Asian women (1.32 [1.16-1.49]). Similarly, non-Hispanic white men had the highest risk of SF, with a 59% higher risk of SF than non-Hispanic black men (1.59 [1.50-1.68]), followed by Hispanic men (1.19 [1.10-1.29]). When examining the total US Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with non-Hispanic white Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. © 2017 American Society for Bone and Mineral Research.

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“…Cortical bone serves primarily to transmit loads, and cancellous bone absorbs shock. Both excessive load‐bearing forces and muscular contraction are implicated as causes of bone stress injuries . Early identification of these injuries is essential because higher‐grade injuries require substantially longer healing times .…”

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confidence: 99%

A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries

Fukushima

Ray

Kraus

et al. 2018

J of Ultrasound Medicine

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Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

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Bone Stress Injuries in Runners

Cited by 87 publications

References 49 publications

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers

A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries

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