Females Have a Greater Incidence of Stress Fractures Than Males in Both Military and Athletic Populations: A Systemic Review

Abstract

Factors possibly explaining why females are more susceptible to stress fractures include bone anatomy, lower aerobic capacity, smaller muscle, and poor diet. However, both female recruits and athletes with normal weight and bone health are less likely to develop stress fractures, showing that gender is less important than the overall physical shape/condition.

High Incidence of Stress Fractures in Military Cadets During Training: A Point of Concern

“…However, in another study, the maximum occurrence of SF was found between the basic phase of training i.e. between nine weeks and 27 weeks [7].…”

“…The significant higher incidence of SFs has been attributed to training with maximum stress on running, jumping, parade on hard ground, and gymnastics [7]. It can be also due to sudden increase in amount and intensity of physical activity along with repeated impact due to running on hard surface, improper technique and equipment [2,8].…”

Update on stress fractures in female athletes: epidemiology, treatment, and prevention

“…Furthermore, the failure to identify and properly manage stress fractures can lead to complications such as progression to complete fracture, malunion or nonunion, chronic pain, prolonged recovery, and/or disability. The female athlete triad (referred to in this report as the triad), which is a significant risk factor for stress fractures in women, describes how prolonged periods of low energy availability and undernutrition due to mismatch of nutrition intake and exercise expenditure leads to amenorrheic state, estrogen deficiency, and the dysfunction of other hormones required for bone health (cortisol, leptin), and result in impaired bone health [3,4]. The triad is common in female athletes at all levels of abilities and ages but is most commonly seen in endurance, aesthetic, and weight-class sports [3][4][5][6].…”

“…The female athlete triad (referred to in this report as the triad), which is a significant risk factor for stress fractures in women, describes how prolonged periods of low energy availability and undernutrition due to mismatch of nutrition intake and exercise expenditure leads to amenorrheic state, estrogen deficiency, and the dysfunction of other hormones required for bone health (cortisol, leptin), and result in impaired bone health [3,4]. The triad is common in female athletes at all levels of abilities and ages but is most commonly seen in endurance, aesthetic, and weight-class sports [3][4][5][6]. Individuals with 1 or more components of triad may have an increased risk for multiple adverse health outcomes, including stress fracture and other musculoskeletal injuries [3,4,7].…”

Common Running Overuse Injuries and Prevention

“…Runners and military recruits are at highest risk (Welck, Hayes, Pastides, Khan, & Rudge, 2015). Additionally, females are aff ected much more oft en than males are (with estimated incidences of 9.8% and 6.5%, respectively) (Wentz, Liu, Haymes, & Ilich, 2011). Th is may be attributed to gender-related risk factors, such as the female athlete triad (a syndrome of three interrelated conditions: amenorrhea, eating disorders, and low bone mineral density) (Nattiv et al, 2007).…”