The Incidence and Distribution of Stress Fractures in Competitive Track and Field Athletes

Bennell, Kim L; Malcolm, S. A.; Thomas, Samantha; Wark, John D.; Brukner, Peter

doi:10.1177/036354659602400217

Cited by 357 publications

(260 citation statements)

References 41 publications

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“…This acute response may be of significance to athletic populations as the net effects of changes in bone resorption and formation have been implicated in both stress fractures [20] and changes in bone mineral density (BMD) [21]. Additionally, the acute response of bone markers to exercise has been reported with both running [19] and cycling [15], and reduced spinal BMD (running and cycling) and an increased incidence of stress fractures (running) have been observed in some groups who regularly perform both types of activity [22][23][24][25][26].…”

Section: 3mentioning

confidence: 99%

Effect of fasting versus feeding on the bone metabolic response to running

Scott

Sale

Greeves³

et al. 2012

Bone

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Abbreviations: ACa, albumin-adjusted calcium; Bone ALP, bone alkaline phosphatase; BMD, bone mineral density; P-CTX, C-terminal telopeptide region of collagen type 1; CHO, carbohydrate; FAST, overnight fast from 21:00; FED, a standardised breakfast consumed at 08:15; GLP-1, glucagon-like peptide-1; GLP-2, glucagon-like peptide-2; GIP, glucosedependent insulinotropic polypeptide; LMM, linear mixed model; OC, osteocalcin; OPG, osteoprotegerin; P1NP, N-terminal propeptides of procollagen type 1; PTH, parathyroid hormone; PO4, phosphate; RER, respiratory exchange ratio; RPE, ratings of perceived exertion; VO2, oxygen uptake; V02max, maximal rate of oxygen uptake. ABSTRACTIndividuals often perform exercise in the fasted state, but the effects on bone metabolism are not currently known. We compared the effect of an overnight fast with feeding a mixed meal on the bone metabolic response to treadmill running. Ten, physically-active males aged 28 ± 4 y (mean ± 1SD) completed two, counterbalanced, 8 d trials. After 3 d on a standardised diet, participants performed 60 min of treadmill running at 65% V02max on Day 4 following an overnight fast (FAST) or a standardised breakfast (FED). Blood samples were collected at baseline, before and during exercise, for 3h after exercise, and on four consecutive follow-up days (FU1-FU4). Plasma/serum were analysed for the c-terminal telopeptide region of collagen type 1 (P-CTX), n-terminal propeptides of procollagen type 1 (P1NP), osteocalcin (OC), bone alkaline phosphatase (bone ALP), parathyroid hormone (PTH), albumin-adjusted calcium, phosphate, osteoprotegerin (OPG), Cortisol, leptin and ghrelin. Only the P-CTX response was significantly affected by feeding. Pre-exercise concentrations decreased more in FED compared with FAST (47% vs 26%, P < 0.001) but increased during exercise in both groups and were not significantly different from baseline at 1 h post-exercise. At 3 h post-exercise, concentrations were decreased (33%, P < 0.001) from baseline in FAST and significantly lower (P < 0.001) than in FED. P1NP and PTH increased, and OC decreased during exercise. Bone markers were not significantly different from baseline on FU1-FU4.Fasting had only a minor effect on the bone metabolic response to subsequent acute, endurance exercise, reducing the duration of the increase in P-CTX during early recovery, but having no effect on changes in bone formation markers. The reduced duration of the P-CTX response with fasting was not fully explained by changes in PTH, OPQ leptin or ghrelin.

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Section: 3mentioning

confidence: 99%

Effect of fasting versus feeding on the bone metabolic response to running

Scott

Sale

Greeves³

et al. 2012

Bone

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“…1,2 We have recently reported a 2.7% estimated lifetime prevalence of this injury in female adolescents, 3 which compares favorably with estimates ranging from 1.0% to 2.6% among general collegiate athletes. 4,5 Although these overall rates seem low, certain subgroups, such as college freshmen 6 and other young adult women participating in track and field [7][8][9][10][11] may have rates of stress fracture between 6.9% 6 and 21.1%. 11 Stress fractures are particularly concerning in active female adolescents and young adults because they may signify insufficiency of the bones to withstand repetitive loading.…”

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confidence: 99%

“…4,5 Although these overall rates seem low, certain subgroups, such as college freshmen 6 and other young adult women participating in track and field [7][8][9][10][11] may have rates of stress fracture between 6.9% 6 and 21.1%. 11 Stress fractures are particularly concerning in active female adolescents and young adults because they may signify insufficiency of the bones to withstand repetitive loading. Although a "fracture threshold" is not yet defined for children and adolescents, ~80% to 90% of in vitro skeletal strength in adults is determined by bone mineral density (BMD).…”

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confidence: 99%

Family History Predicts Stress Fracture in Active Female Adolescents

Loud

Micheli²,

Bristol

et al. 2007

Pediatrics

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OBJECTIVE-Increased physical activity and menstrual irregularity have been associated with increased risk for stress fracture among adult women active in athletics. The purposes of this study were to determine whether menstrual irregularity is also a risk factor for stress fracture in active female adolescents and to estimate the quantity of exercise associated with an increased risk for this injury.PATIENTS AND METHODS-A case-control study was conducted of 13-to 22-year-old females diagnosed with their first stress fracture, each matched prospectively on age and selfreported ethnicity with 2 controls. Patients with chronic illnesses or use of medications known to affect bone mineral density were excluded, including use of hormonal preparations that could alter menstrual cycles. The primary outcome, stress fracture in any extremity or the spine, was confirmed radiographically. Girls with stress fracture had bone mineral density measured at the lumbar spine by dual-energy x-ray absorptiometry.RESULTS-The mean ± SD age of the 168 participants was 15.9 ± 2.1 years; 91.7% were postmenarchal, with a mean age at menarche of 13.1 ± 1.1 years. The prevalence of menstrual irregularity was similar among cases and controls. There was no significant difference in the mean hours per week of total physical activity between girls in this sample with stress fracture (8.2 hours/week) and those without (7.4 hours/week). In multivariate models, case subjects had nearly 3 times the odds of having a family member with osteoporosis or osteopenia. In secondary analyses, participants with stress fracture had a low mean spinal bone mineral density for their age.CONCLUSIONS-Among highly active female adolescents, only family history was independently associated with stress fracture. The magnitude of this association suggests that further investigations of inheritable skeletal factors are warranted in this population, along with evaluation of bone mineral density in girls with stress fracture. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 October 25. Stress fractures are particularly concerning in active female adolescents and young adults because they may signify insufficiency of the bones to withstand repetitive loading. Although a "fracture threshold"is not yet defined for children and adolescents, ~80% to 90% of in vitro skeletal strength in adults is determined by bone mineral density (BMD). 12 A woman's peak bone mass is achieved by her early 20s 13,14 and is one of the strongest predictors of her long-term risk of osteoporosis. 15,16 Understanding the risk factors that predispose to stress fracture in this population could, therefore, indirectly elucidate the risk factors for a low BMD.To our knowledge, no data exist regarding risk factors for stress fracture in adolescents younger than age 17 years. We, therefore, constructed a pathogenetic model of stress fracture on the basis of studies in the adult literature and the observations of experienced clinicians. The risk factors deem...

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“…Tibial stress fractures are common overuse injuries among runners [1]. Tibial stress fractures can cause significant disruption to training, a reduction in physical fitness as well as increased psychological distress [2].…”

Section: Introductionmentioning

confidence: 99%

Characterizing the Learning Effect in Response to Biofeedback Aimed at Reducing Tibial Acceleration during Running

Gelder

Barnes

Wheat

et al. 2018

The 12th Conference of the International Sports Engineering Association

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Abstract:Increased tibial acceleration has been found to be an important risk factor for tibial stress fractures. Interventions aimed at reducing this variable which found a beneficial effect include the use of biofeedback in gait retraining. However, no studies have focused on the time participants take to modify tibial acceleration, therefore we aimed to find the start of a learning plateau in this study. Six participants ran on a treadmill while multisensory feedback was given. A single-subject analysis was used to characterise the learning effects. All participants changed peak tibial acceleration within the first step of running in the feedback condition. Two participants further reduced tibial acceleration to reach a plateau within 120 steps. In four of the six participants a strong effect of the feedback was still present after a week. Further research is needed to optimise the use of biofeedback in reducing the prevalence of tibial stress fractures.

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The Incidence and Distribution of Stress Fractures in Competitive Track and Field Athletes

Cited by 357 publications

References 41 publications

Effect of fasting versus feeding on the bone metabolic response to running

Effect of fasting versus feeding on the bone metabolic response to running

Family History Predicts Stress Fracture in Active Female Adolescents

Characterizing the Learning Effect in Response to Biofeedback Aimed at Reducing Tibial Acceleration during Running

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