Stress fractures and premenstrual syndrome

NewsBot · Nov 1, 2016

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Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study
Takashi Takeda, Yoko Imoto, Hiroyo Nagasawa, Atsuko Takeshita, Masami Shiina
BMJ Open 2016;6:e013103 doi:10.1136/bmjopen-2016-013103

Objectives To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes.

Design Cross-sectional study.

Setting Osaka, Japan.

Participants A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25–38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career.

Main outcome measure Premenstrual symptoms and the occurrence of stress fracture.

Results The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed ‘Work efficiency or productivity, home responsibilities’, ‘Relationships with coworkers or family’ and ‘Athletic performance in training or competition’ more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of ‘Overeating or food cravings’, ‘Physical symptoms’ and ‘Performance in training or competition’ in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, ‘Physical symptoms’ was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62).

Conclusions The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes.
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Admin2 · Nov 2, 2016

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NewsBot · Nov 10, 2017

Stress Fracture Influences Bone Resorption marker (u-NTX) in Female Long Distance Runners
Shimpei Fujita et al
Int J Sports Med; DOI: 10.1055/s-0043-119223

In this study, we aim to clarify the influence based on bone resorption markers at onset of stress fracture. Also, we will clarify the state of the bone resorption markers of female long distance runners who have a history of stress fracture and also ones who routinely practices running long distances. Participants comprised 19 female long distance athletes. The survey period was 2011–2014, and we measured u-NTX as a bone resorption marker at least twice a year, taking the mean±SD of the periodic measured values without stress fracture as the mean value. Measurements were collected sample when stress fractures developed. 132 u-NTX measurements were taken from 19 participants. As a result, the average was 41.03±12.31 nmolBCE/mmolCRE (Q1: 33.15, Q2: 40.55, Q3: 47.95). In six of the 19 participants, u-NTX could be measured following a stress fracture. The mean value of u-NTX for those participants was 40.16±9.10 nmolBCE/mmolCRE, increasing to 64.08±16.07 nmolBCE/mmol CRE with the stress fracture (p<0.01). The findings showed that, in adult female long distance runners, u-NTX values when there was no stress fracture were within the standard value for mean premenopausal women, but increased when the athletes suffered from a stress fracture.
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NewsBot · May 1, 2019

Geometric and “True” Densitometric Characteristics of Bones in Athletes with Stress Fracture and Menstrual Disturbances: A Systematic Review
Rebecca J. MallinsonEmily A. SouthmaydMary Jane De Souza
Sports Medicine: 30 April 2019

Background
Stress fractures can lead to short- and long-term consequences, impacting participation in sport and general health. Recognizing which skeletal characteristics render bones susceptible to stress fracture may aid stress-fracture prevention. Menstrual disturbances among exercising women are a known risk factor for stress fracture; therefore, assessing skeletal commonalities between women with stress fractures and women with menstrual disturbances may increase our understanding of why menstrual disturbances put athletes at greater risk for stress fracture. Three-dimensional (3D) bone imaging tools provide detailed information about volumetric bone mineral density (vBMD) and bone structure that cannot be obtained using traditional two-dimensional (2D) techniques.

Objectives
This systematic review serves to: (1) evaluate the current literature available on vBMD, bone geometry, and bone structure in exercising women with menstrual disturbances and exercising women with stress fractures, and (2) assess the common skeletal characteristics between both conditions. Our aim is to reveal bone properties beyond 2D areal BMD that may indicate increased susceptibility to stress fracture among exercising women with menstrual disturbances.

Search Methods
A search of the PubMed/Medline database was completed in May 2018.

Eligibility Criteria
Eligible articles included those that reported vBMD, bone geometry, or bone structure obtained from 3D imaging techniques or estimated from 2D imaging techniques. Only studies conducted in premenopausal exercising women and girls who had a stress fracture, a menstrual disturbance, or both were included.

Results
Twenty-four articles met the inclusion criteria. Bone area and cortical thickness at the tibia were identified as altered both in women with menstrual disturbances and in women with stress fractures; however, there was inconsistency in the results observed for all bone parameters. The majority of skeletal parameters of the lower extremities were not significantly different between exercising women with and without stress fractures and between those with and without menstrual disturbances.

Discussion
Most studies were moderate or low quality based on study design, and only one article combined both conditions to explore vBMD and bone geometry in athletes with menstrual disturbances and a history of stress fracture. These findings highlight the need for more skeletal research on the intersection of these health conditions in exercising women. The lack of observed differences in skeletal parameters suggests that risk factors other than bone geometry and structure may be the primary causes of stress fracture in these women.
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NewsBot · Jun 16, 2020

Physiological Factors of Female Runners With and Without Stress Fracture Histories: A Pilot Study
Therese E. Johnston, PT, PhD, MBA, Colleen Dempsey, RT, EdD, Frances Gilman, RT, DHSc, ...
Sports Health: A Multidisciplinary Approach June 11, 2020

Background:
Female runners are at increased risk of stress fractures (SFs) compared with men. Literature is lacking with regard to best practice for preventing and treating SFs in women. The purpose of the study was to compare physiological measures and running-related factors between women of various ages and running abilities with and without a history of running-related SFs.

Hypothesis:
Women with and without SF histories will differ with regard to medical and menstrual history, bone health, body composition, nutrition, and running history.

Study Design:
Prospective cohort study.

Level of Evidence:
Level 2.

Methods:
A total of 20 female runners with SF histories were matched based on age and running distance with 20 women without SF histories. Data included medical, menstrual, running, injury, and nutritional histories; blood histology related to nutritional, hormonal, and bone-related risk factors; and bone density, fat, and lean tissue using dual energy x-ray absorptiometry. Paired t tests were used to examine differences between women with and without SF histories, and Spearmen correlations were conducted to examine relationships between physiological factors.

Results:
Women with SF histories had lower hip bone mineral density compared with women without SF histories (P < 0.05). SF history was moderately correlated with menstrual changes during increased training times (r = 0.580; P < 0.0001) but was not correlated with any other physiological factor. There was a moderate correlation within the SF group (r = 0.65; P = 0.004) for bone markers for resorption and formation both increasing, indicating increased bone turnover.

Conclusion:
Female runners with low hip bone mineral density, menstrual changes during peak training, and elevated bone turnover markers may be at increased risk of SF.

Clinical Relevance:
Female runners need routine screening for risks associated with SF occurrence. As bone mineral density and bone turnover markers are not routinely assessed in this population, important risk factors may be missed.
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NewsBot · Jun 22, 2020

Relationship between tartrate‐resistant acid phosphatase 5b and stress fractures in female athletes
Sayaka Nose‐Ogura Osamu Yoshino Michiko Dohi Suguru Torii Mika Kigawa Miyuki Harada Osamu Hiraike Takashi Kawahara Yutaka Osuga Tomoyuki Fujii Shigeru Saito
15 June 2020

Background
Approximately 10% of female athletes have a history of stress fractures, which most commonly occur between the ages of 16 and 17 years old.

Purpose
We investigated whether tartrate‐resistant acid phosphatase 5b (TRACP‐5b), which is a bone resorption marker, can serve as a valid predictor of stress fractures in female athletes in their teens and 20s.

Methods
Three hundred and sixteen elite female athletes were recruited between 2013 and 2015. Serum TRACP‐5b and various hormones were examined in blood samples. The serum TRACP‐5b level was compared between athletes with and without stress fractures within 3 months after the initial collection of their blood samples.

Results
The 316 athletes were divided into two age groups: 13–19 years old and 20–29 years old. Thirty‐six athletes (11.4%) experienced new stress fractures within 3 months after the initial collection of their blood samples. The median serum TRACP‐5b level was significantly higher in teenage athletes with new stress fractures than in teenage athletes without new stress fractures. In univariate logistic regression analysis, the Z‐score of serum TRACP‐5b was a significant predictive factor of stress fractures in teenage athletes only (odds ratio: 1.87; 95% CI: 1.31–2.66; P < 0.0012).

Conclusion
For teenage female athletes, TRACP‐5b is a predictor of the risk of stress fractures, and measuring TRACP‐5b levels may be useful to prevent stress fractures.
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NewsBot · Nov 18, 2020

Risk Factors Associated With Foot and Ankle Insufficiency Fractures in Postmenopausal Sedentary Women
Miguel Viana Pereira Filho, MD, MSc, Kelly Cristina Stéfani, MD, PhD, Gabriel Ferraz Ferreira, MD, MSc, ...
Foot & Ankle International November 17, 2020

Background:
Insufficiency fractures occur in bones with low elastic resistance. In contrast to stress fractures, which affect normal bones and have been extensively studied, insufficiency fractures of the foot and ankle have been the subject of little research. The objective of this study was to identify risk factors associated with the development of foot and ankle insufficiency fractures.

Methods:
The study included 55 postmenopausal sedentary women with foot and ankle insufficiency fractures and 51 women in the control group. The data collected were the fracture site, body mass index, use of corticosteroids, T scores of the femur and lumbar spine measured by bone densitometry, and serum 25-OH vitamin D level. The calcaneal pitch (CP), talar–first metatarsal, and metatarsus adductus (MA) angles were measured on radiographs.

Results:
In 49 patients (89%), fractures occurred in the metatarsals. All metatarsals were affected, and the most common fracture site was the base of the fifth metatarsal, with 21 cases (33%). Twenty patients (36%) in the study group reported chronic use of corticosteroids and had lower bone mineral density levels than controls (P < .05). The factors associated with fracture development (P < .05) were the CP and MA angles and low lumbar bone mineral density.

Conclusion:
Insufficiency fractures in this population were associated with low bone mineral density and unfavorable biomechanical characteristics such as pes cavus and metatarsus adductus.
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NewsBot · Apr 25, 2021

Physical Activity, Menstrual History, and Bone Microarchitecture in Female Athletes with Multiple Bone Stress Injuries
Rudolph, Sara E et al
Medicine & Science in Sports & Exercise: April 7, 2021

Bone stress injuries (BSIs) occur in up to 20% of runners and military recruits and those with a history of BSI have a 5-fold higher risk for a subsequent BSI. Yet, little is known about prior training, menstrual status and bone structure in runners who experience multiple BSIs.

PURPOSE
To determine differences in health and physical activity history, bone density, microarchitecture, and strength among female athletes with a history of multiple BSI, athletes with ≤1 BSI, and non-athletes.

METHODS
We enrolled 101 women (ages 18-32 years) for this cross-sectional study: non-athlete controls (n=17) and athletes with a history of ≥ 3 BSIs (n=21) or ≤1 BSI (n=63). We collected subjects’ health and training history and measured bone microarchitecture of the distal tibia via high-resolution peripheral quantitative computed tomography (HR-pQCT) and areal bone mineral density (aBMD) of the hip and spine by dual-energy X-ray absorptiometry (DXA).

RESULTS
Groups did not differ according to age, BMI, age at menarche, aBMD, or tibial bone microarchitecture. Women with multiple BSIs had a higher prevalence of primary and secondary amenorrhea (p<0.01) compared to other groups. Total hours of physical activity in middle school were similar across groups; however, women with multiple BSIs performed more total hours of physical activity in high school (p=0.05), more hours of uniaxial loading in both middle school and high school (p=0.004, p=0.02) and a smaller proportion of multiaxial loading activity compared to other groups.

CONCLUSION
These observations suggest that participation in sports with multiaxial loading and maintaining normal menstrual status during adolescence and young adulthood may reduce the risk of multiple bone stress injuries.
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NewsBot · Dec 5, 2021

Sex Differences in the Incidence and Risk of Ankle-Foot Complex Stress Fractures Among U.S. Military Personnel
Andrew J MacGregor et al
J Womens Health (Larchmt). 2021 Nov 25

Background: The objective of this study was to evaluate sex differences in the incidence and risk of ankle-foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations. Materials and Methods: The Defense Medical Epidemiology Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (i.e., male and female) occupations were compared with nonintegrated (i.e., male only) occupations. Results: A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years (p-y) for males and 5.78 per 1,000 p-y for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation (relative risk [RR] = 5.74; 95% confidence interval [CI]: 4.80-6.87) and artillery/gunnery (RR = 5.15; 95% CI: 4.62-5.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and nonintegrated occupations (i.e., special forces, infantry, and mechanized/armor). Conclusions: Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.
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Stress fractures and premenstrual syndrome

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Stress fractures and premenstrual syndrome

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Stress Fractures Treated with a Carbon Rigid Stabilizer Plate Insole

Fibula stress fractures

Anterior mid‐shaft tibial stress fractures

Medial malleolus stress fractures

Stress fractures and running wearables: The mistake that could mean injuries

Shockwave Therapy and Stress Fractures

Sesamoid Stress Fractures

Share This Page

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