Bone stress injury

NewsBot · May 28, 2024

Factors Associated With High-Risk and Low-Risk Bone Stress Injury in Female Runners: Implications for Risk Factor Stratification and Management
Adam S. Tenforde, MD et al
Source

Background:
Bone stress injury (BSI) is a common overuse injury in active women. BSIs can be classified as high-risk (pelvis, sacrum, and femoral neck) or low-risk (tibia, fibula, and metatarsals). Risk factors for BSI include low energy availability, menstrual dysfunction, and poor bone health. Higher vertical load rates during running have been observed in women with a history of BSI.
Purpose/Hypothesis:
The purpose of this study was to characterize factors associated with BSI in a population of premenopausal women, comparing those with a history of high-risk or low-risk BSI with those with no history of BSI. It was hypothesized that women with a history of high-risk BSI would be more likely to exhibit lower bone mineral density (BMD) and related factors and less favorable bone microarchitecture compared with women with a history of low-risk BSI. In contrast, women with a history of low-risk BSI would have higher load rates.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
Enrolled were 15 women with a history of high-risk BSI, 15 with a history of low-risk BSI, and 15 with no history of BSI. BMD for the whole body, hip, and spine was standardized using z scores on dual-energy x-ray absorptiometry. High-resolution peripheral quantitative computed tomography was used to quantify bone microarchitecture at the radius and distal tibia. Participants completed surveys characterizing factors that influence bone health—including sleep, menstrual history, and eating behaviors—utilizing the Eating Disorder Examination Questionnaire (EDE-Q). Each participant completed a biomechanical assessment using an instrumented treadmill to measure load rates before and after a run to exertion.
Results:
Women with a history of high-risk BSI had lower spine z scores than those with low-risk BSI (–1.04 ± 0.76 vs –0.01 ± 1.15; P < .05). Women with a history of high-risk BSI, compared with low-risk BSI and no BSI, had the highest EDE-Q subscores for Shape Concern (1.46 ± 1.28 vs 0.76 ± 0.78 and 0.43 ± 0.43) and Eating Concern (0.55 ± 0.75 vs 0.16 ± 0.38 and 0.11 ± 0.21), as well as the greatest difference between minimum and maximum weight at current height (11.3 ± 5.4 vs 7.7 ± 2.9 and 7.6 ± 3.3 kg) (P < .05 for all). Women with a history of high-risk BSI were more likely than those with no history of BSI to sleep <7 hours on average per night during the week (80% vs 33.3%; P < .05). The mean and instantaneous vertical load rates were not different between groups.
Conclusion:
Women with a history of high-risk BSI were more likely to exhibit risk factors for poor bone health, including lower BMD, while load rates did not distinguish women with a history of BSI.
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NewsBot · Aug 21, 2024

Bone stress injuries in athletics (track and field) championships: findings from a prospective injury surveillance conducted across 24 international championships with 29,147 registered athletes
Tim Hoenig et al
BMC Sports Sci Med Rehabil. 2024 Aug 15;16(1):173

Background: Athletics (track and field) athletes are prone to develop bone stress injuries (BSIs) but epidemiological data on BSIs from top-level sports events are scarce.

Objective: To describe the incidence and characteristics of BSIs during 24 international athletics championships held from 2007 to 2023.

Methods: BSI-related data were prospectively collected during 24 international athletics championships, including the Olympic Games (n = 3), World Outdoor Championships (n = 4), European Outdoor Championships (n = 6), World Indoor Championships (n = 3) and European Indoor Championships (n = 8). Descriptive and comparative statistics were used to assess the epidemiological characteristics of BSIs.

Results: BSIs accounted for 1.5% of all reported injuries (n = 36; 1.2 per 1000 registered athletes (95%CI 0.8 to 1.6)). No significant difference of BSI incidence was detected between female (2.0 per 1000 athletes (95%CI: 0.9 to 2.3)) and male athletes (0.9 per 1000 athletes (95%CI: 0.4 to 1.4)) (relative risk (RR) = 1.73, 95%CI: 0.88 to 3.40). BSI incidence was significantly higher during outdoor championships (1.6 per 1000 registered athletes (95%CI: 1.0 to 2.1)) as compared to indoor championships (0.2 per 1000 registered athletes (95%CI: 0.0 to 0.5)) (RR = 10.4, 95%CI: 1.43 to 76.0). Most BSIs were sustained in the foot (n = 50%) or leg (n = 33%). BSIs were reported in athletes participating in endurance disciplines (52.8%) or in explosive disciplines (47.2%).

Conclusions: BSIs represent a small portion of injuries sustained during international athletics championships. Collective results suggest that injury rates are higher in outdoor competitions as compared to indoor competitions. The most common injury locations comprise the foot and leg.
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NewsBot · Oct 21, 2024

Can Trabecular Bone Score Enhance Fracture Risk Assessment in Long-Distance Runners With Bone Stress Injuries?
Madi, Rashad et al
Clinical Journal of Sport Medicine ():10.1097/JSM.0000000000001279, October 15, 2024. | DOI: 10.1097/JSM.0000000000001279

Objective:
To evaluate the trabecular bone score (TBS) Z scores in long-distance runners with bone stress injuries (BSIs) in whom the bone mineral density (BMD) Z score is more than −1.0 (Aim 1) and whether the number of runners with abnormal TBS Z scores would be higher in those with BSI in trabecular-rich sites as compared with cortical-rich sites (Aim 2).

Design:
Retrospective cohort study.

Setting:
Institutional sports medicine center.

Patients:
We analyzed Z scores derived from the TBS and BMD in 44 long-distance runners aged 18 to 40 years who had sustained BSIs between 2017 and 2023 and undergone a dual-energy x-ray absorptiometry scan with reported TBS measurements within 1 year before or 2 years after their injuries.

Independent Variables:
Bone mineral density and TBS Z scores.

Main Outcome Measures:
Evaluation of BMD and TBS Z scores in long-distance runners with BSIs, further stratified according to cortical-rich and trabecular-rich BSIs.

Results:
Bone mineral density assessments revealed an average Z score of −0.96 ± 0.99. In this cohort of 44 runners, 55% (n = 24) of runners were reported to have BMD Z score more than −1.0. Within this subgroup, 54% (n = 13) displayed abnormal TBS. Stratifying BSIs by trabecular- (n = 23) and cortical-rich (n = 19) sites, we found no significant difference in sex, mean BMD, or the number of runners with abnormal TBS between the 2 groups.

Conclusions:
Trabecular bone score Z scores in sports medicine may provide complementary information to BMD in long-distance runners with BSI, particularly when the BMD Z scores are more than −1.0. However, further research is needed to validate the usefulness of TBS Z scores in this context.
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NewsBot · Nov 13, 2024

Diagnostic Accuracy of Dual-Energy CT for Bone Stress Injury of the Lower Limb
Giovanni Foti et al
Radiology. 2024 Nov;313(2):e232415

Background Because of its ability to help assess the presence of subtle morphologic changes in bone and bone marrow edema, dual-energy CT (DECT) could be an alternative to MRI in the diagnosis of bone stress injury that includes a stress fracture (SF) and stress reaction (SR). Purpose To determine the diagnostic accuracy of DECT in identifying bone stress injury of the lower limb using MRI as the reference standard. Materials and Methods This prospective study, conducted between June 2021 and January 2024, included consecutive patients clinically suspected of having stress injury (SF or SR) of the lower limb (leg, ankle, or foot). Imaging diagnosis was based on the absence or presence of cortical or periosteal changes, bone marrow edema, or a fracture line. The diagnostic performance of four blinded independent readers was determined for the entire cohort and for the subset of participants without fracture lines. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Interobserver agreement was evaluated with Kendall coefficient of concordance (W). Results A total of 184 patients (mean age, 58 years ± 17 [SD]; 97 male) were enrolled. At MRI, 107 of 184 participants (58%) had positive diagnoses, including 70 with SF and 37 with SR. The mean overall sensitivity and specificity were 91% (390 of 428; 95% CI: 0.85, 0.95) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.94 (95% CI: 0.91, 0.97). Among patients without fracture lines (n = 114), the mean overall sensitivity and specificity of DECT were 79% (117 of 148; 95% CI: 0.65, 0.88) and 93% (287 of 308; 95% CI: 0.87, 0.97), respectively, with an AUC of 0.87 (95% CI: 0.81, 0.94). The interobserver agreement was very good for diagnosis of SF and SR combined (Kendall W = 0.90) and SR alone (Kendall W = 0.84). Conclusion DECT helped to accurately diagnose bone stress injury of the lower limb by identifying fracture lines and osseous stress reactions.
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NewsBot · Dec 6, 2024 at 5:19 AM

Consensus statement
International Delphi consensus on bone stress injuries in athletes
Tim Hoenig et al
BJSM

Bone stress injuries, commonly referred to as stress reactions and stress fractures, represent overuse injuries to bone. These injuries result in physical limitations in activity and can be career-ending for high-level athletes. While bone stress injuries have received increased attention in recent years, international consensus is lacking on definitions, risk factors and strategies for management and prevention. This study aimed to ascertain and improve the level of agreement on bone stress injuries by utilising a three-part modified Delphi approach on (1) pathophysiology, diagnosis, terminology and classification systems; (2) risk factors, screening and prevention; and (3) management and return to sport. A multidisciplinary steering committee initiated the consensus process. A panel of 41 members from six continents was formed to complete three rounds of voting, including experts (scientists and clinicians) and representatives (athletes and coaches). Thirty-three, 28 and 28 panel members completed Delphi rounds 1, 2 and 3, respectively. Consensus was reached on 41 out of 58 statements. Findings from this Delphi study outline a multifactorial approach to identify and manage bone stress injuries and to promote bone health in athletes. This includes recommendations for diagnostic workup and treatment to assist clinicians in caring for patients with bone stress injuries. Finally, this consensus process identifies knowledge gaps and provides a framework for future research to advance the clinical care and prevention of bone stress injuries.
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Bone stress injury

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Bone quality and stress fractures

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Bone stress injury

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Bone Stress in Runners with Tibial Stress Fracture

Stress distribution comparisons of foot bones in patient with tibia vara: a finite element study

Medial tibial stress syndrome and bone marrow edmea

'Therapeutic Ultrasound' Shows Bone Stress Injuries

Stress Fracture of the Fifth Metatarsal Bone as a Late Complication of Total Knee Arthroplasty

Bone quality and stress fractures

"Silent" bone stress injuries in the feet of diabetic patients

Share This Page

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