Bone Stress Injuries Are Associated With Differences in Bone Microarchitecture in Male Professional Soldiers

Abstract

Bone stress injuries are commonly due to repetitive loading, as often described in competitive athletes or military recruits. The underlying pathophysiology of bone stress injuries is multifactorial. The present cross-sectional study investigated (i) cortical and trabecular bone microstructure as well as volumetric bone mineral density in subjects with bone stress injuries at the tibial diaphysis, measured at the distal tibia and the distal radius by means of high-resolution peripheral quantitative computed tomography (CT), (ii) areal bone mineral density using dual-energy X-ray absorptiometry as well as calcaneal dual X-ray absorptiometry and laser, and (iii) the influence on bone turnover markers of formation and resorption at the early phase after injury. A total of 26 Caucasian male professional soldiers with post-training bone stress injury at the tibial diaphysis were included (case group). A total of 50 male, Caucasian professional soldiers from the same military institution served as controls (control group). High-resolution peripheral quantitative CT revealed a higher total area at the radius within the case group. Cortical bone mineral density was reduced at the radius and tibia within the case group. The trabecular number and trabecular thickness were reduced at the tibia in the case group. The trabecular network was more inhomogeneous at the radius and tibia within the case group. Calcaneal dual X-ray absorptiometry and laser was significantly reduced in the case group. This study quantified differences in bone microstructure among otherwise healthy individuals. Differences in bone microarchitecture may impair the biomechanical properties by increasing the susceptibility to sustain bone stress injuries.

Impaired Bone Microarchitecture at Distal Radial and Tibial Reference Locations Is Not Related to Injury Site in Athletes With Bone Stress Injury

“… 46 Our results are only partly in line with previous observations in male soldiers with BSI (n = 26) who had reduced cortical vBMD and trabecular thickness but not cortical thickness. 35 Together, these results suggest that impaired bone microarchitecture may be a relevant risk factor for BSI, but the results regarding the affected bone compartment or specific parameters are inconsistent. Our data suggest alterations occured in the cortical compartment, which became evident by comparison with a control group and adaptation of the parameters to age-, sex-, and device-specific reference data.…”

“…Few studies have elaborated on the osseous microstructural alterations in athletes with BSI, 1 , 33 , 35 , 36 , 46 albeit no study comprising biochemical, DXA, and HR-pQCT data in a comparable cohort size has been reported thus far. In our study cohort, cortical thickness and area at the distal radius and tibia as well as trabecular bone volume fraction at the distal radius were reduced compared with those in controls.…”

“…However, only a few studies have performed HR-pQCT examinations in patients with BSI. 1 , 33 , 35 , 36 , 46 Importantly, there have been no HR-pQCT studies investigating the association between alterations in bone microarchitecture and anatomic injury site. Therefore, the aim of this study was to assess bone microarchitecture by HR-pQCT in athletes with BSI and to compare findings between injury sites.…”

Bone, Biomarker, Body Composition, and Performance Responses to 8 Weeks of Reserve Officers' Training Corps Training

“…It is often estimated based on measures of bone mineral density (BMD) and content (BMC; eg, areal or volumetric density) and bone morphology and geometric properties (eg, cortical diameter or bone area). 5,6 Using both DXA and pQCT, Beck et al 5 found that recruits who presented with fractures had poorer physical fitness and body composition, smaller midthigh muscle cross-sectional area (mCSA), and less estimated thigh and tibial bone strength than uninjured recruits. Among college-aged adults at the US Naval Academy, Armstrong et al 4 reported that low total body areal BMD (aBMD) was inversely correlated with fracture risk during 8 weeks of training.…”

“…Authors of most studies in young-adult military cohorts have assessed differences between those who had already sustained a fracture and those who had not; less research has been conducted on predictors of estimated tibial bone strength using a prospective design. 6 Although DXA and pQCT provide valuable information regarding estimated bone strength, these imaging techniques cannot assess bone cell responses and are not commonly used for military health assessments, thereby reducing their utility.…”