Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury

Abstract

ObjectivesBone stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners.Methods156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with p<0.05 as threshold for significance. Two regression analyses were performed: (1) baseline risk factors as the independent variable; and (2) annual change in risk factors (longitudinal data) as the independent variable.Results42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI.ConclusionA modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.

The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes

“…Similarly, reports on bone strength, geometry, and structure in exercising men with low BMD and bone stress injuries are not yet available. However, there is evidence that particular subsets of male athletes, such as male distance runners, who are at high risk for having low energy availability are also reported to have low BMD scores [8, 68] and a high prevalence of bone stress injuries [7, 69]. Additionally, there is evidence that bone turnover markers are influenced by periods of energy restriction [22, 70].…”

“…In addition to low BMD scores, male athletes are also reported to have a high incidence of bone stress injuries [7, 69]. Among 80 collegiate runners, 27% sustained at least one bone stress injury over a prospective 2-year period [7].…”

“…In addition to low BMD scores, male athletes are also reported to have a high incidence of bone stress injuries [7, 69]. Among 80 collegiate runners, 27% sustained at least one bone stress injury over a prospective 2-year period [7]. Further, bone stress injuries were predicted by a modified version of the Female Athlete Triad Cumulative Risk Assessment tool that was adapted in a manner to be applicable to male athletes and included low energy availability, low body mass index (BMI), prior bone stress injury, and low BMD as risk factors [7].…”

Measurement, Determinants, and Implications of Energy Intake in Athletes

“…Men cannot suffer from menstrual dysfunction, however, work pioneered by Hackney has identified a corollary in men termed the “exercise-hypogonadal male condition” [89]. Similar effects of low EA in Triad have been identified and reviewed in males [90] and recent research has identified that bone stress injuries occur more often in men who have elevated Triad risk assessment scores (modified for men) [91]. Proposals of a “male athlete triad” are in their infancy [92].…”

Optimal Human Functioning Requires Exercise Across the Lifespan: Mobility in a 1g Environment Is Intrinsic to the Integrity of Multiple Biological Systems

“…Individuals can present with one or more of these Triad components (DeSouza et al, 2014). For male distance runners, Kraus et al (2019) recently published a 7-year retrospective and prospective study of the bone stress injury rates of 156 male United States collegiate distance runners. They used applicable risk assessment categories from a "modified" Female Athlete Triad and discovered that male runners presented with risk factors for bone stress injuries that paralleled those found in female runners as described by the Female Athlete Triad, including ".…”