Current Concepts Review: Stress Fractures of the Foot

Gehrmann, Robin M.; Renard, Régis

doi:10.1177/107110070602700919

Cited by 55 publications

(121 citation statements)

References 44 publications

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“…Inadequate bone remodelling can contribute to the development of stress fracture injury [6], alongside a number of environmental risk factors, including diet and nutrition, training status, training environment and individual biomechanics [7,8]. A genetic contribution to stress fracture risk is likely given that certain individuals present with multiple stress fractures at various skeletal sites [9], comparable stress fracture injuries occurring in monozygotic twins [10], high stress fracture recurrence rates [11], variable stress fracture incidence in military recruits who are exposed to equivalent training loads [12] and candidate gene studies investigating stress fracture prevalence [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Functional polymorphisms in the P2X7 receptor gene are associated with stress fracture injury

Varley

Greeves²,

Sale

et al. 2016

Purinergic Signalling

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Military recruits and elite athletes are susceptible to stress fracture injuries. Genetic predisposition has been postulated to have a role in their development. The P2X7 receptor (P2X7R) gene, a key regulator of bone remodelling, is a genetic candidate that may contribute to stress fracture predisposition. The aim of this study is to evaluate the putative contribution of P2X7R to stress fracture injury in two separate cohorts, military personnel and elite athletes. In 210 Israeli Defense Forces (IDF) military conscripts, stress fracture injury was diagnosed (n = 43) based on symptoms and a positive bone scan. In a separate cohort of 518 elite athletes, selfreported medical imaging scan-certified stress fracture injuries were recorded (n = 125). Non-stress fracture controls were identified from these cohorts who had a normal bone scan or -016-9495-6 no history or symptoms of stress fracture injury. Study participants were genotyped for functional SNPs within the P2X7R gene using proprietary fluorescence-based competitive allelespecific PCR assay. Pearson's chi-squared (χ 2 ) tests, corrected for multiple comparisons, were used to assess associations in genotype frequencies. The variant allele of P2X7R SNP rs3751143 (Glu496Ala-loss of function) was associated with stress fracture injury, whilst the variant allele of rs1718119 (Ala348Thr-gain of function) was associated with a reduced occurrence of stress fracture injury in military conscripts (P < 0.05). The association of the variant allele of rs3751143 with stress fractures was replicated in elite athletes (P < 0.05), whereas the variant allele of rs1718119 was also associated with reduced multiple stress fracture cases in elite athletes (P < 0.05). The association between independent P2X7R polymorphisms with stress fracture prevalence supports the role of a genetic predisposition in the development of stress fracture injury.

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Section: Introductionmentioning

confidence: 99%

Functional polymorphisms in the P2X7 receptor gene are associated with stress fracture injury

Varley

Greeves²,

Sale

et al. 2016

Purinergic Signalling

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“…Any intrinsic and extrinsic factor that disrupts this dynamic balance can increase the risk of stress fracture. Intrinsic factors include metabolic state, menstrual patterns, level of fitness, muscle endurance, anatomic alignment, and bone vascularity [27,33]. Extrinsic factors include training regimens, nutritional or dietary habits, and playing equipment (footwear, playing surface, etc.).…”

Section: Discussionmentioning

confidence: 99%

Use of bisphosphonates for the treatment of stress fractures in athletes

Shima

Engebretsen

Iwasa

et al. 2008

Knee Surg Sports Traumatol Arthrosc

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A literature review was performed to investigate the potential role of bisphosphonates (BPs) for the treatment of stress fractures in athletes. Given the inhibitory action on osteoclast-mediated bone resorption, short-term suppression of bone remodeling using BPs could potentially treat stress fractures and prevent stress fractures to become regular fractures. To date, while there are some animal studies showing the scientific basis of BPs on stress fractures, we must say that there is still no conclusive evidence to prove any effect of BPs on stress fracture healing in humans. Further well-designed clinical trials should be carried out to establish their usefulness and safety. Until the results are available, it is prudent to limit the use of BPs for the treatment of stress fractures.

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“…The underlying cause(s) of SFs are unknown, although various authors have suggested mechanical, environmental, behavioral, or genetic factors predispose individuals to subsequent SFs [8,9,28,42].…”

Section: Introductionmentioning

confidence: 98%

“…Multiple lines of indirect evidence point to genetic factors contributing to SF pathogenesis, specifically, reports of multiple SFs affecting monozygotic twins [29], multiple lower limb SFs in single individuals [19,23,26], high recurrence rate (approximately 10% in a year) of SFs in different anatomic sites in Israel Defense Force (IDF) recruits [9], occurrence of SFs in the pediatric age group [2,17,20,22,25,32,36], and the interindividual variation in SF incidence given the similar training load among soldiers in the same unit [10,21,24]. In some studies relating to predisposing factors of SFs, little or no mention is given to family history of bone diseases [16,24,27].…”

Section: Introductionmentioning

confidence: 99%