Part I: epidemiology and risk factors for stress fractures in female athletes

Abbott, Alexandra; Bird, Mackenzie L.; Wild, Emily; Brown, Symone M.; Stewart, Greg; Mulcahey, Mary K.

doi:10.1080/00913847.2019.1632158

Cited by 41 publications

(53 citation statements)

References 52 publications

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“…Stress fractures are bone injuries related to repeated mechanical stress on the bones over time that occur over a spectrum, from stress reactions (microdamage of the bone with edema) to stress fractures, where small bone fractures are visible on radiographs or magnetic resonance imaging (MRI). The prevalence of stress fractures in athletes ranges from 0.7% to 21% 1,3 in published reports.…”

mentioning

confidence: 99%

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

Millward

Root

Dubois

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Low vitamin D levels along with high-intensity athletic training may put an athlete at increased risk for a stress fracture. Purpose: To assess whether supplementation with vitamin D is associated with a reduced risk of stress fractures in college athletes. We also assessed differences in vitamin D levels among athletes participating in outdoor versus indoor sports. Study Design: Cohort study; Level of evidence, 2. Methods: The study participants included 802 National Collegiate Athletic Association Division I intercollegiate athletes (497 men and 305 women) on a sports team for at least 1 semester from 2012 to 2018. All athletes who had a baseline vitamin D level in their medical record were included. Athletes with vitamin D levels <40 ng/mL were given vitamin D supplements. We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to ≥40 ng/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor). Results: The rate of stress fracture was 12% higher (95% CI, 6-19; P < .001) for those who remained low in vitamin D compared with those who were low at baseline but improved their vitamin D status to ≥40 ng/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P < .001) for those who had low vitamin D levels compared with those who maintained normal levels. The mean baseline vitamin D values were significantly higher for men participating in outdoor sports versus indoor sports. For men, the mean vitamin D level was 5.7 ng/mL higher (95% CI, 0.9-10.5; P = .01) in outdoor athletes. For women, the mean vitamin D level was 3.7 ng/mL higher (95% CI, –0.58 to 8.03; P < .04) for outdoor versus indoor sports. Conclusion: Study results indicated that correcting low serum vitamin D levels reduces the risk of stress fracture. This study also presented evidence that athletes who participate in indoor sports may be at greater risk for vitamin D deficiency than those who compete in outdoor sports.

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confidence: 99%

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

Millward

Root

Dubois

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…A study analyzed the distribution by type of sport on the basis of 671 stress fractures in 11,778,145 athletes [116]. The lower extremity represents 80-95% of all stress fractures and the increased popularity of endurance running has contributed to the tibia (49% prevalence) replacing the metatarsals (9%) as the most common location for lower extremity stress fractures [123].…”

Section: Localization Of Stress Fracturesmentioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

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“…Bone stress injuries (BSIs), specifically stress fractures, account for approximately 10% of all orthopedic injuries and as much as 20% of injuries managed in sports medicine clinics (Pegrum et al, 2014;Changstrom et al, 2015;Abbott et al, 2019a). As many as 22% are recurrent, require prolonged recovery (>3 weeks), and can often be season or career ending injuries (Wentz et al, 2011;Changstrom et al, 2015;Rizzone et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…These high rates and sequelae underscore the significant impact that BSIs have on both the healthcare system's ability to provide optimal care and individuals who experience a multitude of short-and long-term effects. In the short-term, BSIs cause pain, time loss from sport, and disability (Miller and Best, 2016;Abbott et al, 2019a). Longterm effects range from increased risk of re-injury, decreased bone health, and financial burden (Miller and Best, 2016;Rizzone et al, 2017;Abbott et al, 2019a).…”

Section: Introductionmentioning

confidence: 99%

“…In the short-term, BSIs cause pain, time loss from sport, and disability (Miller and Best, 2016;Abbott et al, 2019a). Longterm effects range from increased risk of re-injury, decreased bone health, and financial burden (Miller and Best, 2016;Rizzone et al, 2017;Abbott et al, 2019a). Therefore, it is incumbent on healthcare providers to reexamine current practices and strive for better outcomes in recognizing and managing athletes with BSIs.…”

Section: Introductionmentioning

confidence: 99%

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Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach

Hamstra-Wright¹,

Bliven²,

Napier³

2021

Front. Sports Act. Living

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Bone stress injuries (BSIs) are a common orthopedic injury with short-term, and potentially long-term, effects. Training load capacity, influenced by risk factors, plays a critical role in the occurrence of BSIs. Many factors determine how one's body responds to repetitive loads that have the potential to increase the risk of a BSI. As a scientific community, we have identified numerous isolated BSI risk factors. However, we have not adequately analyzed the integrative, holistic, and cumulative nature of the risk factors, which is essential to determine an individual's specific capacity. In this narrative review, we advocate for a personalized approach to monitor training load so that individuals can optimize their health and performance. We define “cumulative risk profile” as a subjective clinical determination of the number of risk factors with thoughtful consideration of their interaction and propose that athletes have their own cumulative risk profile that influences their capacity to withstand specific training loads. In our narrative review, we outline BSI risk factors, discuss the relationship between BSIs and training load, highlight the importance of individualizing training load, and emphasize the use of a holistic assessment as a training load guide.

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Part I: epidemiology and risk factors for stress fractures in female athletes

Cited by 41 publications

References 52 publications

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach

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