Prediction Model for Stress Fracture in Young Female Recruits during Basic Training

Moran, Daniel S.; Israeli, Eran; Evans, Rachel; Yanovich, Ran; Constantini, Naama; Shabshin, Nogah; Merkel, Drorit; Luria, Orit; Erlich, Tomer; Laor, Arie; Finestone, Aharon S.

doi:10.1249/mss.0b013e3181893164

Cited by 46 publications

(31 citation statements)

References 35 publications

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“…Many clinical risk factors of stress fractures have been identified. In particular, polymorphism of vitamin D receptor (Fokl and Bsml), vitamin D insufficiency, low bone mass, low body mass index, poor physical fitness/condition, gender (female), low bone turnover, and amenorrhea were suggested to be clinical risk factors of stress fractures [4][5][6][7][8][9][10][11] . One athlete in our study who sustained a stress fracture had vitamin D insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Epidemiological studies have identified the clinical risk factors of stress fractures in athletes and military recruits. The etiology of stress fractures is multifactorial and many clinical risk factors have been identified; polymorphism of vitamin D receptor (Fokl and Bsml) [4] , low serum levels of 25(OH)D [5] , high serum parathyroid hormone level [6] , low stiffness index (heel quantitative ultrasound parameter) [4,7] , low bone mineral content and density (BMC and BMD, respectively) of the hip [6] , tall stature [6,8] , leanness [8] , poor physical fitness/condition [6,9,10] , sense of burnout [8] , iron deficiency [8] , higher age [9] , gender (female) [9,11] , low bone turnover [7] , smoking [10] , and amenorrhea [10] . However, no consensus has been reached.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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AIM:To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS:We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS:During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION:The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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“…42 While randomized clinical trials for studying if iron supplements improve bone integrity and strength are lacking, there are two studies that offer strong indirect evidence that iron may enhance bone strength. Moran et al 43 evaluated risk factors that might predict stress fractures among Israeli soldiers during the four-month basic training period in both males and females. Males did not develop stress fractures during basic training, but 27 females developed stress fractures.…”

Section: Human Studiesmentioning

confidence: 99%

Copper, iron, and selenium dietary deficiencies negatively impact skeletal integrity: A review

Medeiros

2016

Exp Biol Med (Maywood)

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Nutrients have been known to have a significant role in maintaining the health of the skeleton, both bone and cartilage. The nutrients that have received the majority of the attention are Vitamin D and calcium. However, limited attention has been directed toward three trace elements that may have mechanistic impact upon the skeletal tissues and could compromise skeletal health resulting from inadequate intakes of copper, iron, and selenium. The role of copper and selenium has been known, but the role of iron has only received recent attention. Copper deficiency is thought to impact bone health by a decrease in lysyl oxidase, a copper-containing enzyme, which facilitates collagen fibril crosslinking. Iron deficiency impact upon bone has only recently been discovered but the exact mechanism on how the deficient states enhance bone pathology is speculative. Selenium deficiency has an impact on cartilage thereby having an indirect impact on bone. However, several studies suggest that a mycotoxin when consumed by humans is the culprit in some cartilage disorders and the presence of selenium could attenuate the pathology. This review summarizes the current knowledge base with respect to skeletal integrity when each of these three trace elements are inadequate in diets of both animals and humans.

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“…Examination of female US Marine Corps recruits identifi ed low aerobic fi tness and <7 months of pre-boot camp lower-extremity weight training as risk factors for stress fracture in logistic regression modeling [ 18 ], while in a large cohort of 2,345 Finnish women military personnel, poor muscle strength and a poor result in a 12 min run were associated with bone stress injuries [ 8 ]. An interesting fi nding associated the subjective report of "burnout" with stress fracture in female Israeli military recruits in basic training [ 19 ]. A systematic review of stress fractures in both athletic and military populations speculated that overall physical fi tness is more important to injury risk than other factors, with the observed increased prevalence in women possibly attributable to poorer pre-activity fi tness, which has typically not been measured, either in studies or routine pre-participation evaluations [ 10 ].…”

Section: Intrinsic Factorsmentioning

confidence: 99%

“…Starting with Myburgh's sentinel 1990 matched case-control study of 38 adult female runners, there has been a growing body of consistent evidence that at least some stress fractures are associated with decreased BMD [ 25 ]. This literature includes retrospective [ 26 ] and prospective studies of American [ 27 -29 ] and international [ 16 ] track and fi eld athletes as well as American [ 21 ] and Israeli [ 19 ] female soldiers. The association between low BMD and stress fracture persists in meta-analyses [ 30 ].…”

Section: Bone Resiliencementioning

confidence: 99%

Stress Fracture

Loud¹

2014

The Female Athlete Triad

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Prediction Model for Stress Fracture in Young Female Recruits during Basic Training

Cited by 46 publications

References 35 publications

Analysis of stress fractures in athletes based on our clinical experience

Analysis of stress fractures in athletes based on our clinical experience

Copper, iron, and selenium dietary deficiencies negatively impact skeletal integrity: A review

Stress Fracture

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