Risk factors for clinical stress fractures in male military recruits: A prospective cohort study

Välimäki, Ville‐Valtteri; Alfthan, Henrik; Lehmuskallio, Eero; Löyttyniemi, Eliisa; Sahi, Timo; Suominen, Harri; Välimäki, Matti

doi:10.1016/j.bone.2005.04.016

Cited by 154 publications

(125 citation statements)

References 43 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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“…The significance of physical and mechanical risk factors in the development of stress fractures is well established [9]. The present findings indicate that genetic factors may also play a role in the development of femoral neck stress fractures.…”

Section: Discussionsupporting

confidence: 60%

“…Bone is continuously degraded and renewed, and inadequate adaptation to mechanical change leads to an imbalance between microdamage and remodeling, and gradually to a fracture. There are numerous risk factors for stress fractures; a Finnish study of male military conscripts reported that tall stature, poor physical fitness, and decreased bone mineral content and bone mineral density (BMD) are factors associated with a greater risk [9]. …”

Section: Introductionmentioning

confidence: 99%

Genetic predisposition for femoral neck stress fractures in military conscripts

et al. 2010

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BackgroundStress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures.ResultsEight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI.ConclusionsOur findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

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“…55 In a prospective study, in Finnish army recruits, high serum PTH levels were identified as a risk factor for stress fracture development. 56 In two studies lower 25(OH)D levels have been found to be associated with a significantly increased risk of stress fracture in young Finnish men 57 and with high-grade stress fractures, in a large army cohort. 58 One randomised controlled trial of more than 5 000 army recruits reports a reduction in stress fractures after daily supplementation of 2 g calcium and 800 IU vitamin D. 59 In addition to the classic role in bone metabolism, vitamin D deficiency may directly impact on athletic performance through other physiological mechanisms including muscle function, 38,[60][61][62] immunity and the potential mediation of exercise-induced inflammation.…”

Section: Discussionmentioning

confidence: 99%