Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors

Beck, Thomas; Ruff, Christopher B.; Shaffer, Richard A.; Betsinger, K; Trone, Daniel W.; Brodine, Stephanie K.

doi:10.1016/s8756-3282(00)00342-2

Cited by 279 publications

(214 citation statements)

References 21 publications

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“…Thus, there would appear to be a biological constraint in the level to which cellular processes (eg, osteoclastic/osteoblastic-driven modeling and remodeling) can be adjusted to mechanically compensate for the natural variation in robustness. It is well known that women tend to have more slender bones than men for a given body size [1,18,19,22], putting them at greater risk of fracturing under extreme loading conditions (eg, military training and falls among the elderly) [1,11,12,17]. However, it had yet to be determined whether this difference in strength is the result of fundamental differences in the manner by which men and women construct bone.…”

Section: Discussionmentioning

confidence: 99%

“…Many have suggested this sex difference in fracture risk, both within and across ethnicities, is predominantly attributable to body size [8,16,22,23] and hormonal differences [14,24]. When looking at population averages within both ethnicities, men have wider bones of greater cortical mass compared with women [1,18,19,22]. This knowledge is often used to identify traits that contribute to fracture susceptibility.…”

Section: Introductionmentioning

confidence: 99%

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How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

Schlecht

Bigelow

Jepsen

2015

Clinical Orthopaedics &Amp; Related Research

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Background The risk of fragility fractures in the UnitedStates is approximately 2.5 times greater among black and white women compared with their male counterparts. On average, men of both ethnicities have wider bones of greater cortical mass compared with the narrower bones of lower cortical mass among women. However, it remains uncertain whether the low cortical area observed in the long bones of women is consistent with their narrower bone diameter or if their cortical area is reduced beyond that which is expected for the sex differences in body size and external bone size. Questions/purposes We asked (1) do black and white women consistently have narrower bones of less strength across long bones compared with black and white men; and (2) do all long bones of black and white women have reduced cortical area compared with black and white men? Methods Peripheral quantitative CT was used to quantify bone strength and cross-sectional morphology from the major long bones of 125 white and 115 black adult men and women (20-35 years of age). Regression analyses were used to test for differences in bone strength and cortical area after for adjusting for either body size, bone size, or both. Results After adjusting bone strength for body size, regression analyses showed that black women had lower bone strength compared with black men (women: mean = 298. ; percent difference = 6%-22%, p = 0.02-0.0001) were shown to have lower cortical area than their male counterparts. Therefore, the long bones of women are not only more slender than those of men, but also show a reduced cortical area that is 6% to 25% greater

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

Schlecht

Bigelow

Jepsen

2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Furthermore, an association between low BMD and stress fractures has been reported in female athletes including dancers [24] [25] [26]. However, BMD represents only one aspect of bone strength.…”

Section: Discussionmentioning

confidence: 99%

Bone Quality in Female Ballet Dancers: A Possible Determinant of Bone Health

Funasaki¹,

Saito²,

Kuno-Mizumura³

et al. 2017

OJO

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Hypotheses: Values of serum markers related to bone quality are abnormal in young female ballet dancers. Methods: In 13 elite Japanese female ballet dancers (average age, 22 years), markers related to bone quality were investigated. These included: serum homocystein (HC), a marker of increased oxidative stress; pentosidine (Pent), a marker of glycation-or oxidation-induced non-enzymatic cross-links; markers of bone metabolism (bone alkaline phosphatase, BAP; tartrate-resistant acid phosphatase 5b, TRAP5b) and bone mineral density (BMD). It was determined whether there is a relationship between bone quality markers' levels are related to amenorrhea and/or fatigue fractures. Results: Two dancers had fatigue fractures and 3 had a history of secondary amenorrhea. The average BMD was 1.305 ± 0.12 (g/cm 2 ), in all these cases the Z-score was higher than −1.0. Although the serum levels of BAP, TRAP5b, and HC were normal in all examined dancers, in 2 out of 3 dancers with a history of secondary amenorrhea, pentosidine serum levels were increased. No relationship between bone quality markers' levels and fatigue fractures was found. Conclusion: Latent deterioration of bone quality may occur in female athletes with secondary amenorrhea and otherwise normal BMD and calcium metabolism markers.

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“…52 Women have a lower bone-section modulus; a lower bone-strength index (ratio of section modulus to bone length); and a thinner and narrower cortical area, which provides less bone strength. 53 These factors may increase females' susceptibility to fractures on ground impact during parachuting.…”

Section: Personal Characteristicsmentioning

confidence: 99%

Risk Factors for Injuries During Military Static-Line Airborne Operations: A Systematic Review and Meta-Analysis

Knapik

Steelman

2016

Journal of Athletic Training

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Objective: To identify and analyze articles in which the authors examined risk factors for soldiers during military staticline airborne operations.Data Sources: We searched for articles in PubMed, the Defense Technical Information Center, reference lists, and other sources using the key words airborne, parachuting, parachutes, paratrooper, injuries, wounds, trauma, and musculoskeletal.Study Selection: The search identified 17 684 potential studies. Studies were included if they were written in English, involved military static-line parachute operations, recorded injuries directly from events on the landing zone or from safety or medical records, and provided data for quantitative assessment of injury risk factors. A total of 23 studies met the review criteria, and 15 were included in the meta-analysis.Data Extraction: The summary statistic obtained for each risk factor was the risk ratio, which was the ratio of the injury risk in 1 group to that of another (baseline) group. Where data were sufficient, meta-analyses were performed and heterogeneity and publication bias were assessed.Data Synthesis: Risk factors for static-line parachuting injuries included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, jumps from fixedwing aircraft rather than balloons or helicopters, jumps onto certain types of terrain, being a female paratrooper, greater body weight, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, higher heat index, winds from the rear of the aircraft on exit entanglements, less experience with a particular parachute system, being an enlisted soldier rather than an officer, and jumps involving a greater number of paratroopers.Conclusions: We analyzed and summarized factors that increased the injury risk for soldiers during military static-line parachute operations. Understanding and considering these factors in risk evaluations may reduce the likelihood of injury during parachuting.Key Words: parachutes, parachuting, wind speed, night, temperature, parachute ankle brace, terrain, wounds, trauma, musculoskeletal Key PointsRisk factors associated with military static-line airborne operations included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, winds from the rear of the aircraft on exit, jumps from fixedwing aircraft, jumps onto certain types of terrain, being a female paratrooper, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, entanglements, being an enlisted soldier, and jumps involving a greater number of paratroopers. Trainers, operators, and medical personnel should consider these risk factors in their injury-risk evaluations and during specific airborne maneuvers to help paratroopers arrive safely at the battleground. P erhaps the most ancient of tactical athletes is the infantry soldier. Since the beginning of recorded history, men have faced each other in combat, first with edged and blunt w...

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Stress fracture in military recruits: gender differences in muscle and bone susceptibility factors

Cited by 279 publications

References 21 publications

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

Bone Quality in Female Ballet Dancers: A Possible Determinant of Bone Health

Risk Factors for Injuries During Military Static-Line Airborne Operations: A Systematic Review and Meta-Analysis

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