Stress fractures in elderly patients

Abstract

Purpose The purpose of this study was to investigate specific risk factors, common fracture locations and possible sexspecific differences in elderly patients with stress fractures. Methods This analysis enrolled 105 patients (83 women, 22 men) with stress fractures. For the analysis of possible risk factors related to increasing age, data from 82 patients (67 women, 15 men) aged 40 years and older (mean age of 57.4 ± 11.0 years) were compared with that from a younger control group [23 patients (16 women, seven men), mean age 28.4±6.7 years]. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry bone densitometry (DXA) and blood samples were taken. Results A total of 211 stress fractures were found. Of these, 177 were found in the study group, of which 90.4 % were located in the lower limb. Lumbar and femoral BMD was significantly lower in elderly patients; however, the BMD of most patients was within the osteopenic or normal range. Within the study group, a total of 83.8 % had a vitamin D insufficiency (<30 μg/ l); 75.5 % were not engaged in regular physical activity more than once a week. Overweight patients within the study group had significantly more stress fractures compared to normal weight patients (2.6±1.7 vs. 1.9±1.1, p<0.05). Conclusions A similar contribution of risk factors has been found for stress fractures in elderly patients and younger controls of the general population. Stress fracture incidence seems to be rather multifactorial and not based on osteoporotic changes alone. A balanced calcium and vitamin D metabolism seems to be of paramount importance for stress fracture prevention in elderly patients.

Risk Factors for Tibial Stress Injuries

“…17,22 One additional report of a positive relationship between calcium and vitamin D insufficiency and stress fractures exists, but refers to elderly patients with nonspecific, non-exercise-related stress fractures and is therefore of limited relevance. 21 The implications of our findings for men are unclear in light of the fact that despite consuming less calcium than uninjured controls, TSI injured men were still calcium replete; meeting or exceeding the daily recommended allowance.…”

“…An association of reduced bone strength with incidence of TSI is intuitive, in light of the mechanostatic adaptive remodeling response of bone to chronic repetitive strain that exceeds the normal physiological threshold. 27 A number of previous studies have reported relationships between bone strength and bone stress injuries, 1,2,12,[14][15][16][17]21,22 supporting the notion that certain morphological features of bone, especially narrow width, predispose individuals to bone stress injury in general 9,11,15,16 and tibial stress injuries more specifically. 20 By contrast, we did not observe differences in BMD between groups, and BMD was normal for the whole cohort, despite previous reports of low BMD as an independent risk factor for stress fractures.…”

“…16 In fact, it is possible a combination of risk factors predisposes an individual to the development of a stress fracture rather than a single cause. 2,3,10,12,17,21 However, it is also possible that some of those data are confounded by attempts to identify risk factors from an approach that includes a simultaneous analysis of different stress fractures types, including tibial, metatarsal, tarsal, fibular, femoral, pelvic, and even upper extremity, rather than specific injury sites. There have been a number of impressive studies examining risk factors of nonspecific stress fractures that have included very large military cohorts, including 1 involving almost 4000 female US military recruits 13 and others including 2500 and 783 Israeli military recruits.…”

“…The strength of this study lies in this specific focus and the rigorous matching of cases and controls for sex, age, body mass, and training intensity. Limitations of the study include relatively low participant numbers, and our inability to collect data related to a number of potential TSI risk factors, such as hormone profile 3,17 and serum vitamin D. 19,21 In summary, we observed that recreational and elite athletes suffering tibial stress injuries are more likely to have lower lean and higher fat mass, as well as smaller lower extremity bones and a higher incidence of foot anomalies than uninjured individuals matched for age, sex, height, weight, and training intensity. Our findings are largely consistent with previous reports of risk factors for nonspecific stress fractures, as well as those specific to TSIs, suggesting a commonality of risk factors for bone stress injuries in general.…”

A case of bilateral stress fractures in an old woman: three years of pain

“…Considering international literature we found many works about stress fractures in athletes (especially in endurance athletes), instead we found a lower number of articles about stress fracture in elderly patients (5,6). Stress fractures result from an unsuccessful bone adaptation to mechanical changes induced by repetitive overload determining the prevalence of osteoclastic bone resorption phenomenon in bone remodeling.…”