The area moment of inertia of the tibia: A risk factor for stress fractures

Milgrom, Charles; Giladi, Michael; Simkin, Ariel; Rand, Nahshon; Kedem, Ron; Kashtan, Hanoch; Stein, Michael D.; Gomori, Moshe

doi:10.1016/0021-9290(89)90226-1

Cited by 164 publications

(142 citation statements)

References 12 publications

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“…These observations are consistent with our earlier work on bone geometry 3 as well as those of Giladi and colleagues. 11,12,18 The results of this study support the hypothesis that stress fracture occurs because fracture cases experience relatively higher skeletal stresses than do those who do not fracture.…”

Section: Discussionsupporting

confidence: 72%

“…Studies on Israeli Army Recruits used radiographic methods to show that fracture cases had narrower tibiae, 12 and smaller tibial mediolateral cross-sectional moments of inertia. 18 In a previous study of male U.S. Marine Corps recruits using a dual-energy X-ray absorptiometry (DXA) method, we similarly found that stress fracture cases had lower mediolateral cross-sectional moments of inertia and section moduli in both the distal third of the tibia and the midshaft of the femur. 3 Fracture cases in our study of men were, on average, physically smaller in body weight and anthropometric dimensions; however, after bone shaft geometries were corrected for body size (weight), diaphyseal dimensions remained significantly smaller in fracture cases, although joint dimensions were not different.…”

Section: Introductionmentioning

confidence: 80%

“…First, like some other stress fracture studies, 11,18 bone geometries were measured in a single plane and are thus relevant mainly to frontal plane stresses. Dynamic loading of the lower limb is known to produce significant stresses in the sagittal plane as well.…”

Section: Gender Differences In Fracture Susceptibility and In Strengtmentioning

confidence: 99%

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

Beck

Ruff

Shaffer

et al. 2000

Bone

280

197

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 80%

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

Beck

Ruff

Shaffer

et al. 2000

Bone

280

197

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“…The changes in bone density and structure enhanced compressive (BSI) torsional (i) and bending ( i AP, i ML) stiffness of the tibial diaphysis, and demonstrates that military training is not only anabolic to bone but possibly yields clinical benefits by protecting the tibia from the risk of fracture [61,62]. However, this is not the case in individuals who begin training with a narrower tibial diaphysis, as indicated by lower CSA at the 38% site in our participants suffering tibial injury and in stress fracture cases of Royal Marine trainees [63].…”

Section: Discussionmentioning

confidence: 96%

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Izard¹,

Fraser

Negus³

et al. 2016

Bone

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2 AbstractPurpose: Few human studies have reported early structural adaptations of bone to weightbearing exercise, which provide a greater contribution to improved bone strength than increased density. This prospective study examined site-and regional-specific adaptations of the tibia during arduous training in a cohort of male military (infantry) recruits to better understand how bone responds in vivo to mechanical loading.Methods: Tibial bone density and geometry were measured in 90 British Army male recruits (ages 21 + 3 y, height 1.78 ± 0.06 m, body mass 73.9 + 9.8 kg) in weeks 1 (Baseline) and 10 of initial military training. Scans were performed at the 4%, 14%, 38% and 66% sites, measured from the distal end plate, using pQCT (XCT2000L, Stratec Pforzheim, Germany).Customised software (BAMPack, L-3 ATI) was used to examine whole bone cross-section and regional sectors. T-tests determined significant differences between time points (P<0.05).Results: Bone density of trabecular and cortical compartments increased significantly at all measured sites. Bone geometry (cortical area and thickness) and bone strength (i, MM i and BSI) at the diaphyseal sites (38 and 66%) were also significantly higher in week 10. Regional changes in density and geometry were largely observed in the anterior, medial-anterior and anterior-posterior sectors. Calf muscle density and area (66% site) increased significantly at week 10 (P<0.01). Conclusions:In vivo mechanical loading improves bone strength of the human tibia by increased density and periosteal expansion, which varies by site and region of the bone.These changes may occur in response to the nature and distribution of forces originating from bending, torsional and shear stresses of military training. These improvements are observed early in training when the osteogenic stimulus is sufficient, which may be close to the fracture threshold in some individuals.3

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“…5,6 The incidence of SF ranges from 1.5% to 31%. [6][7][8][9] Women are reported to be at greater risk, with one study reporting a two-fold increase of bilateral SF over men. 10 Stress fractures were first described in the medical literature as March Fractures by Briethaupt in 1855 who found them in the metatarsals of the Prussian Army recruits.…”

mentioning

confidence: 99%

Stress fractures—a prospective study amongst recruits

Dash¹,

Kushwaha

2012

Medical Journal Armed Forces India

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BACKGROUNDStress fracture (SF) is the single most common cause for the lost number of manpower days during training of recruits in the Armed Forces. This prospective study was undertaken with a view to develop baseline data on incidence of SF and to identify related variables. METHODA prospective study over a period of five years during [2004][2005][2006][2007][2008][2009] in which a total of 8,570 recruits were enrolled at the start of their training to find out the incidence and pattern of SFs. RESULTSA total of 604 (7.04%, 95% CI 6.40-7.40%) out of a total of 8,570 recruits sustained SF during the study period. The majority of fractures occurred during basic training. The factors like urban residence, vegetarianism and those without prior history of physical activity were found to be associated with SF. Tibia was the commonest bone involved. CONCLUSIONPrevention is undoubtedly the best approach in SF and other sports injuries. Priority should be given to individuals with good sports and physical activity background during recruitment. Intensity of training should be gradually increased during first three months (12 weeks) of training.

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The area moment of inertia of the tibia: A risk factor for stress fractures

Cited by 164 publications

References 12 publications

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

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

Increased density and periosteal expansion of the tibia in young adult men following short-term arduous training

Stress fractures—a prospective study amongst recruits

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