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Bone Stress

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Michelle T Barrack – 1st expert on this subject based on the ideXlab platform

  • Bone Stress injuries in male distance runners higher modified female athlete triad cumulative risk assessment scores predict increased rates of injury
    British Journal of Sports Medicine, 2019
    Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael Fredericson

    Abstract:

    Objectives Bone Stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners. Methods 156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low Bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with p Results 42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI. Conclusion A modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.

  • Parallels with the Female Athlete Triad in Male Athletes
    Sports Medicine, 2016
    Co-Authors: Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Michael Fredericson

    Abstract:

    Participation in sports offers many health benefits to athletes of both sexes. However, subsets of both female and male athletes are at increased risk of impaired Bone health and Bone Stress injuries. The Female Athlete Triad (Triad) is defined as the interrelationship of low energy availability (with or without disordered eating), menstrual dysfunction, and low Bone mineral density. The Triad may result in health consequences, including Bone Stress injuries. Our review presents evidence that an analogous process may occur in male athletes. Our review of the available literature indicates that a subset of male athletes may experience adverse health issues that parallel those associated with the Triad, including low energy availability (with or without disordered eating), hypogonadotropic hypogonadism, and low Bone mineral density. Consequently, male athletes may be predisposed to developing Bone Stress injuries, and these injuries can be the first presenting feature of associated Triad conditions. We discuss the evidence for impaired nutrition, hormonal dysfunction, and low Bone mineral density in a subset of male athletes, and how these health issues may parallel those of the Triad. With further research into the mechanisms and outcomes of these health concerns in active and athletic men, evidence-based guidelines can be developed that result in best practice.

  • higher incidence of Bone Stress injuries with increasing female athlete triad related risk factors a prospective multisite study of exercising girls and women
    American Journal of Sports Medicine, 2014
    Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia Nattiv

    Abstract:

    Background:Identifying the risk factors associated with a Bone Stress injury (BSI), including Stress reactions and Stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women.Purpose:To evaluate the effect of single or combined risk factors as defined by the female athlete triad—a syndrome involving 3 interrelated spectrums consisting of energy availability, menstrual function, and Bone mass—with the incidence of BSIs in a multicenter prospective sample of 4 cohorts of physically active girls and women.Study Design:Cohort study; Level of evidence, 3.Methods:At baseline, participants’ (N = 259; mean age, 18.1 ± 0.3 years) anthropometric characteristics, eating attitudes and behaviors, menstrual function, sports participation or exercise activity, and pathological weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured the Bone mass of the whole body, total hip, femoral neck, lumbar spine, and body com…

Michael Fredericson – 2nd expert on this subject based on the ideXlab platform

  • Bone Stress Injuries
    Clinical Care of the Runner, 2019
    Co-Authors: Megan Roche, Michael Fredericson, Emily Kraus

    Abstract:

    Abstract Bone Stress injuries (BSIs) occur when Bone is no longer able to withstand repetitive, mechanical loading. BSIs are common in elite and recreational runners. The 1-year prospective incidence of BSI in competitive cross-country and track-and-field athletes is as high as 21%. Early identification and proper management of BSI may prevent progression of injury down the pathology continuum on magnetic resonance imaging. BSI may represent a systemic deficit in metabolic or hormonal status. Screening for the Female Athlete Triad and parallel male Triad can help prevent BSI or BSI recurrence. This chapter uses evidence-based medicine to highlight the pathophysiology, risk factors, clinical evaluation, and management of common BSIs in runners. Within this framework, BSIs are grouped by high-, moderate-, and low-risk anatomic sites based on healing properties. With evidence-based management and proper rehabilitation principles, most runners can return to play with conservative treatment.

  • Bone Stress injuries in male distance runners higher modified female athlete triad cumulative risk assessment scores predict increased rates of injury
    British Journal of Sports Medicine, 2019
    Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael Fredericson

    Abstract:

    Objectives Bone Stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners. Methods 156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low Bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with p Results 42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI. Conclusion A modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.

  • A Review and Proposed Rationale for the use of Ultrasonography as a Diagnostic Modality in the Identification of Bone Stress Injuries.
    Journal of Ultrasound in Medicine, 2018
    Co-Authors: Yaeko Fukushima, Emily Kraus, Isaac P. Syrop, Michael Fredericson

    Abstract:

    : Bone Stress injuries are common in military personnel and athletes. The delayed diagnosis of a Bone Stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of Bone Stress injuries is a central part of management. Currently, the reference standard for detecting Bone Stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of Bone Stress injuries in the clinical setting. In this article, we review the US detection of Bone Stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

Aurelia Nattiv – 3rd expert on this subject based on the ideXlab platform

  • Bone Stress injuries in male distance runners higher modified female athlete triad cumulative risk assessment scores predict increased rates of injury
    British Journal of Sports Medicine, 2019
    Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael Fredericson

    Abstract:

    Objectives Bone Stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners. Methods 156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low Bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with p Results 42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI. Conclusion A modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.

  • Parallels with the Female Athlete Triad in Male Athletes
    Sports Medicine, 2016
    Co-Authors: Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Michael Fredericson

    Abstract:

    Participation in sports offers many health benefits to athletes of both sexes. However, subsets of both female and male athletes are at increased risk of impaired Bone health and Bone Stress injuries. The Female Athlete Triad (Triad) is defined as the interrelationship of low energy availability (with or without disordered eating), menstrual dysfunction, and low Bone mineral density. The Triad may result in health consequences, including Bone Stress injuries. Our review presents evidence that an analogous process may occur in male athletes. Our review of the available literature indicates that a subset of male athletes may experience adverse health issues that parallel those associated with the Triad, including low energy availability (with or without disordered eating), hypogonadotropic hypogonadism, and low Bone mineral density. Consequently, male athletes may be predisposed to developing Bone Stress injuries, and these injuries can be the first presenting feature of associated Triad conditions. We discuss the evidence for impaired nutrition, hormonal dysfunction, and low Bone mineral density in a subset of male athletes, and how these health issues may parallel those of the Triad. With further research into the mechanisms and outcomes of these health concerns in active and athletic men, evidence-based guidelines can be developed that result in best practice.

  • higher incidence of Bone Stress injuries with increasing female athlete triad related risk factors a prospective multisite study of exercising girls and women
    American Journal of Sports Medicine, 2014
    Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia Nattiv

    Abstract:

    Background:Identifying the risk factors associated with a Bone Stress injury (BSI), including Stress reactions and Stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women.Purpose:To evaluate the effect of single or combined risk factors as defined by the female athlete triad—a syndrome involving 3 interrelated spectrums consisting of energy availability, menstrual function, and Bone mass—with the incidence of BSIs in a multicenter prospective sample of 4 cohorts of physically active girls and women.Study Design:Cohort study; Level of evidence, 3.Methods:At baseline, participants’ (N = 259; mean age, 18.1 ± 0.3 years) anthropometric characteristics, eating attitudes and behaviors, menstrual function, sports participation or exercise activity, and pathological weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured the Bone mass of the whole body, total hip, femoral neck, lumbar spine, and body com…