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Michelle T Barrack - One of the best experts on this subject based on the ideXlab platform.
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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, 2019Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael FredericsonAbstract: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.
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Parallels with the Female Athlete Triad in Male Athletes
Sports Medicine, 2016Co-Authors: Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Michael FredericsonAbstract: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.
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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, 2014Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia NattivAbstract: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...
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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, 2014Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia NattivAbstract: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...
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correlation of mri grading of Bone Stress injuries with clinical risk factors and return to play a 5 year prospective study in collegiate track and field athletes
American Journal of Sports Medicine, 2013Co-Authors: Aurelia Nattiv, Gannon Kennedy, Michelle T Barrack, Ashraf Abdelkerim, Marci Goolsby, Julie C Arends, Leanne L SeegerAbstract:Background:Bone Stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time.Purpose:To examine the relationships between MRI grading of Bone Stress injuries with clinical risk factors and time to return to sport in collegiate track and field athletes.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:A total of 211 male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had preparticipation history, physical examination, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns, and prior injuries, as well as a 3-day diet record. Dual-energy X-ray absorptiometry was performed at baseline and each year of participation in the study. Athletes with clinical evidence of Bone Stress in...
Michael Fredericson - One of the best experts on this subject based on the ideXlab platform.
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Bone Stress Injuries
Clinical Care of the Runner, 2019Co-Authors: Megan Roche, Michael Fredericson, Emily KrausAbstract: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.
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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, 2019Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael FredericsonAbstract: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.
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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, 2018Co-Authors: Yaeko Fukushima, Emily Kraus, Isaac P. Syrop, Michael FredericsonAbstract:: 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.
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association of the female athlete triad risk assessment stratification to the development of Bone Stress injuries in collegiate athletes
American Journal of Sports Medicine, 2017Co-Authors: Adam S Tenforde, Jennifer L Carlson, Audrey O Chang, Kristin L Sainani, Rebecca Shultz, Phil Cutti, Neville H Golden, Michael FredericsonAbstract:Background:The female athlete triad (referred to as the triad) contributes to adverse health outcomes, including Bone Stress injuries (BSIs), in female athletes. Guidelines were published in 2014 for clinical management of athletes affected by the triad.Purpose:This study aimed to (1) classify athletes from a collegiate population of 16 sports into low-, moderate-, and high-risk categories using the Female Athlete Triad Cumulative Risk Assessment score and (2) evaluate the predictive value of the risk categories for subsequent BSIs.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 323 athletes completed both electronic preparticipation physical examination and dual-energy x-ray absorptiometry scans. Of these, 239 athletes with known oligomenorrhea/amenorrhea status were assigned to a low-, moderate-, or high-risk category. Chart review was used to identify athletes who sustained a subsequent BSI during collegiate sports participation; the injury required a physician diagnosis and imaging ...
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Bone Stress injuries in runners
Physical Medicine and Rehabilitation Clinics of North America, 2016Co-Authors: Adam S Tenforde, Emily Kraus, Michael FredericsonAbstract:: Bone Stress injuries (BSIs) are common running injuries and may occur at a rate of 20% annually. Both biological and biomechanical risk factors contribute to BSI. Evaluation of a runner with suspected BSI includes completing an appropriate history and physical examination. MRI grading classification for BSI has been proposed and may guide return to play. Management includes activity modification, optimizing nutrition, and addressing risk factors, including the female athlete triad. BSI prevention strategies include screening for risk factors during preparticipation evaluations, optimizing nutrition (including adequate caloric intake, calcium, and vitamin D), and promoting ball sports during childhood and adolescence.
Aurelia Nattiv - One of the best experts on this subject based on the ideXlab platform.
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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, 2019Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael FredericsonAbstract: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.
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Parallels with the Female Athlete Triad in Male Athletes
Sports Medicine, 2016Co-Authors: Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Michael FredericsonAbstract: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.
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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, 2014Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia NattivAbstract: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...
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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, 2014Co-Authors: Michelle T Barrack, Jenna C Gibbs, Mary Jane De Souza, Nancy I Williams, Jeanne F Nichols, Mitchell J Rauh, Aurelia NattivAbstract: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...
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correlation of mri grading of Bone Stress injuries with clinical risk factors and return to play a 5 year prospective study in collegiate track and field athletes
American Journal of Sports Medicine, 2013Co-Authors: Aurelia Nattiv, Gannon Kennedy, Michelle T Barrack, Ashraf Abdelkerim, Marci Goolsby, Julie C Arends, Leanne L SeegerAbstract:Background:Bone Stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time.Purpose:To examine the relationships between MRI grading of Bone Stress injuries with clinical risk factors and time to return to sport in collegiate track and field athletes.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:A total of 211 male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had preparticipation history, physical examination, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns, and prior injuries, as well as a 3-day diet record. Dual-energy X-ray absorptiometry was performed at baseline and each year of participation in the study. Athletes with clinical evidence of Bone Stress in...
Harri Pihlajamäki - One of the best experts on this subject based on the ideXlab platform.
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Comparison of 1.5T and 3T MRI scanners in evaluation of acute Bone Stress in the foot.
BMC Musculoskeletal Disorders, 2011Co-Authors: Markus J. Sormaala, Ville M. Mattila, Juha-petri Ruohola, Seppo Koskinen, Harri PihlajamäkiAbstract:Background Bone Stress injuries are common in athletes and military recruits. Only a minority of Bone Stress changes are available on plain radiographs. Acute Bone Stress is often visible on MRI as Bone marrow edema, which is also seen in many other disease processes such as malignancies, inflammatory conditions and infections. The purpose of this study was to investigate the ability of radiographs, 1.5T and 3T MRI to identify acute Bone marrow changes in the foot.
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Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study
Clinical Orthopaedics and Related Research, 2009Co-Authors: Maria H. Niva, Martti J. Kiuru, Ville M. Mattila, Harri PihlajamäkiAbstract:Although Bone Stress injuries are common in male military trainees, it is not known how common they are in female trainees. It also is unclear whether asymptomatic Bone Stress injuries heal if intensive training is continued. We prospectively followed 10 female trainees of a military Reserve Officer Course. The subjects underwent clinical and MRI examinations of the pelvis, thighs, and lower legs at the beginning, once during, and at the end of their 3-month course. We identified two to five injuries in every female trainee, all of whom already had the injuries at the beginning of the officer course. None of these injuries increased their severity despite vigorous training. Two-thirds were asymptomatic and low grade. Femoral and tibial shafts were the most common locations. Higher-grade injuries were more likely symptomatic, but regardless of the MRI findings, female trainees expressed only mild to moderate symptoms. Asymptomatic, low-grade Bone Stress injuries of the femoral and tibial shaft are common in female recruits undergoing heavy physical training. Because these injuries seem to remain constant or even disappear despite continued heavy physical activity, we do not recommend routine screening of asymptomatic trainees. As some Bone Stress fractures may have severe consequences (eg, in the femoral neck), symptomatic Bone Stress injuries should be examined and treated.
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risk factors for Bone Stress injuries a follow up study of 102 515 person years
Medicine and Science in Sports and Exercise, 2007Co-Authors: Ville M. Mattila, Martti J. Kiuru, Maria H. Niva, Harri PihlajamäkiAbstract:Purpose: The aim of the present study was to assess the risk factors for magnetic resonance imaging (MRI)-detected Bone Stress injuries in the pelvis, hip, thigh, and knee in a large cohort of Finnish conscripts during a follow-up of 102,515 person-years. Methods: An epidemiologic prospective cohort study of 152,095 conscripts, including 2345 (1.5%) females, was conducted. Localized pain in the pelvis, hip, thigh, or knee resulted in an orthopedic surgeon's consultation and subsequent MRI examination at the Central Military Hospital, Helsinki, Finland. Risk factors were systematically collected from 1998 to 2004, including data on conscripts' physical fitness and body composition measured at the beginning of their military service. Results: Altogether, 319 MRI-detected Bone Stress injuries of the pelvis, hip, thigh, or knee were identified in our cohort; thus, the incidence was 311 (95% CI: 277-345) per 100,000 person-years. The female:male ratio varied substantially, depending on the anatomic location of the injury; it was highest for sacral injuries (female:male ratio = 51.1) and lowest for injuries of the femoral condyle (female:male ratio = 0.8). In univariate Cox regression analysis, poor muscle strength and a poor result in a 12-min run were significantly associated with Bone Stress injuries. In multivariable analysis, the strongest risk factors for Bone Stress injuries were female gender (hazard ratio 8.2; 95% CI: 4.8-14.2) and higher age (hazard ratio 2.1; 95% CI: 1.4-3.1). Conclusions: Female military trainees have a highly increased risk of Bone Stress injuries of the pelvis and hip compared with male conscripts. Sacral Stress fractures are typical Bone Stress injuries in female military recruits. Physicians should remember the possibility of Bone Stress injury, especially when examining Stress-related pain symptoms of the pelvic area in physically active young adult females.
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Bone Stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults
American Journal of Sports Medicine, 2006Co-Authors: Maria H. Niva, Martti J. Kiuru, Juhani Ahovuo, Riina Haataja, Markus J. Sormaala, Harri PihlajamäkiAbstract:BACKGROUND: No comprehensive studies of Bone Stress injuries in the ankle and foot based on magnetic resonance imaging findings have been published. PURPOSE: Using magnetic resonance imaging findings to assess incidence, location, and type of Bone Stress injuries of the ankle and foot in military conscripts with ankle and/or foot pain. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients with ankle or foot pain, negative findings on plain radiography, and magnetic resonance images obtained of the ankle or foot were included in this 86-month study. Magnetic resonance images with Bone Stress injury findings were re-evaluated regarding location and injury type. Based on the number of conscripts within the hospital catchment area, the person-based incidence of Bone Stress injuries was calculated. RESULTS: One hundred thirty-one conscripts displayed 378 Bone Stress injuries in 142 ankles and feet imaged, the incidence being 126 per 100 000 person-years. This incidence represents the Stress injuries not diagnosable with radiographs and requiring magnetic resonance images. Of injuries, 57.7% occurred in the tarsal and 35.7% in the metatarsal Bones. Multiple Bone Stress injuries in 1 foot were found in 63% of the cases. The calcaneus and fifth metatarsal Bone were usually affected alone. Injuries to the other Bones of the foot were usually associated with at least 1 other Stress injury. The talus and calcaneus were the most commonly affected single Bones. High-grade Bone Stress injury (grade IV-V) with a fracture line on magnetic resonance images occurred in 12% (talus, calcaneus), and low-grade injury (grade I-III) presented only as edema in 88% of the cases. CONCLUSION: Multiple, various-stage Bone Stress injuries of the ankle and foot may occur simultaneously in physically active young adults. When considering injuries that were missed by plain radiographs but detected by magnetic resonance imaging, the Bones most often affected were the tarsal Bones, of which the talus and calcaneus were the most prominent single Bones and most common locations for higher grade (IV-V) Bone Stress injuries. With use of magnetic resonance imaging, early detection and grading of Bone Stress injuries are available, which enable early and appropriate injury management.
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association between serum 25 oh d concentrations and Bone Stress fractures in finnish young men
Journal of Bone and Mineral Research, 2006Co-Authors: Juha-petri Ruohola, Riina Haataja, Ville M. Mattila, Ilkka Laaksi, Timo Ylikomi, Timo Sahi, Pentti Tuohimaa, Harri PihlajamäkiAbstract:UNLABELLED: Low vitamin D level may predict rickets, osteomalacia, or osteoporosis. We examined serum 25(OH)D concentration as a predisposing factor for Bone Stress fracture in 756 military recruits. The average serum 25(OH)D concentration was significantly lower in the group with fracture, suggesting a relationship between vitamin D and fatigue Bone Stress fracture. INTRODUCTION: Low vitamin D level may predict rickets, osteomalacia, or osteoporosis. Fatigue Bone Stress fracture is one of the most frequently seen types of overuse injuries in athletes and military recruits. An association was recently shown between vitamin D and BMC. A correlation has also been found between low femoral BMD and Stress fractures. We measured serum 25(OH)D concentration in a population sample of military recruits to determine if vitamin D is a predisposing factor for fatigue Bone Stress fracture. MATERIALS AND METHODS: We prospectively followed 800 randomly selected, healthy Finnish military recruits with a mean age of 19 years for developing Stress fractures in homogenous circumstances. Blood for serum 25(OH)D concentration was drawn at entry into military service, and the weight, height, body mass index (BMI), muscle strength, and 12-minute running were measured for all subjects. Serum 25(OH)D concentrations were measured with enzyme immunoassay. At end of the 90-day follow-up, 756 subjects completed the study. Subjects without fracture constituted controls. RESULTS: Twenty-two recruits with Stress fracture were identified (2.9%), the incidence being 11.6 (95% CI: 6.8-16.5) per 100 person-years. In the final multivariate analysis, the significant risk factor for Stress fracture in conscripts was a below median serum 25(OH)D level (75.8 nM), OR being 3.6 (95% CI: 1.2-11.1). No significant associations between BMI (p = 0.255), age (p = 0.216), or smoking (p = 0.851) and Bone Stress fracture were found in this study population. CONCLUSIONS: A lower level of serum 25(OH)D concentration may be a generally predisposing element for Bone Stress fractures. Considering the obvious need of additional vitamin D in prevention of Stress fractures, the effects of vitamin D fortification of foods and supplementation will be subjects of interest for future research.
Adam S Tenforde - One of the best experts on this subject based on the ideXlab platform.
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prevalence and anatomical distribution of Bone Stress injuries in the elite para athlete
American Journal of Physical Medicine & Rehabilitation, 2019Co-Authors: Adam S Tenforde, Emily M Brook, Elizabeth Broad, Elizabeth Matzkin, Heidi Y Yang, Jamie E Collins, Peter W Braun, Cheri A BlauwetAbstract:AbstractBone Stress injury is a common overuse injury in athletes. Risk factors for Bone Stress injury in athletes include the female athlete triad (triad); this has not been evaluated in para athletes. The aim of this study was to identify risk factors, prevalence, and anatomical distribution of bo
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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, 2019Co-Authors: Emily Kraus, Adam S Tenforde, Aurelia Nattiv, Michelle T Barrack, Kristin L Sainani, Andrea Kussman, Megan Deakinsroche, Sonal Singh, Michael FredericsonAbstract: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.
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low Bone mineral density in male athletes is associated with Bone Stress injuries at anatomic sites with greater trabecular composition
American Journal of Sports Medicine, 2018Co-Authors: Adam S Tenforde, Allyson L. Parziale, Kristin L. Popp, Kathryn E. AckermanAbstract:Background:While sports participation is often associated with health benefits, a subset of athletes may develop impaired Bone health. Bone Stress injuries (BSIs) are a common overuse injury in athletes; site of injury has been shown to relate to underlying Bone health in female athletes.Hypothesis/Purpose:This case series characterizes the association of type of sports participation and anatomic site of BSIs with low Bone mineral density (BMD), defined as BMD Z-score <–1.0. Similar to female athletes, it was hypothesized that male athletes who participate in running and sustain BSIs in sites of higher trabecular Bone content would be more likely to have low BMD.Study Design:Cohort study; Level of evidence, 3.Methods:Chart review identified 28 male athletes aged 14 to 36 years with history of ≥1 lower-extremity BSI who were referred for evaluation of overall Bone health, including assessment of lumbar spine, hip, and/or total body less head BMD per dual-energy x-ray absorptiometry. BMD Z-scores were deter...
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Low Bone Mineral Density in Male Athletes Is Associated With Bone Stress Injuries at Anatomic Sites With Greater Trabecular Composition.
American Journal of Sports Medicine, 2017Co-Authors: Adam S Tenforde, Allyson L. Parziale, Kristin L. Popp, Kathryn E. AckermanAbstract:Background:While sports participation is often associated with health benefits, a subset of athletes may develop impaired Bone health. Bone Stress injuries (BSIs) are a common overuse injury in athletes; site of injury has been shown to relate to underlying Bone health in female athletes.Hypothesis/Purpose:This case series characterizes the association of type of sports participation and anatomic site of BSIs with low Bone mineral density (BMD), defined as BMD Z-score
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association of the female athlete triad risk assessment stratification to the development of Bone Stress injuries in collegiate athletes
American Journal of Sports Medicine, 2017Co-Authors: Adam S Tenforde, Jennifer L Carlson, Audrey O Chang, Kristin L Sainani, Rebecca Shultz, Phil Cutti, Neville H Golden, Michael FredericsonAbstract:Background:The female athlete triad (referred to as the triad) contributes to adverse health outcomes, including Bone Stress injuries (BSIs), in female athletes. Guidelines were published in 2014 for clinical management of athletes affected by the triad.Purpose:This study aimed to (1) classify athletes from a collegiate population of 16 sports into low-, moderate-, and high-risk categories using the Female Athlete Triad Cumulative Risk Assessment score and (2) evaluate the predictive value of the risk categories for subsequent BSIs.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 323 athletes completed both electronic preparticipation physical examination and dual-energy x-ray absorptiometry scans. Of these, 239 athletes with known oligomenorrhea/amenorrhea status were assigned to a low-, moderate-, or high-risk category. Chart review was used to identify athletes who sustained a subsequent BSI during collegiate sports participation; the injury required a physician diagnosis and imaging ...
