Dataset Information

Risk factors for stress fracture in female endurance athletes: a cross-sectional study.

ABSTRACT:

Objective

To identify psychological and physiological correlates of stress fracture in female endurance athletes.

Design

A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit.

Methods

Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using ?², analysis of variance and Mann-Whitney U tests.

Results

Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively).

Conclusions

Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk.

SUBMITTER: Duckham RL

PROVIDER: S-EPMC3533057 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Risk factors for stress fracture in female endurance athletes: a cross-sectional study.

Duckham Rachel L RL Peirce Nicholas N Meyer Caroline C Summers Gregory D GD Cameron Noël N Brooke-Wavell Katherine K

BMJ open 20121119 6

<h4>Objective</h4>To identify psychological and physiological correlates of stress fracture in female endurance athletes.<h4>Design</h4>A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit.<h4>Methods</h4>Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral ...[more]

PMID: 23166136

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Project description:BackgroundFemale runners are at increased risk of stress fractures (SFs) compared with men. Literature is lacking with regard to best practice for preventing and treating SFs in women. The purpose of the study was to compare physiological measures and running-related factors between women of various ages and running abilities with and without a history of running-related SFs.HypothesisWomen with and without SF histories will differ with regard to medical and menstrual history, bone health, body composition, nutrition, and running history.Study designProspective cohort study.Level of evidenceLevel 2.MethodsA total of 20 female runners with SF histories were matched based on age and running distance with 20 women without SF histories. Data included medical, menstrual, running, injury, and nutritional histories; blood histology related to nutritional, hormonal, and bone-related risk factors; and bone density, fat, and lean tissue using dual energy x-ray absorptiometry. Paired t tests were used to examine differences between women with and without SF histories, and Spearmen correlations were conducted to examine relationships between physiological factors.ResultsWomen with SF histories had lower hip bone mineral density compared with women without SF histories (P < 0.05). SF history was moderately correlated with menstrual changes during increased training times (r = 0.580; P < 0.0001) but was not correlated with any other physiological factor. There was a moderate correlation within the SF group (r = 0.65; P = 0.004) for bone markers for resorption and formation both increasing, indicating increased bone turnover.ConclusionFemale runners with low hip bone mineral density, menstrual changes during peak training, and elevated bone turnover markers may be at increased risk of SF.Clinical relevanceFemale runners need routine screening for risks associated with SF occurrence. As bone mineral density and bone turnover markers are not routinely assessed in this population, important risk factors may be missed.

Project description:ObjectiveElderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs and may therefore provide contrasting risk estimations in certain individuals. In this study, we compare these risk calculators in a high-risk cohort of elderly patients admitted to hospital with falls.DesignHospital-based cross-sectional study.SettingSecondary care, London, UK.ParticipantsData from 120 consecutive elderly patients who had falls presenting to a single hospital over 4 months were collected. 10-year major and hip fracture risks were calculated using FRAX, QFracture and Garvan. 1-year major and hip fracture risks from QFracture were assessed against prospective incidence of fracture.ResultsMedian 10-year major fracture risk was: FRAX 19.5%, QFracture 26.0%, Garvan 32.5%. Median 10-year hip fracture risk was: FRAX 9.6%, QFracture 21.1%, Garvan 6.5%. Correlation between FRAX and QFracture was r=0.672 for major, r=0.676 for hip fracture (both p<0.0001); FRAX and Garvan r=0.778 (p<0.0001) for major, r=0.128 (p=0.206) for hip fracture; QFracture and Garvan r=0.658 (p<0.0001) for major, r=0.318 (p<0.001) for hip fracture. QFracture 1-year predicted major and hip fracture rates were 1.8% and 1.2%, respectively, compared with actual rates of 2.1% and 0%, respectively.ConclusionsAlthough strong correlations between calculators were observed in the study cohort, there were differences of up to 13% between estimated risks. QFracture captured several elderly-specific inputs not considered by other calculators and so projected higher fracture risk than the other calculators. QFracture provided 1-year fracture risks that were comparable with the prospective observed fracture incidence in the cohort. This study has important clinical implications for the use of fracture risk calculators to guide treatment decisions, particularly in the high-risk cohort of elderly patients admitted to hospital following falls.

Dataset Information

Risk factors for stress fracture in female endurance athletes: a cross-sectional study.

Objective

Design

Methods

Results

Conclusions

Publications

Risk factors for stress fracture in female endurance athletes: a cross-sectional study.

Similar Datasets

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