Materiały źródłowe

• #1 Stress Fractures: Types and Treatment | Doctor

  https://patient.info/doctor/stress-fractures

  Approximately 20% of all sports medicine injuries are due to stress fractures. […] One study reported that from 2009 to 2012, US military members had 5.69 stress fractures per 1,000 person-years. […] In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%).

• #2 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  A prevalence of stress fractures in females has also been documented within the athletic population, most notably within long distance runners. […] Lower limb stress fractures are prevalent in physically active populations, accounting for up to 90% of all stress fractures and represents up to 20% of all sports related injury. […] Most commonly presenting within the lower limb, a prevalence of these injuries has been reported in the tibia 23.6%, the metatarsals (10-20%), tarsal navicular (17.6%), femur (6.65%) and pelvis (1.6%). […] Risk factor can broadly be sub-classified as intrinsic or extrinsic. […] Studies have identified low aerobic fitness, reduced tibial cross sectional area, low (trabecular and cortical) BMD as well as reduced cortical area of the posterior tibia as potential predisposing factors of fracture.

• #3 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e38

  A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. […] Stress fractures account for more than 10% of all sport-related injuries, and can be as high as 30% in running. It also represent up to 20% of the injuries treated in sports medicine clinics. […] However, there has been no report on the incidence of BSIs or stress fractures among athletes in Korea. Early diagnosis of BSIs is most important for treatment, because delayed diagnosis and continued running can lead to higher-grades of BSI requiring longer healing time.

• #4 Stress Fractures: Types and Treatment | Doctor

  https://patient.info/doctor/stress-fractures

  Approximately 20% of all sports medicine injuries are due to stress fractures. […] One study reported that from 2009 to 2012, US military members had 5.69 stress fractures per 1,000 person-years. […] In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%).

• #5 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #6 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Stress fractures account for about 20% of all sports medicine injuries, and runners who average more than 25 miles a week are considered high risk. Due to the repetitive nature of military training, stress fractures are common among members of the military. From 2009 to 2012, US military members had 5.69 stress fractures per 1000 person-years. In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures in decreasing order of occurrence are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%). These injuries are also more common in women. […] In addition to the intrinsic and extrinsic factors already noted, there are additional factors influencing stress fracture development. One factor is a neuromuscular hypothesis. Due to either muscle loss or fatigue, the muscles become increasingly less able to attenuate the forces applied through the bones. This results in higher peak stress and more microdamage. A study done on U.S. Naval Academy plebes showed those who lost the most weight over the shortest period were more likely to develop a stress fracture. The study was interesting because the authors used a dual-energy x-ray absorptiometry scan to measure body composition. Those who lost weight quickly lost, mainly muscle mass and not fat mass. The results of the study support the neuromuscular hypothesis.

• #7

  https://www.orthobullets.com/evidence/9238304

  Clinically, stress fractures appear to be a common overuse injury among athletes and in military recruits undertaking basic training; however, there is a lack of sound epidemiologic studies describing stress fracture occurrence in athletes. […] Few have directly compared stress fracture rates between sports to establish which poses the greatest risk for this injury. […] Furthermore, incidence rates, expressed in terms of exposure, have rarely been reported for stress fractures in athletes. […] Nevertheless, available data suggest that runners and ballet dancers are at relatively high risk for stress fractures. […] Although a gender difference in rates is clearly evident in military populations, this is less apparent in athletes. […] Other participant characteristics, such as age and race, may also influence stress fracture risk.

• #8 SciELO Brazil – Stress fractures: definition, diagnosis and treatment Stress fractures: definition, diagnosis and treatment

  https://www.scielo.br/j/rbort/a/7V8g8ygyjRWtdd3DkKSrkcb/

  Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. […] The objective of this study was to review the most relevant literature of recent years in order to add key information regarding this pathological condition, as an updating article on this topic. […] Runners, soldiers and dancers are the main victims of stress fractures. […] All the bones of the human body are subject to fracturing caused by stress. […] Stress fractures are mostly commonly diagnosed in the tibia, followed by the metatarsals (especially the second and third metatarsals) and by the fibula. […] Among athletes, the difference in the incidence of stress fractures between men and women is minimal. […] In the military population, the incidence of stress fractures among females is greater than among men.

• #9 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e38

  The purpose of this review is to broaden the understanding of stress fractures, as well as to assist in the treatment and prevention of stress fractures by providing information about the epidemiology, risk factors, diagnosis and classification of BSI. In addition, we look forward to seeing a lot of interest and follow-up studies in Korea, a barren area of research on stress fractures. […] More than a third of cross-country and long-distance runners experience BSIs, and the 1-year prospective incidence of BSI in track and field athletes is reported up to about 21%. […] Of all sports-related injuries encountered in sports medicine clinics, BSIs account for up to 20%. […] Unfortunately, there have been no epidemiological investigations or related studies on BSIs or stress fractures among athletes in Korea.

• #10 Stress fracture – Wikipedia

  https://en.wikipedia.org/wiki/Stress_fracture

  In the United States, the annual incidence of stress fractures in athletes and military recruits ranges from 5% to 30%, depending on the sport and other risk factors. […] Women and highly active individuals are also at a higher risk. The incidence probably also increases with age due to age-related reductions in bone mass density (BMD). Children may also be at risk because their bones have yet to reach full density and strength. The female athlete triad also can put women at risk as disordered eating and osteoporosis can cause the bones to be severely weakened. […] This type of injury is mostly seen in lower extremities, due to the constant weight-bearing (WB). The bones commonly affected by stress fractures are the tibia, tarsals, metatarsals (MT), fibula, femur, pelvis and spine. Upper extremity stress fractures occur less frequently and are usually created in the upper torso by muscle forces.

• #11 Stress fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/stress-fracture-2?embed_domain=hackmd.io%2F%40yipuafecsl2jsu8smr5njq%2Fbnjhjgjghjghjgh&lang=us

  Fatigue fractures are common in athletes, especially runners and military recruits. Insufficiency fractures occur more in women and older people. […] The following conditions increase the risk of a stress injury: female sex, low bone density, nutritional disorders or deficiencies, 'female athlete triad’, long-distance running, inappropriately short recovery time, training changes, inadequate shoes. […] Stress fractures are far more common in the lower limb (~95%) than in the upper limb. High-risk sites of stress fractures are locations at greatest risk of a progression to complete fracture, displacement or non-union as these sites are under tensile stresses and have poor vascularity. […] MRI is the most sensitive modality for diagnosis of a stress fracture and is an important tool to distinguish high and low-risk fractures to help clinicians with management plans and a sensitivity reported to reach close to 100%.

• #12 Stress Fractures: Types and Treatment | Doctor

  https://patient.info/doctor/stress-fractures

  Approximately 20% of all sports medicine injuries are due to stress fractures. […] One study reported that from 2009 to 2012, US military members had 5.69 stress fractures per 1,000 person-years. […] In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%).

• #13 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  A prevalence of stress fractures in females has also been documented within the athletic population, most notably within long distance runners. […] Lower limb stress fractures are prevalent in physically active populations, accounting for up to 90% of all stress fractures and represents up to 20% of all sports related injury. […] Most commonly presenting within the lower limb, a prevalence of these injuries has been reported in the tibia 23.6%, the metatarsals (10-20%), tarsal navicular (17.6%), femur (6.65%) and pelvis (1.6%). […] Risk factor can broadly be sub-classified as intrinsic or extrinsic. […] Studies have identified low aerobic fitness, reduced tibial cross sectional area, low (trabecular and cortical) BMD as well as reduced cortical area of the posterior tibia as potential predisposing factors of fracture.

• #14 Stress Fractures: Types and Treatment | Doctor

  https://patient.info/doctor/stress-fractures

  Approximately 20% of all sports medicine injuries are due to stress fractures. […] One study reported that from 2009 to 2012, US military members had 5.69 stress fractures per 1,000 person-years. […] In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%).

• #15 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Stress fractures account for about 20% of all sports medicine injuries, and runners who average more than 25 miles a week are considered high risk. Due to the repetitive nature of military training, stress fractures are common among members of the military. From 2009 to 2012, US military members had 5.69 stress fractures per 1000 person-years. In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures in decreasing order of occurrence are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%). These injuries are also more common in women. […] In addition to the intrinsic and extrinsic factors already noted, there are additional factors influencing stress fracture development. One factor is a neuromuscular hypothesis. Due to either muscle loss or fatigue, the muscles become increasingly less able to attenuate the forces applied through the bones. This results in higher peak stress and more microdamage. A study done on U.S. Naval Academy plebes showed those who lost the most weight over the shortest period were more likely to develop a stress fracture. The study was interesting because the authors used a dual-energy x-ray absorptiometry scan to measure body composition. Those who lost weight quickly lost, mainly muscle mass and not fat mass. The results of the study support the neuromuscular hypothesis.

• #16 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e38

  In long distance runners, half of the BSI occurs in the tibia and the majority of the other BSI occurs in the femur, fibula, calcaneus and metatarsal bones. […] Because of this difference in weight-bearing styles, long distance runners are more likely to develop BSIs in their long bones, while short distance runners are more vulnerable to BSIs in the tarsal and metatarsal bones.

• #17 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e38

  In long distance runners, half of the BSI occurs in the tibia and the majority of the other BSI occurs in the femur, fibula, calcaneus and metatarsal bones. […] Because of this difference in weight-bearing styles, long distance runners are more likely to develop BSIs in their long bones, while short distance runners are more vulnerable to BSIs in the tarsal and metatarsal bones.

• #18 SciELO Brasil – Stress fractures in the foot and ankle of athletes Stress fractures in the foot and ankle of athletes

  https://www.scielo.br/j/ramb/a/JFYJ4nGBb66gWdQzYhCKbmn/

  Stress fractures were described for the first time in 1855 by Breihaupt among soldiers reporting plantar pain and edema following long marches. For athletes, the first clinical description was given by Devas in 1958, based solely on the results of simple X-rays. Stress injuries are common among athletes and military recruits, accounting for approximately 10% of all orthopedic injuries. […] Although stress fractures may affect all types of bone tissue, they are more common in bones that support bodyweight, especially those in the lower limbs (tibia, 49%; tarsal bones, 25%; metatarsals, 9%). Studies on runners reveal a higher incidence of stress fractures in the tibia, followed by the metatarsals, fibula, femur and navicular bone. […] The locations of stress fractures vary from sport to sport. Runners may develop a stress fracture of the medial malleolus, the distal end of the fibula, calcaneus, lesser metatarsal, and medial sesamoid bone. Classical ballet, aerobic gymnastics, tennis and volleyball athletes mainly present stress fractures in the navicular and sesamoid bones. Basketball athletes have a prominence of the medial malleolus, navicular bone and metatarsal stress fractures, while for footballers lesser metatarsal fractures are more common.

• #19 Upper Extremity Stress Fractures | Sports Medicine – Open | Full Text

  https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-024-00769-7

  Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. […] Upper extremity stress fractures are becoming more common as the workload placed on young athletes continues to increase. […] Stress injuries will affect roughly 40% of athletes at some point during their career, with 80-95% of these injuries affecting the lower extremities and only 5-20% affecting the upper extremities. […] However, upper extremity stress fractures are becoming more common as the demand placed on young athletes and our ability to diagnose these injuries continue to increase. […] Early diagnosis is crucial as most stress injuries can be treated conservatively early in their clinical courses but can become debilitating, cause growth disturbances, and may require surgical intervention if allowed to progress. […] Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent.

• #20 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  Stress fractures of the lower limbs are commonly observed in both military and physically active civilian populations. […] Although stress fractures usually heal without complication, restoration of bone integrity is only part of the rehabilitation process. […] Description of pathophysiology, epidemiology as well as an overview of management perspectives will be considered in this paper. […] Although, the methods of calculating incidence varies between countries it is clear from the widely reported evidence that there is a higher incidence of stress fracture in females than in males. […] In a mixed American cadets population 19.1 % of females presented with stress fractures compared to 5.7 % of males from the same cohort. […] Knapik et al. observed increased stress fracture incidence in female US military recruits (79.9/1,000) compared to males (19.3/1,000) whilst stress fracture incidence observed in the Israeli military highlighted a higher rate in females (23.9 %) compared to that in males (11.2 %).

• #21 Pathophysiology and Epidemiology of Stress Fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/pathophysiology-and-epidemiology-of-stress-fractures/

  Most important, however, is that military personnel appear to have a higher incidence of stress fractures than the general population due to the suddenly increased and extensive exercise associated with training. […] A common theme in this population is a higher reported occurrence or incidence of stress fractures among females compared to males. In one study of cadets, 19.1 % of females and 5.7 % of males reported at least one stress fracture. […] Similarly, in the largest studies of US Army recruits, the incidence of stress fractures was 79.9/1,000 female and 19.3/1,000 male recruits. […] The overall incidence rate of stress fractures in this population was 311/100,000 person-years (95 % confidence interval: 277-345).

• #22 Pathophysiology and Epidemiology of Stress Fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/pathophysiology-and-epidemiology-of-stress-fractures/

  Most important, however, is that military personnel appear to have a higher incidence of stress fractures than the general population due to the suddenly increased and extensive exercise associated with training. […] A common theme in this population is a higher reported occurrence or incidence of stress fractures among females compared to males. In one study of cadets, 19.1 % of females and 5.7 % of males reported at least one stress fracture. […] Similarly, in the largest studies of US Army recruits, the incidence of stress fractures was 79.9/1,000 female and 19.3/1,000 male recruits. […] The overall incidence rate of stress fractures in this population was 311/100,000 person-years (95 % confidence interval: 277-345).

• #23 Pathophysiology and Epidemiology of Stress Fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/pathophysiology-and-epidemiology-of-stress-fractures/

  Most important, however, is that military personnel appear to have a higher incidence of stress fractures than the general population due to the suddenly increased and extensive exercise associated with training. […] A common theme in this population is a higher reported occurrence or incidence of stress fractures among females compared to males. In one study of cadets, 19.1 % of females and 5.7 % of males reported at least one stress fracture. […] Similarly, in the largest studies of US Army recruits, the incidence of stress fractures was 79.9/1,000 female and 19.3/1,000 male recruits. […] The overall incidence rate of stress fractures in this population was 311/100,000 person-years (95 % confidence interval: 277-345).

• #24 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  Stress fractures of the lower limbs are commonly observed in both military and physically active civilian populations. […] Although stress fractures usually heal without complication, restoration of bone integrity is only part of the rehabilitation process. […] Description of pathophysiology, epidemiology as well as an overview of management perspectives will be considered in this paper. […] Although, the methods of calculating incidence varies between countries it is clear from the widely reported evidence that there is a higher incidence of stress fracture in females than in males. […] In a mixed American cadets population 19.1 % of females presented with stress fractures compared to 5.7 % of males from the same cohort. […] Knapik et al. observed increased stress fracture incidence in female US military recruits (79.9/1,000) compared to males (19.3/1,000) whilst stress fracture incidence observed in the Israeli military highlighted a higher rate in females (23.9 %) compared to that in males (11.2 %).

• #25 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  A prevalence of stress fractures in females has also been documented within the athletic population, most notably within long distance runners. […] Lower limb stress fractures are prevalent in physically active populations, accounting for up to 90% of all stress fractures and represents up to 20% of all sports related injury. […] Most commonly presenting within the lower limb, a prevalence of these injuries has been reported in the tibia 23.6%, the metatarsals (10-20%), tarsal navicular (17.6%), femur (6.65%) and pelvis (1.6%). […] Risk factor can broadly be sub-classified as intrinsic or extrinsic. […] Studies have identified low aerobic fitness, reduced tibial cross sectional area, low (trabecular and cortical) BMD as well as reduced cortical area of the posterior tibia as potential predisposing factors of fracture.

• #26

  https://www.orthobullets.com/evidence/9238304

  Clinically, stress fractures appear to be a common overuse injury among athletes and in military recruits undertaking basic training; however, there is a lack of sound epidemiologic studies describing stress fracture occurrence in athletes. […] Few have directly compared stress fracture rates between sports to establish which poses the greatest risk for this injury. […] Furthermore, incidence rates, expressed in terms of exposure, have rarely been reported for stress fractures in athletes. […] Nevertheless, available data suggest that runners and ballet dancers are at relatively high risk for stress fractures. […] Although a gender difference in rates is clearly evident in military populations, this is less apparent in athletes. […] Other participant characteristics, such as age and race, may also influence stress fracture risk.

• #27 SciELO Brazil – Stress fractures: definition, diagnosis and treatment Stress fractures: definition, diagnosis and treatment

  https://www.scielo.br/j/rbort/a/7V8g8ygyjRWtdd3DkKSrkcb/

  Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. […] The objective of this study was to review the most relevant literature of recent years in order to add key information regarding this pathological condition, as an updating article on this topic. […] Runners, soldiers and dancers are the main victims of stress fractures. […] All the bones of the human body are subject to fracturing caused by stress. […] Stress fractures are mostly commonly diagnosed in the tibia, followed by the metatarsals (especially the second and third metatarsals) and by the fibula. […] Among athletes, the difference in the incidence of stress fractures between men and women is minimal. […] In the military population, the incidence of stress fractures among females is greater than among men.

• #28 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  A prevalence of stress fractures in females has also been documented within the athletic population, most notably within long distance runners. […] Lower limb stress fractures are prevalent in physically active populations, accounting for up to 90% of all stress fractures and represents up to 20% of all sports related injury. […] Most commonly presenting within the lower limb, a prevalence of these injuries has been reported in the tibia 23.6%, the metatarsals (10-20%), tarsal navicular (17.6%), femur (6.65%) and pelvis (1.6%). […] Risk factor can broadly be sub-classified as intrinsic or extrinsic. […] Studies have identified low aerobic fitness, reduced tibial cross sectional area, low (trabecular and cortical) BMD as well as reduced cortical area of the posterior tibia as potential predisposing factors of fracture.

• #29 Stress fractures: diagnosis and management in the primary care setting | British Journal of General Practice

  https://bjgp.org/content/69/681/209

  Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. […] The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic and military populations. The career incidence of stress fractures in military personnel has been described as ranging between 520% and is two to five times more common in females. […] In the athletic population, incidence ranges from 510% and stress injuries compromised 2% of all injuries seen at the 2016 Rio Olympic Games. […] Risk factors for stress fracture or reactions can be classified as intrinsic and extrinsic. Intrinsic factors include female sex, steroid use, and nutritional deficits of calcium and vitamin D. Extrinsic factors include high volume or intense exercise, a sudden increase in volume or intensity of exercise, individual biomechanical factors, changes to footground interface, that is, shoe modification, and environmental factors, such as running on hard surfaces. […] Knowing the risk factors and initial management of stress fractures in the primary care setting can help to reduce the delay to diagnosis, accelerate recovery, and avoid serious complications.

• #30 SciELO Brazil – Stress fractures: definition, diagnosis and treatment Stress fractures: definition, diagnosis and treatment

  https://www.scielo.br/j/rbort/a/7V8g8ygyjRWtdd3DkKSrkcb/

  The factors associated with increased risk of development of stress fractures can be divided into extrinsic and intrinsic factors. […] Abrupt increases in the intensity and volume of training are often enough for lesions to develop. […] The intrinsic factors relate to possible anatomical variations, muscle conditions, hormonal states, gender, ethnicity or age. […] There is an inverse relationship between bone mineral density and the risk of stress fractures. […] Low levels of physical and muscle conditioning are also an important risk factor for the genesis of this problem. […] The main complications occur in cases of high-risk stress fractures. […] Inappropriate management may cause progression of the fracture to a complete and displaced fracture line and thus give rise to delayed consolidation, avascular necrosis and pseudarthrosis.

• #31 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #32 Stress fractures: diagnosis and management in the primary care setting | British Journal of General Practice

  https://bjgp.org/content/69/681/209

  Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. […] The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic and military populations. The career incidence of stress fractures in military personnel has been described as ranging between 520% and is two to five times more common in females. […] In the athletic population, incidence ranges from 510% and stress injuries compromised 2% of all injuries seen at the 2016 Rio Olympic Games. […] Risk factors for stress fracture or reactions can be classified as intrinsic and extrinsic. Intrinsic factors include female sex, steroid use, and nutritional deficits of calcium and vitamin D. Extrinsic factors include high volume or intense exercise, a sudden increase in volume or intensity of exercise, individual biomechanical factors, changes to footground interface, that is, shoe modification, and environmental factors, such as running on hard surfaces. […] Knowing the risk factors and initial management of stress fractures in the primary care setting can help to reduce the delay to diagnosis, accelerate recovery, and avoid serious complications.

• #33 Stress fracture epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Stress_fracture_epidemiology_and_demographics

  Dr. Johnathan C Reeser states that, in the US, the annual incidence of stress fractures range from 5% to 30%, depending on the sport and other risk factors. […] Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a higher BMD (bone mineral density) in the former. […] Women and highly active individuals are also at a higher risk. The incidence probably also increases with age due to age-related reductions in BMD, but children may also be at risk because their bones have yet to reach full density and strength. The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

• #34 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  Similarly, both genetics and ethnicity are also considered influential in the causation of stress fracture, with lower rates seen in African-American populations compared to Caucasian and Asian groups. […] Although, it is not possible to prevent all injuries the management of choice for stress fractures should always be prevention. […] A multi-factorial approach has been found to be the most effective strategy to the prevention and management of these injuries. […] The purpose of this review is to present an overview of the pathogenesis, epidemiology and provide a brief overview of management perspectives.

• #35 SciELO Brasil – Stress fractures in the foot and ankle of athletes Stress fractures in the foot and ankle of athletes

  https://www.scielo.br/j/ramb/a/JFYJ4nGBb66gWdQzYhCKbmn/

  From a biomechanical point of view, fatigue fractures are the result of specific, cyclical and repetitive muscle action until exhaustion, with load transfer to the bone exceeding its adaptation capacity. […] Various factors contribute to the pathogenesis of the disease, which may be classified into 2 sub-types: intrinsic and extrinsic. In general, extrinsic factors are related to the type and rhythm of training, the use of unsuitable footwear and sports equipment, precarious physical conditioning, the training location, environmental temperature and insufficient recovery time of previous injuries. Intrinsic factors include age, sex, race, bone density and structure, hormonal, menstrual, metabolic and nutritional balance, sleep pattern and collagen diseases. […] Prospective and retrospective studies show a higher incidence among Caucasians. When compared to American black and Hispanic individuals, white individuals are more susceptible to stress fractures. The same occurs with age: older individuals present a higher incidence of such fractures. Stress fractures are less common in children than adolescents and adults. In relation to sex, some studies have shown that military women have an incidence 5 to 10 times higher than men.

• #36 SciELO Brazil – Stress fractures: definition, diagnosis and treatment Stress fractures: definition, diagnosis and treatment

  https://www.scielo.br/j/rbort/a/7V8g8ygyjRWtdd3DkKSrkcb/

  The factors associated with increased risk of development of stress fractures can be divided into extrinsic and intrinsic factors. […] Abrupt increases in the intensity and volume of training are often enough for lesions to develop. […] The intrinsic factors relate to possible anatomical variations, muscle conditions, hormonal states, gender, ethnicity or age. […] There is an inverse relationship between bone mineral density and the risk of stress fractures. […] Low levels of physical and muscle conditioning are also an important risk factor for the genesis of this problem. […] The main complications occur in cases of high-risk stress fractures. […] Inappropriate management may cause progression of the fracture to a complete and displaced fracture line and thus give rise to delayed consolidation, avascular necrosis and pseudarthrosis.

• #37 Stress fracture – Wikipedia

  https://en.wikipedia.org/wiki/Stress_fracture

  The population that has the highest risk for stress fractures is athletes and military recruits who are participating in repetitive, high intensity training. Sports and activities that have excessive, repetitive ground reaction forces have the highest incidence of stress fractures. […] Women are more at risk for stress fractures than men due to factors such as lower aerobic capacity, reduced muscle mass, lower bone mineral density, among other anatomical and hormone-related elements. Women also have a two- to four-times increased risk of stress fractures when they have amenorrhea compared to women who are eumenorrheic. […] Reduced bone health increases the risk of stress fractures and studies have shown an inverse relationship between bone mineral density and stress fracture occurrences. This condition is most notable and commonly seen on the femoral neck.

• #38

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Intrinsic factors can include: Low bone density, Sex: female male, History of stress fracture, Hormonal status: late menarche (15 years of age), oligo or amenorrhea, BMI 19, Low energy availability and/or eating disorder, Systemic medical conditions that affect metabolic and/or nutritional status, such as thyroid dysfunction.

• #39 Risk Factors for Stress Fractures in Female Runners: Results of a Survey | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/18806-risk-factors-for-stress-fractures-in-female-runners-results-of-a-survey

  Few studies compare women with and without stress fractures and most focus on younger, elite runners. […] For female runners, risk factors for SFs are multifactorial. […] The factors related to SF are intrinsic and extrinsic. […] Some of the extrinsic factors that are associated with SF include increased training intensity, especially in a short period of time; less compliant training surfaces; irregular running terrain; a higher percentage of running on hills; and inappropriate footwear. […] A few studies directly evaluate women with and without a history of SFs. […] The odds of having a stress fracture were 1.43 times higher for going 6 months without a menstrual period. […] The odds of having a SF for those with osteopenia were about four times as high as those without osteopenia (OR: 4.14).

• #40 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Another factor influencing stress fracture development is overtraining, or a more current name would be relative energy deficiency syndrome. This is commonly seen as part of the female athlete triad. The athlete’s training volume is too high, and calorie intake is too restricted, resulting in impaired recovery. This leads to disordered menstruation and hormonal imbalances, with estrogen levels falling, leading to osteoporosis with a stress fracture as a result. There is also a similar phenomenon in male endurance athletes who have similar high training volumes and restricted calorie intake. This will result in lower testosterone levels resulting in osteoporosis and stress fracture development. […] Vitamin D is another potential factor influencing the development of stress fractures. In a prospective trial of Finnish military recruits, those who sustained a stress fracture had a lower average vitamin D concentration than those who did not. A level 1 randomized trial of female military recruits showed vitamin D supplementation might have prevented a significant percentage of trainees from developing a stress fracture.

• #41 Stress Fractures: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/309106-overview

  Studies of US military recruits revealed a higher percentage of stress fractures in female recruits than in male recruits. […] The triad of disordered eating, amenorrhea/oligomenorrhea, and osteoporosis may be extremely prevalent in female distance runners and ballet dancers, as well as in other female athletes who believe that a low body weight or body-fat percentage provides a competitive advantage. […] Early identification of female athletes who are likely to develop the female athlete triad is important for the prevention of stress fractures and for maintaining overall future bone health. […] In a study of military recruits, Markey found no difference in the incidence of stress fractures between recruits of various racial backgrounds.

• #42

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Intrinsic factors can include: Low bone density, Sex: female male, History of stress fracture, Hormonal status: late menarche (15 years of age), oligo or amenorrhea, BMI 19, Low energy availability and/or eating disorder, Systemic medical conditions that affect metabolic and/or nutritional status, such as thyroid dysfunction.

• #43 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #44 Epidemiology of Stress Fracture and Lower-Extremity Overuse Injury in Female Recruits – Dialnet

  https://dialnet.unirioja.es/servlet/articulo?codigo=2794396

  Purpose: The purpose of this prospective study was to examine rates and risk factors for overuse injuries among 824 women during Marine Corps Recruit Depot basic training at Parris Island, SC, in 1999. […] Methods: Data collected included training day exposures (TDE), baseline performance on a standardized 1.5-mile timed run, and a pretraining questionnaire highlighting exercise and health habits. The women were followed during training for occurrence of stress fracture and other lower-extremity overuse injury. […] Results: There were 868 lower-extremity overuse injuries for an overall injury rate of 12.6/1000 TDE. Rates for initial and subsequent injury were 8.7/1000 and 20.7/1000 TDE, respectively. There were 66 confirmed lower-extremity stress fractures among 56 (6.8%) women (1.0/1000 TDE). Logistic regression modeling indicated that low aerobic fitness (a slower time on the timed run ( 14.4 min)), no menses in six or more consecutive months during the past year, and less than 7 months of lower-extremity weight training were significantly associated with stress fracture incidence.

• #45 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #46 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  A prevalence of stress fractures in females has also been documented within the athletic population, most notably within long distance runners. […] Lower limb stress fractures are prevalent in physically active populations, accounting for up to 90% of all stress fractures and represents up to 20% of all sports related injury. […] Most commonly presenting within the lower limb, a prevalence of these injuries has been reported in the tibia 23.6%, the metatarsals (10-20%), tarsal navicular (17.6%), femur (6.65%) and pelvis (1.6%). […] Risk factor can broadly be sub-classified as intrinsic or extrinsic. […] Studies have identified low aerobic fitness, reduced tibial cross sectional area, low (trabecular and cortical) BMD as well as reduced cortical area of the posterior tibia as potential predisposing factors of fracture.

• #47 Common Stress Fractures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1015/p1527.html?__hstc=245162842.14756f51aad28a6d480b0896ec071bae.1402272000028.1402272000029.1402272000030.1&__hssc=245162842.1.1402272000031&__hsfp=3077594379

  In both men and women, stress fractures tend to recur. Approximately 60 percent of persons with a stress fracture have had a previous stress fracture. […] Tibial fractures are the most common lower extremity stress fracture, accounting for approximately one half of all stress fractures in children and adults. […] Metatarsal fractures represent approximately 25 percent of stress fractures. […] In adults, approximately 10 percent of stress fractures occur in the fibula. […] Navicular fractures are the most common stress fractures of tarsal bones, with calcaneus fractures accounting for almost all of the remainder. […] Femoral stress fractures also are rare, representing only about 5 percent of all stress fractures. […] Stress fractures of the lower extremity present as localized dull pain not associated with trauma that worsens during exercise or weight bearing.

• #48

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Intrinsic factors can include: Low bone density, Sex: female male, History of stress fracture, Hormonal status: late menarche (15 years of age), oligo or amenorrhea, BMI 19, Low energy availability and/or eating disorder, Systemic medical conditions that affect metabolic and/or nutritional status, such as thyroid dysfunction.

• #49 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #50 Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

  https://www.mdpi.com/1648-9144/57/3/223

  Stress fractures can occur in both younger and older athletes. […] The use of 25(OH)D in the prevention of stress fractures is one part. […] Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day. […] A very recent pilot study showed a significant decrease in stress fractures from 7.51% to 1.65% with 25(OH)D supplementation.

• #51 Stress fractures: diagnosis and management in the primary care setting | British Journal of General Practice

  https://bjgp.org/content/69/681/209

  Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. […] The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic and military populations. The career incidence of stress fractures in military personnel has been described as ranging between 520% and is two to five times more common in females. […] In the athletic population, incidence ranges from 510% and stress injuries compromised 2% of all injuries seen at the 2016 Rio Olympic Games. […] Risk factors for stress fracture or reactions can be classified as intrinsic and extrinsic. Intrinsic factors include female sex, steroid use, and nutritional deficits of calcium and vitamin D. Extrinsic factors include high volume or intense exercise, a sudden increase in volume or intensity of exercise, individual biomechanical factors, changes to footground interface, that is, shoe modification, and environmental factors, such as running on hard surfaces. […] Knowing the risk factors and initial management of stress fractures in the primary care setting can help to reduce the delay to diagnosis, accelerate recovery, and avoid serious complications.

• #52 SciELO Brazil – Stress fractures: definition, diagnosis and treatment Stress fractures: definition, diagnosis and treatment

  https://www.scielo.br/j/rbort/a/7V8g8ygyjRWtdd3DkKSrkcb/

  The factors associated with increased risk of development of stress fractures can be divided into extrinsic and intrinsic factors. […] Abrupt increases in the intensity and volume of training are often enough for lesions to develop. […] The intrinsic factors relate to possible anatomical variations, muscle conditions, hormonal states, gender, ethnicity or age. […] There is an inverse relationship between bone mineral density and the risk of stress fractures. […] Low levels of physical and muscle conditioning are also an important risk factor for the genesis of this problem. […] The main complications occur in cases of high-risk stress fractures. […] Inappropriate management may cause progression of the fracture to a complete and displaced fracture line and thus give rise to delayed consolidation, avascular necrosis and pseudarthrosis.

• #53 Common Stress Fractures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1015/p1527.html?__hstc=245162842.14756f51aad28a6d480b0896ec071bae.1402272000028.1402272000029.1402272000030.1&__hssc=245162842.1.1402272000031&__hsfp=3077594379

  Lower extremity stress fractures are common injuries most often associated with participation in sports involving running, jumping, or repetitive stress. […] Stress fractures are among the most common sports injuries and are frequently managed by family physicians. […] Stress fractures can result from participation in many activities and sports, especially those requiring running and jumping. […] Athletics, or track and field sports, account for 50 percent of stress fractures in men and 64 percent in women. […] Stress fractures of the lower extremity most commonly involve the tibia and metatarsal bones. […] Stress fractures often occur in nonathletes or deconditioned persons who begin a new exercise program, such as military recruits. […] Women are generally more likely to develop stress fractures than men.

• #54 Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

  https://www.mdpi.com/1648-9144/57/3/223

  Stress fractures are not uncommon in athletes and affect around 20% of all competitors. […] The prevalence of stress fractures is estimated to be between 6.5–9.7% among athletes of different sport disciplines. […] Stress fractures can affect every sporty person, from weekend athletes to top athletes. […] Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. […] The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. […] A prolonged lack of 25(OH)D can lead to stress fractures in athletes. […] Several studies have shown the relationship between low levels of 25(OH)D and an increased risk of stress or insufficiency fractures.

• #55 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #56 Stress fractures: diagnosis and management in the primary care setting | British Journal of General Practice

  https://bjgp.org/content/69/681/209

  Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. […] The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic and military populations. The career incidence of stress fractures in military personnel has been described as ranging between 520% and is two to five times more common in females. […] In the athletic population, incidence ranges from 510% and stress injuries compromised 2% of all injuries seen at the 2016 Rio Olympic Games. […] Risk factors for stress fracture or reactions can be classified as intrinsic and extrinsic. Intrinsic factors include female sex, steroid use, and nutritional deficits of calcium and vitamin D. Extrinsic factors include high volume or intense exercise, a sudden increase in volume or intensity of exercise, individual biomechanical factors, changes to footground interface, that is, shoe modification, and environmental factors, such as running on hard surfaces. […] Knowing the risk factors and initial management of stress fractures in the primary care setting can help to reduce the delay to diagnosis, accelerate recovery, and avoid serious complications.

• #57

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Accounts for 10% of all overuse sports injuries (4). […] Running is the most commonly associated sport accounting for 69% of stress fractures (5). […] 95% occur in the lower extremities due to dissipation of ground reaction forces during load bearing tasks such as marching, walking, running, or jumping (5). […] Typically occur in cortical bone in the following areas, in decreasing order of incidence: tibia, tarsal bones, metatarsals, femur, fibula, pelvis (3). […] Stress fractures can occur in any bone that experiences abnormal stress overload with training (scaphoid in shot putter, rib in rower, lumbar vertebrae in pitcher). […] Risk factors are many and often multifactorial. These can include both intrinsic and extrinsic elements (35). […] Extrinsic factors include: Intensive training regimen/variables, Improper or worn-out footwear, Hard training surface, Type of sport e.g., running swimming, Low vitamin D and/or calcium intake, Muscle fatigue (neuromuscular hypothesis).

• #58 Stress fractures: diagnosis and management in the primary care setting | British Journal of General Practice

  https://bjgp.org/content/69/681/209

  Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. […] The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic and military populations. The career incidence of stress fractures in military personnel has been described as ranging between 520% and is two to five times more common in females. […] In the athletic population, incidence ranges from 510% and stress injuries compromised 2% of all injuries seen at the 2016 Rio Olympic Games. […] Risk factors for stress fracture or reactions can be classified as intrinsic and extrinsic. Intrinsic factors include female sex, steroid use, and nutritional deficits of calcium and vitamin D. Extrinsic factors include high volume or intense exercise, a sudden increase in volume or intensity of exercise, individual biomechanical factors, changes to footground interface, that is, shoe modification, and environmental factors, such as running on hard surfaces. […] Knowing the risk factors and initial management of stress fractures in the primary care setting can help to reduce the delay to diagnosis, accelerate recovery, and avoid serious complications.

• #59

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Accounts for 10% of all overuse sports injuries (4). […] Running is the most commonly associated sport accounting for 69% of stress fractures (5). […] 95% occur in the lower extremities due to dissipation of ground reaction forces during load bearing tasks such as marching, walking, running, or jumping (5). […] Typically occur in cortical bone in the following areas, in decreasing order of incidence: tibia, tarsal bones, metatarsals, femur, fibula, pelvis (3). […] Stress fractures can occur in any bone that experiences abnormal stress overload with training (scaphoid in shot putter, rib in rower, lumbar vertebrae in pitcher). […] Risk factors are many and often multifactorial. These can include both intrinsic and extrinsic elements (35). […] Extrinsic factors include: Intensive training regimen/variables, Improper or worn-out footwear, Hard training surface, Type of sport e.g., running swimming, Low vitamin D and/or calcium intake, Muscle fatigue (neuromuscular hypothesis).

• #60 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Stress fractures account for about 20% of all sports medicine injuries, and runners who average more than 25 miles a week are considered high risk. Due to the repetitive nature of military training, stress fractures are common among members of the military. From 2009 to 2012, US military members had 5.69 stress fractures per 1000 person-years. In runners, stress fractures account for nearly 16% of all injuries. The most common stress fractures in decreasing order of occurrence are the tibia (23.6%), tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%). These injuries are also more common in women. […] In addition to the intrinsic and extrinsic factors already noted, there are additional factors influencing stress fracture development. One factor is a neuromuscular hypothesis. Due to either muscle loss or fatigue, the muscles become increasingly less able to attenuate the forces applied through the bones. This results in higher peak stress and more microdamage. A study done on U.S. Naval Academy plebes showed those who lost the most weight over the shortest period were more likely to develop a stress fracture. The study was interesting because the authors used a dual-energy x-ray absorptiometry scan to measure body composition. Those who lost weight quickly lost, mainly muscle mass and not fat mass. The results of the study support the neuromuscular hypothesis.

• #61

  https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx

  Accounts for 10% of all overuse sports injuries (4). […] Running is the most commonly associated sport accounting for 69% of stress fractures (5). […] 95% occur in the lower extremities due to dissipation of ground reaction forces during load bearing tasks such as marching, walking, running, or jumping (5). […] Typically occur in cortical bone in the following areas, in decreasing order of incidence: tibia, tarsal bones, metatarsals, femur, fibula, pelvis (3). […] Stress fractures can occur in any bone that experiences abnormal stress overload with training (scaphoid in shot putter, rib in rower, lumbar vertebrae in pitcher). […] Risk factors are many and often multifactorial. These can include both intrinsic and extrinsic elements (35). […] Extrinsic factors include: Intensive training regimen/variables, Improper or worn-out footwear, Hard training surface, Type of sport e.g., running swimming, Low vitamin D and/or calcium intake, Muscle fatigue (neuromuscular hypothesis).

• #62 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #63 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Another factor influencing stress fracture development is overtraining, or a more current name would be relative energy deficiency syndrome. This is commonly seen as part of the female athlete triad. The athlete’s training volume is too high, and calorie intake is too restricted, resulting in impaired recovery. This leads to disordered menstruation and hormonal imbalances, with estrogen levels falling, leading to osteoporosis with a stress fracture as a result. There is also a similar phenomenon in male endurance athletes who have similar high training volumes and restricted calorie intake. This will result in lower testosterone levels resulting in osteoporosis and stress fracture development. […] Vitamin D is another potential factor influencing the development of stress fractures. In a prospective trial of Finnish military recruits, those who sustained a stress fracture had a lower average vitamin D concentration than those who did not. A level 1 randomized trial of female military recruits showed vitamin D supplementation might have prevented a significant percentage of trainees from developing a stress fracture.

• #64 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #65 Increased Risk for Stress Fractures and Delayed Healing with NSAID Receipt, U.S. Armed Forces, 2014–2018 | Health.mil

  https://staging-mobile.health.mil/sitecore/content/MHSHome/News/Articles/2020/02/01/Increase-Risk-for-Stress-Fractures-MSMR-2020?type=All&page=14

  This is the first MSMR report on the association between prior NSAID receipt and incident stress fracture diagnosis in service members. […] Prior NSAID receipt was associated with a 70% increased incidence of stress fracture. […] This study suggests that receiving NSAIDs may increase the risk for stress fracture among active component service members. […] These stress fracture injuries may contribute to lost duty days and reduce deployment readiness because of physical limitation. […] Injuries, including stress fractures, are a major public health concern among the military because of their high prevalence, the associated lost working time, and the cost of treatment. […] A previous MSMR article estimated that there were 31,349 incident stress fractures diagnosed (a rate of 3.2 per 1,000 person-years) among active component service members from 2004 through 2010. […] The burden associated with stress fractures is high when taking into consideration the incidence rate, slow recovery time, and medical cost of treatment.

• #66 Increased Risk for Stress Fractures and Delayed Healing with NSAID Receipt, U.S. Armed Forces, 2014–2018 | Health.mil

  https://staging-mobile.health.mil/sitecore/content/MHSHome/News/Articles/2020/02/01/Increase-Risk-for-Stress-Fractures-MSMR-2020?type=All&page=14

  This study found that active component service members who had previously received any NSAIDs experienced a 70% increased incidence in stress fracture diagnoses compared to those who had not received any NSAIDs. […] As a secondary objective, the current study examined whether dispensed NSAIDs were associated with diagnoses of delayed healing and found that stress fracture cases with previous NSAID receipt experienced 1.41 times the odds of a delayed healing diagnosis compared to nonrecipients. […] If confirmed, these findings may have significant implications for military readiness because NSAIDs are used extensively and stress fractures are already a major contributor to the burden of health care encounters and lost duty time.

• #67 Epidemiology of stress fractures – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16324972/

  Stress fractures are a frequent cause of injury in competitive and recreational athletes. […] Although a number of epidemiologic studies have been conducted, the populations studied and data collection methods have varied. […] This article presents an overview of injury epidemiology and reviews the current body of literature regarding the occurrence of stress fractures in athletes. […] Given the heterogeneity of the populations studied and the variations in data collection, few broad conclusions can be drawn. […] There is a pressing need for large prospective studies to better establish the risks of stress fracture by sport, age, and gender.

• #68 Pathophysiology and Epidemiology of Stress Fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/pathophysiology-and-epidemiology-of-stress-fractures/

  The epidemiology of stress fractures is described as the occurrence of stress fractures in athletic populations, and is typically expressed on the basis of exposure (e.g., number of stress fractures per athlete-years or per athlete-exposures). […] A second complicating factor in deciphering the literature defining the occurrence of stress fractures in athletes is the method of diagnosis. Older studies used modalities such as X-ray, which can have poor sensitivity in identifying changes. […] Military populations are a unique group that facilitates epidemiological research on stress fractures. Patient follow-up and activity exposure can be well controlled and documented, which allows for more homogeneous comparisons and higher level of evidence designs such as prospective cohorts. […] Additionally, large numbers of patients can be recruited for study, which is helpful when investigating a condition that typically occurs infrequently or when performing multivariate analyses to identify risk factors.

• #69 The Epidemiology of Stress Fractures in Sport | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-72036-0_2

  Stress injury of bone includes a spectrum from hyperactive bone remodeling to a discrete fracture line visible on imaging. […] Factors that increase load, such as repetitive impact, through competition or training for sports or the military, contribute to the development of a stress fracture. […] The incidence of stress fractures is difficult to establish from the current literature due to variations in imaging modality used for diagnosis, the quality and methods of patient-exposure reporting between studies, and the heterogeneity of stress injury by location. […] Data on the occurrence and incidence rates of stress fracture, however, suggest, that female athletes, runners, and military personnel have the highest incidence rates of these injuries.

• #70 Pathophysiology and Epidemiology of Stress Fractures | Musculoskeletal Key

  https://musculoskeletalkey.com/pathophysiology-and-epidemiology-of-stress-fractures/

  The epidemiology of stress fractures is described as the occurrence of stress fractures in athletic populations, and is typically expressed on the basis of exposure (e.g., number of stress fractures per athlete-years or per athlete-exposures). […] A second complicating factor in deciphering the literature defining the occurrence of stress fractures in athletes is the method of diagnosis. Older studies used modalities such as X-ray, which can have poor sensitivity in identifying changes. […] Military populations are a unique group that facilitates epidemiological research on stress fractures. Patient follow-up and activity exposure can be well controlled and documented, which allows for more homogeneous comparisons and higher level of evidence designs such as prospective cohorts. […] Additionally, large numbers of patients can be recruited for study, which is helpful when investigating a condition that typically occurs infrequently or when performing multivariate analyses to identify risk factors.

• #71 Stress fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/stress-fracture-2?lang=us

  MRI is the most sensitive modality for diagnosis of a stress fracture and is an important tool to distinguish high and low-risk fractures to help clinicians with management plans and a sensitivity reported to reach close to 100%. […] Risk factors such as diet, vitamin D, and calcium should be addressed to prevent recurrence. Other factors, such as a gradual return to training and biomechanical evaluation of gait, may be required. Bone density evaluation can be considered in patients with recurrent stress fractures, a family history of osteoporosis, or stress fractures unexplained by exercise activity.

• #72 Stress fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/stress-fracture-2?embed_domain=hackmd.io%2F%40yipuafecsl2jsu8smr5njq%2Fbnjhjgjghjghjgh&lang=us

  Fatigue fractures are common in athletes, especially runners and military recruits. Insufficiency fractures occur more in women and older people. […] The following conditions increase the risk of a stress injury: female sex, low bone density, nutritional disorders or deficiencies, 'female athlete triad’, long-distance running, inappropriately short recovery time, training changes, inadequate shoes. […] Stress fractures are far more common in the lower limb (~95%) than in the upper limb. High-risk sites of stress fractures are locations at greatest risk of a progression to complete fracture, displacement or non-union as these sites are under tensile stresses and have poor vascularity. […] MRI is the most sensitive modality for diagnosis of a stress fracture and is an important tool to distinguish high and low-risk fractures to help clinicians with management plans and a sensitivity reported to reach close to 100%.

• #73 Epidemiology of stress fractures – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16324972/

  Stress fractures are a frequent cause of injury in competitive and recreational athletes. […] Although a number of epidemiologic studies have been conducted, the populations studied and data collection methods have varied. […] This article presents an overview of injury epidemiology and reviews the current body of literature regarding the occurrence of stress fractures in athletes. […] Given the heterogeneity of the populations studied and the variations in data collection, few broad conclusions can be drawn. […] There is a pressing need for large prospective studies to better establish the risks of stress fracture by sport, age, and gender.

• #74 The Epidemiology of Stress Fractures in Sport | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-72036-0_2

  Stress injury of bone includes a spectrum from hyperactive bone remodeling to a discrete fracture line visible on imaging. […] Factors that increase load, such as repetitive impact, through competition or training for sports or the military, contribute to the development of a stress fracture. […] The incidence of stress fractures is difficult to establish from the current literature due to variations in imaging modality used for diagnosis, the quality and methods of patient-exposure reporting between studies, and the heterogeneity of stress injury by location. […] Data on the occurrence and incidence rates of stress fracture, however, suggest, that female athletes, runners, and military personnel have the highest incidence rates of these injuries.

• #75 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e38

  The purpose of this review is to broaden the understanding of stress fractures, as well as to assist in the treatment and prevention of stress fractures by providing information about the epidemiology, risk factors, diagnosis and classification of BSI. In addition, we look forward to seeing a lot of interest and follow-up studies in Korea, a barren area of research on stress fractures. […] More than a third of cross-country and long-distance runners experience BSIs, and the 1-year prospective incidence of BSI in track and field athletes is reported up to about 21%. […] Of all sports-related injuries encountered in sports medicine clinics, BSIs account for up to 20%. […] Unfortunately, there have been no epidemiological investigations or related studies on BSIs or stress fractures among athletes in Korea.

• #76 Stress Fractures: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/309106-overview

  Studies of US military recruits revealed a higher percentage of stress fractures in female recruits than in male recruits. […] The triad of disordered eating, amenorrhea/oligomenorrhea, and osteoporosis may be extremely prevalent in female distance runners and ballet dancers, as well as in other female athletes who believe that a low body weight or body-fat percentage provides a competitive advantage. […] Early identification of female athletes who are likely to develop the female athlete triad is important for the prevention of stress fractures and for maintaining overall future bone health. […] In a study of military recruits, Markey found no difference in the incidence of stress fractures between recruits of various racial backgrounds.

• #77 Imaging-detected bone stress injuries at the Tokyo 2020 summer Olympics: epidemiology, injury onset, and competition withdrawal rate | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05725-8

  Previous studies of bone stress injury at the Olympic Games were conducted at Rio de Janeiro (2016) and London (2012), where they accounted for approximately 23% of all injuries. […] The current study provided additional details within the track and field category, separately providing data on road events (marathon and race walking). […] High-intensity training is unavoidable for Olympic athletes, meaning that delayed diagnosis can result in the progression of the MRI grade of bone stress injury. […] Most athletes with bone stress injuries (72%) had symptoms before their arrival at the Olympic Village. Furthermore, six of 29 athletes with bone stress injuries (21%) did not start or did not finish their competitions, and four of the six athletes who withdrew had symptoms before entering the Olympic Village. In Olympic athletes, early MRI examination of symptomatic athletes, even before their arrival at the Games, could reduce the risk of withdrawal and stress injury progression. […] The epidemiological characteristics of bone stress injuries in the Tokyo 2020 Olympics showed a trend similar to that reported for the Rio de Janeiro 2016 Olympics.

• #78 Imaging-detected bone stress injuries at the Tokyo 2020 summer Olympics: epidemiology, injury onset, and competition withdrawal rate | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05725-8

  Previous studies of bone stress injury at the Olympic Games were conducted at Rio de Janeiro (2016) and London (2012), where they accounted for approximately 23% of all injuries. […] The current study provided additional details within the track and field category, separately providing data on road events (marathon and race walking). […] High-intensity training is unavoidable for Olympic athletes, meaning that delayed diagnosis can result in the progression of the MRI grade of bone stress injury. […] Most athletes with bone stress injuries (72%) had symptoms before their arrival at the Olympic Village. Furthermore, six of 29 athletes with bone stress injuries (21%) did not start or did not finish their competitions, and four of the six athletes who withdrew had symptoms before entering the Olympic Village. In Olympic athletes, early MRI examination of symptomatic athletes, even before their arrival at the Games, could reduce the risk of withdrawal and stress injury progression. […] The epidemiological characteristics of bone stress injuries in the Tokyo 2020 Olympics showed a trend similar to that reported for the Rio de Janeiro 2016 Olympics.

• #79

  https://www.scirp.org/%28S%28lz5mqp453edsnp55rrgjct55%29%29/reference/referencespapers?referenceid=6547

  S. J. Warden, D. B. Burr, and P. D. Brukner, (2006) Stress fractures: Pathophysiology, epidemiology, and risk factors, Current Osteoporosis Reports, Published online, March 26, 2008. […] Nine tibias in 16 developed stress fracture after the 3-week training. […] This suggests that bioimpedance may be used to monitor the physical condition of a limb, imply its liability to develop stress fracture, and indicate stress fracture during training.

• #80 Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention – Journal of Special Operations Medicine

  https://jsomonline.org/product/Stress-Fractures-Etiology-Epidemiology-Diagnosis-Treatment-and-Prevention/?add-to-cart=11385

  Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. […] Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation, modifications of military equipment, and leadership education with injury surveillance.

• #81 Stress Fractures: Symptoms, Causes, Diagnosis & Treatment – Los Angeles Times

  https://www.latimes.com/doctors-scientists/medicine/primary-care/story/stress-fractures-symptoms-causes-diagnosis-treatment

  Bone stress injuries, which encompass stress fractures, are critical to understand for proper diagnosis, management, and prevention, especially among runners and military personnel. The PMR review (2016) categorizes fractures into: Low-risk fractures: Found in posteromedial tibia, metatarsals and fibula. High-risk fractures: Located in critical load-bearing areas like femoral neck, patella, anterior tibia and talus. […] For prevention, education is key. Strategies include: Gradually increasing training intensity (no more than 10% per week), Cross-training to reduce repetitive stress, Strengthening supporting muscles, Maintaining bone health through proper nutrition, Monitoring for early warning signs like persistent localized pain. […] The Journal of Clinical Endocrinology and Metabolism (2017) even notes that bone density monitoring and early supplementation can significantly reduce stress fracture risk, especially in high-risk groups like female athletes and older adults.

• #82 Common Stress Fractures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1015/p1527.html?__hstc=245162842.14756f51aad28a6d480b0896ec071bae.1402272000028.1402272000029.1402272000030.1&__hssc=245162842.1.1402272000031&__hsfp=3077594379

  Triple phase nuclear bone scans are more sensitive than plain radiographs in the detection of stress fractures early in the clinical course. […] A Cochrane Review involving four trials suggested that the use of shock-absorbing insoles may prevent stress fractures and stress reactions of the lower extremities.

• #83 Stress Fractures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554538/

  Another factor influencing stress fracture development is overtraining, or a more current name would be relative energy deficiency syndrome. This is commonly seen as part of the female athlete triad. The athlete’s training volume is too high, and calorie intake is too restricted, resulting in impaired recovery. This leads to disordered menstruation and hormonal imbalances, with estrogen levels falling, leading to osteoporosis with a stress fracture as a result. There is also a similar phenomenon in male endurance athletes who have similar high training volumes and restricted calorie intake. This will result in lower testosterone levels resulting in osteoporosis and stress fracture development. […] Vitamin D is another potential factor influencing the development of stress fractures. In a prospective trial of Finnish military recruits, those who sustained a stress fracture had a lower average vitamin D concentration than those who did not. A level 1 randomized trial of female military recruits showed vitamin D supplementation might have prevented a significant percentage of trainees from developing a stress fracture.

• #84 Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

  https://www.mdpi.com/1648-9144/57/3/223

  Stress fractures can occur in both younger and older athletes. […] The use of 25(OH)D in the prevention of stress fractures is one part. […] Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day. […] A very recent pilot study showed a significant decrease in stress fractures from 7.51% to 1.65% with 25(OH)D supplementation.

• #85 Epidemiology of Stress Fracture and Lower-Extremity Overuse Injury in Female Recruits – Dialnet

  https://dialnet.unirioja.es/servlet/articulo?codigo=2794396

  Purpose: The purpose of this prospective study was to examine rates and risk factors for overuse injuries among 824 women during Marine Corps Recruit Depot basic training at Parris Island, SC, in 1999. […] Methods: Data collected included training day exposures (TDE), baseline performance on a standardized 1.5-mile timed run, and a pretraining questionnaire highlighting exercise and health habits. The women were followed during training for occurrence of stress fracture and other lower-extremity overuse injury. […] Results: There were 868 lower-extremity overuse injuries for an overall injury rate of 12.6/1000 TDE. Rates for initial and subsequent injury were 8.7/1000 and 20.7/1000 TDE, respectively. There were 66 confirmed lower-extremity stress fractures among 56 (6.8%) women (1.0/1000 TDE). Logistic regression modeling indicated that low aerobic fitness (a slower time on the timed run ( 14.4 min)), no menses in six or more consecutive months during the past year, and less than 7 months of lower-extremity weight training were significantly associated with stress fracture incidence.

• #86 Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

  https://www.mdpi.com/1648-9144/57/3/223

  Stress fractures can occur in both younger and older athletes. […] The use of 25(OH)D in the prevention of stress fractures is one part. […] Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day. […] A very recent pilot study showed a significant decrease in stress fractures from 7.51% to 1.65% with 25(OH)D supplementation.

• #87 Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

  https://www.mdpi.com/1648-9144/57/3/223

  Stress fractures can occur in both younger and older athletes. […] The use of 25(OH)D in the prevention of stress fractures is one part. […] Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day. […] A very recent pilot study showed a significant decrease in stress fractures from 7.51% to 1.65% with 25(OH)D supplementation.

• #88 Stress fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/stress-fracture-2?lang=us

  MRI is the most sensitive modality for diagnosis of a stress fracture and is an important tool to distinguish high and low-risk fractures to help clinicians with management plans and a sensitivity reported to reach close to 100%. […] Risk factors such as diet, vitamin D, and calcium should be addressed to prevent recurrence. Other factors, such as a gradual return to training and biomechanical evaluation of gait, may be required. Bone density evaluation can be considered in patients with recurrent stress fractures, a family history of osteoporosis, or stress fractures unexplained by exercise activity.

• #89 Stress fracture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/stress-fracture-2?embed_domain=hackmd.io%2F%40yipuafecsl2jsu8smr5njq%2Fbnjhjgjghjghjgh&lang=us

  Risk factors such as diet, vitamin D, and calcium should be addressed to prevent recurrence. Other factors, such as a gradual return to training and biomechanical evaluation of gait, may be required. Bone density evaluation can be considered in patients with recurrent stress fractures, a family history of osteoporosis, or stress fractures unexplained by exercise activity.

• #90 Stress Fracture: A Review of the Pathophysiology, Epidemiology and Management Options

  https://www.jscimedcentral.com/jounal-article-info/Journal-of-Fractures-and-Sprains/Stress-Fracture%3A-A-Review-of-the–Pathophysiology%2C-Epidemiology–and-Management-Options-10338

  Similarly, both genetics and ethnicity are also considered influential in the causation of stress fracture, with lower rates seen in African-American populations compared to Caucasian and Asian groups. […] Although, it is not possible to prevent all injuries the management of choice for stress fractures should always be prevention. […] A multi-factorial approach has been found to be the most effective strategy to the prevention and management of these injuries. […] The purpose of this review is to present an overview of the pathogenesis, epidemiology and provide a brief overview of management perspectives.

• #91 Stress Fractures: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/309106-overview

  Studies of US military recruits revealed a higher percentage of stress fractures in female recruits than in male recruits. […] The triad of disordered eating, amenorrhea/oligomenorrhea, and osteoporosis may be extremely prevalent in female distance runners and ballet dancers, as well as in other female athletes who believe that a low body weight or body-fat percentage provides a competitive advantage. […] Early identification of female athletes who are likely to develop the female athlete triad is important for the prevention of stress fractures and for maintaining overall future bone health. […] In a study of military recruits, Markey found no difference in the incidence of stress fractures between recruits of various racial backgrounds.

• #92 1 Pathophysiology and Epidemiology of Stress Fractures in Military Women | Reducing Stress Fracture in Physically Active Military Women | The National Academies Press

  https://nap.nationalacademies.org/read/6295/chapter/3

  Stress fractures were first described in the military as the ”march fracture,” and in the 1950s stress fractures were identified in the civilian athletic population. […] Estimates of stress fracture rates in military women during basic training range from 1 to 20 percent, while rates in military men range from less than 1 to 9 percent. This variation likely reflects both true variation in rates and methodological differences between the studies. Rates in civilian female athletes show less variation and do not substantiate the theory that a true difference exists. Stress fractures are more common in military women than in men, with estimates in women being 1.2 to 11 times higher than in men in the various studies performed to date. […] The incidence of stress fractures of the lower extremities during U.S. military basic training is significantly higher among female military recruits than among male recruits. The prevalence of this injury has a marked impact on the health of service personnel and imposes a significant financial burden on the military by delaying completion of the training of new recruits.

• #93 An epidemiological study of stress fractures among flight cadets at Air Force Academy – Indian Journal of Aerospace Medicine

  https://indjaerospacemed.com/an-epidemiological-study-of-stress-fractures-among-flight-cadets-at-air-force-academy/

  Stress fractures are common among flight cadets during training period and these fractures give rise to morbidity and loss of training hours. […] The incidence of stress fractures among cadets at Air Force Academy varied from 4.5% to 13.5% in the five years of study with minimum incidence in the year 2004. […] The incidence of stress fractures in male US military recruits has been reported to range from 0.2 % to 4.5%. The incidence among females in the same training programs was reportedly higher, ranging from 0.7 % to 9.6% in Officer cadets. […] High incidence of stress fractures has a marked impact on the health of cadets and imposes a significant financial burden on the organization by increasing the length of training time, program costs and time to military readiness. […] The purpose of this study was to analyze the epidemiology of stress fractures among flight cadets at Air Force Academy (AFA).

• #94 Increased Risk for Stress Fractures and Delayed Healing with NSAID Receipt, U.S. Armed Forces, 2014–2018 | Health.mil

  https://staging-mobile.health.mil/sitecore/content/MHSHome/News/Articles/2020/02/01/Increase-Risk-for-Stress-Fractures-MSMR-2020?type=All&page=14

  This is the first MSMR report on the association between prior NSAID receipt and incident stress fracture diagnosis in service members. […] Prior NSAID receipt was associated with a 70% increased incidence of stress fracture. […] This study suggests that receiving NSAIDs may increase the risk for stress fracture among active component service members. […] These stress fracture injuries may contribute to lost duty days and reduce deployment readiness because of physical limitation. […] Injuries, including stress fractures, are a major public health concern among the military because of their high prevalence, the associated lost working time, and the cost of treatment. […] A previous MSMR article estimated that there were 31,349 incident stress fractures diagnosed (a rate of 3.2 per 1,000 person-years) among active component service members from 2004 through 2010. […] The burden associated with stress fractures is high when taking into consideration the incidence rate, slow recovery time, and medical cost of treatment.

• #95 Increased Risk for Stress Fractures and Delayed Healing with NSAID Receipt, U.S. Armed Forces, 2014–2018 | Health.mil

  https://staging-mobile.health.mil/sitecore/content/MHSHome/News/Articles/2020/02/01/Increase-Risk-for-Stress-Fractures-MSMR-2020?type=All&page=14

  This is the first MSMR report on the association between prior NSAID receipt and incident stress fracture diagnosis in service members. […] Prior NSAID receipt was associated with a 70% increased incidence of stress fracture. […] This study suggests that receiving NSAIDs may increase the risk for stress fracture among active component service members. […] These stress fracture injuries may contribute to lost duty days and reduce deployment readiness because of physical limitation. […] Injuries, including stress fractures, are a major public health concern among the military because of their high prevalence, the associated lost working time, and the cost of treatment. […] A previous MSMR article estimated that there were 31,349 incident stress fractures diagnosed (a rate of 3.2 per 1,000 person-years) among active component service members from 2004 through 2010. […] The burden associated with stress fractures is high when taking into consideration the incidence rate, slow recovery time, and medical cost of treatment.

• #96 Increased Risk for Stress Fractures and Delayed Healing with NSAID Receipt, U.S. Armed Forces, 2014–2018 | Health.mil

  https://staging-mobile.health.mil/sitecore/content/MHSHome/News/Articles/2020/02/01/Increase-Risk-for-Stress-Fractures-MSMR-2020?type=All&page=14

  This is the first MSMR report on the association between prior NSAID receipt and incident stress fracture diagnosis in service members. […] Prior NSAID receipt was associated with a 70% increased incidence of stress fracture. […] This study suggests that receiving NSAIDs may increase the risk for stress fracture among active component service members. […] These stress fracture injuries may contribute to lost duty days and reduce deployment readiness because of physical limitation. […] Injuries, including stress fractures, are a major public health concern among the military because of their high prevalence, the associated lost working time, and the cost of treatment. […] A previous MSMR article estimated that there were 31,349 incident stress fractures diagnosed (a rate of 3.2 per 1,000 person-years) among active component service members from 2004 through 2010. […] The burden associated with stress fractures is high when taking into consideration the incidence rate, slow recovery time, and medical cost of treatment.

• #97

  https://www.orthobullets.com/evidence/9238304

  The most common site of stress fracture in athletes is the tibia, although the site reflects the nature of the load applied to the skeleton. […] Stress fracture morbidity, expressed as the time until return to sport or activity, varies depending on the site. […] Generally, a period of 6 to 8 weeks is needed for healing; however, stress fractures at certain sites, such as the navicular and anterior tibial cortex, are often associated with protracted recovery and, in some cases, termination of sporting pursuits.

• #98 Epidemiology of stress fractures – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16324972/

  Stress fractures are a frequent cause of injury in competitive and recreational athletes. […] Although a number of epidemiologic studies have been conducted, the populations studied and data collection methods have varied. […] This article presents an overview of injury epidemiology and reviews the current body of literature regarding the occurrence of stress fractures in athletes. […] Given the heterogeneity of the populations studied and the variations in data collection, few broad conclusions can be drawn. […] There is a pressing need for large prospective studies to better establish the risks of stress fracture by sport, age, and gender.

• #99 Epidemiology of stress fractures – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16324972/

  Stress fractures are a frequent cause of injury in competitive and recreational athletes. […] Although a number of epidemiologic studies have been conducted, the populations studied and data collection methods have varied. […] This article presents an overview of injury epidemiology and reviews the current body of literature regarding the occurrence of stress fractures in athletes. […] Given the heterogeneity of the populations studied and the variations in data collection, few broad conclusions can be drawn. […] There is a pressing need for large prospective studies to better establish the risks of stress fracture by sport, age, and gender.

• #100 Incidence and Risk Factors for Hip Fractures Among U.S. Armed Forces Active Component Women Compared to Men, 2018–2022 | Health.mil

  https://www.health.mil/News/Articles/2024/08/01/MSMR-Hip-Fractures?type=All&page=14

  While this study was unable to assess for any associations between level of fitness and risk of hip fracture, these results show an inverse relationship between BMI and incidence of hip fractures among women and men. […] Future studies are needed to identify modifiable factors such as nutrition or training techniques that can mitigate the risk for devastating fractures in military women, as well as track duration of rehabilitation and rate of medical discharges after hip fractures.

• #101 Understanding Metatarsal Fractures: Epidemiology | Yavapai Foot and Ankle Center

  https://www.yavapaifac.com/library/understanding-metatarsal-fractures-epidemiology.cfm

  Metatarsal fractures account for approximately 5-6% of all fractures, with higher incidence observed in active individuals and older adults (Kahanov et al., 2017). […] Stress fractures are prevalent among runners, military recruits, and dancers due to repetitive microtrauma. […] Osteoporosis and other metabolic bone diseases significantly increase fracture risk, particularly among postmenopausal women (Shuhart et al., 2019). […] Emerging research focuses on biological enhancements to fracture healing, including bone morphogenetic proteins and stem cell therapies. […] Biomechanical studies are exploring improved orthotic designs to prevent stress fractures in high-risk populations (Smith et al., 2023).

• #102 Upper Extremity Stress Fractures | Sports Medicine – Open | Full Text

  https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-024-00769-7

  Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged. […] Upper extremity stress fractures are becoming more common as the workload placed on young athletes continues to increase. […] Stress injuries will affect roughly 40% of athletes at some point during their career, with 80-95% of these injuries affecting the lower extremities and only 5-20% affecting the upper extremities. […] However, upper extremity stress fractures are becoming more common as the demand placed on young athletes and our ability to diagnose these injuries continue to increase. […] Early diagnosis is crucial as most stress injuries can be treated conservatively early in their clinical courses but can become debilitating, cause growth disturbances, and may require surgical intervention if allowed to progress. […] Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent.

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