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Erschienen in: Osteoporosis International 8/2019

29.05.2019 | Original Article

A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes

verfasst von: R. L. Duckham, S. R. Bialo, J. Machan, P. Kriz, C. M. Gordon

Erschienen in: Osteoporosis International | Ausgabe 8/2019

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Abstract

Summary

Since stress fractures are common among adolescent athletes, it is important to identify bone assessment tools that accurately identify risk. We investigated the discriminative ability of two imaging technologies to classify at-risk athletes. Findings suggested that peripheral quantitative computed tomography (pQCT) has the ability to distinguish differences in bone structure in injured vs. uninjured limbs.

Introduction

Given the high stress fracture (SFX) prevalence among adolescent girls, an understanding of the most informative assessment tools to identify SFX risks are required. We investigated the discriminative ability of pQCT vs. dual-energy X-ray absorptiometry (DXA) to classify athletes with or without SFX.

Methods

Twelve adolescent athletes diagnosed with a lower-extremity SFX were compared with 12 matched controls. DXA measured areal bone mineral density (aBMD) and content of the total body, and lumbar spine. Bilateral tibiae were assessed with pQCT. At the metaphysis (3%), total density (ToD), trabecular density (TrD), trabecular area (TrA), and estimated bone strength in compression (BSIc), and at the diaphysis (38% and 66%), total bone area (ToA), cortical density (CoD), cortical area (CoA), estimated bone strength in torsion (SSIp), and peri- and endocortical and muscle area (MuA) were obtained. Cortical bone mass/density around the center of mass and marrow density (estimate of adiposity) were calculated using ImageJ software. General estimated equations adjusting for multiple comparisons (Holm-Bonferroni method) were used to compare means between (1) injured limb of the case athletes vs. uninjured limb of the control athletes and (2) uninjured limb of the case athletes vs. uninjured limbs of the controls and injured vs. uninjured limb of case athletes with a SFX.

Results

aBMD and content showed no significant differences between cases and controls. When comparing the injured vs. uninjured leg in the case athletes by pQCT at the 3% tibia, unadjusted TrD, total density, and BSIc were significantly lower (p < 0.05) in the injured vs. uninjured leg. Marrow density at the 66% site was 1% (p < 0.05) lower in the injured vs. uninjured leg.

Conclusions

These preliminary data in athletes with SFX suggest that pQCT has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. No discriminative bone parameter classifications were identified between adolescent athletes with or without SFX.
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Literatur
1.
Zurück zum Zitat Bennell KL, Malcolm SA, Thomas SA, Ebeling PR, McCrory PR, Wark JD, Brukner PD (1995) Risk-factors for stress-fractures in female track and field athletes - a retrospective analysis. Clin J Sport Med 5:229–235CrossRefPubMed Bennell KL, Malcolm SA, Thomas SA, Ebeling PR, McCrory PR, Wark JD, Brukner PD (1995) Risk-factors for stress-fractures in female track and field athletes - a retrospective analysis. Clin J Sport Med 5:229–235CrossRefPubMed
2.
Zurück zum Zitat Schnackenburg K, MacDonald H, Ferber R (2011) Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc 43:2110–2119CrossRefPubMed Schnackenburg K, MacDonald H, Ferber R (2011) Bone quality and muscle strength in female athletes with lower limb stress fractures. Med Sci Sports Exerc 43:2110–2119CrossRefPubMed
3.
Zurück zum Zitat Field A, CM G, Pierce L, Ramappa A, Kocher MS (2011) Prospective study of physical activity and risk developing a stress fracture among preadolescent and adolescent females. Arch Pediatr Adolesc Med 165:723–728CrossRefPubMedPubMedCentral Field A, CM G, Pierce L, Ramappa A, Kocher MS (2011) Prospective study of physical activity and risk developing a stress fracture among preadolescent and adolescent females. Arch Pediatr Adolesc Med 165:723–728CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Loud K, Gordon CM, Micheli LJ, Field AE (2005) Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics 115:e399–e406CrossRefPubMed Loud K, Gordon CM, Micheli LJ, Field AE (2005) Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics 115:e399–e406CrossRefPubMed
5.
Zurück zum Zitat Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark D (1996) Risk factors for stress fractures in track and field athletes - a twelve-month prospective study. Am J Sports Med 24:810–818CrossRefPubMed Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark D (1996) Risk factors for stress fractures in track and field athletes - a twelve-month prospective study. Am J Sports Med 24:810–818CrossRefPubMed
6.
Zurück zum Zitat Duckham RL, Peirce N, Meyer C, Summers G, Cameron N, Brooke-Wavell K (2012) Risk factors for stress fracture in female endurance athletes: a cross-sectional study. BMJ-online 2:e001920 Duckham RL, Peirce N, Meyer C, Summers G, Cameron N, Brooke-Wavell K (2012) Risk factors for stress fracture in female endurance athletes: a cross-sectional study. BMJ-online 2:e001920
7.
Zurück zum Zitat Duckham RL, Brooke-Wavell K, Summers GD, Cameron N, Peirce N (2015) Stress fracture injury in female endurance athletes in the United Kingdom: a 12-month prospective study. Scand J Med Sci Sports 25:854–859CrossRefPubMed Duckham RL, Brooke-Wavell K, Summers GD, Cameron N, Peirce N (2015) Stress fracture injury in female endurance athletes in the United Kingdom: a 12-month prospective study. Scand J Med Sci Sports 25:854–859CrossRefPubMed
8.
Zurück zum Zitat Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M, Brown BW, Matheson KA, Crawford SL, Cobb KL (2007) Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc 39:1457–1463CrossRefPubMed Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M, Brown BW, Matheson KA, Crawford SL, Cobb KL (2007) Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc 39:1457–1463CrossRefPubMed
9.
Zurück zum Zitat Nattiv A, Puffer JC, Casper J, Dorey F, Kabo JM, Hame S, Fulton K, Moore E, Finerman GA (2000) Stress fracture risk factors, incidence and distribution: a 3 year prospective study in collegiate runners. Med Sci Sports Exerc 32:S347 Nattiv A, Puffer JC, Casper J, Dorey F, Kabo JM, Hame S, Fulton K, Moore E, Finerman GA (2000) Stress fracture risk factors, incidence and distribution: a 3 year prospective study in collegiate runners. Med Sci Sports Exerc 32:S347
10.
Zurück zum Zitat Bennell K, Crossley K, Jayarajan J, Walton E, Warden S, Kiss ZS, Wrigley T (2004) Ground reaction forces and bone parameters in females with tibial stress fracture. Med Sci Sports Exerc 36:397–404CrossRefPubMed Bennell K, Crossley K, Jayarajan J, Walton E, Warden S, Kiss ZS, Wrigley T (2004) Ground reaction forces and bone parameters in females with tibial stress fracture. Med Sci Sports Exerc 36:397–404CrossRefPubMed
11.
Zurück zum Zitat Bennell KL, Malcolm SA, Brukner PD, Green RM, Hopper JL, Wark JD, Ebeling PR (1998) A 12-month prospective study of the relationship between stress fractures and bone turnover in athletes. Calcif Tissue Int 63:80–85CrossRefPubMed Bennell KL, Malcolm SA, Brukner PD, Green RM, Hopper JL, Wark JD, Ebeling PR (1998) A 12-month prospective study of the relationship between stress fractures and bone turnover in athletes. Calcif Tissue Int 63:80–85CrossRefPubMed
12.
Zurück zum Zitat Myburgh KH, Hutchins J, Fataar AB, Hough SF, Noakes TD (1990) Low bone density is an etiologic factor for stress-fractures in athletes. Ann Intern Med 113:754–759CrossRefPubMed Myburgh KH, Hutchins J, Fataar AB, Hough SF, Noakes TD (1990) Low bone density is an etiologic factor for stress-fractures in athletes. Ann Intern Med 113:754–759CrossRefPubMed
13.
Zurück zum Zitat Crossley K, Bennell KL, Wrigley T, Oakes BW (1999) Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc 31:1088–1093CrossRefPubMed Crossley K, Bennell KL, Wrigley T, Oakes BW (1999) Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc 31:1088–1093CrossRefPubMed
14.
Zurück zum Zitat Grimston S, Nigg B, Fisher V, Ajemian S (1994) External loads throughout a 45 minute run in stress fracture and non stress fracture runners. J Biomech 27:668CrossRef Grimston S, Nigg B, Fisher V, Ajemian S (1994) External loads throughout a 45 minute run in stress fracture and non stress fracture runners. J Biomech 27:668CrossRef
15.
Zurück zum Zitat Bass SL (2003) The structural adaptations of cortical bone to loading during different stages of maturation. J Musculoskelet Neuronal Interact 3:345–347PubMed Bass SL (2003) The structural adaptations of cortical bone to loading during different stages of maturation. J Musculoskelet Neuronal Interact 3:345–347PubMed
16.
Zurück zum Zitat Bennell KL, Malcolm SA, Khan KM, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD (1997) Bone mass and bone turnover in power athletes, endurance athletes, and controls: a 12-month longitudinal study. Bone 20:477–484CrossRefPubMed Bennell KL, Malcolm SA, Khan KM, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD (1997) Bone mass and bone turnover in power athletes, endurance athletes, and controls: a 12-month longitudinal study. Bone 20:477–484CrossRefPubMed
17.
Zurück zum Zitat Burrows M, Liu D, McKay H (2010) High-resolution peripheral QCT imaging of bone micro-structure in adolescents. Osteopor Int 21:515–520CrossRef Burrows M, Liu D, McKay H (2010) High-resolution peripheral QCT imaging of bone micro-structure in adolescents. Osteopor Int 21:515–520CrossRef
18.
Zurück zum Zitat Ackerman KE, Nazem T, Chapko D (2011) Bone microarchitecture is impaired in adolscent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab 96:3123–3133CrossRefPubMedPubMedCentral Ackerman KE, Nazem T, Chapko D (2011) Bone microarchitecture is impaired in adolscent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab 96:3123–3133CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Kontulainen SA, Johnston JD, Liu D, Leung C, Oxland TR, McKay H (2008) Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact 8:401–409PubMed Kontulainen SA, Johnston JD, Liu D, Leung C, Oxland TR, McKay H (2008) Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact 8:401–409PubMed
20.
Zurück zum Zitat Rantalainen T, Nikander R, Heinonen A, Daly RM, Sievanen H (2011) An open source approach for regional cortical bone mineral density analysis. J Musculoskelet Neuronal Interact 11:243–248PubMed Rantalainen T, Nikander R, Heinonen A, Daly RM, Sievanen H (2011) An open source approach for regional cortical bone mineral density analysis. J Musculoskelet Neuronal Interact 11:243–248PubMed
21.
Zurück zum Zitat Rantalainen T, Nikander R, Heinonen A, Cervinka T, Sievanen H, Daly R (2013) Differential effects of exerciseon tibial shaft marrow density in young female athletes. J Clin Endo Metab 98:2037–2044CrossRef Rantalainen T, Nikander R, Heinonen A, Cervinka T, Sievanen H, Daly R (2013) Differential effects of exerciseon tibial shaft marrow density in young female athletes. J Clin Endo Metab 98:2037–2044CrossRef
22.
Zurück zum Zitat Snow-Harter CM (1994) Bone health and prevention of osteoporosis in active and athletic women. Clin J Sports Med 13:389–404 Snow-Harter CM (1994) Bone health and prevention of osteoporosis in active and athletic women. Clin J Sports Med 13:389–404
23.
Zurück zum Zitat Lecka-Czernik B (2012) Marrow fat metabolism is linked to the systemic energy metabolism. Bone 50:534–539CrossRefPubMed Lecka-Czernik B (2012) Marrow fat metabolism is linked to the systemic energy metabolism. Bone 50:534–539CrossRefPubMed
25.
Zurück zum Zitat Bredella M, Fazeli P, Miller K, Misra M, Torriani M, Thomas B, Ghomi R, CJ R, Klibanski A (2009) Increased bone fat in anorexia nervosa. J Clin Endo Metab 94:2129–2136CrossRef Bredella M, Fazeli P, Miller K, Misra M, Torriani M, Thomas B, Ghomi R, CJ R, Klibanski A (2009) Increased bone fat in anorexia nervosa. J Clin Endo Metab 94:2129–2136CrossRef
27.
Zurück zum Zitat Ecklund K, Vajapeyam S, Feldman H, Buzney C, Mulkern R, Kleinman PK, CJ R, CM G (2010) Bone marrow changes in adolescent girls with anorexia nervosa. J Bone Miner Res 25:298–304CrossRefPubMed Ecklund K, Vajapeyam S, Feldman H, Buzney C, Mulkern R, Kleinman PK, CJ R, CM G (2010) Bone marrow changes in adolescent girls with anorexia nervosa. J Bone Miner Res 25:298–304CrossRefPubMed
28.
Zurück zum Zitat Therbo M, Petersen MM, Nielsen PK, Lund B (2003) Loss of bone mineral of the hip and proximal tibia following rupture of the Achilles tendon. Scand J Med Sci Sports 13:194–199CrossRefPubMed Therbo M, Petersen MM, Nielsen PK, Lund B (2003) Loss of bone mineral of the hip and proximal tibia following rupture of the Achilles tendon. Scand J Med Sci Sports 13:194–199CrossRefPubMed
29.
Zurück zum Zitat Petersen MM, Gehrchen PM, Nielsen PK, Lund B (1997) Loss of bone mineral of the hip assessed by DEXA following tibial shaft fractures. Bone 20:491–495CrossRefPubMed Petersen MM, Gehrchen PM, Nielsen PK, Lund B (1997) Loss of bone mineral of the hip assessed by DEXA following tibial shaft fractures. Bone 20:491–495CrossRefPubMed
Metadaten
Titel
A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes
verfasst von
R. L. Duckham
S. R. Bialo
J. Machan
P. Kriz
C. M. Gordon
Publikationsdatum
29.05.2019
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 8/2019
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-019-05001-x

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