Yu Shimasaki1, Masashi Nagao2, Takayuki Miyamori3, Yukihiro Aoba1, Norifumi Fukushi4, Yoshitomo Saita5, Hiroshi Ikeda5, Sung-Gon Kim6, Masahiko Nozawa6, Kazuo Kaneko5, Masafumi Yoshimura7. 1. School of Health and Sports Science, Juntendo University, Chiba, Japan. 2. Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan nagao@juntendo.ac.jp. 3. Department of Nursing and Rehabilitation Science, School of Physical Therapy at Odawara, International University of Health and Sports Science, Kanagawa, Japan. 4. Institute of Physical Education, Keio University, Kanagawa, Japan. 5. Department of Orthopedic Surgery, Juntendo University Hospital, Tokyo, Japan. 6. Department of Orthopedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan. 7. School of Health and Sports Science, Juntendo University, Chiba, Japan Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan.
Abstract
BACKGROUND: The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. METHODS: To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. RESULTS: Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. CONCLUSION: 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. LEVEL OF EVIDENCE: Level III, case-control study.
BACKGROUND: The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated. METHODS: To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses. RESULTS: Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively. CONCLUSION: 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures. LEVEL OF EVIDENCE: Level III, case-control study.
Authors: Brittany M Ammerman; Daphne Ling; Lisa R Callahan; Jo A Hannafin; Marci A Goolsby Journal: Sports Health Date: 2020-12-10 Impact factor: 3.843
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