Kristin L Popp1,2,3, Kathryn E Ackerman1,2,4, Sara E Rudolph1, Fjola Johannesdottir2,5, Julie M Hughes3, Adam S Tenforde2,6, Miriam A Bredella7, Chun Xu8, Ginu Unnikrishnan8, Jaques Reifman8, Mary L Bouxsein1,2,5. 1. Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. 2. Harvard Medical School, Boston, Massachusetts, USA. 3. Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA. 4. Boston Children's Hospital, Boston, Massachusetts, USA. 5. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 6. Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA. 7. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA. 8. Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA.
Abstract
BACKGROUND: Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high. PURPOSE: To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings. RESULTS: From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% (P < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg (P < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels (P < .05 for all). CONCLUSION: Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
BACKGROUND: Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high. PURPOSE: To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings. RESULTS: From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% (P < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg (P < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels (P < .05 for all). CONCLUSION: Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
Authors: Tim Hoenig; Kathryn E Ackerman; Belinda R Beck; Mary L Bouxsein; David B Burr; Karsten Hollander; Kristin L Popp; Tim Rolvien; Adam S Tenforde; Stuart J Warden Journal: Nat Rev Dis Primers Date: 2022-04-28 Impact factor: 52.329
Authors: Miriam A Bredella; Pouneh K Fazeli; Jenna Bourassa; Clifford J Rosen; Mary L Bouxsein; Anne Klibanski; Karen K Miller Journal: Bone Date: 2021-09-25 Impact factor: 4.398
Authors: Leigh Gabel; Anna-Maria Liphardt; Paul A Hulme; Martina Heer; Sara R Zwart; Jean D Sibonga; Scott M Smith; Steven K Boyd Journal: Sci Rep Date: 2022-06-30 Impact factor: 4.996