2009 Annual Meeting Podium Presentations

Sports Medicine/Arthroscopy 5: Cartilage Resurfacing / Hip Arthroscopy

Atypical stress fractures predict bone health in athletic females.

Podium No: 525

Friday, February 27, 2009
12:18 PM - 12:24 PM

Location: Venetian Hotel
Room 2201

Pamela J Sherman, MD Dallas TX
Deborah Saint-Phard, MD Denver CO
Jennifer Rogers, MD
Terry Karl, MS, RD, CDN New York NY
Lisa R Callahan, MD New York NY
Jo A Hannafin, MD, PhD New York NY

Moderator(s):
J W Thomas Byrd, MD Nashville TN
Mark J Lemos, MD Rye NH

Atypical stress fractures were likely to occur with underlying abnormal bone mineral density. We recommend women presenting with stress fractures in atypical sites undergo bone mineral density evaluation.

Exercise that overloads the normal repair process of bone may result in a stress fracture. We attempt to determine whether specific sites of stress fracture are associated with underlying abnormal bone density in athletic women.

A prospective, longitudinal, cohort study of women presenting with stress fracture to a tertiary center over a 2 year period was performed. 73 female patients, age 15 to 45, with radiographically documented stress fracture were included. Patients received nutritional consultation and completed multiple questionnaires. The presence of disordered eating and risk factors were assessed by one dietician. Body mass index (BMI), history of menstrual irregularities, and calcium intake was determined. Bone mineral density was measured using DXA scan.

Patients were divided into two groups based on site of fracture. Site was defined as occurring at typical (TYP) (tibia, metatarsal, fibular, tarsal) and atypical (ATYP) sites (femur, acetabulum, sacrum, spine, ribs). Student t-tests were used to evaluate statistical significance. Patients presenting with ATYP sites were more likely to have low density (osteopenia) than those with TYP (spine BMD p<.001, and femoral BMD p=.023). Forearm density was not statistically different (p=0.25) in the two groups. Significance remained the same using t- or z-scores in all of the groups. There was no significant difference in BMI between the groups (ATYP and TYP, p=0.20.) No significance was seen between the presence of amenorrhea and site of fracture (chi-squared evaluation p= 0.916 and p= 0.958 respectively). BMD was assessed in association with BMI, amenorrhea, calcium intake, and eating disorders. Significant but weak associations existed between BMD and BMI in these women when evaluating all three sites of BMD (spine BMD with BMI, p=0.011; femoral BMD with BMI, p=0.006; forearm BMD with BMI, p=0.017). There was no significance between BMD and history of or current amenorrhea.

Atypical stress fractures were more likely to occur with underlying abnormal bone mineral density. We recommend that women presenting with stress fractures in these atypical sites have a bone density evaluation. The diagnosis of underlying osteopenia may help to focus treatment to promote improved bone density along with treating and preventing future stress fractures.

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An alphabetical listing of disclosures will be available at a later time.

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