Fractal analysis of bone texture : a screening tool for stress fracture risk?

Background The aim of this study was to identify specific bone characteristics of stress fracture (SF) cases in sportswomen. To date, no tool is able to distinguish individuals who are at risk, limiting preventive measures.Material and methods We investigated the skeletal system of sportswomen who did sustain SF in the past (n = 19) and compared it with that of female controls (C) with a similar sporting history but without any fracture history (n = 20).Bone mass and body composition were measured using dual-energy X-ray absorptiometry. Bone micro-architecture was investigated by calcaneal ultrasound and fractal analysis of calcaneus radiographic images. Oestradiol levels were measured by E.I.A, and IGF-1 by R.I.A. Menstrual characteristics, nutrient intake, and training were assessed using questionnaires.Results The result of the fractal analysis, expressed by the Hmean parameter, was significantly lower in the SF group, reflecting a more complex structure of the trabecular micro-architectural organization (P &lt; 0&middot;005). Body mass index (BMI) at birth was also found to be lower in the SF cases as compared with their C (P &lt; 0&middot;03).Multivariate analysis revealed that the fractal parameter Hmean, bone mineral content (BMC) at Ward\u27s triangle and the BMI at birth correctly assigned 84&middot;85% of the female athletes into their respective SF or C groups (P = 0&middot;001).Conclusion These results suggest that the fractal parameter and the BMI at birth may be able to identify female athletes most at risk for this overuse bone injury, as their low indexes might reflect a greater skeletal sensitivity.<br /

Stress fractures: Pathophysiology, epidemiology, and risk factors

A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading, which results in structural fatigue and resultant signs and symptoms of localized pain and tenderness. To prevent stress fractures, an appreciation of their risk factors is required. These are typically grouped into extrinsic and intrinsic risk factors. Extrinsic risk factors for stress fractures are those in the environment or external to the individual, including the type of activity and factors involving training, equipment, and the environment. Intrinsic risk factors for stress fractures refer to characteristics within the individual, including skeletal, muscle, joint, and biomechanical factors, as well as physical fitness and gender. This article discusses these extrinsic and intrinsic risk factors, as well as the pathophysiology and epidemiology of stress fractures