Risk factors for stress fracture in female endurance athletes: a cross-sectional study

Objective: To identify psychological and physiological correlates of stress fracture in female endurance athletes. Design: A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit. Methods: Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ², analysis of variance and Mann-Whitney U tests. Results: Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively). Conclusions: Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk

Bone geometry according to menstrual function in female endurance athletes

Athletes have higher bone mineral density (BMD) relative to nonathletes. In amenorrheic athletes BMD may be compromised by estrogen deficiency, but it is unknown whether this is accompanied by structural differences. We compared femoral neck bone geometry and density of a-/oligomenorrheic athletes (AAs), eumenorrheic athletes (EAs), and eumenorrheic controls (ECs). We recruited 156 women: (68 endurance athletes and 88 controls). Femoral neck BMD, section modulus (Z), and width were measured using dual-energy X-ray absorptiometry. Menstrual function was assessed by questionnaire and classified as EA(C10 periods/year) or AA(B9periods/year): 24 athletes were AA and 44 EA. Femoral neck BMD was significantly higher in EA than AA (8 %, difference) and EC (11 % difference): mean [SE] 1.118 [0.015], 1.023 [0.020] and 0.999 [0.014] g cm-2, respectively; p\0.001. Z was significantly higher in EA than EC (11 % difference): EA 667 [19], AA 625 [21], and EC 592 [10] cm3; p\0.001. Femoral neck width did not differ between groups. All differences persisted after adjustment for height, age, and body mass. The higher femoral neck Z and BMD in athletes, despite similar width, may indicate that exercise-related bone gains are endosteal rather than periosteal. Athletes with amenorrhea had smaller increments in bone mass rather than structural adaptation. The maintained femoral neck width in controls may be an adaptive mechanism to conserve bone strength in bending despite inactivity-related bone decrement

Effectiveness of a community group and home based exercise intervention on the maintenance of vertebral body height and prevention of vertebral compression fractures in older adults: The ProAct65+bone study [Abstract]

Effectiveness of a community group and home based exercise intervention on the maintenance of vertebral body height and prevention of vertebral compression fractures in older adults: The ProAct65+bone study [Abstract

Does adherence to falls prevention exercise programmes benefit bone mineral density in older people? The ProAct65+ bone study [abstract]

Does adherence to falls prevention exercise programmes benefit bone mineral density in older people? The ProAct65+ bone study [abstract

Can exercise protect against vertebral deformity? The proact65+bone study [Abstract]

Can exercise protect against vertebral deformity? The proact65+bone study [Abstract

Stress fracture injury in female endurance athletes in the United Kingdom: a 12-month prospective study

Studies of stress fracture (SF) incidence are limited in number and geographical location; this study determined the incidence of SF injury in female endurance athletes based in the United Kingdom. A total of 70 athletes aged between 18 and 45 years were recruited and prospectively monitored for 12 months. Questionnaires at baseline and 12 months assessed SF, menstrual and training history, eating psychopathology, and compulsive exercise. Peak lower leg muscle strength was assessed in both legs using an isometric muscle rig. Bone mineral density (BMD) of total body, spine, hip, and radius was assessed using dual X-ray absorptiometry. Among the 61 athletes who completed the 12-month monitoring, two sustained a SF diagnosed by magnetic resonance imaging, giving an incidence rate (95% confidence intervals) of 3.3 (0.8, 13.1) % of the study population sustaining a SF over 12 months. The SF cases were 800m runners aged 19 and 22 years, training on average 14.2h a week, eumenorrheic with no history of menstrual dysfunction. Case 1 had a higher than average energy intake and low eating psychopathology and compulsive exercise scores, while the reverse was true in case 2. BMD in both cases was similar to mean values in the non-SF group. The incidence of SF in our female endurance athlete population based in the United Kingdom was 3.3%, which is lower than previously reported. Further work is needed to confirm the current incidence of SF and evaluate the associated risk factors

Can exercise interventions designed to reduce falls improve bone quality [Abstract]

Can exercise interventions designed to reduce falls improve bone quality [Abstract

Additional file 1: of Concurrent exergaming and transcranial direct current stimulation to improve balance in people with Parkinson’s disease: study protocol for a randomised controlled trial

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb