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The American Journal of Sports Medicine 24:810-818 (1996)
© 1996 SAGE Publications

Risk Factors for Stress Fractures in Track and Field Athletes

A Twelve-Month Prospective Study

Kim L. Bennell, PhD

School of Physiotherapy, University of Melbourne

Susan A. Malcolm, PhD

Schools of Human Biosciences and Behavioural Health Sciences, La Trobe University

Shane A. Thomas, PhD

Schools of Human Biosciences and Behavioural Health Sciences, La Trobe University

Sally J. Reid, MNutDiet

Nutrition Department, St Vincent's Hospital

Peter D. Brukner, MB, BS

Olympic Park Sports Medicine Centre

Peter R. Ebeling, MB, MD

the Department of Medicine Bone and Mineral Service, University of Melbourne, and the Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia

John D. Wark, MB, BS, PhD

the Department of Medicine Bone and Mineral Service, University of Melbourne, and the Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia

The aim of this 12-month prospective study was to investigate risk factors for stress fractures in a cohort of 53 female and 58 male track and field athletes, aged 17 to 26 years. Total bone mineral content, regional bone density, and soft tissue composition were meas ured using dual-energy x-ray absorptiometry and an thropometric techniques. Menstrual characteristics, current dietary intake, and training were assessed us ing questionnaires. A clinical biomechanical assess ment was performed by a physical therapist. The inci dence of stress fractures during the study was 21.1%, with most injuries located in the tibia. Of the risk factors evaluated, none was able to predict the occurrence of stress fractures in men. However, in female athletes, significant risk factors included lower bone density, a history of menstrual disturbance, less lean mass in the lower limb, a discrepancy in leg length, and a lower fat diet. Multiple logistic regression revealed that age of menarche and calf girth were the best independent predictors of stress fractures in women. This bivariate model correctly assigned 80% of the female athletes into their respective stress fracture or nonstress frac ture groups. These results suggest that it may be pos sible to identify female athletes most at risk for this overuse bone injury.




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