RESUMO
OBJECTIVE: The study tested the hypothesis that females who sustain stress fractures of cancellous bone have decreased bone density. DESIGN: A retrospective, controlled, cross-sectional study. SETTING: The setting of the study was a tertiary care center for Women's Sports Medicine. PATIENTS: 20 female patients under the age of 40 who had suffered a stress fracture and who had a positive diagnostic study (radiograph, bone scan, or magnetic resonance imaging) were included in the study. INTERVENTIONS: Patients who had a positive diagnostic study (radiograph, bone scan, or magnetic resonance imaging) for the diagnosis of stress fracture also underwent dual energy X-ray absorptiometry (DEXA) scans. MAIN OUTCOME MEASURE: Bone density measured by the DEXA scan, as defined by the World Health Organization criteria for osteopenia (greater than one standard deviation from the standard age-matched control). RESULTS: 8 of 9 patients with cancellous stress fractures had DEXA scans indicating osteopenia while only 3 of 11 patients with stress fractures of cortical bone had a scan indicating osteopenia (p = 0.01). CONCLUSIONS: A cancellous stress fracture in a female may be a warning sign of early onset osteopenia. We recommend that young females who have documented stress fractures of cancellous bone or cortical bone (with risk factors for osteopenia) undergo bone density evaluation.
Assuntos
Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Fraturas de Estresse/epidemiologia , Esportes/estatística & dados numéricos , Absorciometria de Fóton , Adulto , Distribuição por Idade , Idoso , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/fisiopatologia , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Exercício Físico , Comportamento Alimentar , Feminino , Humanos , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Distúrbios Nutricionais/epidemiologia , Estudos Retrospectivos , Fatores de RiscoAssuntos
Traumatismos do Tornozelo/diagnóstico , Fraturas de Estresse/diagnóstico , Corrida/lesões , Esportes , Adolescente , Amenorreia/etiologia , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/terapia , Anorexia/etiologia , Dieta , Feminino , Fraturas de Estresse/etiologia , Fraturas de Estresse/terapia , Humanos , Osteoporose/etiologia , Fatores de RiscoRESUMO
Stress fractures are common overuse injuries, reported more frequently in female athletes than in male athletes. The clinician should have a high index of suspicion for this injury whether an athlete presents with complaints of acute pain and disability or insidious onset of pain that is aggravated by activity and relieved by rest. Radiographs, bone scans, CT scans, and MR imaging may all be useful in confirming the diagnosis. Conservative treatment is usually successful, although one must be especially vigilant in treating a stress fracture prone to complications. Identifying risk factors for susceptibility to stress fracture development may help to avoid recurrence of the injury. More research is needed to determine cause versus association of these various risk factors in relationship to stress injury to bone.
