Bone geometry and lower extremity bone stress injuries in male runners

Popp, Kristin L.; Frye, Adam C.; Stovitz, Steven D.; Hughes, Julie M.

Affiliations

¹Military Performance Division, United States Army Research Institute of Environmental, USA

²Endocrine Unit, Massachusetts General Hospital, USA

³Department of Medicine, Harvard Medical School, USA

⁴Laboratory of Musculoskeletal Health, School of Kinesiology, University of Minnesota, USA

⁵Department of Medicine, University of Minnesota, USA

Abstract and keywords

Bone stress injuries (BSI) are common among distance runners and research investigations examining risk factors for BSI among men are limited. Therefore, investigations are needed to determine if men with a history of BSI have skeletal properties that may heighten BSI incidence.

Objectives: To analyze differences in bone density, bone geometry, and estimates of bone strength in male runners with and without a BSI history.

Design: Cross-sectional.

Methods: We recruited 36 male distance runners ages 18–41 for this study. We used peripheral quantitative computed tomography (pQCT) to assess volumetric bone mineral density (vBMD, mg/mm3), bone geometry (total and cortical bone area, mm2), tibia robustness (total area/tibia length, mm) and estimates of bone strength (section modulus and polar strength-strain index, mm3) at 5 tibial sites.

Results: After adjusting for age, the BSI group had more slender tibias (9%), lower stress strain indices (−16%), lower section moduli (−17%) and smaller total cross-sectional (−11%) and cortical areas (−12%) at the 66% site of the tibia compared with controls (P < 0.05 for all). Similar differences were found at all other measurement sites. After adjusting for body size, differences in bone outcomes remained significant at the 66% site.

Conclusions: These results indicate that men with a history of BSI have lower estimated bending strength compared to controls because of narrower tibias. However, differences are largely attenuated in the distal ½ of the tibia after adjusting for body size. Thus, smaller tibia size, particularly at the mid-diaphysis, may be an important indicator for BSI incidence.

Keywords: Stress fracture Running; Injury; Bone imaging; Peripheral quantitative computed tomography; Volumetric bone mineral density (vBMD)

Links

DOI: 10.1016/j.jsams.2019.09.009

PubMed: 31594711

WoS: 000515196100008

History

Received: 2019-05-10

Revised: 2019-08-13

Accepted: 2019-09-17

Online: 2019-09-21

Cited Works (2)

Year	Entry
1996	Beck TJ, Ruff CB, Mourtada FA, Shaffer RA, Maxwell-Williams K, Kao GL, Sartoris DJ, Brodine S. Dual-energy x-ray absorptiometry derived structural geometry for stress fracture prediction in male u.s. marine corps recruits. J Bone Miner Res. May 1996;11(5):645-653.
1996	Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in competitive track and field athletes: a twelve-month prospective study. Am J Sports Med. March–April 1996;24(2):211-217.

Cited By (4)

Year	Entry
2022	Bruce OL, Baggaley M, Khassetarash A, Haider IT, Edwards WB. Tibial-fibular geometry and density variations associated with elevated bone strain and sex disparities in young active adults. Bone. August 2022;161:116443.
2023	Martin JA, Heiderscheit BC. A hierarchical clustering approach for examining the relationship between pelvis-proximal femur geometry and bone stress injury in runners. J Biomech. November 2023;160:111782.
2021	Zendeli A, Bui M, Fischer L, Ghasem-Zadeh A, Schima W, Seeman E. High cortico-trabecular transitional zone porosity and reduced trabecular density in men and women with stress fractures. J Clin Med. March 8, 2021;10(5):1123.
2023	Bruce OL. Tibial-Fibular Morphology: Variation, Sexual Dimorphism, and Mechanical Implications [PhD thesis]. Calgary, AB: University of Calgary; May 2023.