Epidemiology of stress fracture injuries among us high school athletes, 2005-2006 through 2012-2013

Bradley G. Changstrom, Lina Brou, Morteza Khodaee, Cortney Braund, R. Dawn Comstock

Research output: Contribution to journalArticlepeer-review

140 Scopus citations


Background: High school athletes in the United States sustain millions of injuries annually, approximately 10% of which are fractures. However, there is no clear estimate of the number of stress fractures sustained by high school athletes annually despite reports that stress fractures account for 0.7% to 20% of injuries seen in sports medicine clinics. This suggests a high utilization of resources for a potentially preventable injury. In addition, stress fractures have been associated with low energy availability and disordered eating in young athletes, highlighting the importance of early recognition and intervention. Purpose: To investigate stress fracture rates and patterns in a large national sample of US high school athletes. Study Design: Descriptive epidemiologic study. Methods: Data from High School RIO (Reporting Information Online), a national sports injury surveillance study, were analyzed to describe rates and patterns of stress fracture injury sustained from 2005-2006 through 2012-2013, across sports and by sex. Results: From 2005-2006 through 2012-2013, a total of 51,773 injuries were sustained during 25,268,873 athlete-exposures, of which 389 (0.8%) were stress fractures, resulting in an overall stress fracture rate of 1.54 per 100,000 athlete-exposures. Rates per 100,000 athlete-exposures were highest in girls' cross country (10.62), girls' gymnastics (7.43), and boys' cross country (5.42). In sex-comparable sports, girls sustained more stress fractures (63.3%) than did boys (36.7%) and had higher rates of stress fracture (2.22 vs 1.27; rate ratio, 1.75; 95% CI, 1.38-2.23). The most commonly injured sites were the lower leg (40.3% of all stress fractures), foot (34.9%), and lower back/lumbar spine/pelvis (15.2%). Management was nonsurgical in 98.7% of the cases, and 65.3% of injuries resulted in ≥3 weeks of time loss, medical disqualification, or an end to the season before athletes could return to play. Conclusion: Although a rare injury, stress fractures cause considerable morbidity for high school athletes of both sexes. Future research should evaluate risks of stress fractures to drive development of targeted prevention efforts.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalAmerican Journal of Sports Medicine
Issue number1
StatePublished - Jan 8 2015

Bibliographical note

Publisher Copyright:
© 2014 The Author(s).


  • High School RIO
  • epidemiology
  • female athletes
  • injury surveillance
  • pediatric sports medicine
  • stress fractures


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