Prevalence and factors associated with bone stress injury in middle school runners

Adam S. Tenforde; Stephanie DeLuca; Alexander C. Wu; Kathryn E. Ackerman; Margo Lewis; Mitchell J. Rauh; Bryan Heiderscheit; Brian J. Krabak; Emily Kraus; William Roberts; Karen L. Troy; Michelle T. Barrack

doi:10.1002/pmrj.12673

Prevalence and factors associated with bone stress injury in middle school runners

Adam S. Tenforde, Stephanie DeLuca, Alexander C. Wu, Kathryn E. Ackerman, Margo Lewis, Mitchell J. Rauh, Bryan Heiderscheit, Brian J. Krabak, Emily Kraus, William Roberts, Karen L. Troy, Michelle T. Barrack

Family Medicine and Community Health (Twin Cities)

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background: Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. Objective: To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. Design: Retrospective cross-sectional study. Setting: Online survey distributed to middle school runners. Methods: Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. Main Outcome Measurements: Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. Participants: 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. Results: One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p =.004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. Conclusion: Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.

Original language	English (US)
Pages (from-to)	1056-1067
Number of pages	12
Journal	PM and R
Volume	14
Issue number	9
DOIs	https://doi.org/10.1002/pmrj.12673
State	Published - Sep 2022

Bibliographical note

Funding Information:
Dr. Heiderscheit is the owner of Science of Running Medicine, LLC, outside the submitted work. Dr. Tenforde has no disclosures related to this work. He serves as senior editor for . He gives professional talks such as grand rounds and medical conference plenary lectures and receives honoraria from conference organizers. He has participated in research funded by The Arnold P. Gold Foundation (physician and patient care disparities), Football Player Health Study at Harvard (health in American‐Style Football players), and American Medical Society for Sports Medicine (bone density research). PM&R Journal

Publisher Copyright:
© 2021 American Academy of Physical Medicine and Rehabilitation.

Keywords

Adolescent
Bone Density
Child
Cross-Sectional Studies
Female
Humans
Male
Osteoporosis
Prevalence
Retrospective Studies
Running/injuries
Schools

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@article{4426692f41e2461a85d244f28d9a4dc4,

title = "Prevalence and factors associated with bone stress injury in middle school runners",

abstract = "Background: Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. Objective: To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. Design: Retrospective cross-sectional study. Setting: Online survey distributed to middle school runners. Methods: Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. Main Outcome Measurements: Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. Participants: 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. Results: One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p =.004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. Conclusion: Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.",

keywords = "Adolescent, Bone Density, Child, Cross-Sectional Studies, Female, Humans, Male, Osteoporosis, Prevalence, Retrospective Studies, Running/injuries, Schools",

author = "Tenforde, {Adam S.} and Stephanie DeLuca and Wu, {Alexander C.} and Ackerman, {Kathryn E.} and Margo Lewis and Rauh, {Mitchell J.} and Bryan Heiderscheit and Krabak, {Brian J.} and Emily Kraus and William Roberts and Troy, {Karen L.} and Barrack, {Michelle T.}",

note = "Funding Information: Dr. Heiderscheit is the owner of Science of Running Medicine, LLC, outside the submitted work. Dr. Tenforde has no disclosures related to this work. He serves as senior editor for . He gives professional talks such as grand rounds and medical conference plenary lectures and receives honoraria from conference organizers. He has participated in research funded by The Arnold P. Gold Foundation (physician and patient care disparities), Football Player Health Study at Harvard (health in American‐Style Football players), and American Medical Society for Sports Medicine (bone density research). PM&R Journal Publisher Copyright: {\textcopyright} 2021 American Academy of Physical Medicine and Rehabilitation.",

year = "2022",

month = sep,

doi = "10.1002/pmrj.12673",

language = "English (US)",

volume = "14",

pages = "1056--1067",

journal = "PM and R",

issn = "1934-1482",

publisher = "Elsevier Inc.",

number = "9",

}

TY - JOUR

T1 - Prevalence and factors associated with bone stress injury in middle school runners

AU - Tenforde, Adam S.

AU - DeLuca, Stephanie

AU - Wu, Alexander C.

AU - Ackerman, Kathryn E.

AU - Lewis, Margo

AU - Rauh, Mitchell J.

AU - Heiderscheit, Bryan

AU - Krabak, Brian J.

AU - Kraus, Emily

AU - Roberts, William

AU - Troy, Karen L.

AU - Barrack, Michelle T.

N1 - Funding Information: Dr. Heiderscheit is the owner of Science of Running Medicine, LLC, outside the submitted work. Dr. Tenforde has no disclosures related to this work. He serves as senior editor for . He gives professional talks such as grand rounds and medical conference plenary lectures and receives honoraria from conference organizers. He has participated in research funded by The Arnold P. Gold Foundation (physician and patient care disparities), Football Player Health Study at Harvard (health in American‐Style Football players), and American Medical Society for Sports Medicine (bone density research). PM&R Journal Publisher Copyright: © 2021 American Academy of Physical Medicine and Rehabilitation.

PY - 2022/9

Y1 - 2022/9

N2 - Background: Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. Objective: To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. Design: Retrospective cross-sectional study. Setting: Online survey distributed to middle school runners. Methods: Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. Main Outcome Measurements: Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. Participants: 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. Results: One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p =.004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. Conclusion: Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.

AB - Background: Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. Objective: To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. Design: Retrospective cross-sectional study. Setting: Online survey distributed to middle school runners. Methods: Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. Main Outcome Measurements: Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. Participants: 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. Results: One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p =.004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (odds ratio [OR] = 18.5, 95% confidence interval [CI] = 7.3, 47.4), eating disorder (9.8, 95% CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95% CI = 2.6, 18.0), and age (OR = 1.6, 95% CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95% CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95% CI = 1.6, 6.7), and running mileage (OR = 1.1, 95% CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes. Conclusion: Whereas family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming <3 meals daily, also emerged as independent factors associated with BSI. Although cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population.

KW - Adolescent

KW - Bone Density

KW - Child

KW - Cross-Sectional Studies

KW - Female

KW - Humans

KW - Male

KW - Osteoporosis

KW - Prevalence

KW - Retrospective Studies

KW - Running/injuries

KW - Schools

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U2 - 10.1002/pmrj.12673

DO - 10.1002/pmrj.12673

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SN - 1934-1482

VL - 14

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EP - 1067

JO - PM and R

JF - PM and R

IS - 9

ER -

Prevalence and factors associated with bone stress injury in middle school runners

Abstract

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Keywords

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