Abstract
Bone stress injuries (BSIs) are an overuse form of injury resulting from strain in the setting of repetitive loading. A key component of BSI management is the identification and modification of underlying risk factors for BSI, which may include multiple biomechanical and/or biological factors. Biological risk factors for BSI may be both innate and acquired. Appropriate metabolic workup for runners with BSI starts with a detailed history and physical exam with a focus on features that may relate to bone health risk factors. Based on the clinical presentation, diagnostic imaging including radiographs, MR, and DXA scan may be considered. Laboratory evaluation may be considered to evaluate for potential underlying medical etiologies and/or associated comorbidities. Ultimately, management should be interdisciplinary and patient-centered, focused not only on resolution of an athlete's current BSI but, importantly, risk factor reduction and reinjury prevention in the setting of an athlete's return to running. This chapter is the second in this book, pertaining to BSI. Its focus is on factors affecting bone health and metabolic evaluation of those runners with impaired bone health that present with BSI.
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