Evaluation of bone mineral density in cases of bone stress injury among sportspersons

Abstract

Objectives: A bone stress injury (BSI) represents the inability of bone to withstand repetitive mechanical loading, leading to structural fatigue, localized bone pain, and tenderness. Stress fractures account for up to 20% of athletic injuries and occur more commonly in women and track-and-field athletes. Low bone mineral density (BMD) has previously been considered a potential risk factor for developing BSI. This study aims to evaluate BMD, among other factors, in sportspersons diagnosed with BSI and look for association. Materials and Methods: Complete history and examination of a required sample size of 68 were done to reach a diagnosis of BSI, radiologically confirmed by magnetic resonance imaging (MRI). Diagnosed cases were tested for BMD by dual-energy X-ray absorptiometry (DEXA, whole body). Additional parameters studied included demographic profile, site of injury, MRI grade of injury, body mass index (BMI), and serum 25-hydroxy Vitamin D. Results: A total of 70 patients between the ages of 18 and 41 years with BSI were enrolled. Three subjects (4.29%) had low BMD. The mean BMD value was slightly lower in females (1.1 ± 0.07 vs. 1.19 ± 0.06 g/cm2 in males), but all three cases of low BMD were present among males. Additional findings included a high prevalence of low Vitamin D levels, male gender, low daily caloric intake, high-grade injuries on MRI, injuries at cortical-rich bone sites, and high BMI. Conclusion: Low BMD (Z-score<–1) prevalence of 4.29% suggests a lack of association with BSI. On the other hand, the relatively higher prevalence of Vitamin D insufficiency/deficiency, male gender, low daily caloric intake, high-grade injuries on MRI, and high BMI warrant attention.