Abstract
Musculoskeletal injuries, such as stress fracture, are responsible for over 10-million lost-duty days among U.S. Army Soldiers. During Basic Combat Training (BCT), an 8- to 10-week program that transforms civilians into Soldiers, women are four times more likely than men to sustain a stress fracture. In this work, we performed high-resolution peripheral quantitative computed tomography scans on the ultradistal tibia of 90 female recruits [age = 21.5 ± 3.3 (mean ± standard deviation) years] before the start of BCT and after 8 weeks into BCT. Then, we divided the scanned bone volume into four sectors—lateral, posterior, medial, and anterior—and computed the bone density and microarchitectural parameters in each of the four sectors pre- and post-BCT. We used linear mixed models to estimate the mean difference for bone density and microarchitectural parameters, while controlling for age, race, and pre-BCT body mass index. Our results revealed that the total volumetric bone mineral density, trabecular volumetric bone mineral density, and trabecular thickness increased (p < 0.05) in each of the four sectors. In addition, cortical thickness and trabecular bone volume/total volume increased in both medial and posterior sectors (p < 0.05). Overall, six and five out of nine parameters improved in the medial and posterior sectors, respectively, after BCT. In conclusion, the heightened physical activity during BCT led to the most beneficial bone adaptation in the medial and posterior sectors of the ultradistal tibia, which is indicative of higher loading in these sectors during activities performed in the course of BCT.
Highlights
Musculoskeletal injuries resulting from basic and advanced training are often cited as the single greatest medical impediment to Warfighter readiness [1, 2]
By considering the changes in trabecular bone density in female recruits to be one-half of those observed in the female athletes, we found that it would require between 54 and 92 female recruits, both before and after Basic Combat Training (BCT), to observe differences in means ranging from 25 to 6%, respectively, at 75% power with a significance level of 15%
Analyses of pre-BCT bone density and microarchitectural parameters between sectors (Table 2) revealed that Tt.vBMD was lowest in the anterior sector
Summary
Musculoskeletal injuries resulting from basic and advanced training are often cited as the single greatest medical impediment to Warfighter readiness [1, 2]. One such musculoskeletal injury, stress fracture, is a common overuse injury among the military population. Female recruits are more susceptible to stress fracture during BCT than are their male counterparts, with one study showing that males sustain 19.3 injuries for every 1000 recruits whereas females sustain 79.9 [5]. Our recent study of cross-sectional changes of the ultradistal tibia in female recruits who underwent BCT showed increases in bone density and microarchitecture indicative of new bone formation [10]
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