Stress fractures: concepts and therapeutics

Stress fractures are repetitive use injuries in which recurrent strains lead to material fatigue and microarchitectural discontinuities. Stress fractures account for up to 20% of athletic injuries, more commonly sustained by women and in those who engage in track-and-field events. The pathogenesis of stress fractures is multifactorial. Although most stress fracture are reported among women who may experience menstrual disturbances, low body mass index, low energy intake and sometimes low bone mass, these individuals do not regularly seek endocrinological attention. Most published reports, moreover, are not found in Endocrinology journals. There are no standard protocols for evaluation or management of stress fractures.

Available literature published in English was retrieved using the following terms: stress fractures; fractures; osteoporosis, athletes, premenopausal women, athletic triad through Pub Med. Reviews, original reports and case reports were all included in the literature search.

Despite lack of consistency among the publications on this subject, a phenotype does emerge, namely of individuals whose bone mineral density is reduced along with low intake of dietary calcium and low circulating levels of 25-hydroxy vitamin D. Limited systematic experience suggests that calcium and vitamin D supplementation might be efficacious. Bisphosphonates or teriparatide may accelerate fracture healing in special circumstances. There is not enough evidence for a protective effect of oral contraceptives in premenopausal athletes to recommend their use

Most individuals who experience a stress fracture are young and healthy and do not appear to have an underlying metabolic bone disease. On the other hand, the presence of low bone mass and hormonal disturbances in some afflicted individuals might identity a cohort who need endocrinological attention. Prospective, well designed studies of stress fractures are needed to elucidate further underlying pathophysiological elements that predisposed such individuals. Guidelines for prevention and treatment may follow from such well controlled studies.

Autor / Fonte:Carolina A Moreira, John P Bilezikian Journal of Clinical Endocrinology and Metabolism 2016 October 12, : jc20162720