Background:

Bone stress injuries (BSIs) are common sports injuries that occur because of an imbalance between microdamage accumulation and removal through bone remodeling. The underlying bone phenotype has been assumed to be a contributing factor. However, the bone microarchitecture of athletes with BSI is not well characterized, and no study has investigated whether impaired bone microarchitecture is associated with bone composition or anatomic site of injury.

Purpose/Hypothesis:

This cross-sectional study characterizes the bone microarchitecture at distal radial and tibial reference locations in athletes with BSI. Based on previous dual-energy X-ray absorptiometry (DXA) findings, the aim was to compare anatomic injury sites, hypothesizing that athletes with BSIs in bones with greater trabecular composition show impaired bone microarchitecture parameters compared with those with BSIs in bones with greater cortical composition.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Athletes who had presented to our outpatient clinic because of a high-grade BSI (ie, stress fracture) were retrospectively included. Blood and urine samples were collected. Areal bone mineral density (aBMD) was assessed by DXA at the lumbar spine and both hips. Bone microarchitecture was analyzed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and tibia. HR-pQCT parameters were expressed in relation to available sex-, age-, and device-adjusted reference values and compared with a cohort of 53 age- and sex-matched controls.

Results:

In total, 53 athletes had a BSI of the foot (n = 20), tibia/fibula (n = 18), pelvis (n = 9), femur (n = 5), or sternum (n = 1). Based on DXA measurements, a Z-score of −1.0 or lower was found in 32 of 53 (60.4%) of the athletes, of whom 16 of 53 (30.2%) had a Z score −2.0 or lower. While an impairment of cortical area (P = .034 and P = .001) and thickness (P = .029 and P < .001) was detected at the distal radius and tibia in the BSI cohort compared with controls, no differences in BMD or bone microarchitecture were observed between anatomic injury sites. Furthermore, no difference was revealed when BSIs were grouped into cortical- and trabecular-rich sites.

Conclusion:

Reduced aBMD and impaired cortical bone microarchitecture were present in a considerable number of athletes with BSI. Neither aBMD nor bone microarchitecture was related to the injury site, highlighting the multifactorial etiology of BSI.

中文翻译：

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远端桡骨和胫骨参考位置受损的骨微结构与骨应力损伤运动员的损伤部位无关

背景：

骨应力损伤 (BSI) 是常见的运动损伤，是由于微损伤积累和通过骨重塑去除之间的不平衡而发生的。潜在的骨表型被认为是一个促成因素。然而，BSI 运动员的骨微结构没有得到很好的表征，也没有研究调查受损的骨微结构是否与骨成分或解剖损伤部位有关。

目的/假设：

这项横断面研究描述了 BSI 运动员远端桡骨和胫骨参考位置的骨微结构。基于先前的双能 X 射线骨密度仪 (DXA) 发现，目的是比较解剖损伤部位，假设与具有更大皮质骨的 BSI 的运动员相比，具有更大骨小梁组成的 BSI 的运动员显示出受损的骨微结构参数作品。

学习规划：

队列研究；证据水平，3。

方法：

回顾性纳入因高级别 BSI（即应力性骨折）而到我们门诊就诊的运动员。收集血液和尿液样本。通过 DXA 评估腰椎和双髋的面积骨矿物质密度 (aBMD)。通过远端桡骨和胫骨的高分辨率外周定量计算机断层扫描 (HR-pQCT) 分析骨微结构。HR-pQCT 参数根据可用的性别、年龄和设备调整参考值表示，并与 53 名年龄和性别匹配的对照组进行比较。

结果：

总共有 53 名运动员有足部 (n = 20)、胫骨/腓骨 (n = 18)、骨盆 (n = 9)、股骨 (n = 5) 或胸骨 (n = 1) 的 BSI。根据 DXA 测量，53 名运动员中有 32 名（60.4%）的 Z 值为 -1.0 或更低，其中 53 名中有 16 名（30.2%）的 Z 值为 -2.0 或更低。虽然与对照组相比，BSI 队列中桡骨远端和胫骨的皮质面积（P = .034 和P = .001）和厚度（P = .029 和P < .001）受损，但 BMD 没有差异在解剖损伤部位之间观察到或骨微结构。此外，当 BSI 被分为富含皮质和富含小梁的部位时，没有发现差异。

结论：

相当多的 BSI 运动员存在 aBMD 降低和皮质骨微结构受损。aBMD 和骨微结构均与损伤部位无关，突出了 BSI 的多因素病因。