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A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes

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Abstract

Summary

Since stress fractures are common among adolescent athletes, it is important to identify bone assessment tools that accurately identify risk. We investigated the discriminative ability of two imaging technologies to classify at-risk athletes. Findings suggested that peripheral quantitative computed tomography (pQCT) has the ability to distinguish differences in bone structure in injured vs. uninjured limbs.

Introduction

Given the high stress fracture (SFX) prevalence among adolescent girls, an understanding of the most informative assessment tools to identify SFX risks are required. We investigated the discriminative ability of pQCT vs. dual-energy X-ray absorptiometry (DXA) to classify athletes with or without SFX.

Methods

Twelve adolescent athletes diagnosed with a lower-extremity SFX were compared with 12 matched controls. DXA measured areal bone mineral density (aBMD) and content of the total body, and lumbar spine. Bilateral tibiae were assessed with pQCT. At the metaphysis (3%), total density (ToD), trabecular density (TrD), trabecular area (TrA), and estimated bone strength in compression (BSIc), and at the diaphysis (38% and 66%), total bone area (ToA), cortical density (CoD), cortical area (CoA), estimated bone strength in torsion (SSIp), and peri- and endocortical and muscle area (MuA) were obtained. Cortical bone mass/density around the center of mass and marrow density (estimate of adiposity) were calculated using ImageJ software. General estimated equations adjusting for multiple comparisons (Holm-Bonferroni method) were used to compare means between (1) injured limb of the case athletes vs. uninjured limb of the control athletes and (2) uninjured limb of the case athletes vs. uninjured limbs of the controls and injured vs. uninjured limb of case athletes with a SFX.

Results

aBMD and content showed no significant differences between cases and controls. When comparing the injured vs. uninjured leg in the case athletes by pQCT at the 3% tibia, unadjusted TrD, total density, and BSIc were significantly lower (p < 0.05) in the injured vs. uninjured leg. Marrow density at the 66% site was 1% (p < 0.05) lower in the injured vs. uninjured leg.

Conclusions

These preliminary data in athletes with SFX suggest that pQCT has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. No discriminative bone parameter classifications were identified between adolescent athletes with or without SFX.

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Acknowledgments

The authors thank Valerie Marsocci, RT and Nicole DaSilva, RT, CNMT for their excellent technical assistance, Dr. Sara Vogrin affiliated with the Australian Institute for Musculoskeletal Sciences (AIMSS) for biostatistical advice, and our patients and their families for their participation.

Disclosure of funding

This study was funded by the Brown University Department of Orthopedics.

Author information

Authors and Affiliations

  1. Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia

    R. L. Duckham

  2. Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia

    R. L. Duckham

  3. Division of Pediatric Endocrinology, Rhode Island Hospital/Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA

    S. R. Bialo

  4. Division of Biostatistics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA

    J. Machan

  5. Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School Rhode Island Hospital/Hasbro Children’s Hospital, Brown University, Providence, RI, USA

    P. Kriz

  6. Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA

    C. M. Gordon

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  1. R. L. Duckham
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  3. J. Machan
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  4. P. Kriz
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Correspondence to C. M. Gordon.

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Institutional Review Board approval was obtained at Rhode Island Hospital. Written informed assent/consent was obtained for all participants.

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Duckham, R.L., Bialo, S.R., Machan, J. et al. A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes. Osteoporos Int 30, 1573–1580 (2019). https://doi.org/10.1007/s00198-019-05001-x

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