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J Sci Med Sport, 2020; 23(2): 145-150, PMID: 31594711

Bone geometry and lower extremity bone stress injuries in male runners.

Year: 2020

Popp KL, Frye AC, Stovitz SD, Hughes JM
Military Performance Division, United States Army Research Institute of Environmental, USA; Endocrine Unit, Massachusetts General Hospital, USA; Department of Medicine, Harvard Medical School, USA. Electronic address:


Bone stress injuries (BSI) are common among distance runners and research investigations examining risk factors for BSI among men are limited. Therefore, investigations are needed to determine if men with a history of BSI have skeletal properties that may heighten BSI incidence. OBJECTIVES: To analyze differences in bone density, bone geometry, and estimates of bone strength in male runners with and without a BSI history. DESIGN: Cross-sectional. METHODS: We recruited 36 male distance runners ages 18-41 for this study. We used peripheral quantitative computed tomography (pQCT) to assess volumetric bone mineral density (vBMD, mg/mm(3)), bone geometry (total and cortical bone area, mm(2)), tibia robustness (total area/tibia length, mm) and estimates of bone strength (section modulus and polar strength-strain index, mm(3)) at 5 tibial sites. RESULTS: After adjusting for age, the BSI group had more slender tibias (9%), lower stress strain indices (-16%), lower section moduli (-17%) and smaller total cross-sectional (-11%) and cortical areas (-12%) at the 66% site of the tibia compared with controls (P<0.05 for all). Similar differences were found at all other measurement sites. After adjusting for body size, differences in bone outcomes remained significant at the 66% site. CONCLUSIONS: These results indicate that men with a history of BSI have lower estimated bending strength compared to controls because of narrower tibias. However, differences are largely attenuated in the distal (1/2) of the tibia after adjusting for body size. Thus, smaller tibia size, particularly at the mid-diaphysis, may be an important indicator for BSI incidence.

GID: 4984; Last update: 14.10.2019