Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Do proximal-femur structural parameters differ in female athletes with-and-without a history of lower extremity stress-fracture (#355)

Rachel L Duckham 1 2 , Nicolas Peirce 1 3 , Ludovic Humbert 4 , Katherine Brooke-Wavell 1
  1. School of Sport, Exercise and Health Sciences, , Loughborough University, , Loughborough, Leicestershire, United Kingdom
  2. Australian Institute for Musculoskeletal Sciences (AIMSS), , University of Melbourne and Western Health,, St. Albans, Victoria, Australia
  3. England and Wales Cricket Board, Loughborough, Please Select, United Kingdom
  4. 3D-Shaper Medical, , Barcelona, Please Select, Spain

Purpose: Stress fractures (SF) are common in endurance athletes. As BMD and cortical thickness have been implicated in some previous research, femur structural analysis may be predictive of SF risk. We compared 3D femur structural bone parameters according to SF history.

Methods: Participants were 68 female endurance athletes. Questionnaires were used to assess SF, training history and menstrual function. Areal Bone Mineral Density (aBMD) of the hip, %fat and lower leg lean tissue mass (LLLTM) were assessed by dual-energy x-ray absorptiometry (DXA). 3D-DXA modelling was used to estimate cortical and trabecular volumetric BMD (vBMD), cortical surface BMD (sBMD), cortical thickness and strength estimates. Athletes with a history of SF (ASF) and those without (controls; AC) were compared by ANCOVA with post-hoc comparisons and Bonferroni adjustments. 

Results: Nineteen athletes (28%) reported SF history (at mean SD age: 21.4±5.7yrs). SF sites were metatarsals (46%), tibia or fibula (38%) calcaneus (13%), and femur (4%). ASF and AC had similar age (SF: 26.1±6.5yrs, AC: 26.8±7.9 yrs), height (SF:1.68±0.1, AC: 1.67±0.1m), weight (SF:56.2±4.8, AC: 55.2±6.3kg) and %fat (SF:16.7±4.6, AC: 17.4±6.1 %fat). ASF had a higher LLLTM (SF:2.6±0.3, AC: 2.5±0.2kg, p=0.031) and prevalence of current a/oligomenorrhoea (SF:68, C: 33% p=0.007) than AC. Hip aBMD did not differ between ASF and AC (p>0.05). 3D-DXA modeling showed lower trabecular and femoral neck cortical sBMD, but higher cortical sBMD elsewhere (fig 1) in ASF compared to AC, although these differences were non-significant. 

Conclusions:

Femur structural parameters did not differ significantly according to history of (predominantly lower leg) SF, although stronger associations may be seen with larger sample size or with femur SF.

 

Fig 1:  Differences (%) between ASF and AC in cortical surface density (left) and cortical and trabecular vBMD (right, frontal section).

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