Fatigue Fractures in Recreational and Professional Athletes: Risk Factors, Prevention, and Recovery Strategies

Objectives: In the review we synthesized current evidence on fatigue fractures in athletes to bridge pathophysiological mechanisms with clinical strategies for prevention, diagnosis, and recovery. Methods: A comprehensive analysis incorporated epidemiological studies, biomechanical research, clinical trials, and meta-analyses examining risk factors, diagnostics, interventions, and rehabilitation protocols. Key findings: Fatigue fractures arise from repetitive microdamage exceeding bone repair capacity, amplified by intrinsic factors (e.g., low bone mineral density, hormonal imbalances) and extrinsic triggers (training errors, nutritional deficiencies). Magnetic resonance imaging demonstrated 90-95% diagnostic sensitivity. Gradual training progression (acute:chronic workload ratio < 1.5) reduced injuries by 30-50%, while nutritional optimization (calcium 1200-1500 mg/day; vitamin D ≥ 30ng/mL) enhanced recovery by 40%. Female athletes with relative energy deficiency faced 4-fold higher risk, mitigated through hormone/nutrition strategies. Advanced therapies like teriparatide improved outcomes in complex cases. Conclusions: Effective management requires multidisciplinary integration of sport-specific biomechanics, nutritional/hormonal optimization, phased rehabilitation, and individualized load monitoring, with tailored approaches for post-hiatus deconditioning and aging physiology.