Stress Fracture Sites Related to Underlying Bone Health in Athletic Females

OBJECTIVE: The study tested the hypothesis that females who sustain stress fractures of cancellous bone have decreased bone density. DESIGN: A retrospective, controlled, cross-sectional study. SETTING: The setting of the study was a tertiary care center for Women's Sports Medicine. PATIENTS: 20 female patients under the age of 40 who had suffered a stress fracture and who had a positive diagnostic study (radiograph, bone scan, or magnetic resonance imaging) were included in the study. INTERVENTIONS: Patients who had a positive diagnostic study (radiograph, bone scan, or magnetic resonance imaging) for the diagnosis of stress fracture also underwent dual energy X-ray absorptiometry (DEXA) scans. MAIN OUTCOME MEASURE: Bone density measured by the DEXA scan, as defined by the World Health Organization criteria for osteopenia (greater than one standard deviation from the standard age-matched control). RESULTS: 8 of 9 patients with cancellous stress fractures had DEXA scans indicating osteopenia while only 3 of 11 patients with stress fractures of cortical bone had a scan indicating osteopenia (p = 0.01). CONCLUSIONS: A cancellous stress fracture in a female may be a warning sign of early onset osteopenia. We recommend that young females who have documented stress fractures of cancellous bone or cortical bone (with risk factors for osteopenia) undergo bone density evaluation.