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 Sp orts 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, bo ne scan, or magnetic resonance imaging) for the diagnosis of stress fractur e 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 st andard deviation from the standard age-matched control). Results: 8 of 9 patients with cancellous stress fractures had DEXA scans in dicating osteopenia while only 3 of 11 patients with stress fractures of co rtical 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 docume nted stress fractures of cancellous bone or cortical bone (with risk factor s for osteopenia) undergo bone density evaluation.