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Cited by 30Lower Extremity Biomechanics and PathologiesBone health and osteoporosis researchEating Disorders and Behaviors

Low energy availability surrogates associated with lower bone mineral density and bone stress injury site

Holtzman, Bryan, Popp, Kristin L., Tenforde, Adam S., Parziale, Allyson L., Taylor, Kathryn, Ackerman, Kathryn E.·2022·PM&R
DOI 10.1002/pmrj.12821
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Abstract

Background: Exercise is an osteogenic stimulus that should increase bone mineral density (BMD) and protect against injury. However, some female athletes have lower BMD and increased bone stress injury (BSI) risk. Impaired bone health seen in athletes may be explained by low energy availability as described by concepts of Relative Energy Deficiency in Sport (RED‐S) and Female Athlete Triad (Triad). Objective: To elucidate the relationship between RED‐S/Triad risk factors and BSI to high‐risk (femoral neck, sacrum) and low‐risk (other) bones. Design: Cross‐sectional survey and retrospective chart review. Setting: Tertiary care academic center. Patients: Female athletes aged 15–30 years participating in ≥4 h/week of exercise presenting to sports medicine/orthopedics clinic who had a self‐reported BSI and available dual‐energy x‐ray absorptiometry (DXA) measurement of BMD. Interventions: Not applicable. Main Outcome Measurements: Location of BSI. Results: In 127 athletes, high‐risk BSI was associated with surrogates of low energy availability ( p = .032) and having a DXA Z‐score < −1 ( p = .035) but not a current/past history of menstrual dysfunction ( p = .348). Accumulating RED‐S/Triad risk factors increase the odds of incurring a high‐risk BSI ( p = .048). Conclusions: Adolescent/young female athletes who sustain BSI at high‐risk sites (femoral neck, sacrum) may have underlying risk factors (eg, low energy availability, poor overall bone health) that should prompt further workup and referral to optimize health in these athletes.

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Crossref · 10.1002/pmrj.12821

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Authors
Holtzman, B., Popp, K. L., Tenforde, A. S., Parziale, A. L., Taylor, K., & Ackerman, K. E.
Affiliations
  • Boston Children's Hospital (US)
  • U.S. Army Research Institute of Environmental Medicine (US)
Corresponding author
Ackerman, Kathryn E.
ORCID
Venue
PM&R
Publisher
Wiley
Published
2022-05
Volume
14
Issue
5
Pages
587-596
ISSN
  • 1934-1482 (ISSN-L)
  • 1934-1563
DOI
10.1002/pmrj.12821
OpenAlex
W4224313850
Cited by
30
References
40
Citations by year
2026: 9 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 2
FWCI
1.53
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 15 d)
Locations
  • PM&R (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
bone stress injuries, low energy availability, relative energy deficiency in sport, female athlete triad, bone mineral density, female athletes, femoral neck, sacrum, menstrual disorders, youth athletes
MeSH terms
Adolescent, Cross-Sectional Studies, Female, Humans, Retrospective Studies, Absorptiometry, Photon, Bone Density, Female Athlete Triad Syndrome, Athletes

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