Myburgh K H, Hutchins J, Fataar A B, Hough S F, Noakes T D
University of Cape Town Medical School, Observatory, South Africa.
Ann Intern Med. 1990 Nov 15;113(10):754-9. doi: 10.7326/0003-4819-113-10-754.
To determine whether low bone density and other risk factors for osteoporosis are associated with stress fractures in athletes.
Case-control study.
Institutional sports injury clinic with primary and secondary care.
Twenty-five athletes (nineteen women) with scintigraphically confirmed stress fractures matched for sex, age, weight, height, and exercise history with 25 control athletes with no history of bone injury.
Bone mineral density measured by dual-energy x-ray absorptiometry was significantly lower in athletes with fractures than in control athletes: In the spine, bone mineral density was 1.01 +/- 0.14 g/cm2 in athletes with fractures and 1.11 +/- 0.13 g/cm2 in control athletes (P = 0.02). In the femoral neck, it was 0.84 +/- 0.09 g/cm2 in athletes with fractures and 0.90 +/- 0.11 g/cm2 in control athletes (P = 0.005). It was also significantly lower in the Ward triangle (P = 0.01) and the greater trochanter (P = 0.01). Eight athletes with fractures and no control athletes had less than 90% of predicted age-related spine density (P = 0.01), and three athletes with fractures had bone mineral densities that were 2 SDs or more below this predicted level. More athletes with fractures than control athletes had current menstrual irregularity (amenorrhea or oligomenorrhea) (P less than 0.005). Fewer athletes with fractures were using oral contraceptives (P less than 0.05). Seven-day diet records indicated similar energy and nutrient intakes, except athletes with fractures had lower calcium intakes (697 +/- 242 mg/d compared with 832 +/- 309 mg/d; P = 0.02). Dairy product intake was lower in athletes with fractures since leaving high school (P less than 0.05). The incidence of a family history of osteoporosis was similar in both groups.
In athletes with similar training habits, those with stress fractures are more likely to have lower bone density, lower dietary calcium intake, current menstrual irregularity, and lower oral contraceptive use.
确定低骨密度及其他骨质疏松风险因素是否与运动员应力性骨折相关。
病例对照研究。
提供初级和二级护理的机构性运动损伤诊所。
25名经骨闪烁显像确诊为应力性骨折的运动员（19名女性），根据性别、年龄、体重、身高和运动史与25名无骨损伤史的对照运动员匹配。
采用双能X线吸收法测量的骨密度，骨折运动员显著低于对照运动员：在脊柱，骨折运动员骨密度为1.01±0.14g/cm²，对照运动员为1.11±0.13g/cm²（P = 0.02）。在股骨颈，骨折运动员为0.84±0.09g/cm²，对照运动员为0.90±0.11g/cm²（P = 0.005）。在沃德三角（P = 0.01）和大转子处（P = 0.01）也显著更低。8名骨折运动员且无对照运动员的年龄相关脊柱密度低于预测值的90%（P = 0.01），3名骨折运动员的骨密度比该预测水平低2个标准差或更多。骨折运动员中出现当前月经不规律（闭经或月经过少）的人数多于对照运动员（P＜0.005）。骨折运动员中使用口服避孕药的人数较少（P＜0.05）。7天饮食记录显示能量和营养摄入相似，但骨折运动员钙摄入量较低（697±242mg/d，对照为832±309mg/d；P = 0.02）。自高中毕业后，骨折运动员的乳制品摄入量较低（P＜0.05）。两组骨质疏松家族史的发生率相似。
在训练习惯相似的运动员中，发生应力性骨折的运动员更可能骨密度较低、饮食钙摄入量较低、当前月经不规律且口服避孕药使用较少。
