Noll Laboratory, Women's Health and Exercise Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, 16802, USA.
Sports Med. 2019 Jul;49(7):1059-1078. doi: 10.1007/s40279-019-01109-6.
Stress fractures can lead to short- and long-term consequences, impacting participation in sport and general health. Recognizing which skeletal characteristics render bones susceptible to stress fracture may aid stress-fracture prevention. Menstrual disturbances among exercising women are a known risk factor for stress fracture; therefore, assessing skeletal commonalities between women with stress fractures and women with menstrual disturbances may increase our understanding of why menstrual disturbances put athletes at greater risk for stress fracture. Three-dimensional (3D) bone imaging tools provide detailed information about volumetric bone mineral density (vBMD) and bone structure that cannot be obtained using traditional two-dimensional (2D) techniques.
This systematic review serves to: (1) evaluate the current literature available on vBMD, bone geometry, and bone structure in exercising women with menstrual disturbances and exercising women with stress fractures, and (2) assess the common skeletal characteristics between both conditions. Our aim is to reveal bone properties beyond 2D areal BMD that may indicate increased susceptibility to stress fracture among exercising women with menstrual disturbances.
A search of the PubMed/Medline database was completed in May 2018.
Eligible articles included those that reported vBMD, bone geometry, or bone structure obtained from 3D imaging techniques or estimated from 2D imaging techniques. Only studies conducted in premenopausal exercising women and girls who had a stress fracture, a menstrual disturbance, or both were included.
Twenty-four articles met the inclusion criteria. Bone area and cortical thickness at the tibia were identified as altered both in women with menstrual disturbances and in women with stress fractures; however, there was inconsistency in the results observed for all bone parameters. The majority of skeletal parameters of the lower extremities were not significantly different between exercising women with and without stress fractures and between those with and without menstrual disturbances.
Most studies were moderate or low quality based on study design, and only one article combined both conditions to explore vBMD and bone geometry in athletes with menstrual disturbances and a history of stress fracture. These findings highlight the need for more skeletal research on the intersection of these health conditions in exercising women. The lack of observed differences in skeletal parameters suggests that risk factors other than bone geometry and structure may be the primary causes of stress fracture in these women.
应力性骨折可导致短期和长期后果，影响运动参与和整体健康。识别哪些骨骼特征使骨骼易患应力性骨折，可能有助于预防应力性骨折。运动女性的月经紊乱是应力性骨折的已知危险因素；因此，评估有应力性骨折和月经紊乱的女性之间的骨骼共性，可能会增加我们对为什么月经紊乱使运动员更易发生应力性骨折的理解。三维（3D）骨骼成像工具提供了关于体积骨矿物质密度（vBMD）和骨骼结构的详细信息，这些信息是传统二维（2D）技术无法获得的。
本系统评价旨在：（1）评估目前关于运动女性月经紊乱和运动女性应力性骨折患者 vBMD、骨几何形状和骨骼结构的文献；（2）评估两种情况下的常见骨骼特征。我们的目的是揭示二维面积 BMD 之外的骨骼特性，这些特性可能表明运动女性月经紊乱者更容易发生应力性骨折。
于 2018 年 5 月完成了对 PubMed/Medline 数据库的搜索。
符合条件的文章包括那些报告了 3D 成像技术获得的 vBMD、骨几何形状或骨骼结构，或从 2D 成像技术估计的 vBMD、骨几何形状或骨骼结构的文章。仅纳入报告了应力性骨折、月经紊乱或两者都有的绝经前运动女性和女孩的研究。
有 24 篇文章符合纳入标准。胫骨的骨面积和皮质厚度在月经紊乱的女性和应力性骨折的女性中均被确定为改变；然而，所有骨骼参数的结果观察不一致。大多数下肢骨骼参数在有和没有应力性骨折的运动女性以及有和没有月经紊乱的女性之间没有显著差异。
大多数研究根据研究设计被评为中等或低质量，只有一篇文章结合了这两种情况，探讨了有月经紊乱和有应力性骨折病史的运动员的 vBMD 和骨几何形状。这些发现强调了需要对运动女性中这些健康状况的交叉点进行更多骨骼研究。骨骼参数观察到的差异不明显表明，除了骨几何形状和结构之外，其他风险因素可能是这些女性应力性骨折的主要原因。
