Army Health and Performance Research, Army Headquarters, Andover, Hampshire, UK.
Division of Surgery and Interventional Science, UCL, London, UK.
Curr Osteoporos Rep. 2021 Jun;19(3):308-317. doi: 10.1007/s11914-021-00671-1. Epub 2021 Feb 26.
Stress fractures at weight-bearing sites, particularly the tibia, are common in military recruits and athletes. This review presents recent findings from human imaging and biomechanics studies aimed at predicting and preventing stress fractures.
Peripheral quantitative computed tomography (pQCT) provides evidence that cortical bone geometry (tibial width and area) is associated with tibial stress fracture risk during weight-bearing exercise. The contribution of bone trabecular microarchitecture, cortical porosity, and bone material properties in the pathophysiology of stress fractures is less clear, but high-resolution pQCT and new techniques such as impact microindentation may improve our understanding of the role of microarchitecture and material properties in stress fracture prediction. Military studies demonstrate osteogenic outcomes from high impact, repetitive tibial loading during training. Kinetic and kinematic characteristics may influence stress fracture risk, but there is no evidence that interventions to modify biomechanics can reduce the incidence of stress fracture. Strategies to promote adaptive bone formation, in combination with improved techniques to assess bone strength, present exciting opportunities for future research to prevent stress fractures.
承重部位（尤其是胫骨）的应力性骨折在新兵和运动员中很常见。本综述介绍了针对预测和预防应力性骨折的最新人体影像学和生物力学研究结果。
外周定量计算机断层扫描（pQCT）提供的证据表明，在承重运动期间，皮质骨几何形状（胫骨宽度和面积）与胫骨应力性骨折风险相关。骨小梁微观结构、皮质孔隙率和骨材料特性在应力性骨折发病机制中的作用尚不清楚，但高分辨率 pQCT 和冲击微压痕等新技术可能会增进我们对微结构和材料特性在预测应力性骨折中的作用的理解。军事研究表明，在训练期间进行高强度、重复的胫骨负荷会产生成骨效果。运动学和运动学特征可能会影响应力性骨折的风险，但没有证据表明改变生物力学的干预措施可以降低应力性骨折的发生率。促进适应性骨形成的策略，结合评估骨强度的改进技术，为未来预防应力性骨折的研究提供了令人兴奋的机会。
