Stanford Department of Epidemiology and Population Health, Stanford, California.
Department of Family Medicine and Orthopaedic Surgery, Division of Sports Medicine and Non-Operative Orthopedics, University of California Los Angeles, Los Angeles, California.
Clin J Sport Med. 2023 Nov 1;33(6):631-637. doi: 10.1097/JSM.0000000000001180. Epub 2023 Sep 1.
Bone stress injuries (BSIs) in trabecular-rich bone are associated with greater biological risk factors compared with cortical-rich bone. We hypothesized that female runners with high Female Athlete Triad (Triad)-related risk would be at greater risk for trabecular-rich BSIs than runners with low Triad-related risk.
Prospective cohort study.
Two NCAA institutions.
Female runners were followed prospectively for up to 5 years.
The intervention consisted of team nutrition presentations focused on optimizing energy availability plus individualized nutrition sessions. Triad Cumulative Risk Assessment (CRA) categories were assigned yearly based on low-energy availability, menstrual status, age of menarche, low body mass index, low bone mineral density, and prior BSI.
The outcome was the annual incidence of trabecular- and cortical-rich BSI. Generalized Estimating Equations (GEE, to account for the correlated nature of the observations) with a Poisson distribution and log link were used for statistical modeling.
Cortical-rich BSI rates were higher than trabecular-rich BSI rates (0.32 vs 0.13 events per person-year). Female runners with high Triad-related risk had a significantly higher incidence rate ratio of trabecular-rich BSI (RR: 4.40, P = 0.025) and cortical-rich BSI (RR: 2.87, P = 0.025) than women with low Triad-related risk. Each 1-point increase in Triad CRA score was associated with a significant 26% increased risk of trabecular-rich BSI ( P = 0.0007) and a nonsignificant 14% increased risk of cortical-rich BSI ( P = 0.054).
Increased Triad CRA scores were strongly associated with increased risk for trabecular-rich BSI. Incorporating Triad CRA scores in clinical care could guide BSI prevention.
与皮质丰富骨相比，松质骨中的骨应力损伤（BSI）与更大的生物学危险因素相关。我们假设，具有高女性运动员三联征（Triad）相关风险的女性跑步者比具有低 Triad 相关风险的跑步者更容易发生松质骨 BSI。
前瞻性队列研究。
两个 NCAA 机构。
对女性跑步者进行了长达 5 年的前瞻性随访。
干预措施包括以优化能量可用性为重点的团队营养讲座，以及个性化的营养课程。每年根据低能量可用性、月经状态、初潮年龄、低体重指数、低骨密度和既往 BSI 情况，对 Triad 累积风险评估（CRA）类别进行分配。
观察结果是松质骨和皮质骨 BSI 的年发生率。使用广义估计方程（GEE，以考虑观察结果的相关性），采用泊松分布和对数链接进行统计建模。
皮质骨 BSI 的发生率高于松质骨 BSI（0.32 比 0.13 人年事件）。高 Triad 相关风险的女性跑步者发生松质骨 BSI 的发病率比值比（RR：4.40，P = 0.025）和皮质骨 BSI（RR：2.87，P = 0.025）显著高于低 Triad 相关风险的女性。Triad CRA 评分每增加 1 分，松质骨 BSI 的风险增加 26%（P = 0.0007），皮质骨 BSI 的风险增加 14%（P = 0.054）。
Triad CRA 评分的增加与松质骨 BSI 风险的增加密切相关。在临床护理中纳入 Triad CRA 评分可以指导 BSI 的预防。
