Risk factors for stress fractures

Sports Medicine

Volumn 28, Issue 2, 1999, Pages 91-122

  Bennell, Kint ^a   Matheson, Gordon ^b   Meeuwisse, Willem ^c   Brukner, Peter ^d  

^a UNIVERSITY OF MELBOURNE   (Australia)

^b STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c UNIVERSITY OF CALGARY   (Canada)

^d OLYMPIC PARK SPORTS MEDICINE CENTRE   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

SEX HORMONE;

BODY SIZE; BONE DENSITY; BONE TURNOVER; CALORIC RESTRICTION; ENDOCRINOLOGY; ENDURANCE; FEMALE; HUMAN; LEG LENGTH INEQUALITY; MALE; MENSTRUATION DISORDER; METHODOLOGY; MUSCLE STRENGTH; MUSCLE WEAKNESS; NUTRITION; PSYCHOLOGY; REVIEW; RISK FACTOR; SHOE; SPORTS MEDICINE; STRESS FRACTURE; TRAINING;

EID: 0032861934     PISSN: 01121642     EISSN: None     Source Type: Journal    
DOI: 10.2165/00007256-199928020-00004     Document Type: Review

References (179)

1. 1. McBryde AM. Stress fractures in runners. Clin Sports Med 1985; 4: 737-52
2. 2. Lysens RJ, de Weerdt W, Nicuwboer A. Factors associated with injury proneness. Sports Med 1991; 12: 281-9
3. 3. Meeuwisse WH. Athletic injury etiology: distinguishing between interaction and confounding. Clin J Sport Med 1994; 4: 171-5
4. 4. Lanyon LE, Hampson WGJ, Goodship AE, et al. Bone deformation recorded in vivo from strain gauges attached to the human tibial shaft. Acta Orthop Scand 1975; 46: 256-68
5. 5. Burr DB, Milgrom C, Fyhrie D, et al. In vivo measurement of human tibial strains during vigorous activity. Bone 1996; 18: 405-10
6. 6. Ekenman I, Halvorsen K, Westblad P, et al. Local bone deformation at two predominant sites for stress fractures of the tibia: an in vivo study. Foot Ankle Int 1998; 19: 479-84
7. 7. Milgrom C, Burr D, Fyhrie D, et al. A comparison of the effect of shoes in human tibial axial strains recorded during dynamic loading. Foot Ankle Int 1998; 19: 85-90
8. 8. Carter DR. Anisotropic analysis of strain rosette information from cortical bone. J Biomech 1978; 11: 199-202
9. 9. Alho A, Husby T, Hoiseth A. Bone mineral content and mechanical strength: an ex vivo study on human femora at autopsy. Clin Orthop Relat Res 1986; 227: 292-7
10. 10. Carter DR, Hayes WC. The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg Am 1977; 59: 954-62
11. 11. Hayes WC, Gerhart TN. Biomechanics of bone: applications for assessment of bone strength. In: Peck WA, editor. Bone and Mineral Research/3. New York: Elsevier Science, 1985: 259-94
12. 12. Nordin M, Frankel VH. Basic biomechanics of the musculoskeletal system. 2nd ed. Philadelphia: Lea and Febiger, 1989
13. 13. Linhorn TA. Biomechanics of bone. In: Bilezikian JP Raisz LG, Rodan GA. editors. Principles of bone biology. San Diego: Academic Press. 1996: 25-37
14. 14. Nordsletten L, Ekelaud A. Muscle contraction increases the structural capacity of the lower leg: an in vivo study in the izi. J Orthop Res 1993; 11: 299-304
15. 15. Nordsletten L Kaastad TS, Obrant KJ, et al. Muscle contraction increases the in vivo structural strength to the same degree in osteopenic and normal rat tibiae. J Bone Miner Res 1994; 9: 679-85
16. 16. Moshikawi T Mori S, Santiesteban AJ. et al. The effects of muscle fatigue on bone strain J Exp Biol 1994; 188: 217-33
17. 17. Morris PL, Naughton GA, Gibbs JL, et al. Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res 1997; 12: 1453-62
18. 18. Bass S, Pharce G, Bradney M, et al. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnast. J Bone Miner Res 1998: 13: 500-7
19. 19. Carter DR, Hayes WC. Compact bone fatigue damage I : residual strength and stiffness. J Biomech 1977; 10: 325-37
20. 20. Burr DB, Martin RB, Schaffler MB, et al. Bone remodeling in response to in vivo fatigue microdamage. J Biomech 1985: 18: 189-200
21. 21. Borwood MR, Parker AW Microdamage in response to repetitive torsional loading in the rat tibia. Calcif Tiss Int 1989; 45: 47-53
22. 22. Schaffler MB, Radin EL, Burr DB. Mechanical and morphological effects of strain rate on fatigue of compact bone. Bone 1989: 10: 207-14
23. 23. Schaffler MB, Radin EL, Burr DB. Long-term fatigue behavior of compact bone at low strain magnitude and rate. Bone 1990; 11: 321-6
24. 24. Mori S, Burr DB. Increased intracortical remodeling following fatigue damage. Bone 1993; 14: 103-9
25. 25. Frost HM Transient-steady state phynomena in microdamage physiology: a proposed algorithm for lamellar bone. Calcif Tiss Int 1989; 44: 367-81
26. 26. Roub LW, Gumerman LW, Hanley EN, et al. Bone stress: a radionuclide imaging perspective. Radiology 1979; 132: 431-8
27. 27. Li G, Zhatig S Chen G, et al. Radiographic and histologic analyses of stress fracture in rabbit tibias. Am J Sports Med 1985; 13: 285-94
28. 28. Straus FH Marching fractures of metatarsal bones with a report of the pathology. Surg Gynecol Obstet 1932; 54: 581-4
29. 29. Burrows HJ. Fatigue infraction of the middle of the tibia in ballet dancers. J Bone Joint Surg 1956; 38: 83-94
30. 30. Johnson LC, Stradford HT, Geis RW, et al. Histogenesis of stress fractures. J Bone Joint Surg 1963; 45: 1542
31. 31. Michael RH, Holder LE. The soleus syndrome: a cause of medial tibial stress (shin splints). Am J Sports Med 1935; 13: 87-94
32. 32. Carter DR Caler WE, Spengler DM, et al. Uniaxial fatigue of human cortical bone: the influence of tissue physical characteristics. J Biomech 1981; 14: 461-70
33. 33. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. Lancet 1993; 341: 72-5
34. 34. Melton LJ, Atkinson EJ, O'Fallon WM. et al. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993; 8: 1227-33
35. 35. Bennell KL, Malcolm SA, Khan KM, et al. Bone mass and bone turnover in power athletes, endurance athletes and controls: a 12-month longitudinal study. Bone 1997; 20: 477-84
36. 36. Brukner PD, Bennell KL. Stress fractures. Crit Rev Phys Rehabil Med 1497; 9: 151-90
37. 37. Bennell KL, Malcolm SA, Wark JD, et al. Skeletal effects of menstrual disturbances in athletes. Scand J Sci Med Sport 1997; 7: 261-73
38. 38. Giladi M, Milgrom C, Simkin A, et al. Stress fractures: identifiable risk factors. Am J Sports Med 1991; 19: 647-52
39. 39. Beck TJ, Ruff CB, Mourtada FA, et al. Dual-energy x-ray absorptiomety derived structural geometry for stress fracture prediction in male US marine corps recruits. J Bone Miner Res 1996; 11: 645-53
40. 40. Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in track and field athletes: a 12 month prospective study. Am J Sports Med 1996; 24: 810-8
41. 41. Pouilles JM, Bernard J, Tremollieres F, et al. Femoral bone density in young male adults with stress fractures. Bone 1989; 10: 105-8
42. 42. Carbon R, Sambrook PN, Deakin V, et al. Bone density of elite female athletes with stress fractures. Med J Aust 1990; 153: 373-6
43. 43. Frusztajer NT, Dhuper S, Warren MP, et al. Nutrition and the incidence of stress fractures in ballet dancers. Am J Clin Nutr 1990; 51: 779-83
44. 44. Myburgh KH, Hutchins J, Fataar AB, et al. Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med 1990; 113: 754-9
45. 45. Grimston SK, Engsberg JR, Kloiber R, et al. Bone mass, external loads, and stress fractures in female runners. Im J Sport Biomech 1991; 7: 293-302
46. 46. Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med 1995; 5: 229-35
47. 47. Cline AD, Jansen GR, Melby CL. Stress fractures in female army recruits: implications of bone density, calcium intake, and exercise. J Am Coll Nutr 1998; 17: 128-35
48. 48. Crossley K, Bennell KL, Wrigley T, et al. Ground reaction forces, bone characteristics and tibial stress fracture in male runners. Med Sci Sports Exerc 1999. In press
49. 49. Miller GJ, Purkey WW. The geometric properties of paired human tibiae. J Biomech 1980; 13: 1-8
50. 50. Martens M, Van Auderkerke R, de Meester P, et al. The geometrical properties of human femur and tibia and their importance for the mechanical behaviour of these hone structures. Acta Orthop Traumatic Surg 1981; 98: 113-20
51. 51. Giladi M, Milgrom C, Simkin A, et al. Stress fractures and tibial bone width: a risk factor. J Bone Joint Surg Br 1987; 69: 326-9
52. 52. Milgrom C, Giladi M, Simkin A, et al. An analysis of the biomechanical mechanism of tibial stress fractures among Israeli infantry recruits. Clin Orthop Relat Res 1988; 231: 216-21
53. 53. Milgrom C, Giladi M, Simkin A, et al. The area moment of inertia of the tibia: a risk factor for stress fractures. J Biomech 1989; 22: 1243-8
54. 54. Friberg O. Leg length asymmetry in stress fractures: a clinical and radiological study. J Sports Med 1982; 22: 485-8
55. 55. Giladi M, Milgrom C, Stein M, et al. The low arch, a protective factor in stress fractures: a prospective study of 295 military recruits. Orthop Rev 1985; 14: 709-12
56. 56. Giladi M, Milgrom C, Stein M, et al. External rotation of the hip: a predictor of risk for stress fractures. Clin Orthop Relat Res 1987; 216: 131-4
57. 57. Montgomery LC, Nelson FRT, Norton JP, et al. Orthopaedic history and examination in the etiology of overuse injuries. Med Sci Sports Exerc 1989; 21: 237-43
58. 58. Simkin A, Leichter I, Giladi M, et al. Combined effect of foot arch structure and an orthotic device on stress fractures. Foot Ankle 1989; 10: 25-9
59. 59. Milgrom C, Finestone A, Shlamkovitch N, et al. Youth is a risk factor for stress fracture: a study of 783 infantry recruits. J Bone Joint Surg Br 1994; 76: 20-2
60. 60. Cowan DN, Jones BH, Frykman PN, et al. Lower limb morphology and risk of overuse injury among male infantry trainees. Med Sci Sports Exerc 1996; 28: 945-52
61. 61. Winfield AC, Bracker M, Moore J, et al. Risk factors associated with stress reactions in female marines. Mil Med 1997; 162: 698-702
62. 62. Hughes LY. Biomechanical analysis of the foot and ankle for predisposition to developing stress fractures. J Orthop Sport Phys Ther 1985; 7: 96-101
63. 63. Brunet ME, Cook SD, Brinker MR, et al. A survey of running injuries in 1505 competitive and recreational runners. J Sports Med Phys Fitness 1990; 30: 307-15
64. 64. Brosh T, Arcan M. Toward early detection of the tendency to stress fractures. Clin Biomech 1994, 9: 111-6
65. 65. Ekenman I, Tsai-Fellander L, Westblad P, et al. A study of intrinsic factors in patients with stress fractures of the tibia. Foot Ankle Int 1996; 17: 477-82
66. 66. Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes: a study of 320 cases. Am J Sports Med 1987; 15: 46-58
67. 67. Taunton JE, Clement DB, Webber D. Lower extremity stress fractures in athletes. Physician Sports Med 1981; 9: 77-86
68. 68. Sullivan D, Warren RF, Pavlov H, et al. Stress fractures in 51 runners. Clin Orthop Relat Res 1984; 187: 188-92
69. 69. D'Amico JC, Dinowitz HD, Polchaninoff M. Limb length discrepancy: an electrodynographic analysis. J Am Podiatr Med Assoc 1985: 75: 639-43
70. 70. Frederick EC, Hagy JL. Factors affecting peak vertical ground reaction forces in running. Int J Sport Biomech 1986; 2: 41-9
71. 71. Lloyd T, Triantafyllou SJ, Baker ER, et al. Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc 1986; 18: 374-9
72. 72. Warren MP, Brooks-Gunn J, Hamilton LH, et al. Scoliosis and fractures in young ballet dancers. N Engl J Med 1986; 314: 1348-53
73. 73. Barrow GW, Saha S. Menstrual irregularity and stress fractures in collegiate female distance runners. Am J Sports Med 1988; 16: 209-16
74. 74. Kadel NJ, Teitz CC, Kronmal RA. Stress fractures in ballet dancers. Am J Sports Med 1992; 20: 445-9
75. 75. Taimela S, Kujala UM, Dahlstrom S, et al. Risk factors for stress fractures during physical training programs. Clin J Sport Med 1992; 2: 105-8
76. 76. Murguia MJ, Vailas A, Mandelbaum B, et al. Elevated plasma hydroxyproline: a possible risk factor associated with connective tissue injuries during overuse. Am J Sports Med 1988; 16: 660-4
77. 77. Bennell KL, Malcolm SA, Brukner PD, et al. A 12-month prospective study of the relationship between stress fractures und bone turnover in athletes. Calcif Tiss Int 1998; 63: 80-5
78. 78. Stanitski CL, McMaster JH, Scranton PE. On the nature of stress fractures. Am J Sports Med 1978; 6: 391-6
79. 79. Meyer SA, Saltzman CL, Albright JP. Stress fractures of the foot and leg. Clin Sports Med 1993; 12: 395-413
80. 80. Voloshin A, Wosk J. An in vivo study of low back pain und shock absorption in the human locomotor system. J Biomech 1982; 15: 21-7
81. 81. Cavanagh PR, LaFortune MA. Ground reaction forces in dis tante running. J Biomech 1980; 13: 397-406
82. 82. Rates BT, Osternig LR, Sawhill JA. An assessment of subject variability, subject-shoe interaction, and the evaluation of run ning shoes using ground reaction force data. J Biomech 1983; 16: 181-91
83. 83. McNitt-Gray J. Kinematics and impulse characteristics of drop landings from three heights. Int J Sports Biomech 1991; 7: 201-23
84. 84. Paul IL, Munro MB, Abernethy PJ, et al. Musculo-skeletal shock absorption: relative contribution of bone and soft tissues at various frequencies. J Biomech 1978; 11: 237-9
85. 85. Clement DB. Tibial stress syndrome in athletes. J Sports Med 1975; 2: 81-5
86. 86. Benazzo F, Barnabei G, Ferrario A, et al. Stress fractures in track and field athletes. J Sports Traumatol Rel Res 1992; 14; 51-65
87. 87. Milgrom C. The Israeli elite infantry recruit: a model for understanding the biomechanics of stress fractures. J R Coll Surg Edinb 1989; 34 (6 Suppl.): S18-22
88. 88. Scolt SH, Winter DA. Internal forces at chronic running injury sites. Med Sci Sports Exerc 1990; 22: 357-69
89. 89. Hoffman JR, Chapnik L, Shamis A, et al. The effect of leg strength on the incidence of lower extremity overuse injuries during military training. Mil Med 1999; 164: 153-6
90. 90. Grimston SK, Nigg BM, Fisher V, et al. External loads throughout a 45 minute run in stress fracture and non stress fracture runners [abstract]. J Biomech 1994; 27: 668
91. 91. Malina RM, Spriduso WW, Tate C, et al. Age at menarche and selected menstrual characteristics in athletes at different competitive levels and in different sports. Med Sci Sports Exerc 1978; 10: 218-22
92. 92. Kaiserauer S, Snyder AC, Sleeper M, et al. Nutritional, physiological, and menstrual status of distance runners. Med Sci Sports Exerc 1989; 21: 120-5
93. 93. Nattiv A, Puffer JC, Green GA. Lifestyles and health risks of collegiate athletes: a multi-center study. Clin J Sport Med 1997; 7: 262-72
94. 94. Wolman RL, Harries MG. Menstrual abnormalities in elite athletes. Clin Sports Med 1989; 1: 95-100
95. 95. Drinkwater BL, Nilson K, Chesnut III CH, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984; 5: 277-81
96. 96. Rutherford OM. Spine and total body bone mineral density in amenorrheic endurance athletes. J Appl Physiol 1993; 74: 2904-8
97. 97. Micklesfield LK, Lambert EV, Fataar AB, et al. Bone mineral density in mature, premenopausal ultramarathon runners. Med Sci Sports Exerc 1995; 27: 688-96
98. 98. Tomten SE, Falch JA, Birkeland KI, et al. Bone mineral density and menstrual irregularities: a comparative study on cortical and trabecular bone structures in runners with alleged normal eating behaviour. Im J Sports Med 1998; 19: 92-7
99. 99. Beltins IZ, McArthur JW, Turnbull BA, et al. Exercise induces two types of human lateal dysfunction confirmation by urinary free progesterone. J Clin Endocrinol Metab 1991: 72: 1350-8
100. 100. Prior JC, Vigna YM. Ovulation disturbances and exercise training. Clin Obstet Gynecol 1991; 34: 180-90
101. 101. Snow GR, Anderson C. The effects of continuous progestogen treatment on cortical bone remodelling activity in beagles. Calcif Tiss Int 1935; 37: 282-6
102. 102. Karambotova KK, Snow GR, Anderson C. Surface activity on the pertosteal and corticoendosteal envelopes following con tinuous progestogen supplementation in spayed beagles. Calcif Tiss Int 1986: 38: 239-43
103. 103. Snow GR, Anderson C. The effects of 17β-estradiol and progestagen on trabecullar bone remodeling in oophorectomized dogs. Calcif Tiss Int 1986: 39: 198-205
104. 104. Prior JC, Vigna YM. Schechter MT, et al. Spinal bone loss and osulatory disturbances. N Engl J Med 1990; 323: 1221-7
105. 105. Snead DB, Weltman A, Weltman JY, et al. Reproductive hormones and bone mineral density in women runners. J Appl Physiol 1992: 72: 2149-56
106. 106. Barr SI, Prior JC, Vigna YM. Restrained catine and ovulatory disturbances: possible implications for bone health. Am J Clin Nuttr 1994; 19: 92-7
107. 107. Nelson ME, Clark N, Otradovec C, et al. Elite women runners: association between menstrual status, weight history and stress tractures [abstact]. Mied Sci Sports Exerc 1987; 19: S13
108. 108. Clark N, Nelson M, Evans W. Nutrition education for elite female runners. Physician Sports Med 1988: 16: 124-36
109. 109. Lindberg JS, Fears WB, Hunt MM, et al. Exercise-induced amenormea and none density. Ann Intern Med 1984: 101: 647-8
110. 110. Marcus R. Cann C, Madvie P, et al. Menstrual function and bone mass in elite women distance runners Ann Intern Med 1985: 102: 158-63
111. 111. Cook SD, Harding AF Thomas KA, et al. Trabecular bone density and menstrual function in women runners. Am J Sports Med 1987; 15: 503-7
112. 112. Warren MP, Brooks Gunn J, Fox RP, et al. Lack of bone accretion and amenorrhea: evidente for a relative osteopenia in weight bearing bones J Clin Endocrinol Metab 1991; 72: 847-53
113. 113. Grimston SK, Engsberg JR, Kloiber R, et al. Menstrual, calcium, and training history: relationship in bone health in female runners. Clin Sports Med 1990; 2: 119-28
114. 114. Guier F, Hascelik Z. Menstrual dysfunction rate and delayed menarene in top athletes of team games. Sports Med Train Rehabil 1993; 4: 99-106
115. 115. MacDougall JD Webber CE, Martin J, et al Relationship among running mileage, bone density, and serum testosterone in male runners. J Appl Physiol 1992; 73: 1165-70
116. 116. Hetland MI, Haarbo J, Christiansen C. Low bone mass and high bone turnover in male long distance runners J Clin Endocrinol Metab 1993: 77: 770-5
117. 117. Smith R, Rutherford OM. Spine and total body bone mineral density and serum testosterone levels in male athletes. Eur J Appl Physiol 1993: 67: 330-4
118. 118. Burge MR, Lanzi RA, Skarda ST, et al. Idiopathic hypogonadotropic hypogonadism in a male runner is reversed by clomipnene citrate. Fertil Steril 1997; 67: 783-5
119. 119. Skarda ST, Burge MR Prospective evaluation of risk factors for exercise-induced hypogonadism in male runners. West J Med 1998: 169: 9-12
120. 120. Malma RM. Menarche in athletes: a synthesis and hypothesis. Ann Hum Biol 1983; 10: 1-24
121. 121. Stager JM, Hatler LK. Menarche in athletes: the influence of genetics and prepubertal training. Med Sci Sports Exerc 1988; 20: 369-73
122. 122. Lu PW, Briody JN, Ogle GD, et al. Bone mineral density of total body, spine, and femoral neck in children and young adults: a cross-sectional and longitudinal study. J Bone Miner Res 1994; 9: 1451-8
123. 123. Young D, Hopper JL, Nowson CA, et al. Determinants of bone mass in 10-to 26-year-old females: a twin study. J Bone Miner Ees 1995; 10: 558-67
124. 124. Dhuper S, Warren MP, Brooks-Gunn J, et al. Effects of hormonal status on bone density in adolescent girls. J Clin Endocrinol Metab 1990; 71: 1083-8
125. 125. Robinson TL, Snow-Harter C, Taaffe DR, et al. Gymnasts exhibit higher bone mass than runners despite similar prevalence of amenorrhea and oligomenorrhea. J Bone Miner Res 1995; 10: 26-35
126. 126. Fehily AM, Coles RJ, Evans WD, et al. Factors affecting bone density in young adults. Am J Clin Nutr 1902; 56: 579-86
127. 127. Myburgh KH, Bachrach LK, Lewis B, et al. Low bone mineral density at axial and appendicular sites in amenorrheic athletes. Med Sci Sports Exerc 1993; 25: 1197-202
128. 128. Katzman DK, Bachrach LK, Carter DR, et al. Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 1991; 73: 1332-9
129. 129. Armamento-Villareal R, Villareal DT, Avioli LV, et al. Estrogen status and heredity are major determinants of premenopausal bone loss. J Clin Invest 1992; 90: 2464-71
130. 130. Elliot JK, Gilchrist NL, Wells JE, et al. Historical assessment of risk factors in screening for osteopenia in a normal Caucasian population. Aust N Z J Med 1993; 23: 458-62
131. 131. Fox KM, Magaziner J, Sherwin R, et al. Reproductive correlates of bone mass in elderly women. J Bone Miner Res 1993; 8: 901-8
132. 132. Frisch RE, Gotz-Welbergen AV, McArthur JW, et al. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. JAMA 1981; 246: 1559-63
133. 133. Moisan J, Meyer F, Gingras S. A nested case-control study of the correlates of early menarche. Am J Epidemiol 1990; 132: 953-61
134. 134. Mustajoki P, Laapio H, Meurman K. Calcium metabolism, physical activity, and stress fractures. Lancet 1983; 1: 797
135. 135. Lanyon LE, Rubin CT, Baust G. Modulation of bone loss during calcium insufficiency by controlled dynamic loading. Calcif Tiss Int 1986; 38: 209-16
136. 136. Ferretti JL, Tessaro RD, Audisio EO, et al. Long-term effects of high or low Ca intakes and of lack of parathyroid function on rat femur biomechanics. Calcif Tiss Int 1985; 37: 608-12
137. 137. Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res 1996; 11: 1539-44
138. 138. Uusirasi K, Sievanen H, Vnori I, et al. Associations of physical activity and calcium intake with bone mass and size in healthy women at different ages. J Bone Miner Res 1998; 13: 133-42
139. 139. Johnston CC, Miller JZ, Slemenda CW, et al. Calcium supple mentation and increases in bone mineral density in children. N Engl J Med 1992; 327: 82-7
140. 140. Lee WTK, Leung SSF, Wang SH, et al. Double-blind, controlled calcium supplementation and bone mineral accretion in children accustomed to a low-calcium diet. Am J Clin Nutr 1994; 60: 744-50
141. 141. Matkovic V, Heaney RP. Calcium balance during human growth: evidence for threshold behaviour. Am J Clin Nutr 1992; 55: 992-6
142. 142. Schwellnus MP, Jordaan G. Does calcium supplementation prevent bone stress injuries? A clinical trial. Int J Sport Nutr 1092; 2: 165-74
143. 143. Myburgh KH, Grobler N, Noakes TD. Factors associated with shin soreness in athletes. Physician Sports Med 1988; 16: 129-34
144. 144. Gardner LI, Dziados JE, Jones BH, et al. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Am J Public Health 1988; 78: 1563-7
145. 145. Shaffer RA, Brodine SK, Almeida SA, et al. Use of simple measures of physical activity to predict stress fractures in young men undergoing a rigorous physical training program. Am J Epidemiol 1999; 149: 236-42
146. 146. Swissa A, Milgrom C, Giladi M, et al. The effect of pretraining sports activity on the incidence of stress fractures among military recruits. Clin Orthop Relat Res 1989; 245: 256-60
147. 147. Worthen BM, Yanklowitz BAD. The pathophysiology and treatment of stress fractures in military personnel. J Am Podiatr Med Assoc 1978; 68: 317-25
148. 148. Scully TJ, Besterman G. Stress fracture: a preventable training injury. Mil Med 1982; 147: 285-7
149. 149. Reinker KA, Ozbume S. A comparison of male and female orthopaedic pathology in basic training. Mil Med 1979; 144: 532-6
150. 150. Greaney RB, Gerber RH, Laughlin RL, et al. Distribution and natural history of stress fractures in US marine recruits. Radiology 1983; 146: 339-46
151. 151. Proztman RR. Physiologic performance of women compared to men. Am J Sports Med 1979; 7: 191-4
152. 152. Pester S, Smith PC. Stress fractures in the lower extremities of soldiers in basic training. Orthop Rev 1992; 21: 297-303
153. 153. Goldberg B, Pecora C. Stress fractures: a risk of increased training in freshman. Physician Sports Med 1994; 22: 68-78
154. 154. Courtenay BG, Bowers DM. Stress fractures: clinical features and investigation. Med J Aust 1990; 153: 155-6
155. 155. Pecina M, Bojanic I, Dubravcic S. Stress fractures in figure skaters. Am J Sports Med 1090; 18: 277-9
156. 156. Devas MB, Sweetnam R. Stress fractures of the fibula: a review of fifty cases in athletes. J Bone Joint Surg 1956; 38: 818-20
157. 157. McMahon TA, Greene PR. The influence of track compliance on running. J Biomech 1979; 12: 893-904
158. 158. Steele JR, Milburn PD. Effect of different synthetic sport surfaces on ground reactions forces at landing in netball. Int J Sports Biomech 1988; 4: 130-45
159. 159. Marti B, Vader JP, Minder CE, et al. On the epidemiology of running injuries: the 1984 Bern Grand-Prix study. Am J Sports Med 1988; 16: 285-94
160. 160. Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med 1989; 140: 2561-4
161. 161. Frey C. Footwear and stress fractures. In: Mandelbaum BR, Knapp TP, editors. Clinics in sports medicine. Vol. 16. Philadelphia (PA): W.B. Saunders Company, 1907; 249-57
162. 162. Cook SD, Brinker MR, Poche M. Running shoes. Sports Med 1990; 10: 1-8
163. 163. Finestone A, Shlamkovitch N, Eldad A, et al. A prospective study of the effect of the appropriateness of fout-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits. Mil Med 1992; 157: 489-90
164. 164. Milgrorn C, Burr D, Fyhrie D, et al. The effect of shoe gear on human tibial strains recorded during dynamic loading: a pilot study. Foot Ankle Int 1996; 17: 667-71
165. 165. Cinats J, Reid DC, Haddow JB. A biomechanical evaluation of sorbothane. Clin Orthop Relat Res 1987; 222: 281-8
166. 166. Voloshin AS, Wosk J. Influence of artificial shock absorbers on human gait. Clin Orthop Relat Res 1981; 160: 52-6
167. 167. Milgrom C, Burr DB, Boyd RD, et al. The effect of a viscoelastic orthotic on the incidence of tibial stress fractures in an animal model. Foot Ankle 1990; 10: 276-9
168. 168. Milgrom C, Giladi M, Kashtan H, et al. A prospective study of the effect of a shock-absorbing orthotic device on the incidence of stress fractures in military recruits. Foot Ankle 1985; 6: 101-4
169. 169. Schwellnus MP, Jordaan G, Noakes TD. Prevention of common overuse injuries by the use of shock absorbing insoles. Am J Sports Med 1990; 18: 636-41
170. 170. Nigg BM, Herzog W, Read LJ. Effeet of viscoelastic shoe insoles on vertical impact forces in heel-toe running. Am J Sports Med 1988; 16: 70-6
171. 171. Brodsky JW, Kourosh S, Stills M, et al. Objective evaluation of insert material for diabetic and athletic footwear. Foot Ankle 1988; 9: 111-6
172. 172. Nigg BM. Biomechanics, load analysis and sports injuries in the lower extremities. Sports Med 1985; 2: 367-79
173. 173. Schaffler MB, Choi K, Milgrom C. Aging and matrix microdamage accumulation in human compact bone. Bone 1995; 17: 521-5
174. 174. Theintz G, Buchs B, Rizzoli R, et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of the lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992; 75: 1060-5
175. 175. Brudvig TJS, GudgerTD, Obermeyer L. Stress fractures in 295 trainees: a one-year study of incidence as related to age, sex, and race. Mil Med 1983; 148: 666-7
176. 176. Burr DB. Bone, exercise, and stress fractures. Exerc Sport Sci Rev 1997; 25: 171-94
177. 177. Matheson GO, Macintyre JG, Taunton JF., et al. Musculoskeletal injuries associated with physical activity in older adults. Med Sci Sports Exerc 1989; 21: 379-85
178. 178. Taimela S, Kujala UM, Osterman K. Intrinsic risk factors and athletic injuries. Sports Med 1990; 9: 205-15
179. 179. Mosley JR, Lanyon LE. Strain rate as a controlling influence on adaptive modeling in response to dynamic loading of the ulna in growing male rats. Bone 1998; 23: 313-8