Of these, 177 were found in the study group (Table 1) while 34 were found in the younger controls (Table 2). In addition, informed consent to participate in the study was obtained from every patient.Ī total of 211 stress fractures were found in 105 patients. Thus, we were able to categorise the patients’ BMD according to WHO criteria into a) normal bone mass (t-score > −1.0), b) osteopenia (t-score of −2.5 to −1.0) and c) osteoporosis (t-score 30 min, 1× per week, c) >30 min, 2× per week or d) >30 min, ≥3× per week. Following the guidelines of the German Society of Osteology a real BMD was determined using DXA (Lunar Prodigy, Lunar Corporation, Madison, WI, USA) for the lumbar spine and both proximal femurs. As vitamin D serum levels of at least 30 ng/ml or 75 nmol/l, have been considered to be of paramount importance for skeletal health, we considered a level below 30 ng/ml or 75 nmol/l to indicate vitamin D insufficiency. In addition, blood samples were drawn from the patients at their first appointment to determine the calcium and vitamin D serum level. Therefore, the objective of this study was to analyse and characterise elderly patients with stress fractures, and to identify specific risk factors, frequent fracture locations and gender-specific differences.Ĭharacteristics are presented as mean ± standard deviationĪ detailed medical history (including age, sex, height, weight, BMI, medication, affected location, possible history of stress fracture) was taken from every patient with special emphasis on possible risk factors for bone diseases and stress fractures such as vitamin D insufficiency, proton pump inhibitor (PPI) medication, immunosuppressive medication, lactose intolerance, type 2 diabetes, alcohol and nicotine abuse, cortisone therapy, chemotherapy, positive family history of bone diseases, anorexia, and rheumatoid arthritis (Tables 3 and and4). Nevertheless, the incidence of stress fractures in elderly patients is an increasingly important issue due to the aging society and the growing interest of elderly people in physical activity, whether to remain fit or as part of therapeutic regimens. While almost all of these studies focused on patients in their late second to fourth decade of life, studies on stress fractures in elderly patients and their respective risk factors are rare. Numerous studies on young female athletes and military recruits have revealed that factors such as poor physical fitness, low BMD, eating disorders, a body mass index (BMI) less than 20 or disturbed menstrual function lead to an increased risk for stress fractures in young women. Furthermore, female gender has been identified as an important risk factor and thus sex-specific effects appear to play a role in the pathogenesis of stress fractures. The cause of stress fractures is often multifactorial and various modifiable and non-modifiable factors have been proposed to play a role: white race, high bone turnover, vitamin D insufficiency, nicotine and alcohol abuse, steroid use, low bone density, low adult weight, anorexia, or bisphosphonate therapy. Whereas in the past, diagnosis of stress fractures was performed by radiography or scintigraphy, today magnetic resonance imaging (MRI) is the diagnostic agent of choice due to its higher sensitivity and specificity. While fatigue stress fractures occur due to abnormal and/or repeated stress on normal bone and are regularly seen in athletes, insufficiency stress fractures are linked to normal stress on impaired bone structure and thus are often observed in postmenopausal osteoporotic women. Based on their aetiology, stress fractures can be subdivided into either fatigue- or insufficiency-related fractures. Stress fractures have been reported to be a common problem in young and active people such as athletes and military recruits.
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