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Siegel MG. Disaggregation Should Extend to Race and Ethnicity: The Missing Pieces in the SAGER Guidelines. Arthroscopy 2024:S0749-8063(24)00561-9. [PMID: 39127367 DOI: 10.1016/j.arthro.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
The SAGER recommendations on the inclusion of sex and gender as reportable variables in medical trials is a significant advancement. There is an oversight and failure to include race and ethnicity in medical research trials that has profound implications for the development of effective health care treatment. Previous orthopaedic studies have proven that different racial/ethnic population groups have differences that affect both epidemiology of injury and response to surgery. It is only by including and desegregating data from these diverse patient populations will results accurately reflect treatment outcomes.
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Johnson AS, Brismée JM, Hooper TL, Hintz CN, Hando BR. Incidence and Risk Factors for Bone Stress Injuries in United States Air Force Special Warfare Trainees. Mil Med 2024; 189:e1790-e1796. [PMID: 38324749 DOI: 10.1093/milmed/usae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. DESIGN Retrospective cohort study. METHODS AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. RESULTS A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. CONCLUSION BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.
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Affiliation(s)
- Andrew S Johnson
- Operational Medicine Squadron, USAF Special Warfare, San Antonio, TX 78245, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Troy L Hooper
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Courtney N Hintz
- Operational Medicine Squadron, USAF Special Warfare, San Antonio, TX 78245, USA
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Palomino Lago E, Baird A, Blott SC, McPhail RE, Ross AC, Durward-Akhurst SA, Guest DJ. A Functional Single-Nucleotide Polymorphism Upstream of the Collagen Type III Gene Is Associated with Catastrophic Fracture Risk in Thoroughbred Horses. Animals (Basel) 2023; 14:116. [PMID: 38200847 PMCID: PMC10778232 DOI: 10.3390/ani14010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Fractures caused by bone overloading are a leading cause of euthanasia in Thoroughbred racehorses. The risk of fatal fracture has been shown to be influenced by both environmental and genetic factors but, to date, no specific genetic mechanisms underpinning fractures have been identified. In this study, we utilised a genome-wide polygenic risk score to establish an in vitro cell system to study bone gene regulation in horses at high and low genetic risk of fracture. Candidate gene expression analysis revealed differential expression of COL3A1 and STAT1 genes in osteoblasts derived from high- and low-risk horses. Whole-genome sequencing of two fracture cases and two control horses revealed a single-nucleotide polymorphism (SNP) upstream of COL3A1 that was confirmed in a larger cohort to be significantly associated with fractures. Bioinformatics tools predicted that this SNP may impact the binding of the transcription factor SOX11. Gene modulation demonstrated SOX11 is upstream of COL3A1, and the region binds to nuclear proteins. Furthermore, luciferase assays demonstrated that the region containing the SNP has promoter activity. However, the specific effect of the SNP depends on the broader genetic background of the cells and suggests other factors may also be involved in regulating COL3A1 expression. In conclusion, we have identified a novel SNP that is significantly associated with fracture risk and provide new insights into the regulation of the COL3A1 gene.
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Affiliation(s)
- Esther Palomino Lago
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (E.P.L.); (A.C.R.)
| | - Arabella Baird
- Animal Health Trust, Lanwades Park, Kentford, Newmarket CB8 7UU, UK
| | - Sarah C. Blott
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham LE12 5RD, UK;
| | - Rhona E. McPhail
- Animal Health Trust, Lanwades Park, Kentford, Newmarket CB8 7UU, UK
| | - Amy C. Ross
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (E.P.L.); (A.C.R.)
| | - Sian A. Durward-Akhurst
- Department of Veterinary Clinical Sciences, University of Minnesota, Saint Paul, MN 55108, USA;
| | - Deborah J. Guest
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK; (E.P.L.); (A.C.R.)
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Aflatooni J, Martin S, Edilbi A, Gadangi P, Singer W, Loving R, Domakonda S, Solanki N, McCulloch PC, Lambert B. A novel non-invasive method for predicting bone mineral density and fracture risk using demographic and anthropometric measures. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:308-313. [PMID: 38314040 PMCID: PMC10831384 DOI: 10.1016/j.smhs.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 02/06/2024] Open
Abstract
Fractures are costly to treat and can significantly increase morbidity. Although dual-energy x-ray absorptiometry (DEXA) is used to screen at risk people with low bone mineral density (BMD), not all areas have access to one. We sought to create a readily accessible, inexpensive, high-throughput prediction tool for BMD that may identify people at risk of fracture for further evaluation. Anthropometric and demographic data were collected from 492 volunteers (♂275, ♀217; [44 ± 20] years; Body Mass Index (BMI) = [27.6 ± 6.0] kg/m2) in addition to total body bone mineral content (BMC, kg) and BMD measurements of the spine, pelvis, arms, legs and total body. Multiple-linear-regression with step-wise removal was used to develop a two-step prediction model for BMC followed by BMC. Model selection was determined by the highest adjusted R2, lowest error of estimate, and lowest level of variance inflation (α = 0.05). Height (HTcm), age (years), sexm=1, f=0, %body fat (%fat), fat free mass (FFMkg), fat mass (FMkg), leg length (LLcm), shoulder width (SHWDTHcm), trunk length (TRNKLcm), and pelvis width (PWDTHcm) were observed to be significant predictors in the following two-step model (p < 0.05). Step1: BMC (kg) = (0.006 3 × HT) + (-0.002 4 × AGE) + (0.171 2 × SEXm=1, f=0) + (0.031 4 × FFM) + (0.001 × FM) + (0.008 9 × SHWDTH) + (-0.014 5 × TRNKL) + (-0.027 8 × PWDTH) - 0.507 3; R2 = 0.819, SE ± 0.301. Step2: Total body BMD (g/cm2) = (-0.002 8 × HT) + (-0.043 7 × SEXm=1, f=0) + (0.000 8 × %FAT) + (0.297 0 × BMC) + (-0.002 3 × LL) + (0.002 3 × SHWDTH) + (-0.002 5 × TRNKL) + (-0.011 3 × PWDTH) + 1.379; R2 = 0.89, SE ± 0.054. Similar models were also developed to predict leg, arm, spine, and pelvis BMD (R2 = 0.796-0.864, p < 0.05). The equations developed here represent promising tools for identifying individuals with low BMD at risk of fracture who would benefit from further evaluation, especially in the resource or time restricted setting.
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Affiliation(s)
- Justin Aflatooni
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Steven Martin
- Sydney & J.L. Huffines Institute for Sports Medicine & Human Performance, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Adib Edilbi
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Pranav Gadangi
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - William Singer
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Robert Loving
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shreya Domakonda
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Nandini Solanki
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Patrick C. McCulloch
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Bradley Lambert
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
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Ferguson LP, Boden BP, Bailey J, Nye NS. Asymptomatic Progression of Stress Injury to Complete Long Bone Fracture in Three Military Personnel. Curr Sports Med Rep 2023; 22:405-409. [PMID: 38055749 DOI: 10.1249/jsr.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Lauren P Ferguson
- Ft. Belvoir Community Hospital, Department of Sports Medicine, Ft. Belvoir, VA
| | - Barry P Boden
- The Orthopaedic Center, Sports Medicine Division, Rockville, MD
| | - Jonathan Bailey
- Ft. Belvoir Community Hospital, Department of Sports Medicine, Ft. Belvoir, VA
| | - Nathaniel S Nye
- Ft. Belvoir Community Hospital, Department of Sports Medicine, Ft. Belvoir, VA
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Sundaramurthy A, Tong J, Subramani AV, Kote V, Baggaley M, Edwards WB, Reifman J. Effect of stride length on the running biomechanics of healthy women of different statures. BMC Musculoskelet Disord 2023; 24:604. [PMID: 37488528 PMCID: PMC10364351 DOI: 10.1186/s12891-023-06733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Tibial stress fracture is a debilitating musculoskeletal injury that diminishes the physical performance of individuals who engage in high-volume running, including Service members during basic combat training (BCT) and recreational athletes. While several studies have shown that reducing stride length decreases musculoskeletal loads and the potential risk of tibial injury, we do not know whether stride-length reduction affects individuals of varying stature differently. METHODS We investigated the effects of reducing the running stride length on the biomechanics of the lower extremity of young, healthy women of different statures. Using individualized musculoskeletal and finite-element models of women of short (N = 6), medium (N = 7), and tall (N = 7) statures, we computed the joint kinematics and kinetics at the lower extremity and tibial strain for each participant as they ran on a treadmill at 3.0 m/s with their preferred stride length and with a stride length reduced by 10%. Using a probabilistic model, we estimated the stress-fracture risk for running regimens representative of U.S. Army Soldiers during BCT and recreational athletes training for a marathon. RESULTS When study participants reduced their stride length by 10%, the joint kinetics, kinematics, tibial strain, and stress-fracture risk were not significantly different among the three stature groups. Compared to the preferred stride length, a 10% reduction in stride length significantly decreased peak hip (p = 0.002) and knee (p < 0.001) flexion angles during the stance phase. In addition, it significantly decreased the peak hip adduction (p = 0.013), hip internal rotation (p = 0.004), knee extension (p = 0.012), and ankle plantar flexion (p = 0.026) moments, as well as the hip, knee, and ankle joint reaction forces (p < 0.001) and tibial strain (p < 0.001). Finally, for the simulated regimens, reducing the stride length decreased the relative risk of stress fracture by as much as 96%. CONCLUSIONS Our results show that reducing stride length by 10% decreases musculoskeletal loads, tibial strain, and stress-fracture risk, regardless of stature. We also observed large between-subject variability, which supports the development of individualized training strategies to decrease the incidence of stress fracture.
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Affiliation(s)
- Aravind Sundaramurthy
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Adhitya V Subramani
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Vivek Kote
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada
- The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.
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7
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Beymer MR, Apostolou A, Smith CM, Paschane DM, Gomez SAQ, James TD, Bell AM, Santo T, Quartana PJ. Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis. Mil Med 2023; 188:e2292-e2299. [PMID: 36848142 DOI: 10.1093/milmed/usad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. RESULTS A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. CONCLUSIONS Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.
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Affiliation(s)
- Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Colin M Smith
- U.S. Indian Health Service, Rockville, MD 20852, USA
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | - Theresa Santo
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Agarwal S, Germosen C, Bucovsky M, Colon I, Kil N, Walker M. Skeletal Microstructure in Caribbean Hispanic Women. JBMR Plus 2023; 7:e10725. [PMID: 37197315 PMCID: PMC10184017 DOI: 10.1002/jbm4.10725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Hispanic individuals are underrepresented in skeletal research. Bone mineral density (BMD) and fracture data are conflicting. We investigated skeletal health in elderly Caribbean Hispanic (HW), non-Hispanic white (NHW), and non-Hispanic black (NHB) women in a population-based study in New York City. We utilized high-resolution peripheral quantitative CT (HRpQCT), dual-energy X-ray absorptiometry (DXA), and finite element analysis (FEA). Of 442, 48.4% were HW, 21.3% NHW, and 30.3% NHB. Adjusted analyses are shown. Compared to NHW, HW had 8.5% (p < 0.01) lower spine areal BMD (aBMD) and 5.1% lower trabecular bone score (TBS). The frequency of morphometric vertebral fractures did not differ between HW and NHW. By HRpQCT, HW had 2.9% higher cortical (Ct) volumetric BMD (vBMD), 7.9% greater Ct area (Ct.Ar) and 9.4% greater Ct thickness (Ct.Th) at the radius compared to NHW. Results were similar at the tibia but trabecular microstructure tended to be worse. Ultimately, failure load (FL) did not differ between HW and NHW at either site. aBMD was 3.8% to 11.1% lower at the spine, femoral neck, and radius in HW compared to NHB (all p < 0.001) and vertebral fractures were twice as common. Compared to NHB, HW had 7.7% to 10.3% lower Ct.Ar at both the radius and tibia as well as 8.4% lower total vBMD, 6.3% lower trabecular number, and 10.3% lower Ct.Th at the tibia associated with 18.2% and 12.5% lower FL at both sites, respectively. In conclusion, HW had lower spine aBMD and TBS versus NHW women, whereas microstructural differences at the radius and tibia were small and not associated with differences in FL. In contrast, HW had lower aBMD, as well as deteriorated radial and tibial microstructure associated with worse FL compared to NHB women. Our results provide insight into racial/ethnic differences in skeletal health, adding to data that may be used to improve osteoporosis screening and treatment in HW. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sanchita Agarwal
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Carmen Germosen
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Mariana Bucovsky
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Ivelisse Colon
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Nayoung Kil
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Marcella Walker
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
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Greeves JP, Beck B, Nindl BC, O'Leary TJ. Current risks factors and emerging biomarkers for bone stress injuries in military personnel. J Sci Med Sport 2023:S1440-2440(23)00075-0. [PMID: 37188615 DOI: 10.1016/j.jsams.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Bone stress injuries (BSIs) have plagued the military for over 150 years; they afflict around 5 to 10% of military recruits, more so in women, and continue to place a medical and financial burden on defence. While the tibia generally adapts to the rigours of basic military training, the putative mechanisms for bone maladaptation are still unclear. METHODS This paper provides a review of the published literature on current risk factors and emerging biomarkers for BSIs in military personnel; the potential for biochemical markers of bone metabolism to monitor the response to military training; and, the association of novel biochemical 'exerkines' with bone health. RESULTS The primary risk factor for BSI in military (and athletic) populations is too much training, too soon. Appropriate physical preparation before training will likely be most protective, but routine biomarkers will not yet identify those at risk. Nutritional interventions will support a bone anabolic response to training, but exposure to stress, sleep loss, and medication is likely harmful to bone. Monitoring physiology using wearables-ovulation, sleep and stress-offer potential to inform prevention strategies. CONCLUSIONS The risk factors for BSIs are well described, but their aetiology is very complex particularly in the multi-stressor military environment. Our understanding of the skeletal responses to military training is improving as technology advances, and potential biomarkers are constantly emerging, but sophisticated and integrated approaches to prevention of BSI are warranted.
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Affiliation(s)
- Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
| | - Belinda Beck
- School of Health Sciences and Social Work, Griffith University, Australia; The Bone Clinic, Australia.
| | - Bradley C Nindl
- School of Health and Rehabilitation Sciences, University of Pittsburgh, United States.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
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10
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Coombs CV, O'Leary TJ, Tang JCY, Fraser WD, Greeves JP. Hormonal contraceptive use, bone density and biochemical markers of bone metabolism in British Army recruits. BMJ Mil Health 2023; 169:9-16. [PMID: 33722817 DOI: 10.1136/bmjmilitary-2020-001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Hormonal contraceptive use might impair bone health and increase the risk of stress fracture by decreasing endogenous oestrogen production, a central regulator of bone metabolism. This cross-sectional study investigated bone density and biochemical markers of bone metabolism in women taking hormonal contraceptives on entry to basic military training. METHODS Forty-five female British Army recruits had biochemical markers of bone metabolism, areal bone mineral density (aBMD) and tibial speed of sound (tSOS) measured at the start of basic military training. Participants were compared by their method of hormonal contraception: no hormonal contraception (NONE), combined contraceptive pill (CP) or depot-medroxyprogesterone acetate (DMPA) (20±2.8 years, 1.64±0.63 m, 61.7±6.2 kg). RESULTS aBMD was not different between groups (p≥0.204), but tSOS was higher in NONE (3%, p=0.014) when compared with DMPA users. Beta C-terminal telopeptide was higher in NONE (45%, p=0.037) and DMPA users (90%, p=0.003) compared with CP users. Procollagen type 1 N-terminal propeptide was higher in DMPA users compared with NONE (43%, p=0.045) and CP users (127%, p=0.001), and higher in NONE compared with CP users (59%, p=0.014). Bone alkaline phosphatase was higher in DMPA users compared with CP users (56%, p=0.044). CONCLUSIONS DMPA use was associated with increased bone turnover and decreased cortical bone integrity of the tibia. Lower cortical bone integrity in DMPA users was possibly mediated by increased intracortical remodelling, but trabecular bone was not affected by contraceptive use.
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Affiliation(s)
| | - T J O'Leary
- Army Health and Performance Research, British Army, Andover, UK
| | - J C Y Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - W D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK.,Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, UK
| | - J P Greeves
- Army Health and Performance Research, British Army, Andover, UK .,Norwich Medical School, University of East Anglia, Norwich, UK
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11
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Abbott A, Wang C, Stamm M, Mulcahey MK. Part II: Risk Factors for Stress Fractures in Female Military Recruits. Mil Med 2023; 188:93-99. [PMID: 35253041 DOI: 10.1093/milmed/usac033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population. METHODS A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. RESULTS Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening. CONCLUSION This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.
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Affiliation(s)
- Alexandra Abbott
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA
| | - Cindy Wang
- Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Michaela Stamm
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA 70118, USA
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12
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Schowalter S, Le B, Creps J, McInnis KC. Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management. Open Access J Sports Med 2022; 13:89-105. [PMID: 36248020 PMCID: PMC9563740 DOI: 10.2147/oajsm.s288882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.
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Affiliation(s)
- Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Correspondence: Sean Schowalter, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA, Tel +1 617 952 5000, Email
| | - Bryan Le
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - James Creps
- Sports Medicine Service, Boston Red Sox, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
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13
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Cameron KL, Peck KY, Davi SM, Owens CRBD, Svoboda CRSJ, DiStefano LJ, Marshall SW, de la Motte SJ, Beutler CRAI, Padua DA. Association Between Landing Error Scoring System (LESS) Items and the Incidence Rate of Lower Extremity Stress Fracture. Orthop J Sports Med 2022; 10:23259671221100790. [PMID: 35706554 PMCID: PMC9189539 DOI: 10.1177/23259671221100790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Lower extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to screen for modifiable risk factors associated with injury is critical in developing injury-prevention programs. Purpose: To determine if baseline Landing Error Scoring System (LESS) scores are associated with the incidence rate of lower extremity stress fracture. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 1772 participants with no history of lower extremity stress fracture were included. At preinjury baseline, the authors conducted a lower extremity movement assessment during a jump-landing task using the LESS. Incident lower extremity stress fractures were identified during a 4-year follow-up period. Potential incident cases were reviewed by 2 sports medicine fellowship–trained orthopaedic surgeons blinded to baseline LESS data. Univariate and multivariable Poisson regression models were used to estimate the association between baseline total LESS scores, individual LESS items, and the incidence rate ratio (IRR) of lower extremity stress fracture. Results: A total of 94 incident lower extremity stress fractures were documented, for a 5.3% (95% CI, 4.3%-6.5%) cumulative incidence. The overall LESS score was associated with the incidence rate of lower extremity stress fracture. For every additional movement error documented at baseline, there was a 15% increase in the incidence rate of lower extremity stress fracture (IRR, 1.15 [95% CI, 1.02-1.31]; P = .025). In univariate analyses, ankle flexion, stance width, asymmetrical landing, and trunk flexion at initial contact, in addition to overall impression, were associated with the incidence rate of stress fracture. After controlling for sex and year of entry into the study cohort, participants who consistently landed flat-footed or heel-to-toe were 2.33 times (95% CI, 1.36-3.97; P = .002) more likely to sustain a lower extremity stress fracture. Similarly, participants who consistently demonstrated asymmetric landing at initial contact were 2.53 times (95% CI, 1.34-4.74; P = .004) more likely to sustain a stress fracture. Conclusion: Components of the LESS may be associated with increased lower extremity stress fracture risk and may be helpful in efficiently assessing high-risk lower extremity biomechanics in large groups.
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Affiliation(s)
- Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Steven M Davi
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Col Ret Brett D Owens
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA.,Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - Col Ret Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | | | - Stephen W Marshall
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Sarah J de la Motte
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Col Ret Anthony I Beutler
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
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14
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Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers 2022; 8:26. [PMID: 35484131 DOI: 10.1038/s41572-022-00352-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 01/11/2023]
Abstract
Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Belinda R Beck
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,The Bone Clinic, Brisbane, Queensland, Australia
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David B Burr
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
| | - Stuart J Warden
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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15
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Carbuhn AF, Yu D, Magee LM, McCulloch PC, Lambert BS. Anthropometric Factors Associated With Bone Stress Injuries in Collegiate Distance Runners: New Risk Metrics and Screening Tools? Orthop J Sports Med 2022; 10:23259671211070308. [PMID: 35178462 PMCID: PMC8844446 DOI: 10.1177/23259671211070308] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lower limb bone stress injury (BSI) of the pelvis, femur, and tibia is prevalent in collegiate track and field distance runners. Bone mineral density (BMD), body composition (BComp), and anthropometric parameters before initial collegiate injury have not been compared between runners with BSI and their noninjured counterparts. PURPOSE To characterize bone health in relation to BComp and anthropometric measurements from total-body dual x-ray absorptiometry (DXA) scans in collegiate male and female distance runners before BSI and develop BMD prediction models. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Distance runners (N = 79) from a single university track and field team were retrospectively enrolled into this study. The runners completed a DXA scan during the fall season (August-November) and participated in sport activities before the scan. Three months after scanning, electronic medical records were reviewed for the occurrence of BSI. An independent-sample t test was used to compare BMD (total and regional [spine, pelvis, and legs]), BComp (% body fat, fat mass, and lean mass), and anthropometric measurements (shoulder width and leg, arm, and trunk length) between runners with versus without BSI (included subgroup analysis by sex). Multiple linear regression with stepwise removal was used to determine variables most predictive of BMD. RESULTS Of the 79 enrolled participants (42 male, 37 female), 18 runners (22.8%; 11 female, 7 male) sustained a lower limb BSI. Compared with the noninjured group, injured runners had lower total and regional BMD (P < .001 for all) and shorter leg and arm lengths (P < .05 for both), whereas injured male runners had lower fat mass and injured female runners had lower lean mass in the legs (P < .05 for both). Injured runners' age-matched total BMD Z score (-0.1 ± 0.6) was considered clinically normal. BComp and anthropometric measures were predictive of total and regional BMD (P < .05; R 2 = 0.64-0.80; percentage error = 3.8%-4.8%). CONCLUSION The DXA scans of injured runners prior to incidence indicated lower BMD compared with noninjured runners. Shorter limb lengths, lower fat mass (male), and lower leg lean mass (female) may also be indicative of risk. Certain BComp and anthropometric measures were predictive of BMD.
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Affiliation(s)
- Aaron F. Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
| | - Daniel Yu
- Department of Dietetics and Nutrition, University of Kansas Medical
Center, Kansas City, Kansas, USA
- Kansas Team Health, Kansas Athletics Inc, Lawrence, Kansas,
USA
| | | | - Patrick C. McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
| | - Bradley S. Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
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16
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Sammito S, Hadzic V, Karakolis T, Kelly KR, Proctor SP, Stepens A, White G, Zimmermann WO. Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model. Mil Med Res 2021; 8:66. [PMID: 34886915 PMCID: PMC8662851 DOI: 10.1186/s40779-021-00357-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available. METHODS A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the "snowball method"). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made. RESULTS In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the "order of importance" and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors. CONCLUSIONS This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
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Affiliation(s)
- Stefan Sammito
- Section Experimental Aerospace Medicine Research, German Air Force Centre of Aerospace Medicine, Flughafenstraße 1, 51147 Cologne, Germany
- Occupational Medicine, Faculty of Medicine, Otto-Von-Guericke-University of Magdeburg, 39120 Magdeburg, Germany
| | - Vedran Hadzic
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Thomas Karakolis
- Defence Research and Development Canada, Toronto, ON M3K 2C9 Canada
| | - Karen R. Kelly
- Warfighter Performance, Naval Health Research Center, San Diego, CA 92106-3599 USA
| | - Susan P. Proctor
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760 USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130 USA
| | - Ainars Stepens
- Centre for Military Medicine Research, Riga Stradins University, Riga, 1007 Latvia
| | - Graham White
- Human and Social Sciences Group, Defense Science and Technology Laboratory, Portsdown Hill Road, Fareham, PO17 6AD UK
| | - Wes O. Zimmermann
- Department of Military Sports Medicine, Royal Netherlands Army, 3584 AB Utrecht, The Netherlands
- Department of Military/Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814 USA
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17
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Hughes JM, Dickin DC, Wang H. Soccer participation is associated with benefits in tibial bone cross-sectional geometry and strength in young women. J Sports Med Phys Fitness 2021; 62:969-973. [PMID: 34498820 DOI: 10.23736/s0022-4707.21.12519-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Soccer has been hypothesized to be an ideal sport to stimulate favorable changes in bone properties due the high-intensity, multidirectional movements performed during play. The purpose of this study was to determine if participation in soccer is associated with enhanced bone properties such as volumetric bone mineral density (vBMD), cross-sectional geometry, and estimated strength in the tibias of young, healthy women. METHODS Twenty female soccer players (20±1 yr) and twenty mass- and height-matched healthy women (21±1 yr) participated in this cross-sectional study. Peripheral quantitative computed tomography (XCT 3000; Stratec Medizintechnik, Pforzheim, Germany) was used to assess bone characteristics, including vBMD, cross-sectional moments of inertia (CSMI), and strength/strain index (SSI) at 14%, 38%, and 66% of the tibial length proximal to the distal end plate. One-way multivariate analysis of variances was run to determine the influence of soccer training history on tibial properties. RESULTS Compared to healthy controls, soccer players had approximately 1.5% - 3% lower cortical vBMD but 18.5% - 30% greater CSMI and 16.5% -19% greater SSI at the three cross-sectional sites along the tibial diaphysis (all p < 0.05). CONCLUSIONS These results suggest that soccer participation is associated with favorable bone cross-sectional geometry and estimates of bone strength. However, randomized controlled intervention trials are needed to confirm whether soccer participation results in favorable bone adaptations in young, healthy adults.
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Affiliation(s)
- Julie M Hughes
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - D Clark Dickin
- School of Kinesiology, Ball State University, Muncie, IN, USA
| | - He Wang
- School of Kinesiology, Ball State University, Muncie, IN, USA -
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18
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Belluscio V, Orejel Bustos AS, Camomilla V, Rizzo F, Sciarra T, Gabbianelli M, Guerriero R, Morsilli O, Martelli F, Giacomozzi C. Experimental study protocol of the project "MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)". PLoS One 2021; 16:e0254878. [PMID: 34293019 PMCID: PMC8297846 DOI: 10.1371/journal.pone.0254878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022] Open
Abstract
Musculoskeletal injuries, a public health priority also in the military context, are ascribed to several risk factors, including: increased reaction forces; low/reduced muscle strength, endurance, body mass, Vitamin D level, and bone density; inadequate lifestyles and environment. The MOVIDA Project-funded by the Italian Ministry of Defence-aims at developing a transportable toolkit (assessment instrumentation, assessment protocols and reference/risk thresholds) which integrates motor function assessment with biological, environmental and behavioural factors to help characterizing the risk of stress fracture, stress injury or muscle fatigue due to mechanical overload. The MOVIDA study has been designed following the STROBE guidelines for observational cross-sectional studies addressing healthy adults, both militaries and civilians, with varying levels of physical fitness (sedentary people, recreational athletes, and competitive athletes). The protocol of the study has been designed and validated and is hereby reported. It allows to collect and analyse anamnestic, diagnostic and lifestyle-related data, environmental parameters, and functional parameters measured through portable and wearable instrumentation during adapted 6 minutes walking test. The t-test, one and two-way ANOVA with post-hoc corrections, and ANCOVA tests will be used to investigate relevant differences among the groups with respect to biomechanical parameters; non-parametric statistics will be rather used for non-normal continuous variables and for quantitative discrete variables. Generalized linear models will be used to account for risk and confounding factors.
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Affiliation(s)
- Valeria Belluscio
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Amaranta S Orejel Bustos
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Valentina Camomilla
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Francesco Rizzo
- Joint Veterans Defence Center, Army Medical Center, Rome, Italy
| | - Tommaso Sciarra
- Joint Veterans Defence Center, Army Medical Center, Rome, Italy
| | - Marco Gabbianelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Raffaella Guerriero
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Ornella Morsilli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Francesco Martelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
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O'Leary TJ, Wardle SL, Gifford RM, Double RL, Reynolds RM, Woods DR, Greeves JP. Tibial Macrostructure and Microarchitecture Adaptations in Women During 44 Weeks of Arduous Military Training. J Bone Miner Res 2021; 36:1300-1315. [PMID: 33856703 DOI: 10.1002/jbmr.4290] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
Bone adapts to unaccustomed, high-impact loading but loses mechanosensitivity quickly. Short periods of military training (≤12 weeks) increase the density and size of the tibia in women. The effect of longer periods of military training, where the incidence of stress fracture is high, on tibial macrostructure and microarchitecture in women is unknown. This observational study recruited 51 women (age 19 to 30 years) at the start of 44 weeks of British Army Officer training. Tibial volumetric bone mineral density (vBMD), geometry, and microarchitecture were measured by high-resolution peripheral quantitative computed tomography (HRpQCT). Scans of the right tibial metaphysis (4% site) and diaphysis (30% site) were performed at weeks 1, 14, 28, and 44. Measures of whole-body areal bone mineral density (aBMD) were obtained using dual-energy X-ray absorptiometry (DXA). Blood samples were taken at weeks 1, 28, and 44, and were analyzed for markers of bone formation and resorption. Trabecular vBMD increased from week 1 to 44 at the 4% site (3.0%, p < .001). Cortical vBMD decreased from week 1 to 14 at the 30% site (-0.3%, p < .001). Trabecular area decreased at the 4% site (-0.4%); trabecular bone volume fraction (3.5%), cortical area (4.8%), and cortical thickness (4.0%) increased at the 4% site; and, cortical perimeter increased at the 30% site (0.5%) from week 1 to 44 (p ≤ .005). Trabecular number (3.5%) and thickness (2.1%) increased, and trabecular separation decreased (-3.1%), at the 4% site from week 1 to 44 (p < .001). Training increased failure load at the 30% site from week 1 to 44 (2.5%, p < .001). Training had no effect on aBMD or markers of bone formation or resorption. Tibial macrostructure and microarchitecture continued to adapt across 44 weeks of military training in young women. Temporal decreases in cortical density support a role of intracortical remodeling in the pathogenesis of stress fracture. © 2021 Crown copyright. Journal of Bone and Mineral Research © 2021 American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rebecca L Double
- Army Health and Performance Research, Army Headquarters, Andover, UK
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David R Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Northumbria and Newcastle National Health Service (NHS) Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK.,University of Newcastle, Newcastle, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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21
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Kardouni JR, McKinnon CJ, Taylor KM, Hughes JM. Timing of stress fracture in soldiers during the first 6 career months: a retrospective cohort study. J Athl Train 2021; 56:465003. [PMID: 33975344 PMCID: PMC8675322 DOI: 10.4085/1062-6050-0380.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Stress fractures (SF) are injuries that can result from beginning new or higher volume physical training regimens. The pattern of clinical presentation of SF over time after individuals start a new or more demanding physical training regimen is not well defined in medical literature. OBJECTIVE Report trends in the clinical presentation of stress fractures over the first six month of soldiers' time in the service. DESIGN Retrospective Cohort study Setting: This study was conducted using medical encounter and personnel data from U.S. Army soldiers during the first 6 months of their career. PARTICIPANTS U.S. Army soldiers beginning their careers from 2005-2014 (N=701,027). DATA COLLECTION AND ANALYSIS Weekly SF numbers and incidence were calculated overall, as well as by sex, over the first 6 months of military service. RESULTS SF diagnoses (N=14,155) increased steeply in weeks 3 and 4, with a peak in the overall incidence of SF diagnoses occurring during weeks 5-8. Although clinical incidence of stress fracture generally decreased beyond 8 weeks, incident lower extremity stress fractures continued to present for over 20 weeks. The hazard ratio (HR) for SF among women compared to men was 4.14 (95% CI = [4.01, 4.27]). CONCLUSIONS Across the 6-month study period, women showed over 4 times greater hazard for stress fracture. The results also suggest that health care providers should be particularly vigilant for stress fractures within 3 weeks after the beginning of a new or higher intensity exercise regimen. The incidence of SF may continue to climb for several weeks. Even as stress fracture incidence declines, it should be noted that these injuries may also continue to appear clinically even several months after a change in activity or training.
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Affiliation(s)
- Joseph R Kardouni
- 1U.S. Army Forces Command, Fort Bragg, NC, 28310
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Craig J McKinnon
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Kathryn M Taylor
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
| | - Julie M Hughes
- 2U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, MA 01760
- E-mail correspondence may be directed to the authors at the following addresses: Joseph R. Kardouni - , Julie M. Hughes - , Craig J. McKinnon - , Kathryn M. Taylor -
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22
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Orejel Bustos A, Belluscio V, Camomilla V, Lucangeli L, Rizzo F, Sciarra T, Martelli F, Giacomozzi C. Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques. SENSORS (BASEL, SWITZERLAND) 2021; 21:2438. [PMID: 33916269 PMCID: PMC8037357 DOI: 10.3390/s21072438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.
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Affiliation(s)
- Amaranta Orejel Bustos
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Valeria Belluscio
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Valentina Camomilla
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Leandro Lucangeli
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System (BOHNES), Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.O.B.); (V.B.); (V.C.); (L.L.)
| | - Francesco Rizzo
- Joint Veterans Defence Center, Army Medical Center, 00184 Rome, Italy; (F.R.); (T.S.)
| | - Tommaso Sciarra
- Joint Veterans Defence Center, Army Medical Center, 00184 Rome, Italy; (F.R.); (T.S.)
| | - Francesco Martelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00161 Rome, Italy;
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, 00161 Rome, Italy;
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23
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Staab JS, Kolb AL, Tomlinson RE, Pajevic PD, Matheny RW, Hughes JM. Emerging evidence that adaptive bone formation inhibition by non-steroidal anti-inflammatory drugs increases stress fracture risk. Exp Biol Med (Maywood) 2021; 246:1104-1111. [PMID: 33641442 DOI: 10.1177/1535370221993098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is mounting evidence suggesting that the commonly used analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), may inhibit new bone formation with physical training and increase risk of stress fractures in physically active populations. Stress fractures are thought to occur when bones are subjected to repetitive mechanical loading, which can lead to a cycle of tissue microdamage, repair, and continued mechanical loading until fracture. Adaptive bone formation, particularly on the periosteal surface of long bones, is a concurrent adaptive response of bone to heightened mechanical loading that can improve the fatigue resistance of the skeletal structure, and therefore may play a critical role in offsetting the risk of stress fracture. Reports from animal studies suggest that NSAID administration may suppress this important adaptive response to mechanical loading. These observations have implications for populations such as endurance athletes and military recruits who are at risk of stress fracture and whose use of NSAIDs is widespread. However, results from human trials evaluating exercise and bone adaptation with NSAID consumption have been less conclusive. In this review, we identify knowledge gaps that must be addressed to further support NSAID-related guidelines intended for at-risk populations and individuals.
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Affiliation(s)
- Jeffery S Staab
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Alexander L Kolb
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Ryan E Tomlinson
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Ronald W Matheny
- Military Operational Medicine Research Program, Fort Detrick, MD 21702, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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24
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Unnikrishnan G, Xu C, Baggaley M, Tong J, Kulkarni S, Edwards WB, Reifman J. Effects of body size and load carriage on lower-extremity biomechanical responses in healthy women. BMC Musculoskelet Disord 2021; 22:219. [PMID: 33627093 PMCID: PMC7905550 DOI: 10.1186/s12891-021-04076-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal injuries, such as stress fractures, are the single most important medical impediment to military readiness in the U.S. Army. While multiple studies have established race- and sex-based risks associated with a stress fracture, the role of certain physical characteristics, such as body size, on stress-fracture risk is less conclusive. METHODS In this study, we investigated the effects of body size and load carriage on lower-extremity joint mechanics, tibial strain, and tibial stress-fracture risk in women. Using individualized musculoskeletal-finite-element-models of 21 women of short, medium, and tall statures (n = 7 in each group), we computed the joint mechanics and tibial strains while running on a treadmill at 3.0 m/s without and with a load of 11.3 or 22.7 kg. We also estimated the stress-fracture risk using a probabilistic model of bone damage, repair, and adaptation. RESULTS Under all load conditions, the peak plantarflexion moment for tall women was higher than those in short women (p < 0.05). However, regardless of the load condition, we did not observe differences in the strains and the stress-fracture risk between the stature groups. When compared to the no-load condition, a 22.7-kg load increased the peak hip extension and flexion moments for all stature groups (p < 0.05). However, when compared to the no-load condition, the 22.7-kg load increased the strains and the stress-fracture risk in short and medium women (p < 0.05), but not in tall women. CONCLUSION These results show that women of different statures adjust their gait mechanisms differently when running with external load. This study can educate the development of new strategies to help reduce the risk of musculoskeletal injuries in women while running with external load.
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Affiliation(s)
- Ginu Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Chun Xu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada.,The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Junfei Tong
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Sahil Kulkarni
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, Canada.,The McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Ft. Detrick, MD, 21702-5012, USA.
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25
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Popp KL, Ackerman KE, Rudolph SE, Johannesdottir F, Hughes JM, Tenforde AS, Bredella MA, Xu C, Unnikrishnan G, Reifman J, Bouxsein ML. Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty. Am J Sports Med 2021; 49:226-235. [PMID: 33259223 DOI: 10.1177/0363546520971782] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high. PURPOSE To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings. RESULTS From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% (P < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg (P < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels (P < .05 for all). CONCLUSION Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
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Affiliation(s)
- Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fjola Johannesdottir
- Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chun Xu
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Ginu Unnikrishnan
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Jaques Reifman
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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26
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Becerra Sandoval JC, Ventura Huamán L, De La Cruz-Vargas JA. [Factors associated with stress fracture: A case-control study in a Peruvian navy medical center]. Medwave 2020; 20:e7936. [PMID: 32885796 DOI: 10.5867/medwave.2020.05.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 06/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Stress fractures are injuries produced by the overuse of certain extremities, generating repetitive fatigue in the bone with insufficient rest periods and hormonal disorders, among others. High osteoclastic activity and lower activity of the osteoblasts at the cortical level occurs. Objective To determine the factors associated with a stress fracture in a single medical center of the Peruvian navy. Methods We conducted an observational, analytical case-control study. The dependent variable was stress fracture confirmed by magnetic resonance imaging of the patients; the independent variables were age, sex, calcemia, socioeconomic status, and time of daily physical activity. All data were extracted from the medical records. Crude and adjusted odds ratios were calculated with 95% confidence intervals. Results The sample was comprised of 238 patients (119 cases and 119 controls), of which 79.8% were male, and 20.2% were female; the average age was 20.25. In the bivariate analysis, stress fractures were associated with male sex (odds ratio 3.00; 95% confidence interval 1.51 to 5.95), hypocalcemia (2.83; 2.32 to 3.44), more than two hours of daily physical activity (24.7; 12.51 to 48.95) and socioeconomic level C (6.66; 2.82 to 15.74). Time dedicated to physical activity (adjusted odds ratio 44.46; 95% confidence interval 17.93 to 110.22) and socioeconomic level C (adjusted odds ratio 22.57; 95% confidence interval 7.03 to 72.74) were associated in the multivariate analysis. Conclusion We found that stress fractures were associated with physical activity time and a lower socioeconomic level. Further studies are needed to evaluate the relationship with other factors in the military population of Peru.
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Affiliation(s)
- John C Becerra Sandoval
- Centro Médico Naval Cirujano Mayor Santiago Távara, Lima, Perú. Adress: Mz. C Lt 5 Urb. 7 de Agosto 2do programa, Callao, Lima, Perú. . ORCID: 0000-0002-0743-5555
| | | | - Jhony A De La Cruz-Vargas
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú. ORCID: 0000-0002-5592-0504
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27
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Arisumi S, Mawatari T, Ikemura S, Matsui G, Iguchi T, Mitsuyasu H. Spontaneous bilateral femoral neck fractures in a young male adult: a case report and literature review. BMC Musculoskelet Disord 2019; 20:449. [PMID: 31615567 PMCID: PMC6794811 DOI: 10.1186/s12891-019-2857-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Simultaneous bilateral femoral neck fracture is a very rare condition, even in osteoporotic elderly individuals. We report an atypical case of a young male adult who developed simultaneous bilateral femoral neck fractures without previous trauma or overuse. Case presentation A 33-year-old man presented with discomfort in the bilateral groin, which had started 2 weeks previously. Bilateral femoral neck fractures were observed on a radiograph, and in addition, a fracture line was seen at the right subchondral region of the acetabulum using magnetic resonance imaging (MRI). Although the patient had no obvious risk factors associated with bone fragility, his bone mineral density measured using dual X-ray absorptiometry indicated severe osteoporosis (lumber spine: T score − 3.4 standard deviation [SD]; femoral neck: T score − 2.8 SD). Serum 25-hydroxyvitamin D level was deficient (19 ng/mL), which was considered to be partly due to non-sunlight exposure for 3 years owing to social withdrawal. Bilateral osteosynthesis was performed, considering his young age, although more than 2 weeks had passed since the onset of the fracture. Bone union and non-occurrence of osteonecrosis of the femoral head were confirmed via radiography and MRI 8 months after the surgery. Conclusions Our case suggests that simultaneous non-traumatic bilateral femoral neck fractures can occur in healthy young men.
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Affiliation(s)
- Shinkichi Arisumi
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan.
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Gen Matsui
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Takahiro Iguchi
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Hiroaki Mitsuyasu
- Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
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28
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Creighton A, Holtzman G, Ziegler C, Prather H. Sacral Pedicle Stress Fracture in an Adolescent Competitive Basketball and Track and Field Athlete with a Prior Femoral Physeal Injury: A Case Report. PM R 2019; 11:657-660. [PMID: 30729714 DOI: 10.1002/pmrj.12119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022]
Abstract
A sacral pedicle stress fracture is an uncommon source of low back pain in adolescent athletes. Given the extensive differential diagnosis of low back pain coupled with the fact that nondirected specific imaging can be normal, diagnosis can be delayed. We report the case of a 15-year-old African American male, dual-sport athlete who experienced low back pain from a sacral pedicle stress fracture. This case highlights the importance of a thorough history and physical examination in tandem with appropriate testing to identify predisposing factors to ultimately arrive at a diagnosis. A comprehensive, conservative treatment approach is described.
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Affiliation(s)
- Andrew Creighton
- Division, Physical Medicine & Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Gregory Holtzman
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Craig Ziegler
- Division, Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Heidi Prather
- Division, Physical Medicine & Rehabilitation, Departments of Neurology and Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
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29
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Popp KL, Xu C, Yuan A, Hughes JM, Unnikrishnan G, Reifman J, Bouxsein ML. Trabecular microstructure is influenced by race and sex in Black and White young adults. Osteoporos Int 2019; 30:201-209. [PMID: 30397770 DOI: 10.1007/s00198-018-4729-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
UNLABELLED Lower fracture rates in Black men and women compared to their White counterparts are incompletely understood. High-resolution imaging specific to trabecular bone may provide insight. Black participants have enhanced trabecular morphology. These differences may contribute to the lower fracture risk in Black versus White individuals. INTRODUCTION Lower fracture rates in Black men and women compared to their White counterparts may be explained by favorable bone microstructure in Black individuals. Individual trabecular segmentation (ITS) analysis, which characterizes the alignment and plate- and rod-like nature of trabecular bone using high-resolution peripheral quantitative computed tomography (HR-pQCT), may provide insight into trabecular differences by race/ethnic origin. PURPOSE We determined differences in trabecular bone microarchitecture, connectivity, and alignment according to race/ethnic origin and sex in young adults. METHODS We analyzed HR-pQCT scans of 184 adult (24.2 ± 3.4 years) women (n = 51 Black, n = 50 White) and men (n = 34 Black, n = 49 White). We used ANCOVA to compare bone outcomes, and adjusted for age, height, and weight. RESULTS Overall, the effect of race on bone outcomes did not differ by sex, and the effect of sex on bone outcomes did not differ by race. After adjusting for covariates, Black participants and men of both races had greater trabecular plate volume fraction, plate thickness, plate number density, plate surface area, and greater axial alignment of trabeculae, leading to higher trabecular bone stiffness compared to White participants and women, respectively (p < 0.05 for all). CONCLUSION These findings demonstrate that more favorable bone microarchitecture in Black individuals compared to White individuals and in men compared to women is not unique to the cortical bone compartment. Enhanced plate-like morphology and greater trabecular axial alignment, established in young adulthood, may contribute to the improved bone strength and lower fracture risk in Black versus White individuals and in men compared to women.
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Affiliation(s)
- K L Popp
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA, 02114, USA.
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02155, USA.
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - C Xu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advance Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, 21702, USA
| | - A Yuan
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA, 02114, USA
| | - J M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - G Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advance Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, 21702, USA
| | - J Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advance Technology Research Center, United States Army Medical Research and Materiel Command, Fort Detrick, MD, 21702, USA
| | - M L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA, 02114, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Department of Orthopedic Surgery, Harvard Medical School, One Overland Street, Boston, MA, 02215, USA
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30
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Hughes JM, Dickin DC, Wang H. The relationships between multiaxial loading history and tibial strains during load carriage. J Sci Med Sport 2019; 22:48-53. [DOI: 10.1016/j.jsams.2018.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/21/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
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Unnikrishnan G, Xu C, Popp KL, Hughes JM, Yuan A, Guerriere KI, Caksa S, Ackerman KE, Bouxsein ML, Reifman J. Regional variation of bone density, microarchitectural parameters, and elastic moduli in the ultradistal tibia of young black and white men and women. Bone 2018; 112:194-201. [PMID: 29730277 DOI: 10.1016/j.bone.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/11/2018] [Accepted: 05/02/2018] [Indexed: 12/16/2022]
Abstract
Whole-bone analyses can obscure regional heterogeneities in bone characteristics. Quantifying these heterogeneities might improve our understanding of the etiology of injuries, such as lower-extremity stress fractures. Here, we performed regional analyses of high-resolution peripheral quantitative computed tomography images of the ultradistal tibia in young, healthy subjects (age range, 18 to 30 years). We quantified bone characteristics across four regional sectors of the tibia for the following datasets: white women (n = 50), black women (n = 51), white men (n = 50), black men (n = 34), and all subjects (n = 185). After controlling for potentially confounding variables, we observed statistically significant variations in most of the characteristics across sectors (p < 0.05). Most of the bone characteristics followed a similar trend for all datasets but with different magnitudes. Regardless of race or sex, the anterior sector had the lowest trabecular and total volumetric bone mineral density and highest trabecular separation (p < 0.001), while cortical thickness was lowest in the medial sector (p < 0.05). Accordingly, the anterior sector also had the lowest elastic modulus in the anterior-posterior and superior-inferior directions (p < 0.001). In all sectors, the mean anisotropy was ~3, suggesting cross-sector similarity in the ratios of loading in these directions. In addition, the bone characteristics from regional and whole-bone analyses differed in all datasets (p < 0.05). Our findings on the heterogeneous nature of bone microarchitecture in the ultradistal tibia may reflect an adaptation of the bone to habitual loading conditions.
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Affiliation(s)
- Ginu Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, MCMR-TT, 504 Scott Street, Fort Detrick, MD 21702, USA
| | - Chun Xu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, MCMR-TT, 504 Scott Street, Fort Detrick, MD 21702, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA
| | - Amy Yuan
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA
| | - Katelyn I Guerriere
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA
| | - Signe Caksa
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA; Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, 319 Longwood Avenue, Boston, MA 02115, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, One Overland Street, Boston, MA 02215, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Materiel Command, MCMR-TT, 504 Scott Street, Fort Detrick, MD 21702, USA.
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Baird A, Lindsay T, Everett A, Iyemere V, Paterson YZ, McClellan A, Henson FMD, Guest DJ. Osteoblast differentiation of equine induced pluripotent stem cells. Biol Open 2018; 7:bio.033514. [PMID: 29685993 PMCID: PMC5992527 DOI: 10.1242/bio.033514] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Bone fractures occur in horses following traumatic and non-traumatic (bone overloading) events. They can be difficult to treat due to the need for the horse to bear weight on all legs during the healing period. Regenerative medicine to improve fracture union and recovery could significantly improve horse welfare. Equine induced pluripotent stem cells (iPSCs) have previously been derived. Here we show that equine iPSCs cultured for 21 days in osteogenic induction media on an OsteoAssay surface upregulate the expression of osteoblast associated genes and proteins, including COL1A1, SPARC, SPP1, IBSP, RUNX2 and BGALP. We also demonstrate that iPSC-osteoblasts are able to produce a mineralised matrix with both calcium and hydroxyapatite deposition. Alkaline phosphatase activity is also significantly increased during osteoblast differentiation. Although the genetic background of the iPSC donor animal affects the level of differentiation observed after 21 days of differentiation, less variation between lines of iPSCs derived from the same horse was observed. The successful, direct, differentiation of equine iPSCs into osteoblasts may provide a source of cells for future regenerative medicine strategies to improve fracture repair in horses undergoing surgery. iPSC-derived osteoblasts will also provide a potential tool to study equine bone development and disease. Summary: Horse iPSCs can be turned directly into bone forming cells but the efficiency is affected by the donor horse. Less variability is observed using different iPSC lines derived from the same horse.
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Affiliation(s)
- Arabella Baird
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - Timothy Lindsay
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK.,Division of Trauma and Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Alice Everett
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - Valentine Iyemere
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - Yasmin Z Paterson
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK.,Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Alyce McClellan
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
| | - Frances M D Henson
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.,Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Deborah J Guest
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK
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Stress and Insufficiency Fractures. Clin Rev Bone Miner Metab 2017. [DOI: 10.1007/s12018-017-9239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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