Abnormally decreased regional bone density in athletes with medial tibial stress syndrome

Medial tibial stress syndrome, a common condition of uncertain origin found in athletes, is characterized by pain in the distal posteromedial aspect of the tibia during exercise, with or without increased scintigraphic uptake in the affected region. To determine whether medial tibial stress syndrome with increased scintigraphic uptake is associated with a change in tibial bone mineral density confined to the site of the increased uptake, we measured bone mineral density (in grams per square centimeter) in 18 adult male athletes with long-standing medial tibial stress syndrome and compared the measurements with those of 16 age- and sex-matched control subjects and with those of 18 athletes without medial tibial stress syndrome who had a comparable training regimen. Tibial bone mineral density in the region corresponding to the pain was 15%+/-9% lower in the patients than in control subjects and 23%+/-8% lower than in the athletic control subjects (both significant differences). Bone mineral densities in most other regions of the body were higher than in the control subjects but lower than in the athletic controls at the corresponding sites. In summary, medial tibial stress syndrome is associated with low regional bone mineral density.