Higher Triad Risk Scores Are Associated With Increased Risk for Trabecular-Rich Bone Stress Injuries in Female...

Area of Science:

• Sports Medicine
• Orthopedics
• Exercise Physiology

Background:

• Bone stress injuries (BSIs) are common in athletes, with trabecular bone showing greater biological risk factors than cortical bone.
• The Female Athlete Triad (Triad) is a recognized condition linked to increased injury risk in female athletes.

Purpose of the Study:

• To investigate the association between Female Athlete Triad (Triad)-related risk and the incidence of trabecular-rich BSIs in female runners.
• To determine if a high Triad Cumulative Risk Assessment (CRA) score increases the risk of BSIs in female runners.

Main Methods:

• A prospective cohort study followed female runners from two NCAA institutions for up to 5 years.
• Intervention included nutrition presentations and individualized sessions. Triad CRA scores were assigned annually based on energy availability, menstrual status, age of menarche, BMI, BMD, and prior BSI.
• Generalized Estimating Equations (GEE) were used to model the annual incidence of trabecular- and cortical-rich BSIs.

Main Results:

• Cortical-rich BSIs occurred more frequently than trabecular-rich BSIs (0.32 vs 0.13 events/person-year).
• Female runners with high Triad-related risk had significantly higher incidence rates for both trabecular-rich (RR: 4.40) and cortical-rich BSIs (RR: 2.87) compared to those with low risk.
• Each 1-point increase in Triad CRA score correlated with a 26% increased risk of trabecular-rich BSIs (P=0.0007).

Conclusions:

• Elevated Triad CRA scores are strongly linked to an increased risk of developing trabecular-rich BSIs.
• Integrating Triad CRA scores into clinical practice can aid in the prevention of BSIs in female athletes.