Metabolic Workup for Bone Stress Injury: A Practical Approach for Evaluating Bone Health in Athletes

Area of Science:

• Sports Medicine
• Endocrinology
• Orthopedics

Background:

• Athlete bone health is influenced by metabolic factors.
• Bone stress injuries (BSI) in athletes necessitate a thorough evaluation.
• Current literature synthesis is needed for evidence-based clinical guidance.

Purpose of the Study:

• To review metabolic aspects of athlete bone health.
• To provide evidence-based recommendations for clinicians.
• To develop a clinician-friendly algorithm for managing BSI.

Main Methods:

• Systematic literature review of PubMed (1993-2024).
• Inclusion of clinical reviews with evidence levels 1-3.
• Search for relevant terms and identification of pertinent studies.

Main Results:

• A minimum metabolic workup (25-hydroxyvitamin D, CBC, iron panel) is recommended for all athletes with BSI.
• Athletes with low energy availability or multiple BSI risk factors require correction of energy balance and may need DXA scans and further labs.
• Recurrent/multiple BSI or those requiring surgery warrant detailed, stepwise testing for underlying causes.

Conclusions:

• Optimizing nutrition and evaluating factors influencing bone health are essential for athletes with BSI.
• Extensive workup is indicated for athletes with low energy availability, multiple/recurrent BSI, or surgical fixation needs.
• Clinical suspicion of underlying medical disorders necessitates comprehensive laboratory evaluation.