The Evolving Research Landscape of Stress Fracture Risk Factors in Athletes

Stress fractures are repetitive overuse injuries in which loading exceeds the bone's threshold to repair damage, thus being prevalent among active people like athletes and soldiers.

The present bibliometric analysis of 2,365 papers from the Web of Science Core Collection published between 1974 and 2026 aimed at discovering emerging research trends, highly cited authors, and core themes discussed in the scientific literature on the risk factors associated with stress fractures.

A considerable increase in publication numbers was observed, with one sharp peak recorded between 2016 and 2021 that correlated with the heightened interest in the topics related to the Female Athlete Triad and RED-S. Using co-author and keyword analysis, it was possible to outline six main research clusters covering such topics as epidemiology, female athlete physiology, biomechanics and loading in the military setting, stress fractures in the spinal area, foot-related stress injuries, and radiographic examination methods.

The results suggested the evolution of approaches to stress fractures, shifting from mechanical and orthopedic perspectives to a multi-layered one that considered hormonal, dietary, and energy-availability aspects.

Inconsistencies in terminology used to refer to stress fractures were found to be an additional barrier to conducting systematic reviews.