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Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated with Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes. PM & R : the journal of injury, function, and rehabilitation Tenforde, A. S., Carlson, J. L., Sainani, K. L., Chang, A. O., Kim, J. H., Diaz, R., Golden, N. H., Fredericson, M. 2020

Abstract

INTRODUCTION: Determinants of bone health and injury are important to identify in athletes. Bone mineral density (BMD) is commonly measured in athletes with Female Athlete Triad (Triad) risk factors; Trabecular Bone Score (TBS) has been proposed to predict fracture risk independent of BMD. Evaluation of TBS and spine BMD to bone stress injury (BSI) risk has not been studied in female collegiate athletes.OBJECTIVE: We hypothesized that spine BMD and TBS would each independently predict BSI and the combined measures would improve injury prediction in female collegiate athletes. We also hypothesized each measure would be correlated with Triad risk factors.DESIGN: Retrospective cohort SETTING: Academic Institution METHODS: Dual energy x-ray absorptiometry (DXA) of lumbar spine was used to calculate BMD and TBS values. Chart review was used to identify BSI that occurred after the DXA measurement and to obtain Triad risk factors. We used logistic regression to examine the ability of TBS and BMD alone or in combination to predict prospective BSI.RESULTS: Within 321 athletes, 29 (9.0%) sustained a BSI after DXA. BMD and TBS were highly correlated (Pearson's correlation r=0.62, P<0.0001). Spine BMD and TBS had similar ability to predict BSI; the C-statistic and 95% confidence intervals were: 0.69 (0.58, 0.81) for spine BMD versus 0.68 (0.57, 0.79) for TBS. No improvement in discrimination was observed with combined BMD+TBS (C-statistic 0.70 [0.59, 0.81]). Both TBS and BMD predicted trabecular-rich BSI (defined as pelvis, femoral neck and calcaneus) better than cortical-rich BSI. Both measures had similar correlations with Triad risk factors.CONCLUSION: Lower BMD and TBS values are associated with elevated risk for BSI and similar correlation to Triad risk factors. TBS does not improve prediction of BSI. Collectively, our findings suggest BMD may be a sufficient measure of skeletal integrity from DXA in female collegiate athletes. This article is protected by copyright. All rights reserved.

View details for DOI 10.1002/pmrj.12510

View details for PubMedID 33037847