Osteoporosis And Stress Fractures In Female Athletes



Osteoporosis is a condition in which bones become more brittle and porous due loss of mineralization. It can lead to pathologic fractures or stress fractures which can sideline even well conditioned athletes.

There are a number of reasons that osteoporosis can occur including genetic factors, hormonal imbalance, menopause and dietary issues.  A focus on achieving and maintaining a certain weight goal, physical appearance or body fat composition may place the female athlete at risk for a disordered eating pattern. Amenorrhea is often associated with overly restrictive diets and accompanies osteoporosis.  Psychologists often speak of the triad of disordered eating, osteoporosis and amenorrhea.

We treat a number of female runners for stress fractures in our podiatry office in San Antonio.  A stress fracture can occur to anyone due to training errors, poor shoegear choices, biomechanical issues or overuse but when they are repetitive, then attention to underlying issues is needed.  In other words, one must go beyond treating the stress fracture and focus on causes.

Shoegear fads come and go.  We had shoes with rocker soles until the minimalist fad started in 2010. Minimalist shoes were a boon to the shoe industry that could put less materials into shoe construction but charge the same or higher prices.  The profits were turned into marketing efforts to sell runners on claims that runners should not land on their heels, that running shoes should not have a drop (heel higher than forefoot) and that features of shoes that protected feet from injury were deleterious.  All such claims do have elements of truth. The more protective shoegear is, the less attention one need pay to style.  Less protective shoegear would essentially induce runners to improve their style.  I guess if you gave me a bulletproof vest and a big dog to walk, I would be more likely to walk through a dangerous neighborhood....or that is sort of how the line of reasoning goes.  

Why not do a little bit of training with a minimalist shoe to help focus on good running style but then wear a protective shoe when doing distance work?  Stress fractures are due to repetitive loading on a body part which eventually fails.  Reduce the load with the right shoe and make the body part stronger!

Bones will thicken over time when subject to repetitive loading.  Osteoporosis reduces the ability of bones to strengthen accordingly.

Recomendations

  1. Eating disorders need be recognized and treated.  One should seek the help of a psychologist who is well versed in the area or discuss the issue with their family physician or ob-gyn.
  2. The effects of bone loss caused by menopause can be offset by hormone replacement therapy.  One's physician can order bone density testing and make the necessary prescription.
  3. Athletes need to pay attention to nutrition, even more so than non-athletes.  Protein is the basic building block of bone to which calcium is deposited.  A modest amount of carbohydrates and good fats is needed to support energy metabolism.  Vitamin D is one of the key nutrients involved in the absorption of calcium and its placement in bones. The amount of vitamin D recommended in the US had lagged behind Europe for a couple of decades but we are now catching up and many physicians are testing serum vitamin D levels.
  4. Wear running or training shoes that are consistent with ones foot type and needs.  It is worthwhile to patronize a good running store where there is expertise on understanding fit and foot mechanics.  Avoid fads and fad products.
  5. See a podiatrist who emphasizes biomechanics.

If you would like more information or are in need of foot and ankle care, please call our San Antonio podiatry office today at 210-490-3668.



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