{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:31:56Z","timestamp":1787499116071,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T00:00:00Z","timestamp":1607299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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; the trabecular bone score (TBS) has been proposed to predict fracture risk independent of BMD. Evaluation of TBS and spine BMD in relation bone stress injury (BSI) risk has not been studied in female collegiate athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We hypothesized that spine BMD and TBS would each independently predict BSI and that the combined measures would improve injury prediction in female collegiate athletes. We also hypothesized that each measure would be correlated with Triad risk factors.<\/jats:p>\n                    <jats:p>Design: Retrospective cohort.<\/jats:p>\n                    <jats:p>Setting: Academic Institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Dual energy x\u2010ray absorptiometry (DXA) of the 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Within 321 athletes, 29 (9.0%) sustained a BSI after DXA. BMD and TBS were highly correlated (Pearson correlation r\u2009=\u20090.62,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.0001). Spine BMD and TBS had similar ability to predict BSI; the C\u2010statistic and 95% confidence intervals were 0.69 (0.58 to 0.81) for spine BMD versus 0.68 (0.57 to 0.79) for TBS. No improvement in discrimination was observed with combined BMD\u2009+\u2009TBS (C\u2010statistic 0.70, 0.59 to 0.81). Both TBS and BMD predicted trabecular\u2010rich BSI (defined as pelvis, femoral neck, and calcaneus) better than cortical\u2010rich BSI. Both measures had similar correlations with Triad risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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 that BMD may be a sufficient measure of skeletal integrity from DXA in female collegiate athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.12510","type":"journal-article","created":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T06:42:50Z","timestamp":1602312170000},"page":"945-953","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated With Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3966-8070","authenticated-orcid":false,"given":"Adam S.","family":"Tenforde","sequence":"first","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation Harvard Medical School  Charlestown MA 02129"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Stanford University, Department of Pediatrics, Division of Adolescent Medicine  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-303X","authenticated-orcid":false,"given":"Kristin L.","family":"Sainani","sequence":"additional","affiliation":[{"name":"Stanford University, Department of Epidemiology and Population Health  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey O.","family":"Chang","sequence":"additional","affiliation":[{"name":"University of North Carolina Hospitals  Chapel Hill NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Boswell Human Performance Laboratory, Department of Orthopaedic Surgery  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Diaz","sequence":"additional","affiliation":[{"name":"Kaiser Permanente, Department of Orthopedics and Sports Medicine  Santa Clara CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neville H.","family":"Golden","sequence":"additional","affiliation":[{"name":"Stanford University, Department of Pediatrics, Division of Adolescent Medicine  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fredericson","sequence":"additional","affiliation":[{"name":"Boswell Human Performance Laboratory, Department of Orthopaedic Surgery  Stanford CA"},{"name":"Stanford University, Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation  Stanford 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