{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:22:15Z","timestamp":1789154535222,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":15,"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":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise is an osteogenic stimulus that should increase bone mineral density (BMD) and protect against injury. However, some female athletes have lower BMD and increased bone stress injury (BSI) risk. Impaired bone health seen in athletes may be explained by low energy availability as described by concepts of Relative Energy Deficiency in Sport (RED\u2010S) and Female Athlete Triad (Triad).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To elucidate the relationship between RED\u2010S\/Triad risk factors and BSI to high\u2010risk (femoral neck, sacrum) and low\u2010risk (other) bones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional survey and retrospective chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary care academic center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Female athletes aged 15\u201330\u2009years participating in \u22654\u00a0h\/week of exercise presenting to sports medicine\/orthopedics clinic who had a self\u2010reported BSI and available dual\u2010energy x\u2010ray absorptiometry (DXA) measurement of BMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measurements<\/jats:title>\n                    <jats:p>Location of BSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 127 athletes, high\u2010risk BSI was associated with surrogates of low energy availability (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.032) and having a DXA Z\u2010score\u2009&lt;\u2009\u22121 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.035) but not a current\/past history of menstrual dysfunction (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.348). Accumulating RED\u2010S\/Triad risk factors increase the odds of incurring a high\u2010risk BSI (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.048).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adolescent\/young female athletes who sustain BSI at high\u2010risk sites (femoral neck, sacrum) may have underlying risk factors (eg, low energy availability, poor overall bone health) that should prompt further workup and referral to optimize health in these athletes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.12821","type":"journal-article","created":{"date-parts":[[2022,4,23]],"date-time":"2022-04-23T08:33:37Z","timestamp":1650702817000},"page":"587-596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Low energy availability surrogates associated with lower bone mineral density and bone stress injury site"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7539-7514","authenticated-orcid":false,"given":"Bryan","family":"Holtzman","sequence":"first","affiliation":[{"name":"Female Athlete Program, Division of Sports Medicine Boston Children's Hospital  Boston MA United States"},{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia PA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin L.","family":"Popp","sequence":"additional","affiliation":[{"name":"Military Performance Division, United States Army Research Institute of Environmental Medicine  Natick MA United States"},{"name":"Endocrine Division, Massachusetts General Hospital  Boston MA United States"},{"name":"Harvard Medical School  Boston MA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Tenforde","sequence":"additional","affiliation":[{"name":"Female Athlete Program, Division of Sports Medicine Boston Children's Hospital  Boston MA United States"},{"name":"Harvard Medical School  Boston MA United States"},{"name":"Spaulding Rehabilitation Hospital  Charlestown MA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyson L.","family":"Parziale","sequence":"additional","affiliation":[{"name":"Female Athlete Program, Division of Sports Medicine Boston Children's Hospital  Boston MA United States"},{"name":"Department of Pediatrics University of Virginia Health System  Charlottesville VA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Taylor","sequence":"additional","affiliation":[{"name":"Military Performance Division, United States Army Research Institute of Environmental Medicine  Natick MA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Ackerman","sequence":"additional","affiliation":[{"name":"Female Athlete Program, Division of Sports Medicine Boston Children's Hospital  Boston MA United States"},{"name":"Endocrine Division, Massachusetts General Hospital  Boston MA United States"},{"name":"Harvard Medical School  Boston MA United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099193"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093218"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-020369"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/0264041031000140518"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0b013e318149f111"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093502"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1249\/01.MSS.0000142662.21767.58"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-017-1498-8"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.040410"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1249\/JES.0000000000000215"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000574"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513520295"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516676262"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-10-00322"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000276"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093240"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3182963d75"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200104000-00002"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513490645"},{"key":"e_1_2_9_21_1","first-page":"834","article-title":"Does magnetic resonance imaging grading correlate with return to sports after bone stress injuries? A systematic review and meta\u2010analysis","volume":"363546521993807","author":"Hoenig T","year":"2021","journal-title":"Am J Sports Med"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199803000-00013"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2015.09.019"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/15438627.2016.1191489"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.02.2010.2749"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1941738114523381"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-094559"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098958"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2003.011338"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2003.20374.x"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-195909000-00030"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2019.07.001"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12673"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517730584"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.2018-0127"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2005.07.009"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3887-x"},{"issue":"1","key":"e_1_2_9_38_1","first-page":"39","article-title":"Stress fractures: diagnosis, treatment, and prevention","volume":"83","author":"Patel DS","year":"2011","journal-title":"Am Fam Physician"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.1999.14.10.1672"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01880413"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12821","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmrj.12821","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12821","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T09:47:43Z","timestamp":1692870463000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.12821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1002\/pmrj.12821"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.12821","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]},"assertion":[{"value":"2021-11-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}