{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:07:36Z","timestamp":1787749656260,"version":"build-2784847793"},"reference-count":22,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bone stress injuries (BSIs) are common in athletes. Risk factors for BSI may differ by skeletal anatomy and relative contribution of trabecular-rich and cortical-rich bone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>We hypothesized that Female Athlete Triad (Triad) risk factors would be more strongly associated with BSIs sustained at trabecular-rich versus cortical-rich skeletal sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The study population comprised 321 female National Collegiate Athletic Association Division I athletes participating in 16 sports from 2008 to 2014. Triad risk factors and a Triad cumulative risk score were assessed using responses to preparticipation examination and dual energy x-ray absorptiometry to measure lumbar spine and whole-body bone mineral density (BMD). Sports-related BSIs were diagnosed by a physician and confirmed radiologically. Athletes were grouped into those sustaining a subsequent trabecular-rich BSI, a subsequent cortical-rich BSI, and those without a BSI. Data were analyzed with multinomial logistic regression adjusted for participation in cross-country running versus other sports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 19 participants sustained a cortical-rich BSI (6%) and 10 sustained a trabecular-rich BSI (3%) over the course of collegiate sports participation. The Triad cumulative risk score was significantly related to both trabecular-rich and cortical-rich BSI. However, lower BMD and weight were associated with significantly greater risk for trabecular-rich than cortical-rich BSIs. For every value lower than 1 SD, the odds ratios (95% CIs) for trabecular-rich versus cortical-rich BSI were 3.08 (1.25-7.56) for spine BMD; 2.38 (1.22-4.64) for whole-body BMD; and 5.26 (1.48-18.70) for weight. Taller height was a significantly better predictor of cortical-rich than trabecular-rich BSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The Triad cumulative risk score was significantly associated with both trabecular-rich and cortical-rich BSI, but Triad-related risk factors appeared more strongly related to trabecular-rich BSI. In particular, low BMD and low weight were associated with significantly higher increases in the risk of trabecular-rich BSI than cortical-rich BSI. These findings suggest Triad risk factors are more common in athletes sustaining BSI in trabecular-rich than cortical-rich locations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671221123588","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T13:35:57Z","timestamp":1663767357000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Female Athlete Triad Risk Factors Are More Strongly Associated With Trabecular-Rich Versus Cortical-Rich Bone Stress Injuries in Collegiate Athletes"],"prefix":"10.1177","volume":"10","author":[{"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, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole B.","family":"Katz","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin L.","family":"Sainani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neville H.","family":"Golden","sequence":"additional","affiliation":[{"name":"Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fredericson","sequence":"additional","affiliation":[{"name":"Boswell Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA."},{"name":"Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"bibr1-23259671221123588","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000574"},{"key":"bibr2-23259671221123588","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513520295"},{"key":"bibr3-23259671221123588","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000126"},{"key":"bibr4-23259671221123588","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514562739"},{"key":"bibr5-23259671221123588","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093218"},{"key":"bibr6-23259671221123588","first-page":"95","volume":"103208","author":"Harris PA","year":"2019","journal-title":"J Biomed 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